CONGENITAL TOXOPLASMOSIS - 10-YEAR FOLLOW-UP

A long-term follow up was begun in 1982 on offspring of mothers who ac quired toxoplasmosis during gestation. The 114 newborns were subdivide d into 3 groups: (1) 26 born to mothers with certain infection; (2) 51 born to mothers with probable infection, and (3) 37 born to mothers w ith doubtful infection. There were five infections in the first group (19.2%), three in the second (5.8%) and none in the third. For purpose s of data elaboration we considered only the 77 offspring of mothers w ith certain or probable infection. Of these, 2 infected cases out of 5 2 (3.8%) were born to mothers with infection in the first trimester of pregnancy, 4 out of 21 (19%) in the second trimester, and two out of four in the third. There were a total of 8 congenital infections (10.4 %). Specific IgM antibodies were revealed in five out of eight infecte d children (62.5%). Infection was symptomatic in two children (2.6% of newborns at risk, 25% of infected cases), both born to mothers with i nfection in the second trimester. In the other six cases diagnosis was reached by evaluating trends in antibody levels: the percentage of in fected newborns was higher in the group of maternal infections untreat ed (50%) or improperly treated (15.4%), compared to those receiving ad equate treatment (6.9%). We suggest considering as infected children p resenting specific IgM antibodies and/or antibody titres which do not become negative, even when symptoms are absent. Therapy with spiramyci n should be started in all newborns at risk, while the use of sulphami des and pyrimethamine is justified only after the presence of infectio n is confirmed. Conclusion Identification of susceptible women before or early in pregnancy would permit adoption of preventive measures aim ed at reducing the frequency of congenital infection which is still hi gh in our case series.