Mandelbrot L.,Hopital Louis Mourier HUPNVS |
Mandelbrot L.,University Paris Diderot
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2015
Screening for toxoplasmosis during pregnancy is mandatory in France, while it is not common elsewhere. The incidence of toxoplasmosis has strongly decreased over the last decades. The rationale for screening based on the possibility to intervene at several different levels: 1) primary prevention with dietary recommendations for seronegative women; 2) prophylaxis to prevent mother-to-child transmission in case of seroconversion, although its effectiveness has never been proven; 3) prenatal diagnosis using amniocentesis, with highly specific and sensitive PCR; 4) prenatal therapy in case of fetal infection, which appears to be most effective if started early, although the level of evidence is quite low; 5) termination of pregnancy in extreme cases of poor prognosis; 6) therapy for children with congenital toxoplasmosis. Diagnostic pitfalls are frequent and hasty interpretations can lead to unnecessary anxiety. When anti-Toxoplasma IgM are detected, an expert parasitology laboratory should be consulted to determine the timing of maternal primary infection; sequential samples may be required. In case of confirmed seroconversion during pregnancy, the woman should be directed promptly to an expert center, where options for therapy and prenatal diagnosis can be discussed.