Perinatal cytomegalovirus and toxoplasmosis: Challenges of antepartum therapy

Acute maternal toxoplasmosis is associated with increased risk of spontaneous abortion. Congenital toxoplasmosis can present in one of four forms: 1) symptomatic neonatal disease; 2) mild to severe disease manifested within the first month of life; 3) childhood or adolescent sequelae from previously undiagnosed infection; and 4) subclinical infection. The incidence and impact of congenital infection is dependent on the gestational age. The long-term sequelae of congenital toxoplasmosis include seizure disorders, spasticity/palsies, severe visual impairment, hydrocephalus/microcephaly, intracranial calcifications, deafness, and mental retardation. The diagnostic criteria for acute toxoplasmosis include lymphadenopathy, Sabin-Feldman dye test titer greater than 300 IU/ml or ≥ 1:1,000, and a positive IgM-IFA test. The key to preventing congenital infection is the prevention of maternal primary toxoplasmosis infection. Specific hygienic recommendations can prevent maternal infection (primary prevention). Antepartum screening allows consideration of antepartum chemoprophylaxis to reduce fetal infection rates and sequelae (secondary prevention). Antenatal treatment with spiramycin and/or pyrimethamine-sulfonamide can significantly reduce the severity of congenital toxoplasmosis.