Perinatale Toxoplasma gondii-infectie - Een update anno 2002

Toxoplasma gondii infection is mostly an asymptomatic infection prenatally or postnatally acquired. Late - mainly visual - sequelae of congenital toxoplasmosis developed during childhood or even in young adults may be prevented if the diagnosis is made before or immediately after birth. Thus universal perinatal screening for T. gondii infection seems to be logic. Moreover, diagnosis during pregnancy is important because prenatal chemoprophylaxis and/or treatment are available. However prospective controlled studies are lacking worldwide. Therefore the efficacy of universal screening for toxoplasmosis and the cost-benefit/harm balance of prenatal therapy remain largely unknown. Their intrinsic value is questionable, certainly in countries with a low T. gondii seroprevalence. Furthermore recent epidemiologic data suggest that a large number of cases with ocular toxoplasmosis in children and young adults (up to now the main reason for universal T. gondii screening perinatally) is acquired postnatally and does not result from a congenital infection. For the time being and in countries with a high T. gondii seroprevalence (such as Belgium), a universal screening periconceptionally and during pregnancy is still recommended. The available laboratory tests and their limitations for the diagnosis of T. gondii in the mother as well in the fetus/infant, are discussed. The importance of an early communication with the regional and reference labs is emphasized. Finally a flowchart is proposed for the pre- and postnatal management by the attending physician.