Maternal and congenital toxoplasmosis, currently available and novel therapies in horizon (original) (raw)
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Toxoplasmosis : A global infection , so widespread , so neglected
2013
Toxoplasmosis is an epidemiological paradox. It is one of the most prevalent and most widespread parasitic infections, yet one of the most ignored of all human infections. Between 30% and 65% of all persons worldwide are infected with Toxoplasma gondii, the causative organism. It is a coccidian parasite that infects mostly species of warm-blooded animals including man. It is asymptomatic among immunocompetent persons but presents a spectrum of clinical manifestations among the immunocompromised. Approximately 10% of congenital toxoplasmosis results in abortion or neonatal death. Infection may be associated with other diseases such as HIV/AIDS in humans or immunosuppressive therapy in any species. Toxoplasma encephalitis reportedly develops in approximately 40% of individuals with AIDS, and is fatal in 10-30% of these cases. This paper discussed updates and research trends on the biology, epidemiology, transmission, diagnosis, treatment of toxoplasmosis and made recommendations.
Relevant aspects of human toxoplasmosis
Considering the great importance that the infection by Toxoplasma gondii has in public health, the aim of this article was to demonstrate some aspects about this disease in human being. This parasite can cause several behavioral changes and many cases of reactivation of this disease are associated with Acquired Immunodeficiency Syndrome – AIDS. Major cases of human infections by T. gondii are assymptomatic and the main clinical manifestation in the acute phase of this zoonosis is lymphadenopathy, usually in the cervical area. There may also be fever, night sweats, myalgia, maculopapular rash lymphocytic atypia and chorioretinitis. The congenital and/or acquired chronic latent cerebral toxoplasmosis play an important role in the development of some types of neurodegeneration, like Alzheimer disease and Down Syndrome. Humans and animals should not consume raw or undercooked meat, unpasteurized or not boiled dairy products, water without being treated and poorly washed fruits and vegetables. Educational programs focused on reducing T. gondii environmental contamination are essential for the congenital infection control. Due to the severity of this kind of infection and its sequel, it is critical that those responsible for the community's health establish prevention programs to avoid such a situation, obtaining results in the medium and long term, and particularly preserving the involved population's welfare. A lack or incomplete prenatal treatment was identified as an important risk factor for congenital toxoplasmosis, reinforcing the need of improvement of prenatal care. In this study was demonstrated the importance of implementing prevention programs to guide pregnant women to prevent the infection. Preventive measures like information and health education; screening of pregnant women and infants; limiting harm from risk behaviour; treatment of risk cases and vaccination are recommended. Serum monitoring throughout pregnancy, so as detect cases of maternal seroconversion allowing for early maternal treatment is also basic. Some countries have adopted control programs of human toxoplasmosis, however, this issue should be of world attention, considering its relevant aspects of public health, requiring the establishment of community education campaigns and monitoring of pregnant women in the pre and neonatal, especially in a preventive action to reduce the pathogenic effects of this disease. Keywords: Toxoplasma gondii, public health, parasitic control, congenital infection, AIDS
Congenital Toxoplasmosis: The State of the Art
Frontiers in Pediatrics
Infection with the protozoan parasite Toxoplasma gondii occurs worldwide and usually causes no symptoms. However, a primary infection of pregnant women, may infect the fetus by transplacental transmission. The risk of mother-to-child transmission depends on week of pregnancy at the time of maternal infection: it is low in the first trimester, may reach 90% in the last days of pregnancy. Inversely, however, fetal disease is more severe when infection occurs early in pregnancy than later. Systematic serologic testing in pregnant women who have no antibodies at the beginning of pregnancy, can accurately reveal active maternal infection. Therefore, the risk of fetal infection should be assessed and preventive treatment with spiramycin must be introduced as soon as possible to reduce the risk of mother-to-child transmission, and the severity of fetal infection. When maternal infection is confirmed, prenatal diagnosis with Polymerase Chain Reaction (PCR) on amniotic fluid is recommended. ...
Drugs in development for toxoplasmosis: advances, challenges, and current status
Drug Design, Development and Therapy, 2017
Toxoplasma gondii causes fatal and debilitating brain and eye diseases. Medicines that are currently used to treat toxoplasmosis commonly have toxic side effects and require prolonged courses that range from weeks to more than a year. The need for long treatment durations and the risk of relapsing disease are in part due to the lack of efficacy against T. gondii tissue cysts. The challenges for developing a more effective treatment for toxoplasmosis include decreasing toxicity, achieving therapeutic concentrations in the brain and eye, shortening duration, eliminating tissue cysts from the host, safety in pregnancy, and creating a formulation that is inexpensive and practical for use in resource-poor areas of the world. Over the last decade, significant progress has been made in identifying and developing new compounds for the treatment of toxoplasmosis. Unlike clinically used medicines that were repurposed for toxoplasmosis, these compounds have been optimized for efficacy against toxoplasmosis during preclinical development. Medicines with enhanced efficacy as well as features that address the unique aspects of toxoplasmosis have the potential to greatly improve toxoplasmosis therapy. This review discusses the facets of toxoplasmosis that are pertinent to drug design and the advances, challenges, and current status of preclinical drug research for toxoplasmosis.
Toxoplasmosis: A Timeless Challenge for Pregnancy
Tropical Medicine and Infectious Disease
This study aimed to evaluate the prevalence of toxoplasmosis in pregnant women, as well as the general characteristics, clinical and laboratory findings, and pregnancy and fetal outcomes of pregnant women diagnosed with acute toxoplasma infection (ATI). The toxoplasma IgM, IgG, and IgG avidity test results of pregnant women who applied to our referral hospital between January 2016 and June 2022, and among them, those diagnosed with ATI, were analyzed. The 119 patients diagnosed with ATI during this time period were included for further analysis. The prevalence of toxoplasmosis in pregnant women was found to be 46.2%, and the rate of ATI was 4%. The total mother-to-child transmission rate was 5% (5/101). Congenital toxoplasmosis (CT) was observed in 1 (1.1%) child of the 87 pregnant women who received spiramycin prophylaxis, though it was found in 4 (30.8%) of the children of the 13 untreated mothers. With respect to prenatal treatment, CT rates were significantly higher in the child...
Medical Hypotheses, 2014
Toxoplasma gondii infects about 30% of the human population. Common sources of infection are oocysts in cat faeces contaminating drinking water or unwashed vegetables, undercooked meat containing tissue cysts, and organ transplants from infected donors containing tissue cysts. However, very often, it is not possible to identify any potential source of infection in mothers of children with congenital toxoplasmosis. Here we present a hypothesis suggesting that toxoplasmosis is transmitted from infected men to noninfected women during unprotected sexual intercourse, which can result in the most serious form of disease, congenital toxoplasmosis. Arguments for the hypothesis: (1) Toxoplasma tachyzoites are present in the seminal fluid and tissue of the testes of various animals including humans. In some species infection of females by artificial insemination with semen from infected males has been observed. (2) Up to two thirds of Toxoplasma infections in pregnant women cannot be explained by the known risk factors.
Toxoplasmosis: A Review on its Public Health Importance
Toxoplasmosis is a parasitic disease caused by Toxoplasma gondii. Infections with toxoplasmosis usually cause no symptoms in adult humans. It is characterized in humans by a few weeks or months of mild flu-like illness such as muscle aches and tender lymph nodes. In some cases, ocular complications may also develop. The mild symptoms may progress to seizures and in coordination in movements in patients with weaker immune response. The condition of congenital toxoplasmosis proves fatal for carrying mothers during pregnancy.
Memórias do Instituto Oswaldo Cruz, 2000
In a study of congenital transmission during acute infection of Toxoplasma gondii, 23 pregnant BALB/c mice were inoculated orally with two cysts each of the P strain. Eight mice were inoculated 6-11 days after becoming pregnant (Group 1). Eight mice inoculated on the 10th-15th day of pregnancy (Group 2) were treated with 100 mg/kg/day of minocycline 48 h after inoculation. Seven mice inoculated on the 10th-15th day of pregnancy were not treated and served as a control ). Congenital transmission was evaluated through direct examination of the brains of the pups or by bioassay and serologic tests. Congenital transmission was observed in 20 (60.6%) of the 33 pups of Group 1, in one (3.6%) of the 28 pups of Group 2, and in 13 (54.2%) of the 24 pups of Group 3. Forty-nine Balb/c mice were examined in the study of congenital transmission of T. gondii during chronic infection. The females showed reproductive problems during this phase of infection. It was observed accentuated hypertrophy of the endometrium and myometrium. Only two of the females gave birth. Our results demonstrate that Balb/c mice with acute toxoplasmosis can be used as a model for studies of congenital T. gondii infection. Our observations indicate the potential of this model for testing new chemotherapeutic agents against congenital toxoplasmosis.
[Congenital toxoplasmosis treatment]
European review for medical and pharmacological sciences, 2011
Congenital toxoplasmosis is a particular manifestation of Toxoplasma gondii infection, which may present as a mild or severe neonatal disease. This pathology remains a difficult challenge in terms of therapy for the pediatrician and gynecologist. In this article we have set ourselves the objective to provide an overview of the main aspects of the disease, with particular attention to the treatment, based on the information in the literature. Two kinds of treatment are currently available: prenatal and postnatal. When pregnant women seroconvert, spiramycin is administered in order to prevent the mother-to-child transmission. When the fetal infection is confirmed the association of pyrimethamine and sulfadiazine is prescribed. After birth the specific therapy is based on the administration of pyrimethamine and sulfadiazine. However, to date, there is not strong evidence on the effectiveness of treatment, whether prenatal or postnatal. The studies undertaken so far have not given satis...
Toxoplasmosis and Congenital Disturbance
2020
Toxoplasmosis is a disease caused by intracellular protozoan parasites called Toxoplasma gondii. The animal and human could suffer from infections through different routes involving diets, non-hygienic habit, contacts to soil, as well as blood transfusions and organs grafting. Some people with immune-compromised status are at a high risk of infection; examples of these groups are pregnant women, fetuses, and newborns. This study aimed to evaluate the role of Toxoplasma infection in the manifestation of abortions and other congenital disturbances among married women aged 18 to 45 years in Maysan city (in the south of Iraq). Inclusion criteria include the study group with a history of infection with Toxoplasma gondii (100 females) and for controls, those who were free from toxoplasmosis (100 females). Exclusion criteria were pregnant women, unmarried women, and those suffering from immunosuppressive diseases. The serum samples were tested for IgG and IgM against Toxoplasma gondii anti...