Skip to main content
Log in

Recent developments in the prevention and treatment of congenital toxoplasmosis

  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

The manifestations of congenital toxoplasmosis vary considerably in degree, characteristics and time of onset. Options for prevention of the disease include the appropriate disposal of cat litter and the avoidance of ingestion of both contaminated food and undercooked meat by pregnant women. Immunisation of the domestic cat population is a consideration for the future. Alternatively, immunisation of sero-negative pregnant women awaits the introduction of an effective and safe reagent. Current treatment modalities are not universally effective and new drugs are the subject of active development and research. Screening of pregnant women or perhaps newborn infants are potential options but the cost effectivity has yet to be established in many countries and the results of treatment during pregnancy and early childhood are encouraging but are as yet unproven. The majority of patients with congenital toxoplasmosis eventually develop toxoplasmic retinochoroiditis. Current treatment options for this condition are outlined. Acquired immune deficiency syndrome (AIDS) may, in some cases, represent a recrudescence of congenital intracerebral infection. Current treatment strategies for this condition are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Acers TE. Toxoplasmic retinochoroiditis: a double blind therapeutic study. Arch Ophthalmol 1964; 71: 58–62.

    CAS  PubMed  Google Scholar 

  2. Alford CA, Stagno S, Reynolds DW. Congenital toxoplasmosis: clinical, laboratory and therapeutic considerations with special reference to subclinical disease. Bull NY Acad Med 1974; 50: 160–181.

    Google Scholar 

  3. Allegra CJ, Kovacs JA, Drake JC, Chabner BA, Masur H. Potentin vitro andin vivo antitoxoplasma activity of the lipid-soluble antifolate trimetrexate. J Clin Invest 1987; 79: 478–82.

    CAS  PubMed  Google Scholar 

  4. Araujo FG, Guptill DR, Remington JS.In vivo activity of piritrexin againstToxoplasma gondii. J Infect Dis 1987; 156: 828–30.

    CAS  PubMed  Google Scholar 

  5. Araujo FG, Guptill DR, Remington JS. Azithromycin, a macrolide antibiotic with potent activity againstToxoplasma gondii. Antimicrob Agents Chemother 1988; 32: 755–7.

    CAS  PubMed  Google Scholar 

  6. Araujo FG, Remington JS. Effect of clindamycin on acute and chronic toxoplasmosis in mice. Antimicrob Chemother 1974; 5: 647–51.

    CAS  Google Scholar 

  7. Burg JL, Perelman D, Kasper LH, Ware PL, Boothroyd JC. Molecular analysis of the gene encoding the major surface antigen ofToxoplasma gondii. J Immunol 1988; 141: 3584–91.

    CAS  PubMed  Google Scholar 

  8. Carter AO, Frank JW. Congenital toxoplasmosis: epidemiologic features and control. Can Med Assoc J 1986; 135: 618–23.

    CAS  Google Scholar 

  9. Chan J, Luft BJ. Activity of roxithromycin (Ru28965) a macrolide againstToxoplasma gondii infection in mice. Antimicrob Agents Chemother 1986; 30: 323–4.

    CAS  PubMed  Google Scholar 

  10. Chang HR, Pechère J-CF. Activity of roxithromycin againstToxoplasma gondii in murine models. J Antimicrob Chemother 1987; 20 Suppl B: 69–74.

    CAS  PubMed  Google Scholar 

  11. Chang HR, Pechère J-CF. In vitro effects of four macrolides (roxithromycin, spiramycin, azithromycin (CP-62,993) and (A-56268) onToxoplasma gondii. Antimicrob Agents Chemother 1988; 32: 524–9.

    CAS  PubMed  Google Scholar 

  12. Chang HR, Pechère J-C. In vitro toxoplasmacidal activity of cationic electron carriers. J Antimicrob Chemother 1989; 23: 229–36.

    CAS  PubMed  Google Scholar 

  13. Chang HR, Rudareanu FC, Pechère J-C. Activity of A-56268 (TE-031) a new macrolide againstToxoplasma gondii in mice. J Antimicrob Chemother 1988; 22: 359–61.

    CAS  PubMed  Google Scholar 

  14. Couvreur J, Desmonts G. Toxoplasmosis. In: Vinken PJ, Bruyn GW, eds. Handbook of Clinical Neurology Vol 35. Infections of the nervous system. Amsterdam. North Holland Publishing Company 1978: 115–41.

    Google Scholar 

  15. Daffos F, Forestier F, Capella-Pavlovsky M, Thulliez P, Aufrant C, Valenti D, Cox WL. Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis. New Eng J Med 1988; 318: 271–5.

    CAS  PubMed  Google Scholar 

  16. Dannemann BR, Israelski DM, Remington JS. Treatment of toxoplasmic encephalitis with intravenous clindamycin. Arch Intern Med 1988; 148: 2477–82.

    Article  CAS  PubMed  Google Scholar 

  17. Darcy F, Deslee D, Dantoro F, Charif H, Auriault C, Decoster A, Dequesne V, Capron A. Induction of a protective antibody dependent response again toxoplasmosis byin vitro excreted/secreted antigens from tachyzoites ofToxoplasms gondii. Parasite Immunology 1988; 10: 553–68.

    CAS  PubMed  Google Scholar 

  18. De Roever-Bonnet H, Koppe JG, Loewer-Sieger DH. Follow-up of children with congenitalToxoplasma infection and children who became serologically negative after 1 year of age, all born in 1964–1965. In: Thalhammer O, Baumgarten K, Pollak A. eds. Proceedings of the Sixth European Congress on Perinatal Medicine, Vienna, 1978. Thieme, Stuttgart 1979: 61–75.

    Google Scholar 

  19. Derouin F, Thulliez P, Candolfi E, Daffos F, Forestier F. Early pre-natal diagnosis of congenital toxoplasmosis using amniotic fluid samples and tissue culture. Eur J Clin Microbiol Infect Dis 1988; 7: 423–4.

    Article  CAS  PubMed  Google Scholar 

  20. Desmonts G, Couvreur J. Congenital toxoplasmosis. A prospective study of 378 pregnancies. N Eng J Med 1974; 290: 1110–6.

    CAS  Google Scholar 

  21. Desmonts G, Couvreur J. Toxoplasmosis in pregnancy and its transmission to the fetus. Bull NY Acad Med 1974; 50: 146–59.

    CAS  Google Scholar 

  22. Desmonts G, Couvreur J. Congenital toxoplasmosis: a prospective study of the offspring of 542 women who acquired toxoplasmosis during pregnancy. Pathophysiology of congenital disease. In: Thalhammer O, Baumgarten K, Pollak A. eds. Proceedings of the Sixth European Congress of Perinatal Medicine, Vienna, 1978. Thieme, Stuttgart 1979, 51–60.

    Google Scholar 

  23. Desmonts G, Couvreur J. Toxoplasmose congenitale. Étude prospective de l'issue de la grossesse chez 542 femmes atteintes de toxoplasmose acquise en course de gestation. Ann Pediatr (Paris) 1984; 31: 805–9.

    CAS  Google Scholar 

  24. Dutton GN. The causes of tissue damage in toxoplasmic retinochoroiditis. Trans Ophthal Soc UK 1986; 105: 404–12.

    PubMed  Google Scholar 

  25. Eyles DE, Coleman N. Evaluation of the curative effects of pyrimethamine and sulfadiazine, alone and in combination, on experimental mouse toxoplasmosis. Antibiot Chemother 1955; 5: 529–39.

    CAS  Google Scholar 

  26. Frenkel JK. Breaking the transmission chain ofToxoplasma a program for the prevention of human toxoplasmosis. Bull NY Acad Med 1974; 50: 228–35.

    CAS  Google Scholar 

  27. Frenkel JK. Immunity to toxoplasmosis. Pan Am Health Org Bull 1985; 19: 354–67.

    CAS  Google Scholar 

  28. Frenkel JK, Dubey JP. Toxoplasmosis and its prevention in cats and man. J Infect Dis 1972; 126: 664–73.

    CAS  PubMed  Google Scholar 

  29. Fuith LC, Reibnegger G, Honlinger M, Wachter H. Screening for toxoplasmosis in pregnancy. Lancet 1988; 2: 1196.

    CAS  PubMed  Google Scholar 

  30. Giles CL. Pyrimethamine (Daraprim) and the treatment of toxoplasmic uveitis. Survey of Ophthalmology 1971; 16: 88–91.

    CAS  Google Scholar 

  31. Haverkos HW. Assessment of therapy for toxoplasma encephalitis. The TE Study Group. Am J Med 1987; 82: 907–14.

    Article  CAS  PubMed  Google Scholar 

  32. Hofflin JM, Remington JS. In vivo synergism of roxithromycin (RV965) and interferon againstToxoplasma gondii. Antimicrob Agents Chemother 1987; 31: 346–8.

    CAS  PubMed  Google Scholar 

  33. Hofflin JM, Remington JS. Clindamycin in a murine model of toxoplasmic encephalitis. Antimicrob Agents Chemother 1987; 31: 492–6.

    CAS  PubMed  Google Scholar 

  34. Holliman RE. Toxoplasmosis and the acquired immune deficiency syndrome. J Infect 1988; 16: 121–8.

    CAS  PubMed  Google Scholar 

  35. Israelski DM, Tom C, Remington JS. Zidovudine antagonizes the action of pyrimethamine in experimental infection withToxoplasma gondii. Antimicrob Agents Chemother 1989; 33: 30–4.

    CAS  PubMed  Google Scholar 

  36. Johnson AM, Dubey JP, Dame JB. Purification and characterization of theToxoplasma gondii tachyzoite DNA. Aust J Exp Biol Med Sci 1986; 64: 351–5.

    CAS  PubMed  Google Scholar 

  37. Johnson AM, Illana S, Dubey JP, Dame JB.Toxoplasma gondii andHammondia hammondi: DNA comparison using cloned RNA gone probes. Exp Parasitol 1987; 63: 272–8.

    Article  CAS  PubMed  Google Scholar 

  38. Joynson DHM, Payne R. Screening for Toxoplasma in pregnancy. Lancet 1988; 2: 795–6.

    CAS  PubMed  Google Scholar 

  39. Koppe JG, Loewer-Sieger DH, De Roever-Bonnet H. Results of 20 years follow-up of congenital toxoplasmosis. Lancet 1986; 1: 254–5.

    CAS  PubMed  Google Scholar 

  40. Kovacs JA, Allegra CJ, Chabner BA, Swan JC, Drake J, Lunde M, Parrillo JE, Masur H. Potent effect of trimetrexate: a lipid-soluble antifolate onToxoplasma gondii. J Infect Dis 1987; 155: 1027–32.

    CAS  PubMed  Google Scholar 

  41. Lambotte R. Toxoplasmose congénitale: évaluation du bénéfice thérapeutique prénatal. J Gynecol Obstet Biol Reprod (Paris) 1976; 5: 265–9.

    CAS  Google Scholar 

  42. Leport C, Raffi F, Matherson S, Katlama C, Regnier B, Saimot AG, Marche C, Vedrenne C, Vilde JL. Treatment of central nervous system toxoplasmosis with pyrimethamine/sulfadiazine combination in 35 patients with the acquired immunodefficiency syndrome. Efficacy of long-term continuous therapy. Amer J Med 1988; 84: 94–100.

    CAS  PubMed  Google Scholar 

  43. McLeod R, Frenkel JK, Estes RG, Mack DG, Eisenhauer PB, Gibori G. Subcutaneous and intestinal vaccination with tachyzoites ofToxoplasma gondii and acquisition of immunity to peroral and congenital Toxoplasma challenge. J Immunol 1988; 140: 1632–7.

    CAS  PubMed  Google Scholar 

  44. McMaster PRB, Powers KG, Finerty JF, Lunde MN. The effect of two chlorinated lincomycin analogues against acute toxoplasmosis in mice. Am J Trop Med Hyg 1973; 22: 14–7.

    CAS  PubMed  Google Scholar 

  45. Norrby R, Eilard T, Svedham A, Lycke E. Treatment of toxoplasmosis with trimethoprim-sulphamethoxazole. Scand J Infect Dis 1975; 1: 72–5.

    Google Scholar 

  46. Nye FJ. Treating toxoplasmosis. J Antimicrob Chemother 1979; 5: 244–6.

    CAS  PubMed  Google Scholar 

  47. Perkins ES, Smith CH, Schofield PB. Treatment of uveitis with pyrimethamine (Daraprim). Br J Opthalmol 1956; 40: 577–86.

    CAS  Google Scholar 

  48. Peyman GA, Charles HC, Liu KR, Khoobehi B, Niesman M. Intravitreal liposome encapsulated drugs: a preliminary report. Int Ophthalmol 1988; 12: 175–182.

    Article  CAS  PubMed  Google Scholar 

  49. Pfefferkorn ER, Eckel ME, McAdams E. Toxoplasma gondii:in vivo andin vitro studies of a mutant resistant to arprinocid-N-oxide. Exp Parasitol 1988; 65: 282–9.

    Article  CAS  PubMed  Google Scholar 

  50. Rolston KVI. Clindamycin in cerebral toxoplasmosis. Am J Med 1988; 85: 284.

    Google Scholar 

  51. Rolston KV, Hoy J. Role of clindamycin in the treatment of central nervous system toxoplasmosis. Am J Med 1987; 83: 551–4.

    CAS  PubMed  Google Scholar 

  52. Ruoss CF, Bourne GL. Toxoplasmosis in pregnancy. J Obstet Gynaecol Br Commonw 1972; 79: 1115–8.

    CAS  PubMed  Google Scholar 

  53. Saari KM, Päivönsalo T, Partti E. Argon laser coagulation in the treatment of recurrent active toxoplasmic retinochoroiditis. In: Saari KM. ed. Uveitis Update. Elsevier Science Publishers 1984: 529–38.

  54. Salmon RC. Screening for Toxoplasma in pregnancy. The Lancet 1988; 2: 1085.

    CAS  Google Scholar 

  55. Spalter HF, Campbell CJ, Noyori KS, Rittler CM, Koester CJ. Prophylactic photocoagulation of recurrent toxoplasmic retinochoroiditis. A preliminary report. Arch Ophthalmol 1966; 75: 21–31.

    CAS  PubMed  Google Scholar 

  56. Tabbara KF, Dy-Liacco J, Nozik RA, O'Connor GR, Blackman J. Clindamycin in chronic toxoplasmosis. Effect of periocular injections on recoverability of organisms from healed lesions in the rabbit eye. Arch Ophthalmol 1979; 97: 542–4.

    CAS  PubMed  Google Scholar 

  57. Tabbara KF, Nozik RA, O'Connor GR. Clindamycin effects on experimental ocular toxoplasmosis in the rabbit. Arch Ophthalmol 1974; 92: 244–7.

    CAS  PubMed  Google Scholar 

  58. Thorp JM, Seeds JW, Herbert WNP, Bowes WA, Maslow AS, Cefalo RC, Chescheir N, Katz VL. Prenatal management and congenital toxoplasmosis. New Engl J Med 1988; 319: 372–3.

    Google Scholar 

  59. Tuazon CU. Toxoplasmosis in AIDS patients. J Antimicrob Chemother 1989; 23 suppl A: 77–82.

    PubMed  Google Scholar 

  60. Wanke C, Tuazon CU, Kovaks A, Dina T, Davis DO, Burton DK, Lunde M, Levy C.Toxoplasma encephalitis in patients with acquired immune deficiency syndrome. Am J Trop Med Hyg 1987; 36: 509–16.

    CAS  PubMed  Google Scholar 

  61. Williams KAB, Scott JM, MacFarlane DF. Congenital toxoplasmosis: a prospective study in the West of Scotland. J Infect 1981; 3: 219–29.

    CAS  PubMed  Google Scholar 

  62. Wilson CB, Remington JS, Stagno S, Reynolds DW. Development of adverse sequelae in children born with subclinical congenitalToxoplasma infection. Pediatrics 1980; 66: 767–74.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dutton, G.N. Recent developments in the prevention and treatment of congenital toxoplasmosis. Int Ophthalmol 13, 407–413 (1989). https://doi.org/10.1007/BF02306490

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02306490

Key words

Navigation