Congenital Toxoplasmosis in France and the United States: One Parasite, Two Diverging Approaches

• Published in: PLoS neglected tropical diseases 2017-02, Vol.11 (2), p.e0005222-e0005222
• Main Authors: Peyron, Francois, Mc Leod, Rima, Ajzenberg, Daniel, Contopoulos-Ioannidis, Despina, Kieffer, François, Mandelbrot, Laurent, Sibley, L David, Pelloux, Hervé, Villena, Isabelle, Wallon, Martine, Montoya, Jose G
• Format: Article
• Language: English
• Subjects: Antiprotozoal Agents - therapeutic use; Biology and Life Sciences; Colleges & universities; Congenital diseases; Diagnosis; Ecology, environment; Female; France - epidemiology; Funding; Genetic aspects; Health; Health aspects; Human health and pathology; Humans; Infant, Newborn; Infections; Infectious diseases; Laboratories; Life Sciences; Medicine; Medicine and Health Sciences; Microbiology and Parasitology; Parasites; Pediatrics; People and Places; Pregnancy; Pregnancy Complications, Parasitic - epidemiology; Pregnancy Complications, Parasitic - parasitology; Pregnancy Complications, Parasitic - therapy; Pregnant women; Prenatal ultrasonography; Prognosis; Risk factors; Seroepidemiologic Studies; Toxoplasma; Toxoplasma - genetics; Toxoplasma - isolation & purification; Toxoplasmosis; Toxoplasmosis, Congenital - epidemiology; Toxoplasmosis, Congenital - parasitology; Toxoplasmosis, Congenital - therapy; Tropical diseases; United States - epidemiology; Viewpoints
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0005222

The same study reported that when PCR on amniotic fluid was routinely introduced in 1995 (i.e., infected fetuses were treated earlier with pyrimethamine/sulfadiazine), the risk of developing clinical signs in children followed for 3 years dropped significantly (odds ratio [OR] 0.59; 95% CI 0.4 to 0.89; p = 0.012), and the odds of severe neurologic sequelae or death in infants with congenital toxoplasmosis was also significantly lower (OR 0.24; 95% CI 0.07-0.71) [2]. Prusa-Romana et al. recently reported that antenatal treatment reduces the risk of mother-to-child transmission when compared with those without treatment [18]. [...]it is possible that the greater disease severity observed at birth in the US is in part due to the lack of antenatal screening and treatment in these children. Here we propose that, whatever the approach chosen (French-like versus USA-like), there are three underlying issues that need to be addressed by each country or region: parents should be informed about the disease and how to prevent it; health care providers should have access to state-of-the art information and guidelines, and counseling should be available at reference centers; and studies should be performed to address the issue of whether antenatal screening programs are cost-effective.