The Experts below are selected from a list of 5445 Experts worldwide ranked by ideXlab platform
Martine Wallon - One of the best experts on this subject based on the ideXlab platform.
-
The cost-effectiveness of neonatal versus prenatal screening for Congenital Toxoplasmosis
PLoS ONE, 2019Co-Authors: Christine Binquet, Eileen Stillwaggon, Catherine Lejeune, Valérie Seror, François Peyron, Anne-claire Bertaux, Olivier Scemama, Catherine Quantin, Sophie Béjean, Martine WallonAbstract:Background Congenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce Congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of Congenital Toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments. Method To identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge of long-term evolution of the disease in treated children. Epidemiological data were extracted from the scientific literature and clinical data from the French Lyon cohort. Strategies were compared at one year of age, when infection can be definitively evaluated, and at 15 years of age, after which validated outcome data become scarce. The analysis was performed from the French Health Insurance System perspective and included direct medical costs for pregnant women and their children. Results The 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to €21,472 when considering the 15-year endpoint. Conclusions Prenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains. In addition, prenatal screening, by providing closer follow-up of women at risk increases the number of occasions for education avoiding Toxoplasmosis.
-
Congenital Toxoplasmosis a plea for a neglected disease
Pathogenetics, 2018Co-Authors: Martine Wallon, François PeyronAbstract:Maternal infection by Toxoplasma gondii during pregnancy may have serious consequences for the fetus, ranging from miscarriage, central nervous system involvement, retinochoroiditis, or subclinical infection at birth with a risk of late onset of ocular diseases. As infection in pregnant women is usually symptomless, the diagnosis relies only on serological tests. Some countries like France and Austria have organized a regular serological testing of pregnant women, some others have no prenatal program of surveillance. Reasons for these discrepant attitudes are many and debatable. Among them are the efficacy of antenatal treatment and cost-effectiveness of such a program. A significant body of data demonstrated that rapid onset of treatment after maternal infection reduces the risk and severity of fetal infection. Recent cost-effectiveness studies support regular screening. This lack of consensus put both pregnant women and care providers in a difficult situation. Another reason why Congenital Toxoplasmosis is disregarded in some countries is the lack of precise information about its impact on the population. Precise estimations on the burden of the disease can be achieved by systematic screening that will avoid bias or underreporting of cases and provide a clear view of its outcome.
-
Congenital Toxoplasmosis in France and the United States: One Parasite, Two Diverging Approaches.
PLoS neglected tropical diseases, 2017Co-Authors: François Peyron, Francois Kieffer, Herve Pelloux, Isabelle Villena, Daniel Ajzenberg, Rima Mc Leod, Despina G. Contopoulos-ioannidis, Laurent Mandelbrot, L. David Sibley, Martine WallonAbstract:At 29 weeks of gestation, a pregnant woman in the United States was told that her fetal ultrasound had revealed the presence of hydrocephalus. She did not recall having any symptoms or risk factors during gestation. Serological testing at the national reference laboratory for Toxoplasmosis in the US (http://www.pamf.org/serology/) confirmed an acute infection likely acquired around 17 weeks of gestation. She was started on pyrimethamine/sulfadiazine, at 31 weeks. Her amniotic fluid was positive for Toxoplasma gondii DNA by polymerase chain reaction (PCR). The infant was born with hydrocephalus, brain calcifications, and chorioretinitis. In France, a screening program has been in place since 1992, and pregnant women with negative serology are tested monthly until delivery. If this pregnant woman had been followed according to this program, she would have been started on spiramycin 14 weeks earlier than in the US, her amniotic fluid would have been tested for T. gondii by PCR at 18 weeks, and she would have been started on pyrimethamine/sulfadiazine 11 to 8 weeks earlier than in the US. In the US, such a program does not exist, and infection is usually diagnosed when clinical signs are present in the fetus or at birth. Severe disease is not an uncommon situation in the US [1], but it is apparently a rare event in France (Table 1) [2]. Why is a Congenital infection caused by the same parasite approached so differently in France than in the US? Below, we will discuss several factors that could account for these diverging approaches. Table 1 Differences in T. gondii genetics, epidemiology, clinical manifestations, and approach to infection detection and management during pregnancy, between France and the US. France US Parasite Genetics Type II: >95%; other types are very rare Type II: 41.5%; non-type II (including atypicals): 58.5% IgG Seroprevalence in Women of Childbearing Age 37.0% 9.1% Incidence of Acute Infection among Toxoplasma-Seronegative Pregnant Women 2.1/1,000 0.2/1,000* Incidence of Congenital Toxoplasmosis 2.9/10,000 live births 0.5/10,000 live births* Clinical Signs of Congenital Toxoplasmosis in Newborns: Absent, Mild–Moderate, and Severe 85%, 10%, and 3% 12%, 11%, and 77% Screening of Toxoplasma-Seronegative Pregnant Women Yes. Systematic screening is performed every month No. However, systematic screening is performed in some obstetric practices Diagnosis of Acute T. gondii Infection by Seroconversion Yes, because sequential samples are available Rare Diagnosis of Acute T. gondii Infection by the Use of a Single Serum Rare Yes. Only a single serum is available. Positive Toxoplasma IgM samples require confirmatory testing at reference centers such as the Palo Alto Medical Foundation Toxoplasma Serology Laboratory** Recommendation of Treatment, Amniotic Fluid for T. gondii PCR Testing, and Serial Ultrasounds for Acutely Infected Women Yes Yes Indication of Infant's Workup for Congenital Toxoplasmosis at Birth Yes, for each newborn born to a mother infected during gestation regardless of the presence of clinical signs or laboratory/radiological abnormalities Yes, for those with clinical signs and/or laboratory/radiological abnormalities suggestive of Congenital infection. Seldom, for infected infants without clinical signs or laboratory/radiological abnormalities whose mothers were suspected of having or diagnosed with Toxoplasmosis during gestation Postnatal Treatment of Congenitally Infected Infants Yes, for infected infants of acutely infected pregnant women (symptomatic or asymptomatic) diagnosed with Congenital Toxoplasmosis in utero or postnatally, regardless of the presence of clinical, laboratory, or radiological abnormalities Yes, for infants diagnosed with Congenital Toxoplasmosis because of the presence of clinical signs in utero or at birth. Seldom, for infected infants without clinical, laboratory, or radiological abnormalities in whom the diagnosis of Congenital Toxoplasmosis was made in utero or postnatally because of the presence of maternal illness, risk factors, or systematic screening by an obstetric practice Open in a separate window Ig, immunoglobulin.
-
chapter 112 Congenital Toxoplasmosis
Handbook of Clinical Neurology, 2013Co-Authors: Francois Kieffer, Martine WallonAbstract:Congenital Toxoplasmosis results from the transplacental transmission of the parasite Toxoplasma gondii after a maternal infection acquired in pregnancy. Prevalence of Congenital infection ranges from 0.1 to 0.3 per 1000 live births. The maternal–fetal transmission rate increases with gestational age at maternal seroconversion, from less than 15% at 13 weeks of gestation to over 70% at 36 weeks. Conversely, the later the maternal infection, the lower the risk of symptomatic Congenital infection (infections acquired during the third trimester are most often asymptomatic at birth). Prenatal diagnosis is currently performed by PCR analysis in amniotic fluid. Antenatal management and treatment vary considerably among countries. In some European countries, maternal infections are detected through serological screening allowing a prompt treatment with spiramycin, which is expected to reduce the risk of vertical transmission. If PCR analysis in amniotic fluid is positive or if maternal infection was acquired in the third trimester of pregnancy, a combination with pyrimethamine and sulphonamide is given until delivery. Benefits of antenatal treatments remain controversial. Infected newborns are prescribed pyrimethamine and sulphonamide for 12 months. Despite antenatal and postnatal treatment, chorioretinitis can occur at any age (prevalence > 20% at 10 years of age): long-term ophthalmological follow-up remains necessary.
-
comparison of mother and child antibodies that target high molecular mass toxoplasma gondii antigens by immunoblotting improves neonatal diagnosis of Congenital Toxoplasmosis
Clinical and Vaccine Immunology, 2012Co-Authors: Coralie Lollivier, François Peyron, Martine Wallon, B Faucher, Renaud Piarroux, Jacqueline FranckAbstract:This retrospective study proposes a new reading of immunoblotting (IB) in the diagnosis of Congenital Toxoplasmosis. Our findings demonstrate that a three-IgM-band association at 75, 90, and 100 kDa called the IgM triplet increases the sensitivity to 95.8% when combined with prenatal and serological neonatal tests.
François Peyron - One of the best experts on this subject based on the ideXlab platform.
-
The cost-effectiveness of neonatal versus prenatal screening for Congenital Toxoplasmosis
PLoS ONE, 2019Co-Authors: Christine Binquet, Eileen Stillwaggon, Catherine Lejeune, Valérie Seror, François Peyron, Anne-claire Bertaux, Olivier Scemama, Catherine Quantin, Sophie Béjean, Martine WallonAbstract:Background Congenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce Congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of Congenital Toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments. Method To identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge of long-term evolution of the disease in treated children. Epidemiological data were extracted from the scientific literature and clinical data from the French Lyon cohort. Strategies were compared at one year of age, when infection can be definitively evaluated, and at 15 years of age, after which validated outcome data become scarce. The analysis was performed from the French Health Insurance System perspective and included direct medical costs for pregnant women and their children. Results The 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to €21,472 when considering the 15-year endpoint. Conclusions Prenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains. In addition, prenatal screening, by providing closer follow-up of women at risk increases the number of occasions for education avoiding Toxoplasmosis.
-
Congenital Toxoplasmosis a plea for a neglected disease
Pathogenetics, 2018Co-Authors: Martine Wallon, François PeyronAbstract:Maternal infection by Toxoplasma gondii during pregnancy may have serious consequences for the fetus, ranging from miscarriage, central nervous system involvement, retinochoroiditis, or subclinical infection at birth with a risk of late onset of ocular diseases. As infection in pregnant women is usually symptomless, the diagnosis relies only on serological tests. Some countries like France and Austria have organized a regular serological testing of pregnant women, some others have no prenatal program of surveillance. Reasons for these discrepant attitudes are many and debatable. Among them are the efficacy of antenatal treatment and cost-effectiveness of such a program. A significant body of data demonstrated that rapid onset of treatment after maternal infection reduces the risk and severity of fetal infection. Recent cost-effectiveness studies support regular screening. This lack of consensus put both pregnant women and care providers in a difficult situation. Another reason why Congenital Toxoplasmosis is disregarded in some countries is the lack of precise information about its impact on the population. Precise estimations on the burden of the disease can be achieved by systematic screening that will avoid bias or underreporting of cases and provide a clear view of its outcome.
-
Congenital Toxoplasmosis in France and the United States: One Parasite, Two Diverging Approaches.
PLoS neglected tropical diseases, 2017Co-Authors: François Peyron, Francois Kieffer, Herve Pelloux, Isabelle Villena, Daniel Ajzenberg, Rima Mc Leod, Despina G. Contopoulos-ioannidis, Laurent Mandelbrot, L. David Sibley, Martine WallonAbstract:At 29 weeks of gestation, a pregnant woman in the United States was told that her fetal ultrasound had revealed the presence of hydrocephalus. She did not recall having any symptoms or risk factors during gestation. Serological testing at the national reference laboratory for Toxoplasmosis in the US (http://www.pamf.org/serology/) confirmed an acute infection likely acquired around 17 weeks of gestation. She was started on pyrimethamine/sulfadiazine, at 31 weeks. Her amniotic fluid was positive for Toxoplasma gondii DNA by polymerase chain reaction (PCR). The infant was born with hydrocephalus, brain calcifications, and chorioretinitis. In France, a screening program has been in place since 1992, and pregnant women with negative serology are tested monthly until delivery. If this pregnant woman had been followed according to this program, she would have been started on spiramycin 14 weeks earlier than in the US, her amniotic fluid would have been tested for T. gondii by PCR at 18 weeks, and she would have been started on pyrimethamine/sulfadiazine 11 to 8 weeks earlier than in the US. In the US, such a program does not exist, and infection is usually diagnosed when clinical signs are present in the fetus or at birth. Severe disease is not an uncommon situation in the US [1], but it is apparently a rare event in France (Table 1) [2]. Why is a Congenital infection caused by the same parasite approached so differently in France than in the US? Below, we will discuss several factors that could account for these diverging approaches. Table 1 Differences in T. gondii genetics, epidemiology, clinical manifestations, and approach to infection detection and management during pregnancy, between France and the US. France US Parasite Genetics Type II: >95%; other types are very rare Type II: 41.5%; non-type II (including atypicals): 58.5% IgG Seroprevalence in Women of Childbearing Age 37.0% 9.1% Incidence of Acute Infection among Toxoplasma-Seronegative Pregnant Women 2.1/1,000 0.2/1,000* Incidence of Congenital Toxoplasmosis 2.9/10,000 live births 0.5/10,000 live births* Clinical Signs of Congenital Toxoplasmosis in Newborns: Absent, Mild–Moderate, and Severe 85%, 10%, and 3% 12%, 11%, and 77% Screening of Toxoplasma-Seronegative Pregnant Women Yes. Systematic screening is performed every month No. However, systematic screening is performed in some obstetric practices Diagnosis of Acute T. gondii Infection by Seroconversion Yes, because sequential samples are available Rare Diagnosis of Acute T. gondii Infection by the Use of a Single Serum Rare Yes. Only a single serum is available. Positive Toxoplasma IgM samples require confirmatory testing at reference centers such as the Palo Alto Medical Foundation Toxoplasma Serology Laboratory** Recommendation of Treatment, Amniotic Fluid for T. gondii PCR Testing, and Serial Ultrasounds for Acutely Infected Women Yes Yes Indication of Infant's Workup for Congenital Toxoplasmosis at Birth Yes, for each newborn born to a mother infected during gestation regardless of the presence of clinical signs or laboratory/radiological abnormalities Yes, for those with clinical signs and/or laboratory/radiological abnormalities suggestive of Congenital infection. Seldom, for infected infants without clinical signs or laboratory/radiological abnormalities whose mothers were suspected of having or diagnosed with Toxoplasmosis during gestation Postnatal Treatment of Congenitally Infected Infants Yes, for infected infants of acutely infected pregnant women (symptomatic or asymptomatic) diagnosed with Congenital Toxoplasmosis in utero or postnatally, regardless of the presence of clinical, laboratory, or radiological abnormalities Yes, for infants diagnosed with Congenital Toxoplasmosis because of the presence of clinical signs in utero or at birth. Seldom, for infected infants without clinical, laboratory, or radiological abnormalities in whom the diagnosis of Congenital Toxoplasmosis was made in utero or postnatally because of the presence of maternal illness, risk factors, or systematic screening by an obstetric practice Open in a separate window Ig, immunoglobulin.
-
comparison of mother and child antibodies that target high molecular mass toxoplasma gondii antigens by immunoblotting improves neonatal diagnosis of Congenital Toxoplasmosis
Clinical and Vaccine Immunology, 2012Co-Authors: Coralie Lollivier, François Peyron, Martine Wallon, B Faucher, Renaud Piarroux, Jacqueline FranckAbstract:This retrospective study proposes a new reading of immunoblotting (IB) in the diagnosis of Congenital Toxoplasmosis. Our findings demonstrate that a three-IgM-band association at 75, 90, and 100 kDa called the IgM triplet increases the sensitivity to 95.8% when combined with prenatal and serological neonatal tests.
-
long term impact of treated Congenital Toxoplasmosis on quality of life and visual performance
Pediatric Infectious Disease Journal, 2011Co-Authors: François Peyron, Martine Wallon, Justus G Garweg, Elodie Descloux, Muriel Rolland, Jurgen BarthAbstract:Background: Long-term evolution of Congenital Toxoplasmosis is not documented. We assessed the outcome of treated Congenital Toxoplasmosis in a cohort of adult individuals who had undergone ante- and postnatal treatment to provide information for pediatricians and parents on the evolution of the disease. Methods: We conducted a questionnaire study on 126 adults with Congenital Toxoplasmosis (mean age: 22.2 years; age range: 18–31 years) monitored regularly until the time of inclusion. The main outcome measures were quality of life (Psychological General Well-Being Index) and visual function (VF14 questionnaire), and the outcomes were correlated with disease-specific factors. Results: Of the 102 patients (80.9%) who were finally included in the study, 12 (11.8%) presented neurologic effects and 60 (58.8%) manifested ocular lesions; in the latter category, 13 individuals (12.7%) had reduced visual function. The overall global quality-of-life score (74.7 ± 14.2) was close to the expected normal range for the general population (73.7 ± 15.3). Overall, visual function was only slightly impaired (M = 97.3; 95% confidence interval, 95.8–98.8). Although disease-independent critical life circumstances were associated with a reduced Psychological General Well-Being Index, this index was not influenced by any of the clinical characteristics of Congenital Toxoplasmosis. Neurologic pathologies, reduced visual acuity, foveal location of the retinal lesion, and squinting contributed to decreased visual function at follow-up. Conclusions: Our data reveal that treated Congenital Toxoplasmosis has little effect on the quality of life and visual function of the affected individuals. These encouraging findings may help to alleviate the anxiety of affected individuals and their parents.
Rima Mcleod - One of the best experts on this subject based on the ideXlab platform.
-
late diagnosis of Congenital Toxoplasmosis with macrocephaly in dizygotic twins after incidental detection of leukocoria a case report
The Journal of Pediatrics, 2021Co-Authors: Coralee Del Valle Mojica, Jose G. Montoya, Rima Mcleod, Jennifer Mcguire, Krisha L Palma, Karuna Shekdar, Despina G ContopoulosioannidisAbstract:Untreated Congenital Toxoplasmosis remains an important cause of neurologic and ocular disease worldwide. However, Congenitally infected infants may not have signs and symptoms their physicians recognize, leading to delayed diagnosis and missed opportunities for treatment. We describe a pair of twins diagnosed with Congenital Toxoplasmosis at 11 months of age following incidental detection of leukocoria in one twin.
-
Management of Congenital Toxoplasmosis
Current Pediatrics Reports, 2014Co-Authors: Rima Mcleod, Joseph Lykins, A. Gwendolyn Noble, Peter Rabiah, Charles N. Swisher, Peter T. Heydemann, David Mclone, David Frim, Shawn Withers, Fatima ClouserAbstract:Prompt diagnosis and rapid initiation of medical treatment are critical for the best outcomes in infants with Congenital Toxoplasmosis. This is important for pregnant women, fetuses, and infants, including those with active retinitis and choroidal neovascular membranes. For hydrocephalus, prompt placement of a ventriculoperitoneal shunt is key for improved outcomes. Pyrimethamine and Sulfadiazine with Leucovorin are first-line medicines. For later recurrences of active retinitis, Azithromycin or Clindamycin are sometimes substituted for Sulfadiazine as second-line treatments, given with Pyramethamine. Following resolution of active retinitis, these medicines may be useful without Pyrimethamine for suppression and avoid the risk of hypersensitivity from Trimethoprim/Sulfamethoxazole. Antibody to VEGF, in conjunction with antimicrobial therapy, results in resolution of choroidal neovascular membranes. Serologic screening of seronegative pregnant women to detect primary infection during gestation, and facilitating medicine administration and thereby preventing or treating fetal infection, is an optimal, apparently cost-effective, means to reduce disease. Definitively curative medicines currently being developed likely will improve future management and outcomes of this disease.
-
spinal cord lesions in Congenital Toxoplasmosis demonstrated with neuroimaging including their successful treatment in an adult
Journal of Neuroparasitology, 2012Co-Authors: Delilah Burrowes, Peter Rabiah, Charles N. Swisher, Peter T. Heydemann, Gwendolyn A Noble, Mari Sautter, Kenneth M Boyer, Daniel D Lee, Rima McleodAbstract:Neuroimaging studies for persons in the National Collaborative Chicago-Based Congenital Toxoplasmosis Study (NCCCTS) with symptoms and signs referable to the spinal cord were reviewed. Three infants had symptomatic spinal cord lesions, another infant a Chiari malformation, and another infant a symptomatic peri-spinal cord lipoma. One patient had an unusual history of prolonged spinal cord symptoms presenting in middle age. Neuroimaging was used to establish her diagnosis and response to treatment. This 43 year-old woman with Congenital Toxoplasmosis developed progressive leg spasticity, weakness, numbness, difficulty walking, and decreased visual acuity and color vision without documented re-activation of her chorioretinal disease. At 52 years of age, spinal cord lesions in locations correlating with her symptoms and optic atrophy were diagnosed with 3 Tesla MRI scan. Treatment with pyrimethamine and sulfadiazine decreased her neurologic symptoms, improved her neurologic examination, and resolved her enhancing spinal cord lesions seen on MRI.
-
severe Congenital Toxoplasmosis in the united states clinical and serologic findings in untreated infants
Pediatric Infectious Disease Journal, 2011Co-Authors: Tudor Olariu, Jack S Remington, Rima Mcleod, Ambereen Alam, Jose G. MontoyaAbstract:Background Congenital Toxoplasmosis can cause significant neurologic manifestations and other untoward sequelae. Methods The Palo Alto Medical Foundation Toxoplasma Serology Laboratory database was searched for data on infants 0 to 180 days old, in whom Congenital Toxoplasmosis had been confirmed and who had been tested for Toxoplasma gondii-specific immunoglobulin G (IgG), IgM, and IgA antibodies, between 1991 and 2005. Their clinical findings were confirmed at the National Collaborative Chicago-based Congenital Toxoplasmosis Study center. We reviewed available clinical data and laboratory profiles of 164 infants with Congenital Toxoplasmosis whose mothers had not been treated for the parasite during gestation. Results One or more severe clinical manifestations of Congenital Toxoplasmosis were reported in 84% of the infants and included eye disease (92.2%), brain calcifications (79.6%), and hydrocephalus (67.7%). In 61.6% of the infants, eye disease, brain calcifications, and hydrocephalus were present concurrently. T. gondii-specific IgM, IgA, and IgE antibodies were demonstrable in 86.6%, 77.4%, and 40.2% of the infants, respectively. Testing for IgM and IgA antibodies increased the sensitivity of making the diagnosis of Congenital Toxoplasmosis to 93% compared with testing for IgM or IgA individually. IgM and IgA antibodies were still present in 43.9% of infants diagnosed between 1 and 6 months of life. Conclusions Our study reveals that severe clinical signs of Congenital Toxoplasmosis including hydrocephalus, eye disease, or intracranial calcifications occurred in 85% infants whose sera were referred to our reference Toxoplasma Serology Laboratory during a period of 15 years. Laboratory tests, including serologic and polymerase chain reaction tests, were critical for diagnosis in the infants. Our results contrast remarkably with those of European investigators who rarely observe severe clinical signs in infants with Congenital Toxoplasmosis.
-
maternal serologic screening to prevent Congenital Toxoplasmosis a decision analytic economic model
PLOS Neglected Tropical Diseases, 2011Co-Authors: Eileen Stillwaggon, Mari Sautter, Christopher S Carrier, Rima McleodAbstract:Objective: To determine a cost-minimizing option for Congenital Toxoplasmosis in the United States. Methodology/Principal Findings: A decision-analytic and cost-minimization model was constructed to compare monthly maternal serological screening, prenatal treatment, and post-natal follow-up and treatment according to the current French (Paris) protocol, versus no systematic screening or perinatal treatment. Costs are based on published estimates of lifetime societal costs of developmental disabilities and current diagnostic and treatment costs. Probabilities are based on published results and clinical practice in the United States and France. One- and two-way sensitivity analyses are used to evaluate robustness of results. Universal monthly maternal screening for Congenital Toxoplasmosis with follow-up and treatment, following the French protocol, is found to be cost-saving, with savings of $620 per child screened. Results are robust to changes in test costs, value of statistical life, seroprevalence in women of childbearing age, fetal loss due to amniocentesis, and to bivariate analysis of test costs and incidence of primary T. gondii infection in pregnancy. Given the parameters in this model and a maternal screening test cost of $12, screening is cost-saving for rates of Congenital infection above 1 per 10,000 live births. If universal testing generates economies of scale in diagnostic tools—lowering test costs to about $2 per test—universal screening is cost-saving at rates of Congenital infection well below the lowest reported rates in the United States of 1 per 10,000 live births. Conclusion/Significance: Universal screening according to the French protocol is cost saving for the US population within broad parameters for costs and probabilities.
Kenneth M Boyer - One of the best experts on this subject based on the ideXlab platform.
-
outcomes of hydrocephalus secondary to Congenital Toxoplasmosis
Journal of Neurosurgery, 2019Co-Authors: David Mclone, Peter Rabiah, Charles N. Swisher, Peter T. Heydemann, David Frim, Shawn Withers, Gwendolyn A Noble, Kenneth M Boyer, Richard D Penn, Kristen WroblewskiAbstract:OBJECTIVE Hydrocephalus occurs in children with Congenital Toxoplasmosis and can lead to severe disability. In these cases, the decision to intervene is often influenced by the expectation of neurological recovery. In this study, clinical responses to neurosurgical intervention in children with hydrocephalus secondary to Congenital Toxoplasmosis are characterized. METHODS Sixty-five participants with hydrocephalus due to Congenital Toxoplasma gondii infection were evaluated as part of the National Collaborative Chicago-based Congenital Toxoplasmosis Study, and their neuroradiographic findings were reviewed. Clinical outcomes were scored on the basis of cognition and motor skills through the use of IQ scores and Gross Motor Function Classification System (GMFCS) level. Outcomes were then analyzed in relation to approach to management, anatomy of hydrocephalus, and time from diagnosis of hydrocephalus to surgical intervention. RESULTS There was considerable variation in the outcomes of patients whose hydrocephalus was treated in early life, ranging from normal cognitive and motor function to profound developmental delay and functional limitation. Of the 65 participants included in the study, IQ and GMFCS level were available for 46 (70.8%). IQ and motor score were highly correlated (r = -0.82, p < 0.001). There were people with differing patterns of hydrocephalus or thickness of cortical mantle on initial presentation who had favorable outcomes. Time to neurosurgical intervention data were available for 31 patients who underwent ventriculoperitoneal (VP) shunt placement. Delayed shunt placement beyond 25 days after diagnosis of hydrocephalus was associated with greater cognitive impairment (p = 0.02). Motor impairment also appeared to be associated with shunt placement beyond 25 days but the difference did not achieve statistical significance (p = 0.13). Among those with shunt placement within 25 days after diagnosis (n = 19), the mean GMFCS level was 1.9 ± 1.6 (range 1-5). Five (29.4%) of 17 of these patients were too disabled to participate in formal cognitive testing, after excluding 2 patients with visual difficulties or language barriers that precluded IQ testing. Of the patients who had VP shunt placement 25 or more days after diagnosis (n = 12), the mean GMFCS level was 2.7 ± 1.4 (range 1-4). Of these, 1 could not participate in IQ testing due to severe visual difficulties and 8 (72.7%) of the remaining 11 due to cognitive disability. CONCLUSIONS VP shunt placement in patients with hydrocephalus caused by Congenital Toxoplasmosis can contribute to favorable clinical outcomes, even in cases with severe hydrocephalus on neuroimaging. Shunt placement within 25 days of diagnosis was statistically associated with more favorable cognitive outcomes. Motor function appeared to follow the same pattern although it did not achieve statistical significance.
-
spinal cord lesions in Congenital Toxoplasmosis demonstrated with neuroimaging including their successful treatment in an adult
Journal of Neuroparasitology, 2012Co-Authors: Delilah Burrowes, Peter Rabiah, Charles N. Swisher, Peter T. Heydemann, Gwendolyn A Noble, Mari Sautter, Kenneth M Boyer, Daniel D Lee, Rima McleodAbstract:Neuroimaging studies for persons in the National Collaborative Chicago-Based Congenital Toxoplasmosis Study (NCCCTS) with symptoms and signs referable to the spinal cord were reviewed. Three infants had symptomatic spinal cord lesions, another infant a Chiari malformation, and another infant a symptomatic peri-spinal cord lipoma. One patient had an unusual history of prolonged spinal cord symptoms presenting in middle age. Neuroimaging was used to establish her diagnosis and response to treatment. This 43 year-old woman with Congenital Toxoplasmosis developed progressive leg spasticity, weakness, numbness, difficulty walking, and decreased visual acuity and color vision without documented re-activation of her chorioretinal disease. At 52 years of age, spinal cord lesions in locations correlating with her symptoms and optic atrophy were diagnosed with 3 Tesla MRI scan. Treatment with pyrimethamine and sulfadiazine decreased her neurologic symptoms, improved her neurologic examination, and resolved her enhancing spinal cord lesions seen on MRI.
-
unrecognized ingestion of toxoplasma gondii oocysts leads to Congenital Toxoplasmosis and causes epidemics in north america
Clinical Infectious Diseases, 2011Co-Authors: Kenneth M Boyer, Shawn Withers, Gwendolyn A Noble, Kristen Wroblewski, Theodore Karrison, Mari Sautter, D E Hill, Ernest Mui, J P Dubey, Charles N. SwisherAbstract:(See the Editorial Commentary by Linn, on pages 1090–1.) Background. Congenital Toxoplasmosis presents as severe, life-altering disease in North America. If mothers of infants with Congenital Toxoplasmosis could be identified by risks, it would provide strong support for educating pregnant women about risks, to eliminate this disease. Conversely, if not all risks are identifiable, undetectable risks are suggested. A new test detecting antibodies to sporozoites demonstrated that oocysts were the predominant source of Toxoplasma gondii infection in 4 North American epidemics and in mothers of children in the National Collaborative Chicago-based Congenital Toxoplasmosis Study (NCCCTS). This novel test offered the opportunity to determine whether risk factors or demographic characteristics could identify mothers infected with oocysts. Methods. Acutely infected mothers and their Congenitally infected infants were evaluated, including in-person interviews concerning risks and evaluation of perinatal maternal serum samples. Results. Fifty-nine (78%) of 76 mothers of Congenitally infected infants in NCCCTS had primary infection with oocysts. Only 49% of these mothers identified significant risk factors for sporozoite acquisition. Socioeconomic status, hometown size, maternal clinical presentations, and ethnicity were not reliable predictors. Conclusions. Undetected contamination of food and water by oocysts frequently causes human infections in North America. Risks are often unrecognized by those infected. Demographic characteristics did not identify oocyst infections. Thus, although education programs describing hygienic measures may be beneficial, they will not suffice to prevent the suffering and economic consequences associated with Congenital Toxoplasmosis. Only a vaccine or implementation of systematic serologic testing of pregnant women and newborns, followed by treatment, will prevent most Congenital Toxoplasmosis in North America.
-
outcome of treatment for Congenital Toxoplasmosis 1981 2004 the national collaborative chicago based Congenital Toxoplasmosis study
Clinical Infectious Diseases, 2006Co-Authors: Rima Mcleod, Charles N. Swisher, Peter T. Heydemann, Jessica Jalbrzikowski, Theodore Karrison, Kenneth M Boyer, Kristen Kasza, Nancy Roizen, Jack S Remington, Gwendolyn A NobleAbstract:Background Without treatment, Congenital Toxoplasmosis has recurrent, recrudescent, adverse outcomes. Long-term follow-up of infants with Congenital Toxoplasmosis treated throughout their first year of life with pyrimethamine and sulfadiazine has not been reported. Methods Between 1981 and 2004, one hundred twenty infants (current mean age +/- standard deviation, 10.5 +/- 4.8 years) with Congenital Toxoplasmosis were treated with 1 of 2 doses of pyrimethamine plus sulfadiazine; therapy was initiated shortly after birth and continued for 12 months. Children who received treatment were evaluated at birth and at predetermined intervals; the focus of the evaluations was on prespecified end points: motor abnormalities, cognitive outcome, vision impairment, formation of new eye lesions, and hearing loss. Results Treatment of infants without substantial neurologic disease at birth with pyrimethamine and sulfadiazine for 1 year resulted in normal cognitive, neurologic, and auditory outcomes for all patients. Treatment of infants who had moderate or severe neurologic disease (as defined in this article in the Treatments subsection of Methods) at birth resulted in normal neurologic and/or cognitive outcomes for >72% of the patients, and none had sensorineural hearing loss. Ninety-one percent of children without substantial neurologic disease and 64% of those with moderate or severe neurologic disease at birth did not develop new eye lesions. Almost all of these outcomes are markedly better than outcomes reported for children who were untreated or treated for 1 month in earlier decades (P .05). Conclusions Although not all children did well with treatment, the favorable outcomes we noted indicate the importance of diagnosis and treatment of infants with Congenital Toxoplasmosis.
-
risk factors for toxoplasma gondii infection in mothers of infants with Congenital Toxoplasmosis implications for prenatal management and screening
American Journal of Obstetrics and Gynecology, 2005Co-Authors: Charles N. Swisher, Shawn Withers, Kenneth M Boyer, Nancy Roizen, Jack S Remington, Ellen Holfels, Douglas G Mack, Paul Meier, Rima McleodAbstract:Objective The purpose of this study was to determine whether demographic characteristics, history of exposure to recognized transmission vehicles, or illness that was compatible with acute Toxoplasmosis during gestation identified most mothers of infants with Congenital Toxoplasmosis. Study design Mothers of 131 infants and children who were referred to a national study of treatment for Congenital Toxoplasmosis were characterized demographically and questioned concerning exposure to recognized risk factors or illness. Results No broad demographic features identified populations that were at risk. Only 48% of mothers recognized epidemiologic risk factors (direct or indirect exposure to raw/undercooked meat or to cat excrement) or gestational illnesses that were compatible with acute acquired Toxoplasmosis during pregnancy. Conclusion Maternal risk factors or compatible illnesses were recognized in retrospect by fewer than one half of North American mothers of infants with Toxoplasmosis. Educational programs might have prevented acquisition of Toxoplasma gondii by those mothers who had clear exposure risks. However, only systematic serologic screening of all pregnant women at prenatal visits or of all newborn infants at birth would prevent or detect a higher proportion of these Congenital infections.
Charles N. Swisher - One of the best experts on this subject based on the ideXlab platform.
-
outcomes of hydrocephalus secondary to Congenital Toxoplasmosis
Journal of Neurosurgery, 2019Co-Authors: David Mclone, Peter Rabiah, Charles N. Swisher, Peter T. Heydemann, David Frim, Shawn Withers, Gwendolyn A Noble, Kenneth M Boyer, Richard D Penn, Kristen WroblewskiAbstract:OBJECTIVE Hydrocephalus occurs in children with Congenital Toxoplasmosis and can lead to severe disability. In these cases, the decision to intervene is often influenced by the expectation of neurological recovery. In this study, clinical responses to neurosurgical intervention in children with hydrocephalus secondary to Congenital Toxoplasmosis are characterized. METHODS Sixty-five participants with hydrocephalus due to Congenital Toxoplasma gondii infection were evaluated as part of the National Collaborative Chicago-based Congenital Toxoplasmosis Study, and their neuroradiographic findings were reviewed. Clinical outcomes were scored on the basis of cognition and motor skills through the use of IQ scores and Gross Motor Function Classification System (GMFCS) level. Outcomes were then analyzed in relation to approach to management, anatomy of hydrocephalus, and time from diagnosis of hydrocephalus to surgical intervention. RESULTS There was considerable variation in the outcomes of patients whose hydrocephalus was treated in early life, ranging from normal cognitive and motor function to profound developmental delay and functional limitation. Of the 65 participants included in the study, IQ and GMFCS level were available for 46 (70.8%). IQ and motor score were highly correlated (r = -0.82, p < 0.001). There were people with differing patterns of hydrocephalus or thickness of cortical mantle on initial presentation who had favorable outcomes. Time to neurosurgical intervention data were available for 31 patients who underwent ventriculoperitoneal (VP) shunt placement. Delayed shunt placement beyond 25 days after diagnosis of hydrocephalus was associated with greater cognitive impairment (p = 0.02). Motor impairment also appeared to be associated with shunt placement beyond 25 days but the difference did not achieve statistical significance (p = 0.13). Among those with shunt placement within 25 days after diagnosis (n = 19), the mean GMFCS level was 1.9 ± 1.6 (range 1-5). Five (29.4%) of 17 of these patients were too disabled to participate in formal cognitive testing, after excluding 2 patients with visual difficulties or language barriers that precluded IQ testing. Of the patients who had VP shunt placement 25 or more days after diagnosis (n = 12), the mean GMFCS level was 2.7 ± 1.4 (range 1-4). Of these, 1 could not participate in IQ testing due to severe visual difficulties and 8 (72.7%) of the remaining 11 due to cognitive disability. CONCLUSIONS VP shunt placement in patients with hydrocephalus caused by Congenital Toxoplasmosis can contribute to favorable clinical outcomes, even in cases with severe hydrocephalus on neuroimaging. Shunt placement within 25 days of diagnosis was statistically associated with more favorable cognitive outcomes. Motor function appeared to follow the same pattern although it did not achieve statistical significance.
-
Management of Congenital Toxoplasmosis
Current Pediatrics Reports, 2014Co-Authors: Rima Mcleod, Joseph Lykins, A. Gwendolyn Noble, Peter Rabiah, Charles N. Swisher, Peter T. Heydemann, David Mclone, David Frim, Shawn Withers, Fatima ClouserAbstract:Prompt diagnosis and rapid initiation of medical treatment are critical for the best outcomes in infants with Congenital Toxoplasmosis. This is important for pregnant women, fetuses, and infants, including those with active retinitis and choroidal neovascular membranes. For hydrocephalus, prompt placement of a ventriculoperitoneal shunt is key for improved outcomes. Pyrimethamine and Sulfadiazine with Leucovorin are first-line medicines. For later recurrences of active retinitis, Azithromycin or Clindamycin are sometimes substituted for Sulfadiazine as second-line treatments, given with Pyramethamine. Following resolution of active retinitis, these medicines may be useful without Pyrimethamine for suppression and avoid the risk of hypersensitivity from Trimethoprim/Sulfamethoxazole. Antibody to VEGF, in conjunction with antimicrobial therapy, results in resolution of choroidal neovascular membranes. Serologic screening of seronegative pregnant women to detect primary infection during gestation, and facilitating medicine administration and thereby preventing or treating fetal infection, is an optimal, apparently cost-effective, means to reduce disease. Definitively curative medicines currently being developed likely will improve future management and outcomes of this disease.
-
spinal cord lesions in Congenital Toxoplasmosis demonstrated with neuroimaging including their successful treatment in an adult
Journal of Neuroparasitology, 2012Co-Authors: Delilah Burrowes, Peter Rabiah, Charles N. Swisher, Peter T. Heydemann, Gwendolyn A Noble, Mari Sautter, Kenneth M Boyer, Daniel D Lee, Rima McleodAbstract:Neuroimaging studies for persons in the National Collaborative Chicago-Based Congenital Toxoplasmosis Study (NCCCTS) with symptoms and signs referable to the spinal cord were reviewed. Three infants had symptomatic spinal cord lesions, another infant a Chiari malformation, and another infant a symptomatic peri-spinal cord lipoma. One patient had an unusual history of prolonged spinal cord symptoms presenting in middle age. Neuroimaging was used to establish her diagnosis and response to treatment. This 43 year-old woman with Congenital Toxoplasmosis developed progressive leg spasticity, weakness, numbness, difficulty walking, and decreased visual acuity and color vision without documented re-activation of her chorioretinal disease. At 52 years of age, spinal cord lesions in locations correlating with her symptoms and optic atrophy were diagnosed with 3 Tesla MRI scan. Treatment with pyrimethamine and sulfadiazine decreased her neurologic symptoms, improved her neurologic examination, and resolved her enhancing spinal cord lesions seen on MRI.
-
unrecognized ingestion of toxoplasma gondii oocysts leads to Congenital Toxoplasmosis and causes epidemics in north america
Clinical Infectious Diseases, 2011Co-Authors: Kenneth M Boyer, Shawn Withers, Gwendolyn A Noble, Kristen Wroblewski, Theodore Karrison, Mari Sautter, D E Hill, Ernest Mui, J P Dubey, Charles N. SwisherAbstract:(See the Editorial Commentary by Linn, on pages 1090–1.) Background. Congenital Toxoplasmosis presents as severe, life-altering disease in North America. If mothers of infants with Congenital Toxoplasmosis could be identified by risks, it would provide strong support for educating pregnant women about risks, to eliminate this disease. Conversely, if not all risks are identifiable, undetectable risks are suggested. A new test detecting antibodies to sporozoites demonstrated that oocysts were the predominant source of Toxoplasma gondii infection in 4 North American epidemics and in mothers of children in the National Collaborative Chicago-based Congenital Toxoplasmosis Study (NCCCTS). This novel test offered the opportunity to determine whether risk factors or demographic characteristics could identify mothers infected with oocysts. Methods. Acutely infected mothers and their Congenitally infected infants were evaluated, including in-person interviews concerning risks and evaluation of perinatal maternal serum samples. Results. Fifty-nine (78%) of 76 mothers of Congenitally infected infants in NCCCTS had primary infection with oocysts. Only 49% of these mothers identified significant risk factors for sporozoite acquisition. Socioeconomic status, hometown size, maternal clinical presentations, and ethnicity were not reliable predictors. Conclusions. Undetected contamination of food and water by oocysts frequently causes human infections in North America. Risks are often unrecognized by those infected. Demographic characteristics did not identify oocyst infections. Thus, although education programs describing hygienic measures may be beneficial, they will not suffice to prevent the suffering and economic consequences associated with Congenital Toxoplasmosis. Only a vaccine or implementation of systematic serologic testing of pregnant women and newborns, followed by treatment, will prevent most Congenital Toxoplasmosis in North America.
-
Chorioretinal lesions in mothers of children with Congenital Toxoplasmosis in the National Collaborative Chicago-based, Congenital Toxoplasmosis Study
Editora da Pontifícia Universidade Católica do Rio Grande do Sul (EDIPUCRS), 2010Co-Authors: Gwendolyn A Noble, Peter Rabiah, Paul Latkany, Jessica Jalbrzikowski, Jaroslaw Kusmierczyk, Marilyn Mets, Kenneth Boyer, Kristen Wroblewski, Theodore Karrison, Charles N. SwisherAbstract:Aims: To determine whether mothers of children with Congenital Toxoplasmosis have chorioretinal lesions consistent with Toxoplasmosis.Methods: Prospective cohort study. Ophthalmologists in our study have examined 173 children with Congenital Toxoplasmosis in a hospital outpatient setting. These children were referred to us by their primary care physicians. One hundred and thirty mothers of these children had retina examinations of both eyes at least once. Main outcome measure was lesion(s) consistent with ocular Toxoplasmosis.Results: Of 130 mothers examined between 1991-2005, 10 (7.7%, 95% Confidence Interval 3.8%, 13.7%) had chorioretinal lesions which likely represent resolved toxoplasmic chorioretinitis. Most of these were small peripheral chorioretinal lesions. None reactivated between 1991-2005.Conclusions: Chorioretinal lesions consistent with quiescent ocular Toxoplasmosis occur in mothers of children with Congenital Toxoplasmosis in the United States