trimethoprim--sulfamethoxazole-drug-combination and Toxoplasmosis--Congenital

In this work we presented our own experience with recognized and treated toxoplasmosis among children. Treated cases were observed over several years afterwards. We analyzed the frequency and character of clinical changes, evaluated the validity of serological screening and the effectiveness of treatment. The largest age group treated were children 13 months to 5 years old. 13 children had the congenital and 12 the acquired form. The most cases occurred in the nodal, ocular and ocular-cranial forms. Thus, the most common symptoms were enlarged lymphatic nodes, strabismus, febrile seizures, intracranial calcifications. In the acquired forms of the illness a distinct correlation between treatment and the decrease antibody levels, the clinical pictures showed stagnation. The fall in antibody levels occurred earlier with intermediate immunofluorescence than with ELISA method. Among 20 children associated 30-day treatment was implemented (Daraprim, Rovamycine, Biseptol), among 4 with Fansidar and Rovamycine for 2-3 weeks. Few complications occurred at the end of or after treatment and did not require treatment/intervention. Usually it was leukopenia and thrombocytopenia. Long time observation allows to state that both therapeutic models prevent renewal of illness and can be recommended for further use.

Topics: Adolescent; Anti-Infective Agents; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Fluorescent Antibody Technique; Follow-Up Studies; Humans; Infant; Infant, Newborn; Mass Screening; Pyrimethamine; Serologic Tests; Spiramycin; Sulfadoxine; Toxoplasmosis; Toxoplasmosis, Congenital; Trimethoprim, Sulfamethoxazole Drug Combination

There is weak evidence on the best treatment of pregnant women with Toxoplasma gondii infection to prevent the vertical transmission to the fetus.. We conducted a 28-year retrospective study aiming to compare the efficacy of three therapeutic regimens [Spiramicyn alone (Spy) vs. Pyrimethamine-Sulfadiazine (P/S) vs. Spiramicyn with Trimethoprim-Sulfamethoxazole (Spy+TMP-SMX)] for the prevention of mother-to-fetus transmission of T. gondii infection.. 170 women were included: 58 (34.1%) had certain congenital toxoplasmosis (CT), 61 (35.9%) a probable infection and 41 (24.1%) possible infection. In total 97 mothers (57.1%) were treated with the Spy+TMP-SMX combination, 64 mothers (37.6%) were treated with Spy only and 8 mothers (4.7%) with P/S. Infected infants were 20/170 (11.7%). However, 8.2% (8/97) of infants born to mothers treated with Spy+TMP-SMX were infected, 20% (11/55) of infants born to women treated with Spy and 12.5% (1/8) of infants born to mothers treated with P/S were infected. Logistic regression analysis demonstrated that Spy treatment alone was associated with an increased risk of CT compared to the Spy+TMP-SMX combination (OR, 2.78, 95% CI 1.04-7.41, P value 0.041). No difference was observed when the Spy+TMP-SMX was compared with the P/S combination (OR 1.59; 95% CI 0.17 - 14.58; P value 0.682). Results were confirmed when the analyses were corrected by trimester of infection and by type of maternal treatment (OR 7.72; 95% CI 3.40-17.53, P value <0.001).. The combination of Spy+TMP-SMX may be more effective in reducing the risk of maternal-fetal transmission of Toxoplasmosis compared to Spy alone; furthermore, this combination is not inferior to P/S, the current international standard-of-care maternal treatment for the prevention of CT. A prospective trial comparing the combination Spy+TMP-SMX with P/S would be necessary to provide definitive evidence on the best regimen for pregnant women with T. gondii infection.

Topics: Female; Fetus; Humans; Infant; Mothers; Pregnancy; Pregnant Women; Prospective Studies; Retrospective Studies; Toxoplasmosis; Toxoplasmosis, Congenital; Trimethoprim, Sulfamethoxazole Drug Combination

Most infants infected with Toxoplasma gondii are completely asymptomatic at birth, yet they may develop ocular and neurological sequelae in the first few months of life. Cases of congenital toxoplasmosis with severe jaundice early after birth combined with pancytopenia and splenomegaly are extremely rare. Here, we report on a rare case of congenital toxoplasmosis presenting with severe jaundice and hemolysis early after birth combined with pancytopenia and splenomegaly.. A male preterm infant with severe jaundice and splenomegaly was admitted to our department. Laboratory examinations revealed severe hyperbilirubinemia, increased reticulocytes, and pancytopenia. After comprehensive analysis and examination, the final diagnosis was congenital toxoplasmosis, and the infant was treated with azithromycin and subsequently trimethoprim-sulfamethoxazole. Regular follow-up revealed congenital toxoplasmosis in both eyes, which was surgically treated, while neurofunctional assessment results were unremarkable. In this case of congenital toxoplasmosis combined with severe jaundice, we treated the infant with two courses of azithromycin, followed by trimethoprim-sulfamethoxazole after the jaundice resolved. Clinical follow-up indicated that this treatment was effective with few side effects; thus, this report may serve as a valuable clinical reference.. Timely diagnosis and adequate treatment are closely associated with congenital toxoplasmosis-related prognosis. Infants with congenital toxoplasmosis require long-term follow-up, focusing on nervous system development and ophthalmology.

Topics: Azithromycin; Humans; Infant, Newborn; Infant, Premature; Male; Toxoplasma; Toxoplasmosis, Congenital; Trimethoprim, Sulfamethoxazole Drug Combination

To compare the effectiviness of spiramycin/cotrimoxazole (Sp/C) versus pyrimethamine/sulfonamide (Pyr/Sul) and spiramycin alone (Spy) on mother-to-child transmission of toxoplasmosis infection in pregnancy.. Retrospective study of pregnant women evaluated for suspected toxoplasmosis between 1992 and 2011.. A total of 120 mothers and their 123 newborns were included. Prenatal treatment consisted of spiramycin in 43 mothers (35%), spiramycin/cotrimoxazole in 70 (56.9%) and pyrimethamine/sulfonamide in 10 (8.1%). A trend toward reduction in toxoplasmosis transmission was found when Sp/C was compared with Pyr/Sul and particularly with Spy alone (P=0.014). In particular, Spy increased the risk of congenital infection when compared with Sp/C (odds ratio (OR) 4.368; 95% CI: 1.253 to 15.219), but there was no significant reduction when Sp/C was compared with Pyr/Sul (OR 1.83; 95% CI: 0.184 to 18.274).. The treatment based on Sp/C has significant efficacy in reducing maternal-fetal transmission of Toxoplasma gondii when compared with Pyr/Sul and particularly to Spy. Randomized controlled trials would be required.

Topics: Adult; Anti-Infective Agents; Drug Combinations; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Italy; Pregnancy; Pregnancy Complications, Parasitic; Prenatal Care; Pyrimethamine; Retrospective Studies; Spiramycin; Sulfanilamide; Sulfanilamides; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Congenital; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Congenital toxoplasmosis is still one of the most frequent causes of fetal death. Despite a significant improvement in diagnosis, particularly in utero diagnosis, maternal treatment is only partially effective in preventing transmission to the fetus and treating fetal infection. Maternal treatment is based on drugs developed 50 years ago, which may have limited efficacy (spiramycin) or serious side-effects (pyrimethamine). Data on the use of cotrimoxazole in mouse models of toxoplasmosis and for preventing toxoplasmic encephalitis in patients suffering from AIDS have led Francis Derouin and colleagues to consider the potential of cotrimoxazole for prenatal prevention and treatment of toxoplasmic fetal death.

Topics: Animals; Anti-Infective Agents; Disease Models, Animal; Female; Humans; Mice; Pregnancy; Pregnancy Complications, Parasitic; Toxoplasmosis; Toxoplasmosis, Animal; Toxoplasmosis, Congenital; Trimethoprim, Sulfamethoxazole Drug Combination

We report seven cases of subclinical congenital toxoplasmosis secondary to maternal primary infections. Mothers were infected between two and four weeks prior to delivery. The diagnostic criteria of congenital infections included: IgM antibody (Ab) (1 case); IgM and IgA Ab (1 case); a real IgG seroconversion in the neonatal and postnatal samples (3 cases); persistence of IgG Ab beyond 6 months post-delivery (2 cases). A treatment was initiated, including a combination of pyrimethamine + sulfadiazine (6 cases); trimethoprim + sulfamethoxazole (1 case). This retrospective study suggests that it is important to screen the non-immune pregnant women until delivery. We confirmed the usefulness of a combination of isotypes of antibodies for the accurate assessment of congenital infection. Finally, infected infants have to be treated and monitored clinically and immunologically during the first year of life.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antibodies, Protozoan; Female; Humans; Immunoglobulin A; Immunoglobulin G; Infant, Newborn; Pregnancy; Pregnancy Complications, Parasitic; Retrospective Studies; Spiramycin; Toxoplasmosis; Toxoplasmosis, Congenital; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Animals; Drug Combinations; Female; Humans; Mice; Pregnancy; Sulfamethoxazole; Toxoplasmosis; Toxoplasmosis, Animal; Toxoplasmosis, Congenital; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination