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Previous Volume 331:695-699 September 15, 1994 Number 11 Next

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ABSTRACT

Background Congenital infection with Toxoplasma gondii can produce serious sequelae. However, there is little consensus about screening during pregnancy, and the tests used to establish a prenatal diagnosis of toxoplasmosis are complex and slow. We evaluated a simpler approach that is based on a polymerase-chain-reaction (PCR) test.

Methods Prenatal diagnostic tests, including ultrasonography, amniocentesis, and fetal-blood sampling, were performed in 2632 women with T. gondii infection acquired during pregnancy. In 339 consecutive women, a competitive PCR test for T. gondii was performed on amniotic fluid, and its results were compared with those of conventional diagnostic tests. The PCR test targets the B1 gene of T. gondii, uses an internal control, and can be completed in a day. Positive tests were confirmed by serologic testing of newborns or by autopsy in terminated pregnancies.

Results Overall, the risk of fetal infection was 7.4 percent, but it increased sharply with gestational age. Congenital infection was demonstrated in 34 of 339 fetuses by conventional methods, and the PCR test was positive in all 34. In three other fetuses, only the PCR test gave positive results, and follow-up testing confirmed the presence of congenital toxoplasmosis. The PCR test gave one false negative result but no false positive results. The PCR test performed better than conventional parasitologic methods (sensitivity, 97.4 percent vs. 89.5 percent; negative predictive value, 99.7 percent vs. 98.7 percent).

Conclusions For the prenatal diagnosis of congenital T. gondii infection, an approach based on a PCR test performed on amniotic fluid is rapid, safe, and accurate.

Source Information

From the Service de Medecine et de Biologie Foetales (P.H., F.D., J.-M.C., F.F., M.V.) and Laboratoire de la Toxoplasmose (P.T.), Institut de Puericulture de Paris, Paris.

Address reprint requests to Dr. Vidaud at the Service de Medecine et de Biologie Foetales, 26, Blvd. Brune, 75014 Paris, France.

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