Background Congenital infection with Toxoplasma gondii can produceserious sequelae. However, there is little consensus about screeningduring pregnancy, and the tests used to establish a prenataldiagnosis of toxoplasmosis are complex and slow. We evaluateda 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 2632women with T. gondii infection acquired during pregnancy. In339 consecutive women, a competitive PCR test for T. gondiiwas performed on amniotic fluid, and its results were comparedwith those of conventional diagnostic tests. The PCR test targetsthe B1 gene of T. gondii, uses an internal control, and canbe completed in a day. Positive tests were confirmed by serologictesting 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 infectionwas 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 testingconfirmed the presence of congenital toxoplasmosis. The PCRtest gave one false negative result but no false positive results.The PCR test performed better than conventional parasitologicmethods (sensitivity, 97.4 percent vs. 89.5 percent; negativepredictive value, 99.7 percent vs. 98.7 percent).
Conclusions For the prenatal diagnosis of congenital T. gondiiinfection, an approach based on a PCR test performed on amnioticfluid 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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