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Previous Volume 330:1858-1863 June 30, 1994 Number 26 Next

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ABSTRACT

Background Most infants with congenital Toxoplasma gondii infection have no symptoms at birth, but many will have retinal disease or neurologic abnormalities later in life. Early detection and treatment of congenital toxoplasmosis may reduce these sequelae.

Methods In Massachusetts since January 1986, and in New Hampshire since July 1988, newborns have been screened for intrauterine infection with T. gondii by means of an IgM capture immunoassay of blood specimens routinely collected for screening for metabolic disorders. Congenital infection is confirmed by assays for specific IgG and IgM antibodies in serum from infants and their mothers. For this study, infants with serologic evidence of infection underwent extensive clinical evaluation and received one year of treatment.

Results Through June 1992, 100 of 635,000 infants tested had positive screening tests. Congenital infection was confirmed in 52 infants, 50 of whom were identified only through neonatal screening and not through initial clinical examination. However, after the serologic results became available, more detailed examinations revealed abnormalities of either the central nervous system or the retina in 19 of 48 infants evaluated (40 percent). After treatment, only 1 of 46 children had a neurologic deficit (hemiplegia attributable to a cerebral lesion present at birth). Thirty-nine treated children had follow-up ophthalmologic examinations when one to six years old; four (10 percent) had eye lesions that may have developed postnatally (a macular lesion in one child and minor retinal scars in three).

Conclusions Routine neonatal screening for toxoplasmosis identifies congenital infections that are subclinical, and early treatment may reduce the severe long-term sequelae.

Source Information

From the Divisions of Infectious Diseases and Newborn Medicine, Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, and the Division of Neonatology, Newton-Wellesley Hospital, Newton, Mass. (N.G.G.); the New England Regional Newborn Screening Program, Massachusetts State Laboratory Institute, Boston (H.-W.H., R.L., R.H., R.B.E., G.F.G.); the Department of Pediatric Infectious Diseases, New England Medical Center, and the Department of Pediatrics, Tufts University School of Medicine, Boston (H.C.M.); the Department of Infectious Diseases, Brigham and Women's Hospital, and the Department of Medicine, Harvard Medical School, Boston (J.H.M.); the Pediatric Infectious Disease Unit, Massachusetts General Hospital, and the Department of Pediatrics, Harvard Medical School, Boston (R.L., M.S.P.); the Division of Pediatric Infectious Diseases, Baystate Medical Center, Springfield, Mass., and the Department of Pediatrics, Tufts University School of Medicine, Boston (B.S.); and the Department of Neurology, University of Massachusetts Medical Center, Worcester (I.A.). The other members of the New England Regional Toxoplasma Working Group are Sarah H. Cheeseman, M.D. (University of Massachusetts Medical Center, Worcester), Kenneth McIntosh, M.D. (Children's Hospital, Boston), Donald N. Medearis, Jr., M.D. (Massachusetts General Hospital, Boston), Richard Robb, M.D. (Children's Hospital, Boston), and Barbara J. Weiblen, M.S. (Massachusetts State Laboratory Institute, Boston).

Address reprint requests to Dr. Guerina at the Division of Newborn Medicine, New England Medical Center (NEMC #44), 750 Washington St., Boston, MA 02111.

Full Text of this Article

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Screening for Neonatal Toxoplasmosis
Schoen E. J., Black S., Cohen D., Potasman I., Pick N., Srugo I.
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N Engl J Med 1994; 331:1458-1459, Nov 24, 1994. Correspondence

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