Role of spiramycin in prevention of fetal toxoplasmosis

Amaç

The aim of this study is to evaluate the efficacy of Spiramycin (Spy) in the mother-to-child transmission of Toxoplasma gondii infection.

Yöntem

Patients within first trimester of their pregnancy with Toxoplasma IgM positivity (>0.65 index, ELISA, VIDAS) and IgG positivity (>8 IU/ml), who had low IgG avidity, (<0.50 index, ELISA, Architet) were considered as acute toxoplasmosis (AT). Those patients with AT who had amniocentesis at the 19th-21st week of pregnancy and had polymerase chain reaction (PCR) test for toxoplasmosis, and also were followed up for one year after delivery were included in this study.

Bulgular

The medical records of a total of 129 pregnant women with the diagnosis of suspected AT were reviewed retrospectively. Among them, 61 patients (The mean age of thesepatients 27.2±6.1 the mean gravida and parity were 2.8±1.2 and 1.6±1.1 respectively) who fulfilled the inclusion criteria were taken. Remained 68 patients were excluded from study due to high avidity levels despite toxoplasma IgM and IgG positivity. Out of 61 patients, 55 (90.2%) had received Spy prophylaxis while 6 (9.8%) cases refused Spy prophylaxis. Toxoplasma PCR test was found to be positive in amniotic fluid of 4 (6.6%) patients obtained by amniocentesis at the 19th-21st week of pregnancy. While none of the 55 patients who received Spy prophylaxis had Toxoplasma PCR test positivity, four of the six patients who refused Spy prophylaxis had positive Toxoplasma PCR in amniotic fluid (p<0.01). There are no significant differences between the laboratory data of PCR (+) patients and that of PCR (-) patients. Except for two cases, none of the fetuses had abnormalities on ultrasonographic examination. We found intracranial calcification, ventriculomegaly and hepatomegaly in one fetus and found intracranial calcification, ventriculomegaly, cataracts and hepatomegaly in another fetus via ultrasonography. Termination of pregnancy was performed in these four patients with Toxoplasma PCR test positivity upon demand of the parents, but autopsy could not be performed unfortunately, because of the refusal of the parents. The rest of the pregnancies ended up with the delivery of healthy newborns. The newborns and infants up to one year follow-up did not have any congenital abnormalities.

Sonuç

We think that Spy is an antibiotic with high safety profile and efficient in prevention of fetal infection. Our results seem to encourage the use of Spy in pregnant women with AT in the first trimester of pregnancy. 

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