Association of Parasite Load Levels in Amniotic Fluid With Clinical Outcome in Congenital Toxoplasmosis
OBJECTIVE:To correlate neonatal and infant clinical outcome with parasite load in amniotic fluid (AF). METHODS:We conducted a retrospective cohort study of 122 children whose mothers had toxoplasmosis during pregnancy. The children were monitored from birth to 12 months old. Stored AF samples were o...
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| Veröffentlicht in: | Obstetrics and gynecology (New York. 1953) 2017-08, Vol.130 (2), p.335-345 |
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| creator | Yamamoto, Lidia Targa, Lília S. Sumita, Laura M. Shimokawa, Paulo T. Rodrigues, Jonatas C. Kanunfre, Kelly A. Okay, Thelma S. |
| description | OBJECTIVE:To correlate neonatal and infant clinical outcome with parasite load in amniotic fluid (AF).
METHODS:We conducted a retrospective cohort study of 122 children whose mothers had toxoplasmosis during pregnancy. The children were monitored from birth to 12 months old. Stored AF samples were obtained at maternal diagnosis and tested by quantitative polymerase chain reaction. Gestational age at maternal infection, quantitative polymerase chain reaction results, neonatal anti–Toxoplasma gondii immunoglobulin (Ig) M, and clinical outcome at 12 months were correlated.
RESULTS:Maternal infection occurred in 18 of 122 (14.7%) and 104 of 122 (85.2%) women in the first and second trimesters, respectively. At birth, IgM was present in 107 of 122 (87.7%) neonates and 36 (29.5%) were symptomatic. Of these, half occurred in the first and the other half in the second trimester and 6 of 36 had severe infections (16.7% of symptomatic, 4.9% of total), all infected in the first trimester. Parasite load levels were highly variable (median 35 parasites/mL, range 2–30,473). Logistic regression correlated symptomatic infection with gestational age (odds ratio [OR] 0.47, CI 0.31–0.73) and parasite load (OR 2.04, CI 1.23–3.37), but not with positive IgM (OR 6.81, CI 0.86–53.9). Negative correlations were found between gestational age and parasite load (rs –0.780, CI −0.843 to −0.696), gestational age and symptoms (rs –0.664, CI −0.755 to −0.547), but not gestational age and IgM (rs −0.136, CI −0.311 to 0.048). Parasite load levels distributed by percentile showed that all symptomatic patients appeared from the 75th percentile and all severe infections from the 95th percentile. Load rankings showed doubled the OR for each 20 parasite/mL increment. Parasite load was associated with symptomatic infections (area under the curve 0.959, CI 0.908–0.987) as well as gestational age (area under the curve 0.918, CI 0.855–0.960) and both parameters combined (area under the curve 0.969, CI 0.920–0.992).
CONCLUSION:Parasite load in AF is associated with the clinical outcome in congenital toxoplasmosis, irrespective of gestational age at maternal infection. |
| doi_str_mv | 10.1097/AOG.0000000000002131 |
| format | Article |
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METHODS:We conducted a retrospective cohort study of 122 children whose mothers had toxoplasmosis during pregnancy. The children were monitored from birth to 12 months old. Stored AF samples were obtained at maternal diagnosis and tested by quantitative polymerase chain reaction. Gestational age at maternal infection, quantitative polymerase chain reaction results, neonatal anti–Toxoplasma gondii immunoglobulin (Ig) M, and clinical outcome at 12 months were correlated.
RESULTS:Maternal infection occurred in 18 of 122 (14.7%) and 104 of 122 (85.2%) women in the first and second trimesters, respectively. At birth, IgM was present in 107 of 122 (87.7%) neonates and 36 (29.5%) were symptomatic. Of these, half occurred in the first and the other half in the second trimester and 6 of 36 had severe infections (16.7% of symptomatic, 4.9% of total), all infected in the first trimester. Parasite load levels were highly variable (median 35 parasites/mL, range 2–30,473). Logistic regression correlated symptomatic infection with gestational age (odds ratio [OR] 0.47, CI 0.31–0.73) and parasite load (OR 2.04, CI 1.23–3.37), but not with positive IgM (OR 6.81, CI 0.86–53.9). Negative correlations were found between gestational age and parasite load (rs –0.780, CI −0.843 to −0.696), gestational age and symptoms (rs –0.664, CI −0.755 to −0.547), but not gestational age and IgM (rs −0.136, CI −0.311 to 0.048). Parasite load levels distributed by percentile showed that all symptomatic patients appeared from the 75th percentile and all severe infections from the 95th percentile. Load rankings showed doubled the OR for each 20 parasite/mL increment. Parasite load was associated with symptomatic infections (area under the curve 0.959, CI 0.908–0.987) as well as gestational age (area under the curve 0.918, CI 0.855–0.960) and both parameters combined (area under the curve 0.969, CI 0.920–0.992).
CONCLUSION:Parasite load in AF is associated with the clinical outcome in congenital toxoplasmosis, irrespective of gestational age at maternal infection.</description><identifier>ISSN: 0029-7844</identifier><identifier>EISSN: 1873-233X</identifier><identifier>DOI: 10.1097/AOG.0000000000002131</identifier><identifier>PMID: 28697120</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Adult ; Amniocentesis ; Amniotic Fluid - parasitology ; Antibodies, Protozoan - blood ; Brazil ; DNA, Protozoan - analysis ; Female ; Gestational Age ; Humans ; Immunoglobulin M - blood ; Infant, Newborn ; Middle Aged ; Parasite Load ; Polymerase Chain Reaction ; Pregnancy ; Pregnancy Complications, Parasitic - parasitology ; Pregnancy Outcome ; Prenatal Diagnosis ; Retrospective Studies ; Toxoplasma - genetics ; Toxoplasma - immunology ; Toxoplasmosis - complications ; Toxoplasmosis, Congenital - diagnosis ; Toxoplasmosis, Congenital - parasitology</subject><ispartof>Obstetrics and gynecology (New York. 1953), 2017-08, Vol.130 (2), p.335-345</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4011-220318f4bb3ed7bfcc36cd5a331045f59d1f1549f142b047776aadb41b55f3dc3</citedby><cites>FETCH-LOGICAL-c4011-220318f4bb3ed7bfcc36cd5a331045f59d1f1549f142b047776aadb41b55f3dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28697120$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yamamoto, Lidia</creatorcontrib><creatorcontrib>Targa, Lília S.</creatorcontrib><creatorcontrib>Sumita, Laura M.</creatorcontrib><creatorcontrib>Shimokawa, Paulo T.</creatorcontrib><creatorcontrib>Rodrigues, Jonatas C.</creatorcontrib><creatorcontrib>Kanunfre, Kelly A.</creatorcontrib><creatorcontrib>Okay, Thelma S.</creatorcontrib><title>Association of Parasite Load Levels in Amniotic Fluid With Clinical Outcome in Congenital Toxoplasmosis</title><title>Obstetrics and gynecology (New York. 1953)</title><addtitle>Obstet Gynecol</addtitle><description>OBJECTIVE:To correlate neonatal and infant clinical outcome with parasite load in amniotic fluid (AF).
METHODS:We conducted a retrospective cohort study of 122 children whose mothers had toxoplasmosis during pregnancy. The children were monitored from birth to 12 months old. Stored AF samples were obtained at maternal diagnosis and tested by quantitative polymerase chain reaction. Gestational age at maternal infection, quantitative polymerase chain reaction results, neonatal anti–Toxoplasma gondii immunoglobulin (Ig) M, and clinical outcome at 12 months were correlated.
RESULTS:Maternal infection occurred in 18 of 122 (14.7%) and 104 of 122 (85.2%) women in the first and second trimesters, respectively. At birth, IgM was present in 107 of 122 (87.7%) neonates and 36 (29.5%) were symptomatic. Of these, half occurred in the first and the other half in the second trimester and 6 of 36 had severe infections (16.7% of symptomatic, 4.9% of total), all infected in the first trimester. Parasite load levels were highly variable (median 35 parasites/mL, range 2–30,473). Logistic regression correlated symptomatic infection with gestational age (odds ratio [OR] 0.47, CI 0.31–0.73) and parasite load (OR 2.04, CI 1.23–3.37), but not with positive IgM (OR 6.81, CI 0.86–53.9). Negative correlations were found between gestational age and parasite load (rs –0.780, CI −0.843 to −0.696), gestational age and symptoms (rs –0.664, CI −0.755 to −0.547), but not gestational age and IgM (rs −0.136, CI −0.311 to 0.048). Parasite load levels distributed by percentile showed that all symptomatic patients appeared from the 75th percentile and all severe infections from the 95th percentile. Load rankings showed doubled the OR for each 20 parasite/mL increment. Parasite load was associated with symptomatic infections (area under the curve 0.959, CI 0.908–0.987) as well as gestational age (area under the curve 0.918, CI 0.855–0.960) and both parameters combined (area under the curve 0.969, CI 0.920–0.992).
CONCLUSION:Parasite load in AF is associated with the clinical outcome in congenital toxoplasmosis, irrespective of gestational age at maternal infection.</description><subject>Adult</subject><subject>Amniocentesis</subject><subject>Amniotic Fluid - parasitology</subject><subject>Antibodies, Protozoan - blood</subject><subject>Brazil</subject><subject>DNA, Protozoan - analysis</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Immunoglobulin M - blood</subject><subject>Infant, Newborn</subject><subject>Middle Aged</subject><subject>Parasite Load</subject><subject>Polymerase Chain Reaction</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Parasitic - parasitology</subject><subject>Pregnancy Outcome</subject><subject>Prenatal Diagnosis</subject><subject>Retrospective Studies</subject><subject>Toxoplasma - genetics</subject><subject>Toxoplasma - immunology</subject><subject>Toxoplasmosis - complications</subject><subject>Toxoplasmosis, Congenital - diagnosis</subject><subject>Toxoplasmosis, Congenital - parasitology</subject><issn>0029-7844</issn><issn>1873-233X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkctOwzAQRS0EouXxBwh5ySbgsZ04WVYVL6lSWYBgFzmO3RqcuMQOj78nVQEhFjCb0VydOyPdQegIyCmQQpxN5pen5EdRYLCFxpALllDGHrbReBCLROScj9BeCI8DBFnBdtGI5lkhgJIxWkxC8MrKaH2LvcE3spPBRo1nXtZ4pl-0C9i2eNK01ker8IXrbY3vbVziqbOtVdLheR-Vb_Sam_p2oVsbB_XWv_mVk6HxwYYDtGOkC_rws--ju4vz2-lVMptfXk8ns0RxApBQShjkhlcV07WojFIsU3UqGQPCU5MWNRhIeWGA04pwIUQmZV1xqNLUsFqxfXSy2bvq_HOvQywbG5R2Trba96GEAnImshzEgPINqjofQqdNuepsI7v3Eki5jrgcIi5_RzzYjj8v9FWj62_TV6YDkG-AV--i7sKT6191Vy61dHH5327-h3WNZTQlCSUgSD5MyfqllH0An16XlQ</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Yamamoto, Lidia</creator><creator>Targa, Lília S.</creator><creator>Sumita, Laura M.</creator><creator>Shimokawa, Paulo T.</creator><creator>Rodrigues, Jonatas C.</creator><creator>Kanunfre, Kelly A.</creator><creator>Okay, Thelma S.</creator><general>Lippincott Williams & Wilkins</general><general>by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Association of Parasite Load Levels in Amniotic Fluid With Clinical Outcome in Congenital Toxoplasmosis</title><author>Yamamoto, Lidia ; Targa, Lília S. ; Sumita, Laura M. ; Shimokawa, Paulo T. ; Rodrigues, Jonatas C. ; Kanunfre, Kelly A. ; Okay, Thelma S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4011-220318f4bb3ed7bfcc36cd5a331045f59d1f1549f142b047776aadb41b55f3dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Amniocentesis</topic><topic>Amniotic Fluid - parasitology</topic><topic>Antibodies, Protozoan - blood</topic><topic>Brazil</topic><topic>DNA, Protozoan - analysis</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Immunoglobulin M - blood</topic><topic>Infant, Newborn</topic><topic>Middle Aged</topic><topic>Parasite Load</topic><topic>Polymerase Chain Reaction</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Parasitic - parasitology</topic><topic>Pregnancy Outcome</topic><topic>Prenatal Diagnosis</topic><topic>Retrospective Studies</topic><topic>Toxoplasma - genetics</topic><topic>Toxoplasma - immunology</topic><topic>Toxoplasmosis - complications</topic><topic>Toxoplasmosis, Congenital - diagnosis</topic><topic>Toxoplasmosis, Congenital - parasitology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yamamoto, Lidia</creatorcontrib><creatorcontrib>Targa, Lília S.</creatorcontrib><creatorcontrib>Sumita, Laura M.</creatorcontrib><creatorcontrib>Shimokawa, Paulo T.</creatorcontrib><creatorcontrib>Rodrigues, Jonatas C.</creatorcontrib><creatorcontrib>Kanunfre, Kelly A.</creatorcontrib><creatorcontrib>Okay, Thelma S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yamamoto, Lidia</au><au>Targa, Lília S.</au><au>Sumita, Laura M.</au><au>Shimokawa, Paulo T.</au><au>Rodrigues, Jonatas C.</au><au>Kanunfre, Kelly A.</au><au>Okay, Thelma S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Parasite Load Levels in Amniotic Fluid With Clinical Outcome in Congenital Toxoplasmosis</atitle><jtitle>Obstetrics and gynecology (New York. 1953)</jtitle><addtitle>Obstet Gynecol</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>130</volume><issue>2</issue><spage>335</spage><epage>345</epage><pages>335-345</pages><issn>0029-7844</issn><eissn>1873-233X</eissn><abstract>OBJECTIVE:To correlate neonatal and infant clinical outcome with parasite load in amniotic fluid (AF).
METHODS:We conducted a retrospective cohort study of 122 children whose mothers had toxoplasmosis during pregnancy. The children were monitored from birth to 12 months old. Stored AF samples were obtained at maternal diagnosis and tested by quantitative polymerase chain reaction. Gestational age at maternal infection, quantitative polymerase chain reaction results, neonatal anti–Toxoplasma gondii immunoglobulin (Ig) M, and clinical outcome at 12 months were correlated.
RESULTS:Maternal infection occurred in 18 of 122 (14.7%) and 104 of 122 (85.2%) women in the first and second trimesters, respectively. At birth, IgM was present in 107 of 122 (87.7%) neonates and 36 (29.5%) were symptomatic. Of these, half occurred in the first and the other half in the second trimester and 6 of 36 had severe infections (16.7% of symptomatic, 4.9% of total), all infected in the first trimester. Parasite load levels were highly variable (median 35 parasites/mL, range 2–30,473). Logistic regression correlated symptomatic infection with gestational age (odds ratio [OR] 0.47, CI 0.31–0.73) and parasite load (OR 2.04, CI 1.23–3.37), but not with positive IgM (OR 6.81, CI 0.86–53.9). Negative correlations were found between gestational age and parasite load (rs –0.780, CI −0.843 to −0.696), gestational age and symptoms (rs –0.664, CI −0.755 to −0.547), but not gestational age and IgM (rs −0.136, CI −0.311 to 0.048). Parasite load levels distributed by percentile showed that all symptomatic patients appeared from the 75th percentile and all severe infections from the 95th percentile. Load rankings showed doubled the OR for each 20 parasite/mL increment. Parasite load was associated with symptomatic infections (area under the curve 0.959, CI 0.908–0.987) as well as gestational age (area under the curve 0.918, CI 0.855–0.960) and both parameters combined (area under the curve 0.969, CI 0.920–0.992).
CONCLUSION:Parasite load in AF is associated with the clinical outcome in congenital toxoplasmosis, irrespective of gestational age at maternal infection.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>28697120</pmid><doi>10.1097/AOG.0000000000002131</doi><tpages>11</tpages></addata></record> |
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| subjects | Adult Amniocentesis Amniotic Fluid - parasitology Antibodies, Protozoan - blood Brazil DNA, Protozoan - analysis Female Gestational Age Humans Immunoglobulin M - blood Infant, Newborn Middle Aged Parasite Load Polymerase Chain Reaction Pregnancy Pregnancy Complications, Parasitic - parasitology Pregnancy Outcome Prenatal Diagnosis Retrospective Studies Toxoplasma - genetics Toxoplasma - immunology Toxoplasmosis - complications Toxoplasmosis, Congenital - diagnosis Toxoplasmosis, Congenital - parasitology |
| title | Association of Parasite Load Levels in Amniotic Fluid With Clinical Outcome in Congenital Toxoplasmosis |
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