NEONATAL SEROLOGIC SCREENING AND EARLY TREATMENT FOR CONGENITAL TOXOPLASMA-GONDII INFECTION
NEONATAL SEROLOGIC SCREENING AND EARLY TREATMENT FOR CONGENITAL TOXOPLASMA-GONDII INFECTION
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DOI：
10.1056/nejm199406303302604
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发表时间：
1994-06-30
影响因子：
158.5
通讯作者：
WEIBLEN, BJ
中科院分区：
文献类型：
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作者：
GUERINA, NG;HSU, HW;WEIBLEN, BJ
背景大多数先天性弓形虫感染的婴儿在出生时没有症状，但许多人在以后的生活中会出现视网膜疾病或神经异常。早期发现和治疗先天性弓形虫病可能会减少这些后遗症。在马萨诸塞州，自1986年1月以来，以及在新罕布什尔州，自1988年7月以来，新生儿都接受了T.通过常规采集用于代谢紊乱筛查的血液标本的IgM捕获免疫测定法检测弓形虫。先天性感染通过检测婴儿及其母亲血清中的特异性IgG和IgM抗体来确认。在这项研究中，有感染血清学证据的婴儿接受了广泛的临床评估，并接受了一年的治疗。到1992年6月为止，在635 000名接受检查的婴儿中，有100名婴儿的检查结果呈阳性。52名婴儿被确诊为先天性感染，其中50名仅通过新生儿筛查而不是通过初步临床检查发现。然而，在血清学结果可用后，更详细的检查显示，在48名接受评估的婴儿中，有19名（40%）的中枢神经系统或视网膜异常。治疗后，46名儿童中只有1名出现神经功能缺损（出生时脑损伤导致的偏瘫）。39名接受治疗的儿童在1至6岁时进行了随访眼科检查; 4名（10%）儿童的眼部病变可能是出生后发展的（1名儿童有黄斑病变，3名儿童有轻微的视网膜瘢痕）。弓形虫病的常规新生儿筛查可以识别亚临床的先天性感染，早期治疗可以减少严重的长期后遗症。
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.