Congenital Toxoplasmosis: Risks, Epidemiology, Diagnosis, and Clinical Manifestations

Authors

DOI:

https://doi.org/10.18041/2390-0512/biociencias.2.13672

Keywords:

zoonosis, vertical transmission, congenital toxoplasmosis, pregnancy, epidemiology, prevention, public health

Abstract

Toxoplasmosis is a worldwide zoonotic disease caused by Toxoplasma gondii, a parasite of the Apicomplexa family. Its life cycle involves definitive hosts, such as felines, and intermediate hosts, including humans. Infection can be acquired through the ingestion of contaminated meat, exposure to environmental oocysts, blood transfusions, or vertical transmission. In immunocompetent individuals, the disease is usually asymptomatic; however, in immunocompromised patients or pregnant women, it can lead to severe complications. Congenital toxoplasmosis (CT) is one of the most serious forms, as it may cause severe neurological and ophthalmological damage in the fetus. Despite its impact, knowledge about risk factors and prevention remains insufficient. This review analyzes the epidemiology, prevalence, clinical manifestations, and associated risks of toxoplasmosis acquired during pregnancy and congenital toxoplasmosis.

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References

1. Bahia-Oliveira LM, Jones JL, Azevedo-Silva J, Alves CC, Oréfice F, Addiss DG. Highly endemic, waterborne toxoplasmosis in north Rio de Janeiro state, Brazil. Emerg Infect Dis. 2003;9(1):55–62.

2. Elmore SA, Jones JL, Conrad PA, Patton S, Lindsay DS, Dubey JP. Toxoplasma gondii: epidemiology, feline clinical aspects, and prevention. Trends Parasitol. 2010 Apr;26(4):190–6.

3. Sundar P, Mahadevan A, Jayshree RS, Subbakrishna DK, Shankar SK. Toxoplasma seroprevalence in healthy voluntary blood donors from urban Karnataka. Indian J Med Res. 2007 Jul;126(1):50–5.

4. Remington JS, McLeod R, Thulliez P, Desmonts G. Toxoplasmosis. In: Remington JS, Klein JO, Baker CB, Wilson CJ, editors. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia, PA: Elsevier Saunders; 2006. p. 947–1091.

5. Vogel N, Kirisits M, Michael E, Bach H, Hostetter M, Boyer K, et al. Congenital toxoplasmosis transmitted from an immunologically competent mother infected before conception. Clin Infect Dis. 1996;23(5):1055–60.

6. Maldonado YA, Read JS. Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States. Pediatrics. 2017 Feb 1;139(2).

7. Daher D, Shaghlil A, Sobh E, Hamie M, Hassan ME, Moumneh MB, et al. Comprehensive Overview of Toxoplasma gondii-Induced and Associated Diseases. Pathogens. 2021 Oct 20;10(11):1351.

8. Bale JF. Fetal Infections and Brain Development. Clin Perinatol. 2009 Sep;36(3):639–53.

9. Ben-Harari RR, Connolly MP. High burden and low awareness of toxoplasmosis in the United States. Postgrad Med. 2019 Feb 17;131(2):103–8.

10. Milne GC, Webster JP, Walker M. Is the incidence of congenital toxoplasmosis declining? Trends Parasitol. 2023 Jan;39(1):26–37.

11. Flegr J, Prandota J, Sovičková M, Israili ZH. Toxoplasmosis – A Global Threat. Correlation of Latent Toxoplasmosis with Specific Disease Burden in a Set of 88 Countries. PLoS One. 2014 Mar 24;9(3):e90203.

12. Colzato L, Zhang W, Beste C, Stock AK. Dissociating direct and indirect effects: a theoretical framework of how latent toxoplasmosis affects cognitive profile across the lifespan. Neurobiol Aging. 2021 Jun;102:119–28.

13. Bigna JJ, Tochie JN, Tounouga DN, Bekolo AO, Ymele NS, Youda EL, et al. Global, regional, and country seroprevalence of Toxoplasma gondii in pregnant women: a systematic review, modelling and meta-analysis. Sci Rep. 2020 Jul 21;10(1):12102.

14. Montoya JG, Kovacs J, Remington JS. Toxoplasma gondii. In: Mandell GL, Dolin R, editors. Mandel, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 3170–97.

15. Gilbert R. Epidemiology of infection in pregnant women. In: Ambroise-Thomas P, Petersen E, editors. Congenital toxoplasmosis Scientific background, clinical management and control. Paris: Springer-Verlag; 2000. p. 237–49.

16. Rivera ME, Lavayén SN, Sánchez P, others. Toxoplasma gondii seropositivity associated to peri-urban living places in pregnant women in a rural area of Buenos Aires province, Argentina. Parasite Epidemiol Control. 2019;7:e00121.

17. Desmonts G, Couvreur J. Congenital toxoplasmosis. A prospective study of 378 pregnancies. N Engl J Med. 1974;290(20):1110–6.

18. Cárdenas Sierra DM, Domínguez Julio GC, Blanco Oliveros MX, Soto JA, Tórres Morales E. Seroprevalencia y factores de riesgo asociados a toxoplasmosis gestacional en el Nororiente Colombiano. Revista Cuidarte. 2022;14(1).

19. Felín MS, Wang K, Raggi C, Moreira A, Pandey A, Grose A, et al. Building Programs to Eradicate Toxoplasmosis Part III: Epidemiology and Risk Factors. Curr Pediatr Rep. 2022 Jun 22;10(3):109–24.

20. López-Castillo CA, Díaz-Ramírez J, Gómez-Marín JE. Factores de riesgo en mujeres embarazadas, infectadas por Toxoplasma gondii en Armenia-Colombia. Revista de Salud Pública [Internet]. 2005;7(2):180–90. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0124-00642005000200006&lng=en&tlng=

21. Hohlfeld P, Daffos F, Thulliez P, Aufrant C, Couvreur J, MacAleese J, et al. Fetal toxoplasmosis: outcome of pregnancy and infant follow-up after in utero treatment. J Pediatr. 1989;115(5 Pt 1):765–9.

22. Rostami A, Riahi SM, Contopoulos-Ioannidis DG, others. Acute Toxoplasma infection in pregnant women worldwide: A systematic review and meta-analysis. PLoS Negl Trop Dis [Internet]. 2019;13. Available from: https://doi.org/10.1371/journal.pntd.0007807

23. Zhu S, VanWormer E, Shapiro K. More people, more cats, more parasites: Human population density and temperature variation predict prevalence of Toxoplasma gondii oocyst shedding in free-ranging domestic and wild felids. PLoS One. 2023 Jun 21;18(6):e0286808.

24. Cabral Monica T, Pinto‐Ferreira F, Martins FDC, de Matos RLN, de Matos AMRN, Santos AC, et al. Epidemiology of a toxoplasmosis outbreak in a research institution in northern Paraná, Brazil. Zoonoses Public Health. 2020 Nov 29;67(7):760–4.

25. Doline FR, Farinhas JH, Biondo LM, de Oliveira PRF, Rodrigues NJL, Patrício KP, et al. Toxoplasma gondii exposure in Brazilian indigenous populations, their dogs, environment, and healthcare professionals. One Health. 2023 Jun;16:100567.

26. de Paula HL, Vendrame SA, Wess LC, Konopka CK, Gonçalves T de L, Beck ST. Toxoplasma gondii outbreak in southern Brazil: heterogeneity of the serological humoral response in pregnant women and outcomes in newborns. Diagn Microbiol Infect Dis. 2022 Aug;103(4):115724.

27. Nunes do Rego e Silva G, Freitas Carvalho Branco M dos R, Ribeiro Rodrigues ZM, Miranda dos Santos A, Mendes Pereira PR, da Silva M do S, et al. Toxoplasmosis outbreak in Brazil, 2006 - Revisited. Parasite Epidemiol Control. 2019 Nov;7:e00117.

28. Bowie WR, King AS, Werker DH, Isaac-Renton JL, Bell A, Eng SB, et al. Outbreak of toxoplasmosis associated with municipal drinking water. The BC Toxoplasma Investigation Team. Lancet. 1997 Jul 19;350(9072):173–7.

29. Gómez Marín JE. Toxoplasmosis: Un problema de Salud Pública en Colombia. Revista de Salud Pública [Internet]. 2002;4(Suppl. 1):7–10. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0124-00642002000400003&lng=en&tlng=es

30. Gallego-Marin C. Clinical Validation of a Western Blot Assay for Congenital Toxoplasmosis and Newborn Screening in a Hospital in Armenia (Quindio) Colombia. J Trop Pediatr. 2005 Nov 16;52(2):107–12.

31. Montoya JG, Kovacs J, Remington JS. Toxoplasma gondii. In: Mandell GL, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2005. p. 3170–97.

32. Bollani L, Auriti C, Achille C, Garofoli F, De Rose DU, Meroni V, et al. Congenital Toxoplasmosis: The State of the Art. Front Pediatr. 2022 Jul 6;10.

33. Dunn D, Wallon M, Peyron F, Petersen E, Peckham C, Gilbert R. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling. The Lancet. 1999 May;353(9167):1829–33.

34. Castro AT, Góngora A, González ME. Seroprevalencia de anticuerpos a Toxoplasma gondii en mujeres embarazadas de Villavicencio, Colombia. Orinoquia. 2008;12(1):91–100.

35. Gomez-Marin JE, Montoya-de-Londono MT, Castano-Osorio JC. A Maternal Screening Program for Congenital Toxoplasmosis in Quindio, Colombia and Application of Mathematical Models to Estimate Incidences Using Age-Stratified Data. Am J Trop Med Hyg. 1997 Aug;57(2):180–6.

36. Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO. Remington and Klein’s Infectious Diseases of the Fetus and Newborn Infant [Internet]. 8th ed. Elsevier Saunders; 2015. Available from: https://shop.elsevier.com/books/remington-and-kleins-infectious-diseases-of-the-fetus-and-newborn-infant/wilson/978-0-323-24147-2

37. Rostami A, Riahi SM, Contopoulos-Ioannidis DG, Gamble HR, Fakhri Y, Shiadeh MN, et al. Acute Toxoplasma infection in pregnant women worldwide: A systematic review and meta-analysis. PLoS Negl Trop Dis. 2019 Oct 14;13(10):e0007807.

38. Torgerson PR, Mastroiacovo P. The global burden of congenital toxoplasmosis: a systematic review. Bull World Health Organ. 2013 Jul 1;91(7):501–8.

39. Remington JS, McLeod R, Thulliez P, Desmonts G. Toxoplasmosis. In: Infectious Diseases of the Fetus and Newborn Infant. Elsevier; 2006. p. 947–1091.

40. Montoya JG, Liesenfeld O. Toxoplasmosis. The Lancet [Internet]. 2004;363(9425):1965–76. Available from: https://doi.org/10.1016/S0140-6736(04)16412-X

41. Montoya JG, Rosso F. Diagnosis and Management of Toxoplasmosis. Clin Perinatol. 2005 Sep;32(3):705–26.

42. Garweg JG, Scherrer J, Wallon M, Kodjikian L, Peyron F. Reactivation of ocular toxoplasmosis during pregnancy. BJOG. 2005 Feb 14;112(2):241–2.

43. McLeod R, Boyer K, Karrison T, Kasza K, Swisher C, Roizen N, et al. Outcome of Treatment for Congenital Toxoplasmosis, 1981-2004: The National Collaborative Chicago-Based, Congenital Toxoplasmosis Study. Clinical Infectious Diseases. 2006 May 15;42(10):1383–94.

44. Wallon M, Garweg JG, Abrahamowicz M, Cornu C, Vinault S, Quantin C, et al. Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence. Pediatrics. 2014 Mar 1;133(3):e601–8.

45. Peyron F, Wallon M, Kieffer F, Garweg J. Toxoplasmosis. In: Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO, editors. Remington and Klein’s Infectious Diseases of the Fetus and Newborn Infant [Internet]. 8th ed. Philadelphia: Elsevier Saunders; 2015. p. 949–1042. Available from: https://shop.elsevier.com/books/remington-and-kleins-infectious-diseases-of-the-fetus-and-newborn-infant/wilson/978-0-323-24147-2

46. Boyer KM, Holfels E, Roizen N, Swisher C, Mack D, Remington J, et al. Risk factors for Toxoplasma gondii infection in mothers of infants with congenital toxoplasmosis: Implications for prenatal management and screening. Am J Obstet Gynecol. 2005 Feb;192(2):564–71.

47. Montoya JG, Remington JS. Studies on the Serodiagnosis of Toxoplasmic Lymphadenitis. Clinical Infectious Diseases. 1995 Apr 1;20(4):781–9.

48. Montoya JG. Laboratory Diagnosis of Toxoplasma gondii Infection and Toxoplasmosis. J Infect Dis. 2002 Feb 15;185(s1):S73–82.

49. Press C, Montoya JG, Remington JS. Use of a Single Serum Sample for Diagnosis of Acute Toxoplasmosis in Pregnant Women and Other Adults. J Clin Microbiol. 2005 Jul;43(7):3481–3.

50. Liesenfeld O, Press C, Montoya JG, Gill R, Isaac-Renton JL, Hedman K, et al. False-positive results in immunoglobulin M (IgM) toxoplasma antibody tests and importance of confirmatory testing: the Platelia Toxo IgM test. J Clin Microbiol. 1997 Jan;35(1):174–8.

51. Stepick-Biek P, Thulliez P, Araujo FG, Remington JS. 19A Antibodies for Diagnosis of Acute Congenital and Acquired Toxoplasmosis. Journal of Infectious Diseases. 1990 Jul 1;162(1):270–3.

52. Dannemann BR, Vaughan WC, Thulliez P, Remington JS. Differential agglutination test for diagnosis of recently acquired infection with Toxoplasma gondii. J Clin Microbiol. 1990 Sep;28(9):1928–33.

53. Remington JS, Thulliez P, Montoya JG. Recent Developments for Diagnosis of Toxoplasmosis. J Clin Microbiol. 2004 Mar;42(3):941–5.

54. Romand S, Chosson M, Franck J, Wallon M, Kieffer F, Kaiser K, et al. Usefulness of quantitative polymerase chain reaction in amniotic fluid as early prognostic marker of fetal infection with Toxoplasma gondii. Am J Obstet Gynecol. 2004 Mar;190(3):797–802.

55. Foulon W, Villena I, Stray-Pedersen B, Decoster A, Lappalainen M, Pinon JM, et al. Treatment of toxoplasmosis during pregnancy: A multicenter study of impact on fetal transmission and children’s sequelae at age 1 year. Am J Obstet Gynecol. 1999 Feb;180(2):410–5.

56. Romand S. Prenatal diagnosis using polymerase chain reaction on amniotic fluid for congenital toxoplasmosis. Obstetrics & Gynecology. 2001 Feb;97(2):296–300.

57. Freeman K, Salt A, Prusa A, Malm G, Ferret N, Buffolano W, et al. Association between congenital toxoplasmosis and parent-reported developmental outcomes, concerns, and impairments, in 3 year old children. BMC Pediatr. 2005 Jul 13;5(1):23.

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2025-12-15

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