Camille Codaccioni1,2, Olivier Picone1,2, Véronique Lambert3, Paul Maurice4, Léo Pomar3, Norbert Winer5, Laurent Guibaud6, Rose-Anne Lavergne7, Anne-Hélène Saliou8, Dorothée Quinio9, Alexandra Benachi10, Catherine Noel11, Yves Ville12, Fabrice Cuillier13, Christelle Pomares14, Nicole Ferret15, Denis Filisetti16, Anne-Sophie Weingertner17, Valérie Vequeau-Goua18, Estelle Cateau19, Guillaume Benoist20, Martine Wallon21, Marc Dommergues22, Isabelle Villena23, Laurent Mandelbrot1,2. 1. Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP Nord Université de Paris, Colombes, France. 2. Inserm, IAME, Université de Paris, Paris, France. 3. Service de Gynécologie-Obstétrique, Centre Hospitalier de l'Ouest Guyanais, St Laurent du Maroni, France. 4. Assistance Publique-Hôpitaux de Paris, Service de Médecine Foetale, Hôpital Trousseau, APHP Sorbonne, Paris, France. 5. Centre Hospitalier Universitaire de Nantes, Service de Gynécologie-Obstétrique, NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France. 6. Centre Hospitalier Universitaire de Nantes, Laboratoire Parasitologie et Mycologie, and NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France. 7. Service de Radiologie, Centre Hospitalier Universitaire de Lyon, Lyon, France. 8. Service de Gynécologie-Obstétrique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France. 9. Laboratoire Parasitologie et Mycologie, Centre Hospitalier Régional et Universitaire de Brest, Brest, France. 10. Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Université Paris-Saclay, Clamart, France. 11. Service de Gynécologie-Obstétrique, Centre Hospitalier René Dubos, Pontoise, France. 12. Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Necker Enfants Malades APHP Centre Université de Paris, Paris, France. 13. Service de Gynécologie-Obstétrique, Centre Hospitalier Régional Félix Guyon, Saint-Denis, Réunion, France. 14. Centre Hospitalier Universitaire de Nice, Service de Parasitologie-Mycologie, C3M INSERM 1065, Université Côte d'Azur, Nice, France. 15. Centre Hospitalier Universitaire de Nice, Service de Pédiatrie, Université Côte d'Azur, Nice, France. 16. Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France. 17. Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France. 18. Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Poitiers, Poitiers, France. 19. Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France. 20. Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Caen, Caen, France. 21. Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Lyon, Lyon, France. 22. Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital de la Pité-Salpêtrière, APHP Sorbonne, Paris, France. 23. Centre National de Référence de la Toxoplasmose, Centre de Ressources Biologiques Toxoplasma, Service de Parasitologie-Mycologie, EA 7510, UFR Médecine, Centre Hospitalier Universitaire de Reims, Reims, France.
Abstract
OBJECTIVE: To describe the lesions detected by prenatal ultrasound examination in congenital toxoplasmosis (CT). METHODS: We retrospectively analyzed all cases of fetal infection with Toxoplasma gondii with ultrasound anomalies described by fetal medicine experts in 2009 to 2019 in 30 French centers. RESULTS: Eighty-eight cases of CT were included. Forty-five (51.1%) had one or more cerebral signs only, 35 (39.8%) had cerebral plus extracerebral signs and 8 (9.1%) had extracerebral signs only. The main cerebral signs were intracranial hyperechogenic nodular foci (n = 60) of which 20 were isolated, ventriculomegalies (n = 44) which generally increased during follow-up, and periventricular abscesses (n = 12). The main extracerebral signs were hepatomegaly and/or splenomegaly (n = 14), small for gestational age (n = 14), ascites (n = 14, including 2 with hydrops), and hyperechogenic bowel (n = 11). Maternal infection occurred mostly in the first or second trimester (81 cases), periconceptionally in one and in the third trimester in six cases. The first ultrasound signs were detected after a median of 7 weeks (range: 1.4; 24.0) following maternal toxoplasmosis seroconversion. CONCLUSION: While no sign was specific of CT, there were typical associations of cerebral signs with or without extracerebral signs. Detailed ultrasound examination could improve prognostic evaluation, as well as diagnosis of CT in settings lacking serological screening.
OBJECTIVE: To describe the lesions detected by prenatal ultrasound examination in congenital toxoplasmosis (CT). METHODS: We retrospectively analyzed all cases of fetal infection with Toxoplasma gondii with ultrasound anomalies described by fetal medicine experts in 2009 to 2019 in 30 French centers. RESULTS: Eighty-eight cases of CT were included. Forty-five (51.1%) had one or more cerebral signs only, 35 (39.8%) had cerebral plus extracerebral signs and 8 (9.1%) had extracerebral signs only. The main cerebral signs were intracranial hyperechogenic nodular foci (n = 60) of which 20 were isolated, ventriculomegalies (n = 44) which generally increased during follow-up, and periventricular abscesses (n = 12). The main extracerebral signs were hepatomegaly and/or splenomegaly (n = 14), small for gestational age (n = 14), ascites (n = 14, including 2 with hydrops), and hyperechogenic bowel (n = 11). Maternal infection occurred mostly in the first or second trimester (81 cases), periconceptionally in one and in the third trimester in six cases. The first ultrasound signs were detected after a median of 7 weeks (range: 1.4; 24.0) following maternal toxoplasmosis seroconversion. CONCLUSION: While no sign was specific of CT, there were typical associations of cerebral signs with or without extracerebral signs. Detailed ultrasound examination could improve prognostic evaluation, as well as diagnosis of CT in settings lacking serological screening.