TY - JOUR
T1 - Unrecognized ingestion of toxoplasma gondii oocysts leads to congenital toxoplasmosis and causes epidemics in North America
AU - Boyer, Kenneth
AU - Hill, Dolores
AU - Mui, Ernest
AU - Wroblewski, Kristen
AU - Karrison, Theodore
AU - Dubey, J. P.
AU - Sautter, Mari
AU - Noble, A. Gwendolyn
AU - Withers, Shawn
AU - Swisher, Charles
AU - Heydemann, Peter
AU - Hosten, Tiffany
AU - Babiarz, Jane
AU - Lee, Daniel
AU - Meier, Paul
AU - McLeod, Rima
N1 - Funding Information:
Financial support. This work was supported by the National Institute of Allergy and Infectious Diseases (R01AI027530 to R. M.); the Research to Prevent Blindness Foundation, the Stanley Foundation and Medical Research Institute (07R-1890 to R. M.), the United States Department of Agriculture, ARS (to D. H.); and gifts from the Blackmon, Brennan, Cornwell, Cussen, Dougiello, Jackson, Kapnick, Kiewiet, Koshland, Langel, Lipskar, Mann, Morel, Rooney-Alden, Rosenstein, Samuel, and Taub families. The funding source and study sponsors had no involvement in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the paper for publication. Potential conflicts of interest. All authors: No reported conflicts.
PY - 2011/12/1
Y1 - 2011/12/1
N2 - (See the Editorial Commentary by Linn, on pages 1090-1.)Background. Congenital toxoplasmosis presents as severe, life-altering disease in North America. If mothers of infants with congenital toxoplasmosis could be identified by risks, it would provide strong support for educating pregnant women about risks, to eliminate this disease. Conversely, if not all risks are identifiable, undetectable risks are suggested. A new test detecting antibodies to sporozoites demonstrated that oocysts were the predominant source of Toxoplasma gondii infection in 4 North American epidemics and in mothers of children in the National Collaborative Chicago-based Congenital Toxoplasmosis Study (NCCCTS). This novel test offered the opportunity to determine whether risk factors or demographic characteristics could identify mothers infected with oocysts.Methods.Acutely infected mothers and their congenitally infected infants were evaluated, including in-person interviews concerning risks and evaluation of perinatal maternal serum samples.Results.Fifty-nine (78%) of 76 mothers of congenitally infected infants in NCCCTS had primary infection with oocysts. Only 49%of these mothers identified significant risk factors for sporozoite acquisition. Socioeconomic status, hometown size, maternal clinical presentations, and ethnicity were not reliable predictors.Conclusions.Undetected contamination of food and water by oocysts frequently causes human infections in North America. Risks are often unrecognized by those infected. Demographic characteristics did not identify oocyst infections. Thus, although education programs describing hygienic measures may be beneficial, they will not suffice to prevent the suffering and economic consequences associated with congenital toxoplasmosis. Only a vaccine or implementation of systematic serologic testing of pregnant women and newborns, followed by treatment, will prevent most congenital toxoplasmosis in North America.
AB - (See the Editorial Commentary by Linn, on pages 1090-1.)Background. Congenital toxoplasmosis presents as severe, life-altering disease in North America. If mothers of infants with congenital toxoplasmosis could be identified by risks, it would provide strong support for educating pregnant women about risks, to eliminate this disease. Conversely, if not all risks are identifiable, undetectable risks are suggested. A new test detecting antibodies to sporozoites demonstrated that oocysts were the predominant source of Toxoplasma gondii infection in 4 North American epidemics and in mothers of children in the National Collaborative Chicago-based Congenital Toxoplasmosis Study (NCCCTS). This novel test offered the opportunity to determine whether risk factors or demographic characteristics could identify mothers infected with oocysts.Methods.Acutely infected mothers and their congenitally infected infants were evaluated, including in-person interviews concerning risks and evaluation of perinatal maternal serum samples.Results.Fifty-nine (78%) of 76 mothers of congenitally infected infants in NCCCTS had primary infection with oocysts. Only 49%of these mothers identified significant risk factors for sporozoite acquisition. Socioeconomic status, hometown size, maternal clinical presentations, and ethnicity were not reliable predictors.Conclusions.Undetected contamination of food and water by oocysts frequently causes human infections in North America. Risks are often unrecognized by those infected. Demographic characteristics did not identify oocyst infections. Thus, although education programs describing hygienic measures may be beneficial, they will not suffice to prevent the suffering and economic consequences associated with congenital toxoplasmosis. Only a vaccine or implementation of systematic serologic testing of pregnant women and newborns, followed by treatment, will prevent most congenital toxoplasmosis in North America.
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U2 - 10.1093/cid/cir667
DO - 10.1093/cid/cir667
M3 - Article
C2 - 22021924
AN - SCOPUS:80755136920
VL - 53
SP - 1081
EP - 1089
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 11
ER -
