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Congenital toxoplasmosis: Clinical and biological analysis of 11 cases in Tunisia. [Congenital toxoplasmosis: clinical and biological analysis of 11 cases in Tunisia].
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International audience. Early diagnosis of congenital toxoplasmosis (CT) is necessary to prevent serious complications. The CT is diagnosed by the identification of the parasite in amniotic fluid during pregnancy or at birth by detection of antibodies synthesized by the fetus. The aim of this study was to determine the clinical and biological particularities of CT in a cohort of 11 cases observed in Tunisia and to evaluate the performance of the prenatal and neonatal diagnostic techniques that were used. In all patients, the presumed date of maternal contamination was determined based on the mother's serological data. Neonatal serological screening included assays for immunoglobulins (Ig) G and IgM by enzyme-linked-immuno-sorbent assay (ELISA), IgM by immuno-sorbent-agglutination-assay (ISAGA), and comparison of the mother-baby immunological profile by western blot IgG and IgM. Seven out of the 11 cases had been diagnosed prenatally; only 3 (43%) had a positive polymerase chain reaction (PCR) test. Ten newborns out of 11 had serological criteria of fetal infection; western blot results were positive in all of them, ISAGA was positive in 2 and ELISA in none. The newborn who had a negative serology had been treated in utero. The date of positivity of the western blot test varied: 6 cases at birth, 2 at 12 days of life and 2 at 1 month of life. The 2 patients who had positive ISAGA results had been contaminated during the 3rd trimester of gestation. . Le diagnostic precoce de la toxoplasmose congenitale (TC) est primordial, afin d’eviter certaines complications graves. Il peutse faire soit pendant la grossesse par la recherche du parasite dans le liquide amniotique ou a la naissance par la mise en evidence d’anticorps neosynthetises par le fœtus. Ce travail rapporte les particularites cliniques et biologiques d’une serie tunisienne de 11 cas de TC et discute la place des explorations antenatales et neonatales dans le diagnostic. Dans les cas presentes, la date presumee de la contamination maternelle a ete precisee sur lesdonnees serologiques de la mère pendant la grossesse. Le bilan serologique neonatal a comporte la recherche d’immunoglobulines (Ig) G et d’IgM par l’ enzyme-linked-immuno-sorbent assay (ELISA),la recherche d’IgM par l’ immuno-sorbent-agglutination-assay (ISAGA) et l’etude des profils maternels et neonatals compares des IgG et des IgM par western blot . Parmi les 11 cas de TC, 7 avaient beneficie d’une exploration antenatale, parmi lesquels 3 seulement (43 %) avaient une polymerase chain reaction (PCR) positive. Dix nouveau-nes sur 11 avaient des criteres serologiques d’atteinte fœtale, les resultats etaient tous positifs en western blot 2 l’etaient en ISAGA et aucun en ELISA. Le seul nouveau-nepresentant une serologie negative avait et traite in utero. La date de positivite au western blotetait variable : 6 cas des la naissance, 2 au 12 ejour de vie et 2 a 1 mois. Les 2 cas positifs en ISAGA avaient ete contamines lors du 3e trimestre, ce qui confirme la meilleure sensibilite de cette technique lors des contaminations tardives
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