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<p>Congenital toxoplasmosis (CT) is a serious parasitic infection whose prevention relies on early maternal screening and adequate treatment. In Tunisia, the lack of standardized protocols for managing this disease necessitates an evaluation of current diagnostic and therapeutic practices. To evaluate the diagnostic strategy, treatment protocols, and clinical outcomes in maternal and congenital toxoplasmosis, including statistical analyses of risk factors for vertical transmission. An 8-year retrospective and prospective study (2017–2024) was conducted at the Parasitology-Mycology Laboratory of Charles Nicolle Hospital in Tunis. It included pregnant women suspected of having active toxoplasmosis, and newborns followed up postnatally. Maternal diagnosis was based on serology and avidity index. Antenatal diagnosis of CT included PCR on amniotic fluid and foetal ultrasound. Postnatal diagnosis relied on clinical examination, serology, ocular fundus and transfontanelar ultrasounds. Out of 8886 screened women, 185 (2.08%) had confirmed or probable primary infection. Amniocentesis was performed in 48.6% of cases, with PCR positivity detected in 4.4% of cases. Eight instances of CT were confirmed among 75 followed newborns, corresponding to a congenital toxoplasmosis incidence of 0.9 per 1,000 pregnancies and a maternal–fetal transmission rate of 4.32%. No significant association was found between confirmed maternal status and CT occurrence (p = 0.3642). A significant association was observed with third-trimester infections (p = 0.0106). Spiramycin did not significantly reduce CT occurrence (p &gt; 0.9999). Most cases were subclinical at birth. Our findings emphasize the value of early and systematic screening, combined with gestational age-based management. Spiramycin, while only partially effective, remains essential in the absence of curative alternatives. Statistical analyses confirm the influence of infection timing on fetal transmission. Prolonged postnatal follow-up is vital for early detection of late-onset complications. This work contributes to the understanding of public health responses and prenatal risk management strategies in a Mediterranean region, offering insights that support regional integration of infectious disease monitoring and maternal care protocols.</p>

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Maternal and congenital toxoplasmosis in Tunisia: diagnostic approaches, therapeutic strategies, and public health implications

  • 期刊论文

  • 发表日期：

    2025年12月27日

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  • Mohamed Lemine N’Dah,
  • Meriam Bouchekoua,
  • Dorsaf Aloui,
  • El Hafedh El Mouhab,
  • Imen Sfar,
  • Sonia Trabelsi

摘要

Congenital toxoplasmosis (CT) is a serious parasitic infection whose prevention relies on early maternal screening and adequate treatment. In Tunisia, the lack of standardized protocols for managing this disease necessitates an evaluation of current diagnostic and therapeutic practices. To evaluate the diagnostic strategy, treatment protocols, and clinical outcomes in maternal and congenital toxoplasmosis, including statistical analyses of risk factors for vertical transmission. An 8-year retrospective and prospective study (2017–2024) was conducted at the Parasitology-Mycology Laboratory of Charles Nicolle Hospital in Tunis. It included pregnant women suspected of having active toxoplasmosis, and newborns followed up postnatally. Maternal diagnosis was based on serology and avidity index. Antenatal diagnosis of CT included PCR on amniotic fluid and foetal ultrasound. Postnatal diagnosis relied on clinical examination, serology, ocular fundus and transfontanelar ultrasounds. Out of 8886 screened women, 185 (2.08%) had confirmed or probable primary infection. Amniocentesis was performed in 48.6% of cases, with PCR positivity detected in 4.4% of cases. Eight instances of CT were confirmed among 75 followed newborns, corresponding to a congenital toxoplasmosis incidence of 0.9 per 1,000 pregnancies and a maternal–fetal transmission rate of 4.32%. No significant association was found between confirmed maternal status and CT occurrence (p = 0.3642). A significant association was observed with third-trimester infections (p = 0.0106). Spiramycin did not significantly reduce CT occurrence (p > 0.9999). Most cases were subclinical at birth. Our findings emphasize the value of early and systematic screening, combined with gestational age-based management. Spiramycin, while only partially effective, remains essential in the absence of curative alternatives. Statistical analyses confirm the influence of infection timing on fetal transmission. Prolonged postnatal follow-up is vital for early detection of late-onset complications. This work contributes to the understanding of public health responses and prenatal risk management strategies in a Mediterranean region, offering insights that support regional integration of infectious disease monitoring and maternal care protocols.