Prenatal Treatment for Serious Neurological Sequelae of Congenital Toxoplasmosis: An Observational Prospective Cohort Study
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{"title"=>"Prenatal treatment for serious neurological sequelae of congenital toxoplasmosis: An observational prospective cohort study", "type"=>"journal", "authors"=>[{"first_name"=>"Mario", "last_name"=>"Cortina-Borja", "scopus_author_id"=>"26643625100"}, {"first_name"=>"Hooi Kuan", "last_name"=>"Tan", "scopus_author_id"=>"55197592100"}, {"first_name"=>"Martine", "last_name"=>"Wallon", "scopus_author_id"=>"7004601589"}, {"first_name"=>"Malgorzata", "last_name"=>"Paul", "scopus_author_id"=>"35509393500"}, {"first_name"=>"Andrea", "last_name"=>"Prusa", "scopus_author_id"=>"6603669616"}, {"first_name"=>"Wilma", "last_name"=>"Buffolano", "scopus_author_id"=>"6602101214"}, {"first_name"=>"Gunilla", "last_name"=>"Malm", "scopus_author_id"=>"6603793310"}, {"first_name"=>"Alison", "last_name"=>"Salt", "scopus_author_id"=>"12781290100"}, {"first_name"=>"Katherine", "last_name"=>"Freeman", "scopus_author_id"=>"34770891900"}, {"first_name"=>"Eskild", "last_name"=>"Petersen", "scopus_author_id"=>"7202854790"}, {"first_name"=>"Ruth E.", "last_name"=>"Gilbert", "scopus_author_id"=>"7401932225"}], "year"=>2010, "source"=>"PLoS Medicine", "identifiers"=>{"isbn"=>"1549-1277", "scopus"=>"2-s2.0-78149373357", "pui"=>"359922536", "doi"=>"10.1371/journal.pmed.1000351", "sgr"=>"78149373357", "pmid"=>"20967235", "issn"=>"15491277"}, "id"=>"f17635b4-f5ad-3112-8a66-59d706ee45f4", "abstract"=>"BACKGROUND: The effectiveness of prenatal treatment to prevent serious neurological sequelae (SNSD) of congenital toxoplasmosis is not known.\\n\\nMETHODS AND FINDINGS: Congenital toxoplasmosis was prospectively identified by universal prenatal or neonatal screening in 14 European centres and children were followed for a median of 4 years. We evaluated determinants of postnatal death or SNSD defined by one or more of functional neurological abnormalities, severe bilateral visual impairment, or pregnancy termination for confirmed congenital toxoplasmosis. Two-thirds of the cohort received prenatal treatment (189/293; 65%). 23/293 (8%) fetuses developed SNSD of which nine were pregnancy terminations. Prenatal treatment reduced the risk of SNSD. The odds ratio for prenatal treatment, adjusted for gestational age at maternal seroconversion, was 0.24 (95% Bayesian credible intervals 0.07-0.71). This effect was robust to most sensitivity analyses. The number of infected fetuses needed to be treated to prevent one case of SNSD was three (95% Bayesian credible intervals 2-15) after maternal seroconversion at 10 weeks, and 18 (9-75) at 30 weeks of gestation. Pyrimethamine-sulphonamide treatment did not reduce SNSD compared with spiramycin alone (adjusted odds ratio 0.78, 0.21-2.95). The proportion of live-born infants with intracranial lesions detected postnatally who developed SNSD was 31.0% (17.0%-38.1%).\\n\\nCONCLUSION: The finding that prenatal treatment reduced the risk of SNSD in infected fetuses should be interpreted with caution because of the low number of SNSD cases and uncertainty about the timing of maternal seroconversion. As these are observational data, policy decisions about screening require further evidence from a randomized trial of prenatal screening and from cost-effectiveness analyses that take into account the incidence and prevalence of maternal infection. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/prenatal-treatment-serious-neurological-sequelae-congenital-toxoplasmosis-observational-prospective-2", "reader_count"=>38, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>2, "Researcher"=>5, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>4, "Student > Postgraduate"=>5, "Student > Master"=>7, "Other"=>1, "Student > Bachelor"=>6, "Professor"=>4}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>2, "Researcher"=>5, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>4, "Student > Postgraduate"=>5, "Student > Master"=>7, "Other"=>1, "Student > Bachelor"=>6, "Professor"=>4}, "reader_count_by_subject_area"=>{"Mathematics"=>1, "Medicine and Dentistry"=>30, "Agricultural and Biological Sciences"=>5, "Economics, Econometrics and Finance"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>30}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Mathematics"=>{"Mathematics"=>1}}, "reader_count_by_country"=>{"Colombia"=>1, "Ecuador"=>1, "France"=>1}, "group_count"=>2}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/824713"], "description"=>"<p>OR, odds ratio.</p>", "links"=>[], "tags"=>["analyses", "ratios", "snsd"], "article_id"=>495072, "categories"=>["Infectious Diseases", "Medicine"], "users"=>["Mario Cortina-Borja", "Hooi Kuan Tan", "Martine Wallon", "Malgorzata Paul", "Andrea Prusa", "Wilma Buffolano", "Gunilla Malm", "Alison Salt", "Katherine Freeman", "Eskild Petersen", "Ruth E. Gilbert"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000351.t006", "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Sensitivity_analyses_odds_ratios_for_SNSD_and_95_BCIs_/495072", "title"=>"Sensitivity analyses (odds ratios for SNSD and 95% BCIs).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-12 01:24:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/824837"], "description"=>"a<p>Adjusted for gestational age at maternal seroconversion.</p>b<p>Sample restricted to live births.</p>c<p>Sample restricted to mother-child pairs in prenatal centres who had fetal ultrasound (218/221).</p>d<p>Sample restricted to those prescribed prenatal treatment.</p><p>P&S, pyrimethamine and sulphonamide treatment.</p>", "links"=>[], "tags"=>["characteristics"], "article_id"=>495194, "categories"=>["Infectious Diseases", "Medicine"], "users"=>["Mario Cortina-Borja", "Hooi Kuan Tan", "Martine Wallon", "Malgorzata Paul", "Andrea Prusa", "Wilma Buffolano", "Gunilla Malm", "Alison Salt", "Katherine Freeman", "Eskild Petersen", "Ruth E. Gilbert"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000351.t005", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Prenatal_characteristics_associated_with_SNSD_/495194", "title"=>"Prenatal characteristics associated with SNSD.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-12 01:26:34"}
  • {"files"=>["https://ndownloader.figshare.com/files/824624"], "description"=>"a<p>Abnormal or suspicious neurological examination leading to referral to a specialist.</p>b<p>Ocular microphthalmia (<i>n</i> among all live births with SNSD = 5), visual opacities (<i>n</i> = 4), cataract (<i>n</i> = 2), strabismus (<i>n</i> = 4).</p><p>NR, not reported.</p>", "links"=>[], "tags"=>["births", "congenital", "toxoplasmosis"], "article_id"=>494983, "categories"=>["Infectious Diseases", "Medicine"], "users"=>["Mario Cortina-Borja", "Hooi Kuan Tan", "Martine Wallon", "Malgorzata Paul", "Andrea Prusa", "Wilma Buffolano", "Gunilla Malm", "Alison Salt", "Katherine Freeman", "Eskild Petersen", "Ruth E. Gilbert"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000351.t003", "stats"=>{"downloads"=>0, "page_views"=>18, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_live_births_with_congenital_toxoplasmosis_and_SNSD_/494983", "title"=>"Characteristics of live births with congenital toxoplasmosis and SNSD.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-12 01:23:03"}
  • {"files"=>["https://ndownloader.figshare.com/files/824750"], "description"=>"<p>Brain, intracranial calcification or ventricular dilatation detected on postnatal cranial ultrasound examination; eye, retinochoroiditis; LHS, lymphadenopathy or hepatosplenomegaly.</p>a<p>Sample excludes Danish cohort recruited 1992–1996.</p>", "links"=>[], "tags"=>["manifestations", "infancy", "probability"], "article_id"=>495106, "categories"=>["Infectious Diseases", "Medicine"], "users"=>["Mario Cortina-Borja", "Hooi Kuan Tan", "Martine Wallon", "Malgorzata Paul", "Andrea Prusa", "Wilma Buffolano", "Gunilla Malm", "Alison Salt", "Katherine Freeman", "Eskild Petersen", "Ruth E. Gilbert"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000351.t007", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Postnatal_clinical_manifestations_detected_in_early_infancy_and_probability_of_SNSD_/495106", "title"=>"Postnatal clinical manifestations detected in early infancy and probability (%) of SNSD.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-12 01:25:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/824791"], "description"=>"<p>All fetuses had positive PCR detection of <i>T. gondii</i> DNA in amniotic fluid (<i>n</i> = 8) or culture based on mouse inoculation of fetal products (<i>n</i> = 3).</p>a<p>Intracranial calcification or ventricular dilatation on fetal ultrasound scan.</p>", "links"=>[], "tags"=>["fetuses", "terminated", "congenital"], "article_id"=>495152, "categories"=>["Infectious Diseases", "Medicine"], "users"=>["Mario Cortina-Borja", "Hooi Kuan Tan", "Martine Wallon", "Malgorzata Paul", "Andrea Prusa", "Wilma Buffolano", "Gunilla Malm", "Alison Salt", "Katherine Freeman", "Eskild Petersen", "Ruth E. Gilbert"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000351.t004", "stats"=>{"downloads"=>1, "page_views"=>14, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_fetuses_terminated_with_congenital_toxoplasmosis_/495152", "title"=>"Characteristics of fetuses terminated with congenital toxoplasmosis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-12 01:25:52"}
  • {"files"=>["https://ndownloader.figshare.com/files/824453"], "description"=>"<p>Probability of SNSD according to imputed gestational age at seroconversion and 95% Bayesian credible limits: dotted lines denote treated pregnancies; solid lines denote untreated pregnancies.</p>", "links"=>[], "tags"=>["Infectious diseases", "pediatrics and child health"], "article_id"=>494812, "categories"=>["Infectious Diseases", "Medicine"], "users"=>["Mario Cortina-Borja", "Hooi Kuan Tan", "Martine Wallon", "Malgorzata Paul", "Andrea Prusa", "Wilma Buffolano", "Gunilla Malm", "Alison Salt", "Katherine Freeman", "Eskild Petersen", "Ruth E. Gilbert"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000351.g001", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Probability_of_SNSD_/494812", "title"=>"Probability of SNSD.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-10-12 01:20:12"}
  • {"files"=>["https://ndownloader.figshare.com/files/410955", "https://ndownloader.figshare.com/files/410985"], "description"=>"<div><h3>Background</h3><p>The effectiveness of prenatal treatment to prevent serious neurological sequelae (SNSD) of congenital toxoplasmosis is not known.</p><h3>Methods and Findings</h3><p>Congenital toxoplasmosis was prospectively identified by universal prenatal or neonatal screening in 14 European centres and children were followed for a median of 4 years. We evaluated determinants of postnatal death or SNSD defined by one or more of functional neurological abnormalities, severe bilateral visual impairment, or pregnancy termination for confirmed congenital toxoplasmosis. Two-thirds of the cohort received prenatal treatment (189/293; 65%). 23/293 (8%) fetuses developed SNSD of which nine were pregnancy terminations. Prenatal treatment reduced the risk of SNSD. The odds ratio for prenatal treatment, adjusted for gestational age at maternal seroconversion, was 0.24 (95% Bayesian credible intervals 0.07–0.71). This effect was robust to most sensitivity analyses. The number of infected fetuses needed to be treated to prevent one case of SNSD was three (95% Bayesian credible intervals 2–15) after maternal seroconversion at 10 weeks, and 18 (9–75) at 30 weeks of gestation. Pyrimethamine-sulphonamide treatment did not reduce SNSD compared with spiramycin alone (adjusted odds ratio 0.78, 0.21–2.95). The proportion of live-born infants with intracranial lesions detected postnatally who developed SNSD was 31.0% (17.0%–38.1%).</p><h3>Conclusion</h3><p>The finding that prenatal treatment reduced the risk of SNSD in infected fetuses should be interpreted with caution because of the low number of SNSD cases and uncertainty about the timing of maternal seroconversion. As these are observational data, policy decisions about screening require further evidence from a randomized trial of prenatal screening and from cost-effectiveness analyses that take into account the incidence and prevalence of maternal infection.</p><h3></h3><p><em>Please see later in the article for the Editors' Summary</em></p></div>", "links"=>[], "tags"=>["prenatal", "neurological", "sequelae", "congenital", "observational", "prospective", "cohort"], "article_id"=>141176, "categories"=>["Cancer", "Medicine"], "users"=>["Mario Cortina-Borja", "Hooi Kuan Tan", "Martine Wallon", "Malgorzata Paul", "Andrea Prusa", "Wilma Buffolano", "Gunilla Malm", "Alison Salt", "Katherine Freeman", "Eskild Petersen", "Ruth E. Gilbert"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1000351.s001", "https://dx.doi.org/10.1371/journal.pmed.1000351.s002"], "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Prenatal_Treatment_for_Serious_Neurological_Sequelae_of_Congenital_Toxoplasmosis_An_Observational_Prospective_Cohort_Study/141176", "title"=>"Prenatal Treatment for Serious Neurological Sequelae of Congenital Toxoplasmosis: An Observational Prospective Cohort Study", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2010-10-12 00:19:36"}
  • {"files"=>["https://ndownloader.figshare.com/files/824587"], "description"=>"<p>IgG<sub>R</sub> involves detection of IgG seroconversion by comparing neonatal sample with prenatal booking sample from mother.</p><p>Neo, neonatal screening based on detection of specific antibodies in Guthrie card bloodspots; P&S, pyrimethamine and sulphonamide; PN, prenatal screening.</p>", "links"=>[], "tags"=>["neonatal", "protocols", "patients"], "article_id"=>494945, "categories"=>["Infectious Diseases", "Medicine"], "users"=>["Mario Cortina-Borja", "Hooi Kuan Tan", "Martine Wallon", "Malgorzata Paul", "Andrea Prusa", "Wilma Buffolano", "Gunilla Malm", "Alison Salt", "Katherine Freeman", "Eskild Petersen", "Ruth E. Gilbert"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000351.t002", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_neonatal_screening_protocols_and_patients_in_study_centres_/494945", "title"=>"Characteristics of neonatal screening protocols and patients in study centres.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-12 01:22:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/824667"], "description"=>"<p>Characteristics of universal prenatal screening protocols and patients in study centres.</p>", "links"=>[], "tags"=>["prenatal", "protocols", "patients"], "article_id"=>495026, "categories"=>["Infectious Diseases", "Medicine"], "users"=>["Mario Cortina-Borja", "Hooi Kuan Tan", "Martine Wallon", "Malgorzata Paul", "Andrea Prusa", "Wilma Buffolano", "Gunilla Malm", "Alison Salt", "Katherine Freeman", "Eskild Petersen", "Ruth E. Gilbert"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000351.t001", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_universal_prenatal_screening_protocols_and_patients_in_study_centres_/495026", "title"=>"Characteristics of universal prenatal screening protocols and patients in study centres.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-10-12 01:23:46"}

PMC Usage Stats | Further Information

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Relative Metric

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