Neonatal diagnosis of congenital toxoplasmosis is based on a combination of serological and molecular tests. Maternal screening and treatment differ according to national policies and may impact the sensitivity of diagnostic methods in infants at birth. In this multicenter study, 115 neonates born to 61 treated (53%) and 54 (47%) untreated women were retrospectively included in three centers (France, Serbia, and the United States) to assess the impact of maternal anti-Toxoplasma treatment on the performance of neonatal workup at birth (neosynthesized anti-Toxoplasma IgM, IgA, and IgG and quantitative PCR [qPCR]) using univariate and multivariate approaches. Independently of the time of maternal seroconversion, the serological techniques were impacted differently by maternal treatment. The detection of IgM by immunosorbent agglutination assay (ISAGA) and Western blotting (WB) dropped from 90.7% and 88.2% in untreated neonates to 53.3% and 51.9% in treated neonates (P < 0.05), whereas IgM enzyme-linked immunosorbent assay (ELISA) and IgA ISAGA were not significantly affected by maternal treatment. A 2-fold reduction in the sensitivity of neosynthesized IgG by WB was also observed in the case of treatment during pregnancy (37.7% versus 82.3%). Interestingly, the effect of treatment was shown to be duration dependent, especially for IgM detection, when the treatment course exceeded 8 weeks, whatever the therapy. The sensitivity of Toxoplasma PCR in blood was also lowered by maternal treatment from 39.1% to 23.2%. These results highlight that anti-Toxoplasma therapy during pregnancy may set back biological evidence of neonatal infection at birth and underline the need for a careful serological follow-up of infants with normal workup.

中文翻译：

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孕期孕妇抗弓形虫治疗与新生儿先天性感染诊断测试敏感性降低相关

先天性弓形虫病的新生儿诊断基于血清学和分子检测的结合。孕产妇的筛查和治疗根据国家政策而有所不同，可能会影响婴儿出生时诊断方法的敏感性。在这项多中心研究中，将三个治疗中心（法国，塞尔维亚和美国）中的115名新生儿（其中61名接受过治疗（53％）和54名（47％）未经治疗的妇女）回顾性纳入研究，以评估母体抗弓形虫治疗对新生儿检查时的表现（新合成的抗弓形虫IgM，IgA和IgG，并使用单变量和多变量方法进行定量PCR [qPCR]）。与母体血清转化时间无关，母体治疗对血清学技术的影响不同。免疫吸附凝集分析（ISAGA）和蛋白质印迹（WB）对IgM的检测率从未经治疗的新生儿的90.7％和88.2％降至经过治疗的新生儿的53.3％和51.9％（P<0.05），而产妇治疗对IgM酶联免疫吸附测定（ELISA）和IgA ISAGA的影响不明显。在怀孕期间进行治疗的情况下，WB也使新合成的IgG的敏感性降低了2倍（37.7％对82.3％）。有趣的是，无论采用哪种疗法，当治疗过程超过8周时，治疗效果均显示为持续时间依赖性，尤其是对于IgM检测。母体治疗也将弓形虫PCR在血液中的敏感性从39.1％降低到23.2％。这些结果表明，妊娠期抗弓形虫疗法可能会使出生时新生儿感染的生物学证据受挫，并强调需要对正常检查婴儿进行认真的血清学随访。