No abstract available.
Drug Therapy, Combination ; Female ; Human ; Infant ; Male ; Serologic Tests ; Toxoplasma/immunology ; Toxoplasmosis, Congenital/complications ; Toxoplasmosis, Congenital/diagnosis ; Toxoplasmosis, Congenital/pathology*

Congenital toxoplasmosis is caused by vertical transmission of Toxoplasma gondii from the mother during pregnancy. The road clinical spectrum of congenital toxoplasmosis ranges from stillbirth or death shortly after birth to survival with either cerebral damage or mild or subclinical disease, consisting usually of ocular involvement. Recently we experienced a neonate with congenital toxoplasmosis. The diagnosis of congenital toxoplasmosis was confirmed on the basis of clinical findings such as chorioretinitis, CT findings of multiple cerebral calcifications calcifications, hydrocephalus, and positive serologic test for toxoplasma IgM anti body. Therefore, we report our case with a review of related literature.
Chorioretinitis ; Diagnosis ; Humans ; Hydrocephalus ; Immunoglobulin M ; Infant, Newborn* ; Mothers ; Parturition ; Pregnancy ; Serologic Tests ; Stillbirth ; Toxoplasma ; Toxoplasmosis, Congenital*

Some parasitic diseases are more prevalent in children than in adults. Such agespecific diseases usually result from the mode of infection. Enterobiasis and head lice infestations are contact-borne. Congenital toxoplasmosis is a transplacental infection. Hepatic capillariasis results from contact with an environment contaminated with cat stools. Enterobiasis is the most common helminthic disease in children. The diagnosis and treatment is difficult because of its characteristic life cycle: eggs are present at the end of the life of the female adult worm. Vigorous screening and repeated chemotherapy for the entire family and contact group are required. Recently, there have been reports of congenital toxoplasmosis. There may be an increase in the number of cases of toxoplasmosis owing to the increase in the number of stray cats. Cryptosporidiosis does not evoke serious illness in immunocompetent children, while severe diarrhea can occur in immunocompromised children. One case of hepatic capillariasis has been reported in Korea. Owing to its high morbidity and mortality, prompt diagnosis and treatment are required. Head lice infestation is easy to diagnose and is still an indication of public health status. Mass screening and prevention are required. In local clinics, parasitic diseases are rarely suspected, since their incidence is very low and the symptoms are usually non-specific, except in a few parasitic diseases. Therefore, a thorough evaluation of the symptoms and past history and appropriate laboratory tests are necessary.
Adult ; Animals ; Cats ; Child* ; Cryptosporidiosis ; Diagnosis ; Diarrhea ; Drug Therapy ; Eggs ; Enterobiasis ; Female ; Helminths ; Humans ; Incidence ; Korea ; Lice Infestations ; Life Cycle Stages ; Mass Screening ; Mortality ; Ovum ; Parasitic Diseases* ; Pediculus ; Public Health ; Toxoplasmosis ; Toxoplasmosis, Congenital

The diagnosis of congenital toxoplasmosis may be difficult due to diversity of symptoms. However, the diagonosis is very important for treatment and determination of the prognosis of infected infants. We recently experienced two cases of congenital toxoplasmosis. The first case was suspected as congenital infection with hydrocephalus that was detected by prenatal ultrasonography. Postnatal evaluation revealed positive latex agglutination and ELISA IgG antibodies, and negative ELISA IgM antibodies for Toxoplasma gondii. Histologic examination of the biopsied brain tissue revealed microcalcification. The second case presented with jaundice and intraventricular hemorrhage, and serological evaluation revealed positive latex agglutination and ELISA IgG antibodies, and negative ELISA IgM antibodies for T. gondii. The mother was positive for ELISA IgM antibodies as well as for latex agglutination and ELISA IgG antibodies. In the blood and CSF of both infants as well as in the blood of their mothers, Toxoplasma specific B1 gene was detected by polymerase chain reaction and Southern blot analysis. Based on these results, we have confirmed two cases of congenital toxoplasmosis whose presenting symptoms were hydrocephalus, seizure, or jaundice, and these cases represent the first series of congenital toxoplasmosis diagnosed in Korea by polymerase chain reaction.
Agglutination ; Antibodies ; Blotting, Southern ; Brain ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Humans ; Hydrocephalus ; Immunoglobulin G ; Immunoglobulin M ; Infant ; Jaundice ; Korea ; Latex ; Mothers ; Polymerase Chain Reaction* ; Prognosis ; Seizures ; Toxoplasma ; Toxoplasmosis ; Toxoplasmosis, Congenital* ; Ultrasonography, Prenatal

The diagnosis of congenital toxoplasmosis may be difficult due to diversity of symptoms. However, the diagonosis is very important for treatment and determination of the prognosis of infected infants. We recently experienced two cases of congenital toxoplasmosis. The first case was suspected as congenital infection with hydrocephalus that was detected by prenatal ultrasonography. Postnatal evaluation revealed positive latex agglutination and ELISA IgG antibodies, and negative ELISA IgM antibodies for Toxoplasma gondii. Histologic examination of the biopsied brain tissue revealed microcalcification. The second case presented with jaundice and intraventricular hemorrhage, and serological evaluation revealed positive latex agglutination and ELISA IgG antibodies, and negative ELISA IgM antibodies for T. gondii. The mother was positive for ELISA IgM antibodies as well as for latex agglutination and ELISA IgG antibodies. In the blood and CSF of both infants as well as in the blood of their mothers, Toxoplasma specific B1 gene was detected by polymerase chain reaction and Southern blot analysis. Based on these results, we have confirmed two cases of congenital toxoplasmosis whose presenting symptoms were hydrocephalus, seizure, or jaundice, and these cases represent the first series of congenital toxoplasmosis diagnosed in Korea by polymerase chain reaction.
Agglutination ; Antibodies ; Blotting, Southern ; Brain ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Humans ; Hydrocephalus ; Immunoglobulin G ; Immunoglobulin M ; Infant ; Jaundice ; Korea ; Latex ; Mothers ; Polymerase Chain Reaction* ; Prognosis ; Seizures ; Toxoplasma ; Toxoplasmosis ; Toxoplasmosis, Congenital* ; Ultrasonography, Prenatal

The results of Brain CT in 93 children with seizure and or other neurologic problems are evaluated in relation to the age of onset, patients' history, final diagnosis & EEG. The overall incidence of abnormal scans were 78.5% in our series. Analysis of CT results showed that the incidence of abnormal scan was closely related to the following criteria. 1. Patients with onset of neurologic problems during the age of 1 year, have a higher incidence of abnormal CT scans(87.5%), particularly if the onset was below 1 month of age. (93.8%), Also the results of CT were markedly different between the age under the 6 years and the age above the 6 years. In the former group of paients, brain atrophy and hydrocephalus were the most common cause of abnormal findings and in the latter group, brain tumor and vascular lesions. 2. Patients with a first attack of seizure have a higher incidence of abnormal scans than that of recurrent attacks(87%, 75%). 3. CT was particularly valuable for the diagnosis of tumor, complicated with meningitis, congenital hydrocephalus, vascular lesions, tuberous sclerosis, infarction, abscess, congenital toxoplasmosis & skull fracture. 4. Patients with focal slowing or focal spike with focal slowing on EEG findings manifested significant positive results on CT scan.(93.4%, 100%). 5. The number of patients who revealed abnormalities on contrast enhancement were 13 patients Among those 13 patients, 4 patients were with tuberculous meningitis and these all 4 patients showed characteristic findings of hydrocephalus with prominent basal and Sylvian fissure enhancement after injection of intravenous contrast media. 6. No. particular correlationship was noticed between simple skull roentgenorraphy and brain CT scan in the diagnosis of intracranial pathology except in the detection of skull fracture & large calcification.
Abscess ; Age of Onset ; Atrophy ; Brain Neoplasms ; Brain* ; Child ; Contrast Media ; Diagnosis ; Electroencephalography ; Humans ; Hydrocephalus ; Incidence ; Infarction ; Meningitis ; Pathology ; Pediatrics* ; Seizures ; Skull ; Skull Fractures ; Tomography, X-Ray Computed ; Toxoplasmosis, Congenital ; Tuberculosis, Meningeal ; Tuberous Sclerosis

OBJECTIVETo study the therapeutic effects of azithromycin in treatment of congenital toxoplasmosis in children.

METHODSDefinite diagnosis of congenital toxoplasmosis was made on the basis of clinical manifestation combined with one or more positive results of the following laboratory tests and excluded other congenital infectious diseases: toxoplasma DNA (TOX-DNA), circulating toxoplasma antigen (TOX-CAG), and toxoplasma IgM antibody (TOX-IgM). All the patients were given oral azithromycin 10 mg/(kg.d) for 6 days followed by 8 days without medication (one course of treatment), and the regimen was persisted for 2 months and then another 2-month treatment was given at a 1-month interval. The authors continued to provide further treatment according to the state of the illness at one month interval. The patients received 2 to 8 (average 5) courses of treatment. The patients were followed-up for 2.5 to 5 (average 4) years.

RESULTSThe treatment was effective in all the patients and the patient's condition was improved. The authors repeated in 12 cases the four tests for toxoplasma (TOX-DNA, TOX-CAG, TOX-IgM, and TOX-IgG) 9 months to one and a half years after treatment. In 10 cases all these tests showed negative results, in 2 cases TOX-IgG was positive and in the other 4 cases symptoms disappeared.

CONCLUSIONThe results of the study showed that oral azithromycin had significant therapeutic effects with little side effect and was well tolerated. Azithromycin may become an alternative therapy in treatment of congenital Toxoplasma gondii infection in children.

Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Azithromycin ; administration & dosage ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Male ; Prognosis ; Toxoplasmosis, Congenital ; diagnosis ; drug therapy ; Treatment Outcome

PURPOSE: This study is to evaluate the clinical significance and possible etiologies of abnormal neurosonographic findings that revealed linear or branching linear hyperechoic vascular lesions in the thalami and basal ganglia of neonates and infants. METHODS: Analysis of 2,866 cranial sonograms (US) and doppler ultrasonography obtained from 1,150 patients identified 53 patients with linear hyperechoic vascular lesions in the thalami or basal ganglia. Patients with only punctate or coarse, nonlinear lesions of echogenicity in these lesions were excluded. Clinical records in 53 patients were reviewed for documentation of congenital cytomegalovirus (CMV) infection, rubella, syphilis, toxoplasmosis, chromosomal abnormality and other major diagnoses. Brain computed tomography (CT) had been performed in 23 of the 53 patients and these images were compared with the cranial sonograms. RESULTS: There were five CMV infection, two congenital syphilis, three Down syndrome, and one Patau syndrome patients. Other major diagnoses encountered included perinatal asphyxia, ventriculomegaly, intraventricular hemorrhage, periventricular leukomalacia, small-for-gestational age, prematurity with hyaline membrane disease, multiple congenital anomalies, neonatal seizure, meningitis, congenital choroid plexus cyst, neonatal hyperbilirubinemia, congenital heart disease, bronchopulmonary dysplasia and others. Brain CT found small calcification in basal ganglia from one patient. Resolution of lesions found in 5 cases with follow-up US studies. CONCLUSION: A broad etiologic basis for linear hyperechoic vascular lesions in the thalami and basal ganglia of neonates and infants indicates complete screening for possible various etiologies.
Asphyxia ; Basal Ganglia* ; Brain ; Bronchopulmonary Dysplasia ; Choroid Plexus ; Chromosome Aberrations ; Cytomegalovirus ; Diagnosis ; Down Syndrome ; Follow-Up Studies ; Heart Defects, Congenital ; Hemorrhage ; Humans ; Hyaline Membrane Disease ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn* ; Leukomalacia, Periventricular ; Mass Screening ; Meningitis ; Rubella ; Seizures ; Syphilis ; Syphilis, Congenital ; Toxoplasmosis ; Ultrasonography* ; Ultrasonography, Doppler