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539 Severe form of Congenital Toxoplasmosis with Extensive Cerebral findings
  1. B Wiebe,
  2. C Fremerey,
  3. M Ehlen
  1. Neonatology and Paediatric Critical Care, Children's Hospital Asklepios Klinik St. Augustin, St. Augustin, Germany

Abstract

Introduction Congenital toxoplasmosis, a parasitic disease caused by the protozoon toxoplasma gondii is one of the classic intrauterine infections. The combination of hydrocephalus, retinochorioditis, intracranial calcification and parenchymal necrosis is rare. The majority of infected newborns present with uncharacteristic symptoms or remain asymptomatic. We report on a newborn with congenital toxoplasmosis and extensive cerebral findings.

Case report Term male newborn, pregnancy and delivery uneventful, no maternal toxoplasmosis screening, admission on day 18 due to lethargy, sucking and muscular weakness, increase in head circumference of 4 cm since birth with gaping cranial sutures and recurrent cerebral convulsions. Brain ultrasound demonstrated distinctive ventriculomegaly with multiple intraventricular filaments. Liquor findings revealed elevated protein and positive toxoplasmosis PCR. Serologically toxoplasmosa antibodies showed positive as well. Treatment was commenced with pyrimethamine, sulfadiazine and folin acid. Ophthamological examination showed microphthalmus and retinal scars; NMR reveals multiple necrosis of basal ganglia and cerebellum. Multiple neurosurgical interventions were indispensible due to progressive intraventricular filament formation and subdural hygroma. Furthermore, severe thrombosis of the vena cava superior and the subclavian veins developed due to extensive clotting activation. Catheter intervention to achieve recanalization was performed with subsequent enoxaprarin therapy. After development of sinus thrombosis and progressive intracranial haemorrhage intensive care treatment was limited. The baby deceased after 28 days of treatment.

Discussion Our case demonstrates that though maternal screening is available and despite of existing treatment options severe courses of the disease are still possible. In case of excessive increase in head circumference an elaborate search for intrauterine infections should be mandatory.

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