Maternal and Congenital Toxoplasmosis: Diagnosis and Treatment Recommendations of a French Multidisciplinary Working Group.

Women infected with toxoplasmosis during pregnancy do not present symptoms in most cases, but the consequences of the congenital infection may be severe for the unborn child. Fetal damage can range from asymptomatic to severe neurological alterations to retinal lesions prone to potential flare up and relapses lifelong. Despite the possible severity of outcome, congenital toxoplasmosis (CT) is a neglected disease. There is no consensus regarding screening during pregnancy, prenatal/postnatal treatment or short or medium term follow-up. Since 1992, France has offered systematic serological testing to non-immune pregnant women, monthly until delivery. Any maternal infection is thus detected; moreover, diagnosis of congenital infection can be made at birth and follow-up can be provided. "Guidelines" drawn up by a multidisciplinary group are presented here, concerning treatment, before and after birth. The recommendations are based on the regular analysis of the literature and the results of the working group. The evaluation of the recommendations takes into account the robustness of the recommendation and the quality of the evidence.

Screening for retinopathy of prematurity: results of a retrospective 3-year study of 502 infants.

PURPOSE: To describe the surveillance, results of screening, and treatment of retinopathy of prematurity (ROP) in a university hospital setting in southeast France. PATIENTS AND METHODS: Five hundred two premature infants were included in the screening protocol between January 1997 and December 1999. Criteria for inclusion in the study were a gestational age of 32 weeks or younger, a birth weight of less than 1,501 g, or both. The first fundus examination was performed between 4 and 6 weeks of life. Thereafter, fundus examination was performed in the absence of ROP every 2 weeks until complete retinal vasculature developed, gestational age of 50 weeks, or death. Examination was weekly in cases of retinopathy, biweekly if progression was ascertained, and less frequent only if regression was evident. Hospital records were reviewed to assess the presence or absence and eventual degree of ROP. RESULTS: Stage 1 was observed in 32 infants, and stage 2 in 11 infants; all of these cases regressed. Three cases of bilateral stage 3 (two threshold and one prethreshold) disease underwent diode laser peripheral retinal ablation and regressed. One infant with bilateral stage 3 disease who underwent peripheral cryoablative surgery progressed to stage 4A in one eye and 4B in the other eye and then underwent scleral buckling surgery in the second eye. CONCLUSIONS: Despite survival increasing with improved neonatal intensive care, the incidence of ROP does not appear to be increasing. In our center, the incidence appears to be lower than previously reported.

Three new cases of Alström syndrome.

PURPOSE: To report three further cases of Alström syndrome and to present a review of the literature. METHODS: Three siblings, two brothers and a sister, are described. They had complete ophthalmologic examination with retinography and fluoroscein angiography. They also underwent general and metabolic examination and genetic study. RESULTS: Alström syndrome is a rare autosomal recessive disorder characterized by atypical retinal pigmentary degeneration, sensorineural hearing loss, obesity, non-insulin-dependent diabetes mellitus, and chronic nephropathy. The diagnosis is based on clinical, biologic (hyperglycemia with hyperinsulinism), and genetic criteria (autosomal recessive disorder on chromosome 2). CONCLUSION: Blindness, hearing loss, complications of diabetes, and renal failure confirm the gravity of this syndrome. The prognosis regarding survival is correlated with the severity of renal failure.