[Management of XXXX in France: current data].

@entity1 @entity66 @entity3217 @entity11682 @entity19 @entity7912 @entity281 @entity3251 @entity4765 @entity2241
@entity3251 is caused by transplacental contamination of the fetus withToxoplasma gondiifollowing maternal @entity281 . The risk of mother-to- @entity1 transmission depends on the term of pregnancy at the time of @entity281 . The risk is lower than 5% in the first trimester but can reach 90% in the last days of pregnancy. Inversely, however, @entity2241 is more severe when contamination occurs early in pregnancy. The French prevention program officially recommends monthly serological screening of susceptible @entity1 during pregnancy and information about hygiene and dietary rules. Prenatal diagnosis of @entity3251 is based on a combination of examinations: PCR testing for the parasite in amniotic fluid, @entity19 inoculation, fetal ultrasonography, and magnetic resonance imaging. Neonatal screening consists of PCR of the placenta, @entity19 inoculation, detection of specific IgM and IgA in the newborn, ocular fundus examinations by indirect ophthalmoscopy, and transfontanellar ultrasonography. As soon as @entity281 is suspected, preventive treatment with @entity7912 begins; the treatment is changed to a combination of @entity4765 - @entity11682 if fetal infection is proved. Some teams are using this combination as first-line treatment after 30 weeks of gestation, without performing amniocentesis. Recent European multicenter studies raise questions about the effectiveness of prenatal treatment on mother-to- @entity1 transmission and on the reduction in the number and severity of fetal sequelae. A randomized controlled trial is required to prove the efficacy of prenatal treatment in general and of specific drugs, in particular. As soon as infection is confirmed, infected @entity1 are treated with the @entity4765 - @entity11682 combination for 12 to 24 months. Recent multicenter studies show that postnatal treatment does not prevent @entity3217 : 5% of treated @entity1 had @entity66 at birth, 20% at 5 years, and 30% at 8 years of age. Furthermore no consensus exists about the duration of postnatal treatment (3 months in Denmark versus 12 months in France). A multicenter randomized controlled trial is necessary to assess the efficacy of postnatal treatment and determine its duration. A surveillance system was set up in 2007 by the National Reference Center for Toxoplasmosis to determine the perinatal burden of this infection and to assess the national policy.
