Characterization of Congenital Toxoplasmosis in Israel: A 17-year Nationwide Study Experience

מיכל אבידר ^2,3 Yaara Kahan ^1,3 Eli Somekh ^2,3 Bat-Sheva Gottesman ^3,4,5 Michal Meir ^6,7 Gilad Sherman ^3,8 Daniel Glikman ⁹ Shirin Shehadeh ^7,10 Efraim Bilavsky ^3,11 Diana Averbuch ^12,13 Ilan Youngster ^3,14 Orli Megged ^13,15 Galia Grisaru-Soen ^3,16 Irena Riklis ^17,18 Zeev Dveyrin ¹⁷ Efrat Rorman ¹⁷ Michal Stein ^7,19 Gil Talmon ^7,20 Ilan Dalal ^3,21 Diana Tasher ^1,3
¹Pediatric Infectious Disease Unit, E.Wolfson Medical Center, ישראל
²Department of Pediatric, Mayanei Hayeshua Medical Center, ישראל
³Sackler Faculty of Medicine, Tel-Aviv University, ישראל
⁴Infectious Diseases Unit, Meir Medical Center, ישראל
⁵Department of Family Medicine, Clalit Health Services, ישראל
⁶Pediatric Infectious Diseases Unit, The Ruth Rappaport Children’s Hospital Rambam Health Care Campus, ישראל
⁷Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, ישראל
⁸Pediatric Infectious Diseases Unit, Sheba Medical Center, Tel-Hashomer, ישראל
⁹The Azrieli Faculty of Medicine in the Galilee, Bar Ilan university, ישראל
¹⁰Department of Pediatrics, Carmel Medical Center, ישראל
¹¹Department of Pediatrics, Schneider Children's Medical Center, ישראל
¹²Pediatric Infectious Diseases Unit, Hadassah-Hebrew University Medical Center, ישראל
¹³School of Medicine, Hebrew University-Hadassah, ישראל
¹⁴Pediatric Infectious Diseases, Assaf Harofeh Medical Center, ישראל
¹⁵Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center, ישראל
¹⁶Pediatric Infectious Disease Unit, Dana Children's Hospital, Tel Aviv Medical Center, ישראל
¹⁷National Public Health Laboratory, Israel Ministry of Health, ישראל
¹⁸National Toxoplasmosis Reference Laboratory, Israel Ministry of Health, ישראל
¹⁹Infectious Diseases & Infection Control Unit, Hillel-Yaffe Medical Center, ישראל
²⁰Department of Neonatology, Emek Medical Center, ישראל
²¹Department of Pediatrics, E.wolfson Medical Center, ישראל

Background: Congenital toxoplasmosis (CT) can cause significant neurologic manifestations and other untoward sequelae. Neither the current prevalence nor the disease severity of CT in Israel is known.

Methods: Records of CT were collected from the National Toxoplasmosis Reference Laboratory and from 15 medical centers across Israel between 2001 and 2017. Eligible case-patients were fetuses or infants diagnosis.

Results: Forty-three cases of CT were identified (a prevalence of 1.6 per 100,000 live births). The rate was higher in Arab (non-Bedouin) infants than in Jewish and Bedouin infants (prevalence of 2.7, 1.2, and 0 per 100,000 live births, respectively).

One or more severe clinical manifestations were reported in 12 (46%) of the 28 live-born infants, and included cerebral calcifications (7 cases), chorioretinitis (4 cases),

hydrocephalus (2 cases), and one case of death. Sensitivities of blood polymerase chain reaction (PCR), CSF PCR, and IgM antibody tests were 50% each. However, analyzing PCR samples from both sites, together with IgM testing, increased the
sensitivity to 93%.

Conclusions: The rate of CT infection in Israel was found to be similar to the lower end of the range reported in Europe and the United-States. However, the relative rate of severe manifestations was higher than in previous European reports. Arab
(non-Bedouin) infants are at higher risk for contracting CT. Performing serologic and PCR tests simultaneously is essential to improve CT diagnosis. This study also demonstrates a need for an educational program to target high risk populations.