A case of congenital toxoplasmosis stillbirth diagnosed at autopsy and the incidence of congenital toxoplasmosis stillbirth in Japan calculated from the autopsy database of the Japanese Society of Pathology and vital statistics from the Ministry of Health, Labour and Welfare

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  • HOSHINO Tatsuji
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • KITAMURA Sachiko
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • OHTAKE Noriko
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • SUGA Mami
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • OKADA Yuko
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • MIYAMOTO Kazunao
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • NISHIMURA Junichi
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • TAKAOKA Aki
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • IMAMURA Yuko
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • YAMADA Yoko
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • KITA Masato
    Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital
  • IMAI Yukihiro
    Department of Clinical Pathology, Kobe City Medical Center General Hospital

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Other Title
  • 病理解剖で診断された先天性トキソプラズマ症胎児死亡
  • 症例報告 病理解剖で診断された先天性トキソプラズマ症胎児死亡
  • ショウレイ ホウコク ビョウリ カイボウ デ シンダン サレタ センテンセイ トキソプラズマショウ タイジ シボウ

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Abstract

A case of congenital toxoplasmosis stillbirth diagnosed at autopsy was recently encountered and the clinical course is reported. The patient was a 28-year-old primigravida. She was diagnosed as having intrauterine fetal death at 15 weeks of pregnancy. Fetal age was presumed to be 14 weeks based on the ultrasonographic measurement of size. Autopsy, chromosomal examination of the placenta, anti-phospholipid antibody inspection and other assessments were performed in order to investigate the cause of intrauterine fetal death. Macroscopic appearances of the fetus, placenta and umbilical cord were normal; the fetus was female with a weight of 50g and a length of 12cm. Placental chromosomal examination demonstrated normal 46 XX chromosomes. There were no anti-phospholipid antibodies. Histopathological examination of autopsy specimen demonstrated the presence of toxoplasma gondii cysts in the placenta, the heart, adrenal gland and brain, and thus this case was diagnosed as the intrauterine fetal death due to congenital toxoplasmosis. Toxoplasma antibody IHA (<160) at 12 weeks of pregnancy was 2560. Toxoplasma antibody IHA after stillbirth was 10240 or more. Toxoplasma IgG EIA (<6) was 5900 IU/mL. Toxoplasma IgM EIA (<0.8) was 2.3 C.O.I. It was considered that the intrauterine fetal death was caused by initial infection at the time of conception. Two possible routes of infection were considered based on memories reported by the patient. One route was during strawberry picking excursions that she had taken three times during pregnancy. The other possible route was roast meat eaten at a restaurant. The incidence of congenital toxoplasmosis intrauterine fetal death was calculated based on the autopsy database of the Japanese Society of Pathology and the vital statistics of the Ministry of Health, Labour and Welfare. There were five congenital toxoplasmosis stillbirths reported in the database between 1974 and 2007. Since the number of stillbirths in this period was 1,982,839 and the number of dissections was 22,827, the number of stillbirths by congenital toxoplasmosis infection was calculated as 5×(number of stillbirth during this period: 1,982,839) / (number of dissections during this period: 22,827) /34≒13 persons per year. The autopsy rate for stillbirths was also calculated as 22,827/1,982,839≒0.0115 (1.15%). It is necessary for obstetricians to pay sufficient attention to congenital toxoplasmosis. [Adv Obstet Gynecol, 62 (3) :241-247, 2010 (H22.8)]

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