Sabin-Feldman Syndrome

At a glance

An infective disorder, sporadic in nature, that leads to chorioretinitis and cerebral calcification. Transplacental infection may occur with devastating results for fetal development.

Synonyms

Toxoplasma gondii; T. gondii; Chorioretinitis-Toxoplasmosis Syndrome; Toxoplasmosis Disease.

History

This syndrome was described by Albert Sabin and Harry Feldman, American epidemiologists and developed the dye test in 1948.

Incidence

Many adults demonstrate antibodies to Toxoplasma gondii, the causative organism; consequently, subclinical infection is probably common. In the United States, it is demonstrated that 3 to 70% of healthy adults are serologically positive for T. gondii. In general, the incidence of the infection varies with the population group and the geographical area studied. T. gondii infection affects more than 3,500 newborns in the United States each year. T. gondii seropositivity rates among human immunodeficiency virus (HIV)-infected patients vary from 10 to 45%. Toxoplasmic encephalitis (TE) has been reported in 1 to 5% of Acquired Immunodeficiency Syndrome (AIDS) patients. Internationally, the seropositivity prevalence rate is as high as 75% by the fourth decade of life, in countries such as France and El Salvador. As many as 90% of adults in Paris are seropositive. Approximately 50% of the adult population in Germany is infected. Women of childbearing age in much of Western Europe, Africa, and South and Central America have seroprevalence rates of greater than 50%.

Pathophysiology

Felids are its definitive host and T. gondii oocysts are shed in animal feces and may be ingested in dust form by humans. There is no vaccine and to prevent toxoplasmosis in humans and hygiene remains the best preventative measure.

Diagnosis

Fever, headache, lymphadenopathy, myalgia, anorexia, and arthralgia are the most common presenting features in adults and children infected with toxoplasmosis. A minority of patients develop visual symptoms; however, about half of patients show characteristic lesions in the retina on ophthalmoscopy. Why some hosts develop clinical toxoplasmosis whereas most remain asymptomatic is largely unknown.

Precautions before anesthesia

Patients with toxoplasmosis should be treated as potentially contagious to the operating room personnel. In view of the serious consequences of transplacental spread, patient contact with pregnant personnel must be avoided. Patients should be assessed to determine the degree of involvement. Dehydration may be a feature of the acute illness. As these patients are infected, arrangements must be made to use disposable anesthetic and surgical equipment or to protect nondisposable equipment from bacterial contamination.

Anesthetic considerations

There are no reports of anesthesia with this medical condition. The presence of cerebral calcification might be associated with seizures and potentially a change in the intracranial dynamic, ie, intracranial pressure. The antiepileptic medications must be continued throughout the perioperative ...