Management of Toxoplasma Seroconversions during Pregnancy in a Resource-Limited Setting: Experience from the Diamniadio Health District (Senegal)

Objective. To describe the management of toxoplasma seroconversions observed in 2024 in a resource-limited Senegalese district, detailing the laboratory strategy, ultrasound assessment, recourse to amniocentesis, and neonatal outcomes at 6 months. Methods. Multicenter observational study conducted from January to December 2024 in 16 public maternity units in the Diamniadio Health District. Women included were seronegative (IgG−/IgM−) at the first antenatal visit in the first trimester. Non-immune women underwent monthly serology. Any seroconversion was confirmed in a reference laboratory by a second blood draw and an IgG avidity test. Management combined immediate spiramycin, standard and targeted ultrasounds, and amniocentesis from 18 weeks’ gestation with Toxoplasma gondii PCR. Neonates were followed up to 6 months. Results. Of 22,691 antenatal consultations, 5,249 were first-trimester first visits. Seven seroconversions were confirmed (incidence 0.13%). Median maternal age was 27 years (IQR 24 - 32). Three amniocenteses were performed (43%): two PCR-negative and one positive. Transient ultrasound findings (ventriculomegaly, ascites, hepatosplenomegaly, hydramnios) were observed and regressed spontaneously except in the PCR-positive case. That patient delivered prematurely at 34 weeks a neonate with congenital infection but with satisfactory progress at 6 months. Conclusion. In a context without legal termination for fetal anomaly, a simplified protocol combining spiramycin, IgG avidity, close ultrasound surveillance, and targeted amniocentesis appears feasible. PCR cost remains the main barrier, underscoring the need for structured neonatal follow-up and tailored parental counseling.