Sabin-Feldman Syndrome

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

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

Many adults demonstrate antibodies to Toxoplasma gondii, the causative organism; consequently, subclinical infection is probably common. In the United States, it is demonstrated that 3-70% 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 3500 newborns in the United States each year. T. gondii seropositivity rates among HIV-infected patients vary from 10-45%. Toxoplasmic encephalitis (TE) has been reported in 1-5% of 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%.

This syndrome was described by A.B. Sabin and H.A. Feldman, American epidemiologists.

T. gondii oocysts are shed in animal feces and may be ingested in dust form by humans.

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.

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.

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, i.e., intracranial pressure. The antiepileptic medications must be continued until the morning of surgery. Antibiotic must be given before anesthesia and elective surgical procedures should be delayed in patients with active infections.

No agents are indicated or contraindicated, except in the presence of seizure activities, triggering anesthetic agents should be avoided. In the case of ophthalmic disease occurring subsequent to acute infection, treatment may involve steroid administration and preoperative steroid stress doses may be necessary. Antibiotics may be administered and any possible drug interaction should be considered.