Gestational and congenital toxoplasmosis: Report of a clinical evaluation in Brazil

Abstract

Background: Toxoplasmosis is a cosmopolitan zoonosis caused by the intracellular parasite Toxoplasma gondii. Despite usually asymptomatic, in pregnant women, may lead to fetuses threat of miscarriage or disabilities. To diagnose gestational and congenital/fetal infection, must be analyzed the IgM and IgG serologies as well the PCR in amniotic fluid. The main purpose was to describe the clinical aspects from pregnant women's with clinical suspicion of gestacional toxoplasmosis as well from their newborns until their first 18 months of life. Methods & Materials: A retrospective study was conducted in a tertiary teaching hospital in São Paulo state, Brazil and 49 medical records of pregnant women who received prenatal monitoring at the High-Risk Pregnancy Clinic of the Hospital de Base from the Regional School of Medicine Foundation (FUNFARME) in 2009 to 2013 were evaluated according to: gestational age, recommended treatment, obstetrical ultrasounds, clinical and laboratory diagnosis, which included IgM and IgG serologies and amniotic fluid PCRs. 39 records of their potencially infected newborns were screened observing: neurological, visual and otologic development and exams, prematurity and recommended treatment. Results: The average age of the 49 pregnant women was 23,6 ± 6,3 (min: 13; max: 39; median: 23); 75,5% (n = 37) presented positive serology for toxoplasmosis; 46,9% (n = 23) underwent amniocentesis, 20,4% (n = 10) had a positive amniotic fluid PCR and 8,16% (n = 4) fetal ultrasound scans showed changes (shortened long bones, retrocorionic hematoma, retroamniotic hematoma and hyperechogenic intracardiac focus). Their recommended treatment included spiramycin or the triple scheme (sulfadiazine, pyrimethamine and folinic acid). Among the babies were presented: positive IgM serology (2,5% with n = 1), or positive blood PCR (7,69% with n = 3) or suspicion and signs of clinical changes (17,94% with n = 7) as cerebral calcifications, schizencephaly, seizures, chorioretinal alterations and prematurity. Although only 17,94% (n = 7) underwent treatment for congenital toxoplasmosis, based on the triple scheme, not necessarily those with clinical features. Conclusion: The toxoplasmosis prevalience of gestational infection is high indicating the epidemiological relevance of toxoplasmosis in this region. The positive PCR in amniotic fluid confirm a reasonable number of fetal infection; However, the number of children underwent the recommended treatment was low.