Gestational and congenital toxoplasmosis - the clinicial findings in a teaching hospital

Abstract

Purpose: Toxoplasmosis is a cosmopolitan zoonosis caused by the intracellular parasite Toxoplasma gondii, usually asymptomatic, in pregnant women may lead to fetuses threat of miscarriage or disabilities. There is no official coutrywide protocol describing laboratory and clinical protocols to be used in prenatal and postnatal care. Here we describe the clinical findings in pregnant women's with clinical suspicion of gestacional toxoplasmosis and as well as in their newborns until their first 18 months of life. Methods & Materials: A retrospective study was conducted and 49 medical records of pregnant women who received prenatal monitoring at the High-Risk Pregnancy Clinic of the Base Hospital of 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); 22,4% (n = 11) were primigravidae and 42,8% (n = 21) multigravidae.; 75,5% (n = 37) of the pregnants presented positive serology; 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) of the children underwent treatment for congenital toxoplasmosis, based on the triple scheme, not necessarily those with clinical features. Conclusion: The gestational toxoplasmosis is occurring in multigravidae more than in primigravidae. The amount of positive amniotic fluid PCRs confirm a reasonable number of fetal infection, confirming congenital toxoplasmosis; however, the number of children underwent the treatment was very low.