Estudo prospectivo de gestantes e seus bebês com risco de transmissão de toxoplasmose congênita em município do Rio Grande do Sul

Abstract

This study followed up 2,126 pregnant women cared for at SUS day-care clinics (Public Health Insurance System) of the northwest of the State of Rio Grande do Sul, Brazil. After serological screening we performed a follow up of all pregnant women and their babies. Serologic tests included: IgG, IgM, IgA and IgG avidity levels, mice inoculation and polymerase chain reaction (PCR) also placentas and umbilical materials were tested using immunoperoxidase as well as clinical evaluation. Of all the pregnant women screened, 74.5% were reactive to toxoplasmosis, and 3.6% presented IgM seropositivity. At ophthalmic evaluation ten women had ocular lesions and one infant presented eye lesions and brain calcification. The presence of anti-T.gondii specific IgM throughout the entire pregnancy did not characterize acute phase infection, for this, complementary tests were necessary. The importance is underscored for attendance of the newborn of mothers presenting serology compatible with this infection even in the absence of signs and symptoms of congenital toxoplasmosis.

Association of the presence of residual anti-Toxoplasma gondii IgM in pregnant women and their respective family groups in Miracema, Northwest Rio de Janeiro, Brazil

“…In epidemiological surveys, the seroprevalence for toxoplasmosis has been reported to be above 50% in several regions in Brazil and the rest of the world, independently of the target population (Coutinho et al 1981, Jeannel et al 1988, Jenum et al 1998, Tenter et al 2000, Spalding et al 2003, Heukelbach et al 2007. The data presented here confirm the high prevalence of toxoplasmosis (75.1%) in Miracema.…”

Suspected acute toxoplasmosis in pregnant women

“…They are useful for the initial identification of pregnant women and newborns, 11,18 and are advocated in the prenatal routine of public health care services in the region. The fact that IgM remains at high levels for many months, 9 and the difficulty of accessing other laboratory techniques, rendered serodiagnosis of acute toxoplasmosis inadequate.…”

“…2,10 Therefore, clinical and serological follow-up for all neonates of IgM-reagent pregnant women, even if they are asymptomatic, is recommended. 15,18 Brazil is a vast country, with marked differences in socioeconomic conditions and health care levels among its population. The performance of programs for control of congenital toxoplasmosis in different regions of the country must be assessed.…”

Monitoramento de gestantes com toxoplasmose em serviços públicos de saúde

“…Atualmente, para conclusão do diagnóstico de fase aguda em gestantes é recomendável a inclusão de outros marcadores (IgA, IgE, teste de avidez da IgG ou PCR) para comprovação dos resultados iniciais 1 2 . Associado aos dados laboratoriais, o exame tomográfico pode ser útil para detectar calcificações que podem ser advindas da infecção 7 .…”

“…As taxas de transmissão congênita e as manifestações clínicas variam de forma acentuada entre os indivíduos com infecção por T. gondii 7 . Neste trabalho evidenciou-se a necessidade de investimento em melhoria de técnicas laboratoriais, a fim de otimizar a assistência às gestantes e filhos expostos, uma vez que a indicação terapêutica pode ser onerosa ao serviço, apesar de saber-se que a utilização de quimioprofilático pode reduzir a transmissão ou as seqüelas ao feto 6 .…”