Congenital toxoplasmosis and prenatal care state programs
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Data
2014
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Background: Control programs have been executed in an attempt to reduce vertical transmission and the severity
of congenital infection in regions with a high incidence of toxoplasmosis in pregnant women. We aimed to
evaluate whether treatment of pregnant women with spiramycin associated with a lack of monitoring for
toxoplasmosis seroconversion affects the prognosis of patients.
Methods: We performed a prospective cohort study with 246 newborns (NB) at risk for congenital toxoplasmosis in
GoiĆ¢nia (Brazil) between October 2003 and October 2011. We analyzed the efficacy of maternal treatment with
spiramycin.
Results: A total of 40.7% (66/162) of the neonates were born seriously infected. Vertical transmission associated
with reactivation during pregnancy occurred in 5.5% (9/162) of the NB, with one showing severe infection
(systemic). The presence of specific immunoglobulins (fetal IgM and NB IgA) suggested the worst prognosis.
Treatment of pregnant women by spiramycin resulted in reduced vertical transmission. When infected pregnant
women did not undergo proper treatment, the risk of severe infection (neural-optical) in NB was significantly increased.
Fetal IgM was associated with ocular impairment in 48.0% (12/25) of the fetuses and neonatal IgA-specific was related
to the neuro-ophthalmologic and systemic forms of the disease. When acute toxoplasmosis was identified in
the postpartum period, a lack of monitoring of seronegative pregnant women resulted in a higher risk of severe
congenital infection.
Conclusion: Treatment of pregnant women with spiramycin reduces the possibility of transmission of infection
to the fetus. However, a lack of proper treatment is associated with the onset of the neural-optical form of
congenital infection. Primary preventive measures should be increased for all pregnant women during the prenatal
period and secondary prophylaxis through surveillance of seroconversion in seronegative pregnant woman should be
introduced to reduce the severity of congenital infection in the environment.
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Congenital toxoplasmosis, Pregnancy, Seronegative
CitaĆ§Ć£o
AVELINO, Mariza M.; AMARAL, Waldemar N.; RODRIGUES, Isolina M. X.; RASSI, Alan R.; GOMES, Maria B. F.; COSTA, Tatiane L.; CASTRO, Ana M. Congenital toxoplasmosis and prenatal care state programs. BMC Infectious Diseases, London, v. 14, n. 33, p. 1-10, 2014.