Assessment of laboratory methods used in the diagnosis of congenital toxoplasmosis after maternal treatment with spiramycin in pregnancy
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Data
2014
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Background: The different laboratory methods used in the diagnosis of congenital toxoplasmosis have variable
sensitivity and specificity. There is no evidence to prove that maternal treatment reduces the risk of fetal infection.
The purpose of this study was to assess methods for the confirmation of congenital toxoplasmosis after maternal
treatment with spiramycin during pregnancy, and to evaluate the effect of this treatment on clinical manifestations
of the disease in newborns (NB).
Methods: This was a community-based, cross-sectional study of acute toxoplasmosis in newborns at risk of acquiring
congenital infection. Participating newborns were born in the Clinical Hospital Maternity Ward of the Federal University
of Goiás. Eligible participants were divided into 2 groups: group 1 consisted of 44 newborns born to mothers treated
with spiramycin during pregnancy and group 2 consisted of 24 newborns born to mothers not treated with spiramycin
during pregnancy because the diagnosis of toxoplasmosis was not performed. The sensitivity and specifity of PCR for
T. gondii DNA in peripheral blood and serological testing for specific anti-T. gondii IgM and IgA, and the effects of
maternal spiramycin treatment on these parameters, were determined by associating test results with clinical
manifestations of disease.
Results: The sensitivity of the markers (T. gondii DNA detected by PCR, and the presence of specific anti-T. gondii IgM
and IgA) for congenital toxoplasmosis was higher in group 2 than in group 1 (31.6, 68.4, 36.8% and 3.7, 25.9, 11.1%
respectively). Even with a low PCR sensitivity, the group 2 results indicate the importance of developing new
techniques for the diagnosis of congenital toxoplasmosis in newborns. Within group 1, 70.4% of the infected newborns
were asymptomatic and, in group 2, 68.4% showed clinical manifestations of congenital toxoplasmosis.
Conclusions: The higher proportion of infants without clinical symptoms in group 1 (70.4%) suggests the maternal
treatment with spiramycin delays fetal infection, reducing the clinical sequelae of the disease in newborns. Given the
low sensitivity of the tests used, when there is suspicion of congenital transmission several serological and
parasitological tests are required in order to confirm or exclude congenital toxoplasmosis in newborns.
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Palavras-chave
Congenital toxoplasmosis, Symptoms, Treatment, Serology, PCR
Citação
RODRIGUES, Isolina M. X.; COSTA, Tatiane L .; AVELAR, Juliana B.; AMARAL, Waldemar N.; CASTRO, Ana M.; AVELINO, Mariza M. Assessment of laboratory methods used in the diagnosis of congenital toxoplasmosis after maternal treatment with spiramycin in pregnancy. BMC Infectious Diseases, London, v. 14, p. 2-9, 2014.