RESUMO
Untreated acute toxoplasmosis among pregnant women can lead to serious sequelae among newborns, including neurological impairment and blindness. In Brazil, the risk of congenital toxoplasmosis (CTox) has not been fully evaluated. Our aim was to evaluate trends in acute toxoplasmosis prevalence from 1998-2005, the incidence of CTox and the rate of mother-to-child transmission (MTCT). A cross-sectional study was undertaken to dentify patients who fit the criteria for acute toxoplasmosis during pregnancy. Exposed newborns were included in a historical cohort, with a median follow-up time of 11 months, to establish definite diagnosis of CTox. Diagnoses for acute infection in pregnancy and CTox were based on European Research Network on Congenital Toxoplasmosis criteria. In 41,112 pregnant women, the prevalence of acute toxoplasmosis was 4.8/1,000 women. The birth prevalence of CTox was 0.6/1,000 newborns [95% confidence interval (CI): 0.4-0.9]. During the follow-up study, 12 additional cases were detected, increasing the CTox rate to 0.9/1,000 newborns (95% CI: 0.6-1.3). Among the 200 newborns exposed to Toxoplasma gondii,there were 37 babies presenting diagnostic criteria of CTox, leading to an MTCT rate of 18.5% (95% CI: 13.4-24.6%). The additional cases identified during follow-up reinforce the need for serological monitoring during the first year of life, even in the absence of evidence of congenital infection at birth.
Assuntos
Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Complicações Parasitárias na Gravidez/epidemiologia , Toxoplasmose/epidemiologia , Doença Aguda , Animais , Brasil/epidemiologia , Estudos Transversais , Feminino , Hospitais Públicos , Humanos , Incidência , Recém-Nascido , Gravidez , Complicações Parasitárias na Gravidez/diagnóstico , Prevalência , Toxoplasmose/diagnóstico , Toxoplasmose/transmissão , Toxoplasmose Congênita/diagnóstico , Toxoplasmose Congênita/epidemiologia , Toxoplasmose Congênita/transmissãoRESUMO
Untreated acute toxoplasmosis among pregnant women can lead to serious sequelae among newborns, including neurological impairment and blindness. In Brazil, the risk of congenital toxoplasmosis (CTox) has not been fully evaluated. Our aim was to evaluate trends in acute toxoplasmosis prevalence from 1998-2005, the incidence of CTox and the rate of mother-to-child transmission (MTCT). A cross-sectional study was undertaken to dentify patients who fit the criteria for acute toxoplasmosis during pregnancy. Exposed newborns were included in a historical cohort, with a median follow-up time of 11 months, to establish definite diagnosis of CTox. Diagnoses for acute infection in pregnancy and CTox were based on European Research Network on Congenital Toxoplasmosis criteria. In 41,112 pregnant women, the prevalence of acute toxoplasmosis was 4.8/1,000 women. The birth prevalence of CTox was 0.6/1,000 newborns [95 percent confidence interval (CI): 0.4-0.9]. During the follow-up study, 12 additional cases were detected, increasing the CTox rate to 0.9/1,000 newborns (95 percent CI: 0.6-1.3). Among the 200 newborns exposed to Toxoplasma gondii,there were 37 babies presenting diagnostic criteria of CTox, leading to an MTCT rate of 18.5 percent (95 percent CI: 13.4-24.6 percent). The additional cases identified during follow-up reinforce the need for serological monitoring during the first year of life, even in the absence of evidence of congenital infection at birth.
Assuntos
Animais , Feminino , Humanos , Recém-Nascido , Gravidez , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Complicações Parasitárias na Gravidez/epidemiologia , Toxoplasmose/epidemiologia , Doença Aguda , Brasil/epidemiologia , Estudos Transversais , Hospitais Públicos , Incidência , Prevalência , Complicações Parasitárias na Gravidez/diagnóstico , Toxoplasmose Congênita/diagnóstico , Toxoplasmose Congênita/epidemiologia , Toxoplasmose Congênita/transmissão , Toxoplasmose/diagnóstico , Toxoplasmose/transmissãoRESUMO
O estudo descreve 29 casos de gestaçäo entre mulheres infectadas pelo vírus HIV-1 ocorridos entre março de 1998 e novembro de 2000 no Hospital Geral da Universidade de Caxias do Sul. A via de contaminaçäo materna predominante foi a sexual (41,4 por cento), seguida do uso de drogas injetáveis (34,4 por cento). Vinte e três gestantes referiram ter realizado acompanhamento médico pré-natal. Em 21 casos (72,3 por cento) o diagnóstico da infecçäo materna foi obtido antes do nascimento, sendo que somente 19 gestantes (65,5 por cento) receberam doses profiláticas de Zidovudina (AZT) durante a gravidez visando a prevençäo da transmissäo vertical do vírus. Em nenhum caso a administraçäo de AZT iniciou na 14ª semana de gestaçäo como preconizado internacionalmente. Verificou-se associaçäo com outras doenças sexualmente transmissíveis em 31 por cento dos casos (n=9), sendo a sífilis a mais prevalente (66,6 por cento). Vinte e oito (96,5 por cento) neonatos apresentaram sorologia positiva para o HIV-1, destes, somente sete (24,1 por cento) mantiveram-se em acompanhamento médico após a alta hospitalar. Seis (20,6 por cento) permaneceram HIV-positivos e dois (6,8 por cento) tornaram-se soronegativos.