Clinical presentation and follow up of children with congenital toxoplasmosis in Brazil

Abstract

We evaluated the clinical presentation and determined the ocular and neurologic sequelae in children with congenital toxoplasmosis in Brazil, taking into consideration the shortage of national publications on this disease. Follow-up evaluations were made of 43 children with congenital toxoplasmosis referred to Santa Casa de São Paulo, during a period of at least five years. Selection of the cases was based in clinical and laboratory criteria. A clear predominance of children with subclinical presentation of the disease at birth (88%) was found. Of the 43 children, 22 (51%) developed neurological manifestations. Using skull radiography, we detected neuroradiologic alterations in seven children (16%) and with tomography in 33 children (77%). Neurological sequelae were identified in 15 children (54%) in the group with cerebral calcifications and in 7 (47%) in the group without cerebral calcifications. We observed chorioretinitis in 95% of the cases. Reactivation of cicatricial lesions and the emergence of new ocular lesions were observed in five cases. The most frequent neurological manifestation was a delay in neuropsychomotor development. Most remarkable was the finding that cerebral calcifications were not associated with a higher incidence of neurological sequelae among the children. Chorioretinitis was the main ocular sequel of the infection, found in nearly all children; it can manifest years from birth, even in children submitted to specific therapy during the first year of life, highlighting the importance of a follow-up of these children

Profile of pregnant women and children treated at a reference center for congenital toxoplasmosis in the northern state of Minas Gerais, Brazil

“…In agreement with previous reports in the literature, most (72.4%) children were asymptomatic at birth: similar data were found by Sáfadi in São Paulo, where 43 children with Toxoplasma gondii were studied, and 88% were found to have had subclinical infection at birth 25 .…”

Suspected acute toxoplasmosis in pregnant women

“…14 Primary infection during gestation may cause serious neurological damage, blindness and even fetal death. 15,22 The chances of fetal infection by T. gondii increase with the stage of pregnancy, from 5-15% in the first half of gestation, to 60-80% in the second half. Conversely, the chances of serious lesions and death decrease, declining from 70-80% in the first half to less than 10% in the second half.…”

“…Tissue damage can begin during pregnancy and sometimes continues after birth, during infancy, or later in adulthood, causing neuropsychomotor and optical sequelae. 7,11,15 Because of the persistence of certain classes of antibodies, such as IgM and IgA, and the high sensitivity of the serological methods currently available, complementary tests are necessary in order to assess more accurately the chronology of the infection in pregnant women. 8 However, the risk of congenital transmission may exist not only in cases of seroconversion, but also in cases of suspected infection as detected by elevated mean titers of IgM and/or IgA and IgG.…”

“…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.…”

Prevalence of acute toxoplasmosis infection among 41,112 pregnant women and the mother-to-child transmission rate in a public hospital in South Brazil

“…Although newborns affected by congenital infection may seem normal upon first examination, serious sequelae, such as neurological impairment and blindness, can develop a few years later (Mombro et al 1995, Dunn et al 1999, Safadi et al 2003, Remington et al 2005.…”