Suspected acute toxoplasmosis in pregnant women

Abstract

OBJECTIVE:To determine the prevalence of reagent serology for suspected acute toxoplasmosis in pregnant women and to describe clinical, laboratory and therapeutic profiles of mothers and their children. METHODS:A retrospective study was conducted with IgM-anti-Toxoplasma gondiireagent pregnant women and their children who attended the public health system in the state of Paraná, Southern Brazil, from January 2001 to December 2003. Information were obtained from clinical, laboratory (ELISA IgM/IgG) and ultrasonographic data and from interviews with the mothers. To test the homogeneity of the IgM indices in relation to the treatment used, the Pearson's Chi-square test was applied. Comparisons were considered significant at a 5% level. RESULTS:Two hundred and ninety (1.0%) cases of suspected IgM-reagent infection were documented, with a prevalence of 10.7 IgM-reagent women per 1,000 births. Prenatal care started within the first 12 weeks for 214/290; 146/204 were asymptomatic. Frequent complaints included headaches, visual disturbance and myalgia. Ultrasonography revealed abnormalities in 13 of 204 pregnancies. Chemoprophylaxis was administered to 112/227; a single ELISA test supported most decisions to begin treatment. Pregnant women with IgM indices =2.000 tended to be treated more often. Among exposed children, 44/208 were serologically followed up and all were IgGreagent, and three IgM-reagent cases showed clinical symptoms. CONCLUSIONS:The existence of pregnant women with laboratorially suspected acute toxoplasmosis who were not properly followed up, and of fetuses that were not adequately monitored, shows that basic aspects of the prenatal care are not being systematically observed. There is need of implementing a surveillance system of pregnant women and their children exposed to T. gondii. CONCLUSÕES: A existência de gestantes com suspeita laboratorial de toxoplasmose aguda não devidamente investigada e de conceptos sem monitoração adequada evidenciam que aspectos fundamentais da assistência pré-natal não estão sendo sistematicamente observados. Aponta-se a necessidade de implementar o sistema de vigilância para gestantes e crianças expostas ao T. gondii.28 Rev Saúde Pública 2007;41(1):27-34 Suspected acute toxoplasmosis in pregnancy Castilho-Pelloso MP et al Para testar a homogeneidade dos indices de IgM em relação ao tratamento usado, aplicou

Association between the risk of congenital toxoplasmosis and the classification of toxoplasmosis in pregnant women and prenatal treatment in Brazil, 1994–2009

“…Similarly, a study from the south of Brazil reported a lower degree of uninterrupted treatment (57%) for 290 pregnant women. 32 In the present study, continuous treatment (until the end of pregnancy) was a protective factor against CT (p = 0.001), probably because it prevents the transmission of T. gondii in the last trimesters of pregnancy when the placenta is more vascularized. Couto et al 33 strongly recommend that spiramycin should be given up until delivery.…”

Epidemiologic aspects of toxoplasmosis and evaluation of its seroprevalence in pregnant women

“…According to Margonato et al, existing prenatal triage programs for toxoplasmosis need to be revised, especially the prophylactic guidelines given to pregnant women 11 . Conversely, Castilho-Pelloso et al pointed out the existence of pregnant women suspected of toxoplasmosis that was not being investigated and fetuses without adequate monitoring 50 . The authors' evidence that fundamental aspects of prenatal care are not observed systematically highlight the need to implement a surveillance system for pregnant women and children exposed to T. gondii.…”

Preventive behavior for toxoplasmosis in pregnant adolescents in the state of Ceara, Brazil

“…As a new serology and IgG Avidity Assay Tests were not performed, the interpretation of IgM results had to be cautious in order to avoid the exposure of the mother and fetus to unnecessary procedures [48], showing the importance of the diagnostic confirmation. The Avidity Assay was not performed because this study does not perform serum prevalence analysis.…”