title: Birth prevalence and characteristics of congenital toxoplasmosis in Sergipe, North-east Brazil.
abstract: OBJECTIVE
  To estimate, by neonatal screening, the birth prevalence of congenital toxoplasmosis among live-born infants in Sergipe state, Brazil, and to investigate the clinical features of affected infants.
  
  
  METHODS
  Dried blood spot specimens obtained from 15 204 neonates were assayed for the presence of anti-T. gondii IgM antibodies. Duplicate retesting was done in infants with positive and borderline results. Confirmatory testing in peripheral blood samples consisted of testing for anti-T. gondii IgG and IgM in infants and mothers. Those with possible congenital toxoplasmosis were evaluated and followed up to a median age of 20 months. Congenital infection was confirmed in the presence of persisting anti-T. gondii IgG antibodies beyond 12 months of age. All infants with confirmed infection were treated with pyrimethamine, sulfadiazine and folinic acid for 1 year.
  
  
  RESULTS
  Fifty-three infants had detectable IgM in dried blood spot specimens. Confirmatory testing was reactive in 39/50, of which, 38 completed follow-up. Six of 15 204 newborns were diagnosed with congenital toxoplasmosis, resulting in an estimated birth prevalence of four per 10 000 [CI 95% 1.4-8.0]. Four infants (67%) showed signs of congenital toxoplasmosis in their first year of life; three (75%) had retinochoroidal scars, and one had cerebral calcifications. Two infants remained asymptomatic until 20 months of age.
  
  
  CONCLUSIONS
  The birth prevalence of congenital toxoplasmosis is high in the Brazilian state of Sergipe, with most of the infants showing ocular lesions. Preventive measures are strongly warranted.
authors.affiliation: Department of Nursing, Federal University of Sergipe, Aracaju, Brazil  Department of Paediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil  Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil  Laboratory of the University Hospital, Federal University of Sergipe, Aracaju, Brazil  Serology Laboratory, Centre of Hemotherapy and Central Laboratory of Public Health of Sergipe, Aracaju, Brazil  Ophthalmology Service, Nossa Senhora de Lourdes Maternity, Aracaju, Brazil  Ultrasonography Centre, Nossa Senhora de Lourdes Maternity, Aracaju, Brazil.
authors.forename: Ana Dorcas
authors.initials: AD
authors.lastname: de Melo Inagaki
authors.forename: Cristina Gardonyi
authors.initials: CG
authors.lastname: Carvalheiro
authors.forename: Rosana
authors.initials: R
authors.lastname: Cipolotti
authors.forename: Ricardo Queiroz
authors.initials: RQ
authors.lastname: Gurgel
authors.forename: Dayse Alves
authors.initials: DA
authors.lastname: Rocha
authors.forename: Kariny Souza
authors.initials: KS
authors.lastname: Pinheiro
authors.forename: Raquel Melo
authors.initials: RM
authors.lastname: Araújo
authors.forename: Dorothy Ribeiro Resende
authors.initials: DR
authors.lastname: Lima
authors.forename: Jacques Leon
authors.initials: JL
authors.lastname: Winandy
authors.forename: Marisa Márcia
authors.initials: MM
authors.lastname: Mussi-Pinhata
mesh_terms: D000913:Antibodies, Protozoan / Q000097:blood*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D002955:Leucovorin / Q000627:therapeutic use*; D015997:Neonatal Screening / Q000379:methods*; D011739:Pyrimethamine / Q000627:therapeutic use; D013411:Sulfadiazine / Q000627:therapeutic use; D014122:Toxoplasma / Q000302:isolation & purification*; D014125:Toxoplasmosis, Congenital / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000913:Antibodies, Protozoan; D000981:Antiprotozoal Agents; D007075:Immunoglobulin M; D013411:Sulfadiazine; D002955:Leucovorin; D011739:Pyrimethamine