Congenital toxoplasmosis and prenatal care state programs.
BACKGROUND
Control programs have been executed in an attempt to reduce vertical transmission and the severity of congenital infection in regions with a high incidence of toxoplasmosis in pregnant women. We aimed to evaluate whether treatment of pregnant women with spiramycin associated with a lack of monitoring for toxoplasmosis seroconversion affects the prognosis of patients.


METHODS
We performed a prospective cohort study with 246 newborns (NB) at risk for congenital toxoplasmosis in Goiânia (Brazil) between October 2003 and October 2011. We analyzed the efficacy of maternal treatment with spiramycin.


RESULTS
A total of 40.7% (66/162) of the neonates were born seriously infected. Vertical transmission associated with reactivation during pregnancy occurred in 5.5% (9/162) of the NB, with one showing severe infection (systemic). The presence of specific immunoglobulins (fetal IgM and NB IgA) suggested the worst prognosis. Treatment of pregnant women by spiramycin resulted in reduced vertical transmission. When infected pregnant women did not undergo proper treatment, the risk of severe infection (neural-optical) in NB was significantly increased. Fetal IgM was associated with ocular impairment in 48.0% (12/25) of the fetuses and neonatal IgA-specific was related to the neuro-ophthalmologic and systemic forms of the disease. When acute toxoplasmosis was identified in the postpartum period, a lack of monitoring of seronegative pregnant women resulted in a higher risk of severe congenital infection.


CONCLUSIONS
Treatment of pregnant women with spiramycin reduces the possibility of transmission of infection to the fetus. However, a lack of proper treatment is associated with the onset of the neural-optical form of congenital infection. Primary preventive measures should be increased for all pregnant women during the prenatal period and secondary prophylaxis through surveillance of seroconversion in seronegative pregnant woman should be introduced to reduce the severity of congenital infection in the environment.
Pediatrics and Childcare Department of the Medical School of Federal University of Goiás (UFG), Goiânia, Brazil. mariza.avelino@gmail.com.
Mariza M
MM
Avelino
Waldemar N
WN
Amaral
Isolina M X
IM
Rodrigues
Alan R
AR
Rassi
Maria B F
MB
Gomes
Tatiane L
TL
Costa
Ana M
AM
Castro
D000328:Adult; D001938:Brazil; D003049:Coccidiostats / Q000627:therapeutic use*; D015331:Cohort Studies; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy*; D011295:Prenatal Care; D011379:Prognosis; D011446:Prospective Studies; D012698:Serologic Tests; D015572:Spiramycin / Q000627:therapeutic use*; D014123:Toxoplasmosis / Q000188:drug therapy; D014125:Toxoplasmosis, Congenital / Q000097:blood / Q000517:prevention & control*
D003049:Coccidiostats; D007070:Immunoglobulin A; D015572:Spiramycin