Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ

Abstract

Acute toxoplasmosis in pregnancy is caused by Toxoplasma gondii transmitted by ingestion of infected food, blood transfusion, organ transplantation and by vertical transmission (VT). The VT occurs during the acute phase of the disease in pregnancy and may cause fetal malformations such as cerebral calcifications, chorioretinitis, seizure, hydrocephalus or microcephaly, in addition to other gestational complications. It is estimated that 25-30% of the world population is infected by T.gondii approximately and the prevalence of congenital infection is around 0.2 to 2 per 1,000 live births. Ministry of Health in Brazil establishes a clear guideline on the screening and treatment of acute toxoplasmosis during pregnancy. However, the national and international literature presents controversies regarding the conduct of the disease, and there is no concrete evidence on the efficacy of the treatment and the validity of prenatal screening. The aim of this study was to evaluate the VT rate and other unfavourable gestational outcomes in pregnant women with acute T.gondii infection, as well as the sociodemographic variables of these patients. A concurrent cohort study was performed with a sample of 26 patients with acute toxoplasmosis. Pregnant women diagnosed or suspected of acute toxoplasmosis were clinically evaluated, have answered to a sociodemographic questionnaire and treated according to the Ministry of Health in Brazil protocol. These patients were submitted to PCR in amniotic fluid and monthly fetal US for the establishment of fetal infectious status. At the conclusion of the study, the EPI-INFO 3.5.2 program and SPSS version 20 were used for statistical analysis. There was a high intake of non-potable water, inadequate basic sanitation and a high number of felines contacts in our sample. Twenty-three patients were carefully treated in the prenatal setting, presenting a vertical transmission rate (VT) of the disease of 17.4%. The remaining patients (three) were not treated, evolving with a VT rate of 33.3%. Congenital toxoplasmosis was diagnosed in 19.2% (5/26) of cases. There was a higher vertical transmission of the disease in infected patients in the third trimester (p <0.05). PCR was performed in amniotic fluid in 15 patients with positive results in only one pregnant woman, and the fetus submitted to triple intrauterine treatment, presenting as asymptomatic and without alterations in complementary tests at birth. The other infected concepts (4/26) presented hydrocephalus (2), intracranial calcifications (1) and chorioretinitis (1). CSF (pleocytosis and hyperproteinorrachy) occurred in 3/5 new-borns with congenital toxoplasmosis. There was a fetal death without confirmation of the congenital infection. Therefore, there was a direct correlation between toxoplasmosis during gestation and the low socioeconomic level / inadequate sanitary hygiene conditions, higher vertical transmission of the disease in infected patients in the third trimester (p <0.05), in agreement with other studies. There was also a higher rate of vertical transmission of the disease in inappropriately treated patients. Among the new-borns with congenital toxoplasmosis, 80% were symptomatic with intracranial calcifications, chorioretinitis and hydrocephalus. There was a change in cerebrospinal fluid alteration (pleocytosis and hyperproteinorraquia) in 60% of the concepts with congenital toxoplasmosis. The disease was not correlated with an increase in the rate of preterm birth and caesarean sections and / or decrease in Apgar.