Antenatal factors related to congenital toxoplasmosis in Rio De Janeiro, Brazil.

BACKGROUND: Toxoplasmosis is one of the main preventable congenital infections in Brazil. This manuscript aims to describe antenatal factors possibly associated with congenital toxoplasmosis (CT). METHODS: This is a case-control study, with data collected from medical records, from infants admitted under one year of age at the Infectious Diseases Clinic of Instituto de Puericultura e Pediatria Martagão Gesteira, reference center from Rio de Janeiro, exposed to toxoplasmosis during their antenatal period. Patients diagnosed with CT were classified as cases and those exposed without infection as controls. RESULTS: A total of 289 patients were followed up in 10 years. CT was confirmed in 43 (14.9%) of which six (14%) were asymptomatic, five (12%) had the classic triad (retinochoroiditis, hydrocephalus and intracranial calcifications), 27/42 (64.3%) had reactive IgM. Even after adjusted for prematurity, cases were born with lower weight (OR 0.49 - IC95% 0.33-0.73). There was a 13% increase in chance of CT per gestational week of the maternal diagnosis. Maternal fever, consumption of poorly washed vegetables during pregnancy, and diagnosis in the third trimester were associated with CT (OR: 6.43, 6.55, and 2.16, respectively). CONCLUSION: Fever during pregnancy, consumption of poorly washed vegetables and diagnosis in the third trimester were associated with CT. Infants with diagnosis of CT were born with lower weight than the controls.

Serum IgG Titers Against Toxoplasma gondii in Uninfected Infants Exposed In Utero to Toxoplasmosis.

OBJECTIVES: To describe the mean time of decrease of T. gondii IgG titers in uninfected infants exposed in utero to toxoplasmosis. METHODS: A retrospective cohort study was conducted between 2008-2017, among infants under 12 months and exposed in utero to toxoplasmosis. Serial monthly monitoring of serum IgG titers were done till undetectable levels. RESULTS: 240 infants with mean gestational age at diagnosis of 19.2 weeks were included in the study. The mean (range) time for IgG level to become undetectable was 7.9 (0.8-25.0) months. 14 infants became negative between 13-24 months. CONCLUSIONS: Majority of asymptomatic infants exposed in utero to T. gondii become seronegative before 12 months of age.

Congenital Toxoplasmosis: Missed Opportunities for Diagnosis and Prevention.

OBJECTIVES: Identify missed opportunities for the prevention and early diagnosis of congenital toxoplasmosis (CT) in infants followed up in a reference center for pediatric infectious diseases (PID) in Rio de Janeiro between January 2007 and December 2016. METHODS: Descriptive study including infants with CT, diagnosis established based on Brazil's Ministry of Health's criteria. All data regarding the infants and their mother's prenatal care were collected from the medical records of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG)-a tertiary public pediatric university hospital. The study enrolled infants aged between 0 and 12 months followed up in the PID department of IPPMG and with confirmed infection by Toxoplasma gondii in the period between January 2007 and December 2016. All patients with diagnosis of CT registered in the PID database of the IPPMG and admitted in the above-mentioned period were included in the study. Patients whose records were not available, or who went to just one clinic appointment were excluded. RESULTS: The obstetric history of all 44 women, whose infants (45) were diagnosed with CT, was analyzed. Their median age was 22 years. None had undergone preconception serological testing for toxoplasmosis. Only 20 (45%) of them started antenatal care during the first trimester of gestation, a total of 24 (55%) had more than six antenatal care visits, and 16% of those did not undergo serological testing for toxoplasmosis. None were adequately informed of preventive measures. The diagnosis of acute toxoplasmosis was made in 50% of these pregnancies but 32% of the women were not treated. Only 10 children of these mothers were adequately screened and treated at birth. CONCLUSION: Despite the existence of national recommendations, several opportunities were missed to prevent CT during the antenatal period and to diagnose and treat this condition in the neonatal period.