RESUMO
Congenital toxoplasmosis in twin pregnancies is infrequent. We present the case of a monozygotic and monocorial twin pregnancy with maternal toxoplasmosis infection diagnosed at 33 weeks gestation by detecting reactive IgM and IgG and low avidity test for IgG. The detection of the parasite in amniotic fluid could not be performed because the amniocentesis was not done. The term newborns presented cerebral calcifications and bilateral active chorioretinitis without other associated clinical manifestations. They had IgG and IgM reactive for toxoplasmosis. The detection of Toxoplasma gondii was not performed by placental PCR or cord blood. They received treatment during the first year of life with pyrimethamine, sulfadiazine and folinic acid. They had no adverse events associated with the therapy. The diagnostic assessment and treatment does not differ from pregnancies with a single fetus. One or both newborns may be compromised. Multidisciplinary monitoring is essential for the early detection of reactivations or progression of lesions.
Assuntos
Complicações Infecciosas na Gravidez , Complicações Parasitárias na Gravidez , Toxoplasma , Toxoplasmose Congênita , Anticorpos Antiprotozoários , Feminino , Humanos , Recém-Nascido , GravidezRESUMO
Resumen La toxoplasmosis congénita en embarazos gemelares es infrecuente. Presentamos el caso de un embarazo gemelar monocigótico, monocorial con una infección materna por toxoplasmosis diagnosticada a las 33 semanas de gestación mediante detección de IgM e IgG reactivas y test de baja avidez de IgG. No pudo realizarse la detección del parásito en líquido amniótico debido a que no se hizo amniocentesis. Las recién nacidas (RN) de término presentaron calcificaciones cerebrales y coriorretinitis activa bilateral, sin otras manifestaciones clínicas asociadas. Tuvieron IgG e IgM reactiva para toxoplasmosis. No se realizó RPC para Toxoplasma gondii en placenta ni en sangre de cordón. Recibieron tratamiento durante el primer año de vida con pirimetamina, sulfadiazina y ácido folínico, sin eventos adversos asociados a la terapia. La metodología diagnóstica y el tratamiento no difieren de los embarazos con feto único. Uno o ambos RN pueden estar comprometidos. Es fundamental el seguimiento multidisciplinario para la detección precoz de reactivaciones o progresión de las lesiones.
Abstract Congenital toxoplasmosis in twin pregnancies is infrequent. We present the case of a monozygotic and monocorial twin pregnancy with maternal toxoplasmosis infection diagnosed at 33 weeks gestation by detecting reactive IgM and IgG and low avidity test for IgG. The detection of the parasite in amniotic fluid could not be performed because the amniocentesis was not done. The term newborns presented cerebral calcifications and bilateral active chorioretinitis without other associated clinical manifestations. They had IgG and IgM reactive for toxoplasmosis. The detection of Toxoplasma gondii was not performed by placental PCR or cord blood. They received treatment during the first year of life with pyrimethamine, sulfadiazine and folinic acid. They had no adverse events associated with the therapy. The diagnostic assessment and treatment does not differ from pregnancies with a single fetus. One or both newborns may be compromised. Multidisciplinary monitoring is essential for the early detection of reactivations or progression of lesions.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Complicações Infecciosas na Gravidez , Toxoplasma , Toxoplasmose Congênita , Complicações Parasitárias na Gravidez , Anticorpos AntiprotozoáriosRESUMO
Etiología en la diarrea aguda. Manifestaciones clínicas. Tratamiento
