Recém-nascidos com risco de toxoplasmose congênita, revisão de 16 anos

Autores

  • Joana Verdelho Andrade Centro Hospitalar Tondela-Viseu E.P.E. http://orcid.org/0000-0002-7128-2821
  • Catarina Resende Centro Hospitalar Tondela-Viseu E.P.E.
  • Joana Campos Centro Hospitalar Tondela-Viseu E.P.E.
  • Cristina Batista Centro Hospitalar Tondela-Viseu E.P.E.
  • Cristina Faria Centro Hospitalar Tondela-Viseu E.P.E.
  • Cecília Figueiredo Centro Hospitalar Tondela-Viseu E.P.E.
  • Vitor Bastos Centro Hospitalar Tondela-Viseu E.P.E.
  • Nuno Andrade Centro Hospitalar Tondela-Viseu E.P.E.
  • Isabel Andrade Centro Hospitalar Tondela-Viseu E.P.E.

DOI:

https://doi.org/10.15448/1980-6108.2018.4.32169

Palavras-chave:

transmissão vertical de doença infecciosa, toxoplasmose congênita, coriorretinite, estudos transversais, prevalência.

Resumo

OBJETIVOS: Analisar os dados de gestações com risco de toxoplasmose congênita e investigar a evolução dos recém-nascidos, em um hospital de nível II em Portugal.

MÉTODOS: Um estudo transversal retrospetivo incluiu recém-nascidos com risco de toxoplasmose congênita e suas mães, cujo parto ocorreu entre janeiro de 2000 e dezembro de 2015. Os critérios de inclusão foram mãe com soroconversão para toxoplasmose durante a gestação ou primeira amostra sérica com IgM e IgG específicas positivas. O diagnóstico de toxoplasmose congênita foi definido por IgM específica positiva ao nascimento e/ou reação em cadeia da polimerase positiva no líquido amniótico e/ou persistência de IgG específica até os 12 meses de vida. A toxoplasmose congênita foi definida como sintomática quando os achados clínicos foram atribuídos à doença. Os testes Qui-quadrado ou Exato de Fisher foram usados para testar associações entre variáveis, assumindo-se significado estatístico quando p<0,05.

RESULTADOS: Ocorreram 39.585 nascimentos vivos no período em estudo e foram identificados 98 casos com risco de toxoplasmose congênita, dos quais 89 completaram o seguimento. A prevalência de IgG para T. gondii nas gestantes foi de 26% (intervalo de confiança [IC] 95% 24-27%). Foram confirmados 22 casos de toxoplasmose congênita (5,6 por 10.000 nascidos vivos, IC95% 3,5-8,5 por 10.000). Dos 22 recém-nascidos, 18 (82%, IC95% 61-93%) eram sintomáticos. Os achados clínicos mais frequentes foram calcificação intracraniana (64%), hepatomegalia e/ou elevação das transaminases (32%) e retinocoroidite (14%). As lesões cerebrais foram mais frequentes quando a infeção materna foi documentada no primeiro e segundo trimestres em comparação com o terceiro (p=0,018). Em 31 casos (35%), as gestantes foram tratadas desde o momento do diagnóstico até o parto com espiramicina, não se tendo encontrado diferenças relativamente à taxa de transmissão vertical ou ao aparecimento de manifestações clínicas entre os recém-nascidos de mães tratadas e não tratadas.

CONCLUSÕES: A prevalência de toxoplasmose congênita foi superior à reportada em outros países da Europa. A prevalência de calcificações intracranianas foi maior do que a descrita na literatura, enquanto que a de retinocoroidite e estrabismo foi menor. As alterações cerebrais nos recém-nascidos foram mais frequentes nas infecções de primeiro e segundo trimestre. Não houve diferença na taxa de transmissão vertical e na ocorrência de manifestações clínicas entre os recém-nascidos cujas mães receberam espiramicina na gestação ou não receberam tratamento.

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Publicado

2018-12-21

Como Citar

Andrade, J. V., Resende, C., Campos, J., Batista, C., Faria, C., Figueiredo, C., Bastos, V., Andrade, N., & Andrade, I. (2018). Recém-nascidos com risco de toxoplasmose congênita, revisão de 16 anos. Scientia Medica, 28(4), ID32169. https://doi.org/10.15448/1980-6108.2018.4.32169

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