Difficulties observed in a reference center in the diagnosis and management of pregnant women with toxoplasmosis
AbstractOBJECTIVES: To evaluate the difficulties met in the care of pregnant women with toxoplasmosis diagnosis in antenatal care services. METHODS: Longitudinal prospective study with 262 pregnant women referred to the Toxoplasmosis Clinic at Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, between January 2005 and July 2009. RESULTS: Most women (91.2%) were in the second and third trimesters of pregnancy, and 81.3% were referred by public health services. The average delay was 113.4 days in the collection of the first sample for serological tests in antenatal care, 52.1 days for referral and 160.6 days in starting treatment. Younger women and those from the public health system were referred later. Treatment was initiated at the origin for only 16% of the pregnant women, and 5% of these did not receive the recommended dose of spiramycin. At the Reference Center there was a low rate of confirmation of the serological tests performed in the health services of origin. It was found that 12.6% of pregnant women with an initial diagnosis of acute toxoplasmosis were susceptible to infection by Toxoplasma gondii. These tests were considered false positives. CONCLUSIONS: This study highlights the difficulties met in the management of pregnant women with toxoplasmosis in the antenatal care, including the quality of diagnostic tests and the need for greater emphasis on continuing education of health professionals.
Desmonts G, Couvreur J. Toxoplasmosis in pregnancy and its transmission to the fetus. Bull N Y Acad Med.1974;50:146-59.
Kimball AC, Kean BH, Fuchs F. Congenital toxoplasmosis: a prospective study of 4,048 obstetric patients. Am J Obstet Gynecol. 1971;111:211-8.
Stray-Pedersen B. A prospective study of acquired toxoplasmosis among 8,043 pregnant women in the Oslo area. Am J Obstet Gynecol. 1980;136:399-406.
Guerina NG, Hsu HW, Meissner HC, et al. Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection. The New England Regional Toxoplasma Working Group. N Engl J Med. 1994;330:1858-63.
Wilson CB, Remington JS, Stagno S, et al. Development of adverse sequelae in children born with subclinical congenital Toxoplasma infection. Pediatrics. 1980; 66:767-74.
Koppe JG, Loewer-Sieger DH, de Roever-Bonnet H. Results of 20-year follow-up of congenital toxoplasmosis. Lancet. 1986;1:254-6.
Montoya JG, Remington JS. Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis. 2008;47:554-66.
Naot Y, Desmonts G, Remington JS. IgM enzyme-linked immunosorbent assay test for the diagnosis of congenital Toxoplasma infection. J Pediatr. 1981;98:32-6.
Montoya JG. Laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis. J Infect Dis. 2002;185(Suppl 1):s73-82.
Siegel JP, Remington JS. Comparison of methods for quantitating antigen-specific immunoglobulin M antibody with a reverse enzyme-linked immunosorbent assay. J Clin Microbiol.1983;18:63-70.
Sabin AB, A. FH. Dyes as microchemical indicators of a new immunity phenomenon affecting a protozoan parasite (Toxoplasma). Science.1948;10:660-3.
Liesenfeld O, Press C, Montoya JG, et al. False-positive results in immunoglobulin M (IgM) toxoplasma antibody tests and importance of confirmatory testing: the Platelia Toxo IgM test. J Clinical Microbiol. 1997;35:174-8.
Gilbert R, Gras L. Effect of timing and type of treatment on the risk of mother to child transmission of Toxoplasma gondii. BJOG. 2003;110:112-20.
The SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group, Thiebaut R, Leproust S, et al. Effectiveness of prenatal treatment for congenital toxoplasmosis: a metanalysis of individual patients’ data. Lancet. 2007;369:115-22.
Gras L, Wallon M, Pollak A, et al. Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: a cohort study in 13 European centres. Acta Paediatr. 2005;94:1721-31.
Gras L, Gilbert RE, Ades AE, et al. Effect of prenatal treatment on the risk of intracranial and ocular lesions in children with congenital toxoplasmosis. Int J Epidemiol. 2001;30:1309-13.
Fernandes GC, Azevedo RS, Amaku M, et al. Seroepidemiology of Toxoplasma infection in a metropolitan region of Brazil. Epidemiol Infect. 2009;137:1809-15.
Barbosa IR, de Carvalho Xavier Holanda CM, de Andrade-Neto VF. Toxoplasmosis screening and risk factors amongst pregnant females in Natal, northeastern Brazil. Trans R Soc Trop Med Hyg. 2009;103:377-82.
Haidar FH, Oliveira UF, Nascimento LF. Maternal educational level: correlation with obstetric indicators. Cad Saúde Pública. 2001;17:1025-9.
Puccini RF, Pedroso GC, da Silva EM, et al. Prenatal and childbirth care equity in an area in Greater Metropolitan Sao Paulo, 1996. Cad Saúde Pública. 2003;19:35-45.
Paredes I, Hidalgo L, Chedraui P, et al. Factors associated with inadequate prenatal care in Ecuadorian women. Int J Gynaecol Obstet. 2005;88:168-72.
Carellos EV, Andrade GM, Aguiar RA. Evaluation of prenatal screening for toxoplasmosis in Belo Horizonte, Minas Gerais State, Brazil: a cross-sectional study of postpartum women in two maternity hospitals. Cad Saúde Pública. 2008;24:391-401.
Jones JL, Dietz VJ, Power M, et al. Survey of obstetrician-gynecologists in the United States about toxoplasmosis. Infect Dis Obstet Gynecol. 2001;9:23-31.
Giles ML, Pedrana A, Jones C, et al. Antenatal screening practice for infectious diseases by general practitioners in Australia. Aust N Z J Obstet Gynaecol. 2009; 49:39-44.
Ashburn D, Evans R, Skinner LJ, et al. Comparison of relative uses of commercial assays for Toxoplasma gondii IgM antibodies. J Clin Pathol. 1992;45:483-6.
Del Bono V, Canessa A, Bruzzi P, et al. Significance of specific immunoglobulin M in the chronological diagnosis of 38 cases of toxoplasmic lymphadenopathy. J Clin Microbiol. 1989;27:2133-5.
Bobic B, Sibalic D, Djurkovic-Djakovic O. High levels of IgM antibodies specific for Toxoplasma gondii in pregnancy 12 years after primary toxoplasma infection: case report. Gynecol Obstet Invest. 1991;31:182-4.
The submission of originals to Scientia Medica implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Scientia Medica as the site of original publication.
Creative Commons License
Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.