Birth prevalence and characteristics of congenital toxoplasmosis in Sergipe, North‐east Brazil

• Published in: Tropical medicine & international health 2012-11, Vol.17 (11), p.1349-1355
• Main Authors: de Melo Inagaki, Ana Dorcas, Carvalheiro, Cristina Gardonyi, Cipolotti, Rosana, Gurgel, Ricardo Queiroz, Rocha, Dayse Alves, Pinheiro, Kariny Souza, Araújo, Raquel Melo, Lima, Dorothy Ribeiro Resende, Winandy, Jacques Leon, Mussi‐Pinhata, Marisa Márcia
• Format: Article
• Language: English
• Subjects: Antibodies, Protozoan - blood; Antiprotozoal Agents - therapeutic use; Biological and medical sciences; Brazil - epidemiology; Congenital toxoplasmosis; cribado neonatal; dépistage néonatal; General aspects; heel prick test; Human protozoal diseases; Humans; Immunoglobulin M - blood; Infant; Infant, Newborn; infecciones perinatales; infections périnatales; Infectious diseases; Leucovorin - therapeutic use; Medical sciences; neonatal screening; Neonatal Screening - methods; Parasitic diseases; perinatal infections; Protozoal diseases; prueba del Talón; Pyrimethamine - therapeutic use; Sulfadiazine - therapeutic use; test de Guthrie; Toxoplasma - isolation & purification; Toxoplasma gondii; toxoplasmose congénitale; Toxoplasmosis; toxoplasmosis congénita; Toxoplasmosis, Congenital - diagnosis; Toxoplasmosis, Congenital - drug therapy; Toxoplasmosis, Congenital - epidemiology
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2012.03079.x

Objectives  To estimate, by neonatal screening, the birth prevalence of congenital toxoplasmosis among live‐born infants in Sergipe state, Brazil, and to investigate the clinical features of affected infants. Methods  Dried blood spot specimens obtained from 15 204 neonates were assayed for the presence of anti‐T. gondii IgM antibodies. Duplicate retesting was done in infants with positive and borderline results. Confirmatory testing in peripheral blood samples consisted of testing for anti‐T. gondii IgG and IgM in infants and mothers. Those with possible congenital toxoplasmosis were evaluated and followed up to a median age of 20 months. Congenital infection was confirmed in the presence of persisting anti‐T. gondii IgG antibodies beyond 12 months of age. All infants with confirmed infection were treated with pyrimethamine, sulfadiazine and folinic acid for 1 year. Results  Fifty‐three infants had detectable IgM in dried blood spot specimens. Confirmatory testing was reactive in 39/50, of which, 38 completed follow‐up. Six of 15 204 newborns were diagnosed with congenital toxoplasmosis, resulting in an estimated birth prevalence of four per 10 000 [CI 95% 1.4–8.0]. Four infants (67%) showed signs of congenital toxoplasmosis in their first year of life; three (75%) had retinochoroidal scars, and one had cerebral calcifications. Two infants remained asymptomatic until 20 months of age. Conclusions  The birth prevalence of congenital toxoplasmosis is high in the Brazilian state of Sergipe, with most of the infants showing ocular lesions. Preventive measures are strongly warranted. Objectifs:  Estimer par le dépistage néonatal, la prévalence à la naissance de la toxoplasmose congénitale chez les enfants nés vivants dans l’état de Sergipe, au Brésil et étudier les caractéristiques cliniques des nourrissons atteints. Méthodes:  Des spécimens séchés de goutte de sang obtenus à partir de 15.204 nouveau‐nés ont été testés pour la présence d’anticorps IgM anti T. gondii. Un second test a été effectué chez les nourrissons ayant des résultats positifs et intermédiaires. Les tests de confirmation sur les échantillons de sang périphérique ont consistéà tester pour les anticorps IgG et IgM anti T. gondii chez les nourrissons et les mères. Ceux atteints d’une éventuelle toxoplasmose congénitale ont étéévalués et suivis jusqu’à un âge médian de 20 mois. L’infection congénitale a été confirmée dans la présence de la persistance d’anticorps IgG anti T. gondii au delà de l’