Malaria congénita por Plasmodium falciparum / Congenital malaria by Plasmodium falciparum

INTRODUCCIÓN: La malaria congénita (MC) es la infección por Plasmodium spp adquirida in útero o durante el parto y sus manifestaciones clínicas son inespecíficas. Puede causar enfermedad grave en la embaraza da y en el recién nacido. OBJETIVO: describir dos casos de MC causados por Plasmodium falciparum, diagnóstico diferencial de sepsis en recién nacidos de gestantes que hayan visitado o residan en áreas endémicas para malaria. CASOS CLÍNICOS: Neonatos de sexo femenino, nacidos en área no endémica para malaria, diagnosticados con sepsis neonatal y tratados con antibióticos sin respuesta clínica. Después de la primera semana de vida la gota gruesa identificó trofozoítos de Plasmodium falciparum y los neonatos recibieron tratamiento con quinina intravenosa con mejoría. Las madres de las recién nacidas tuvieron malaria en el embarazo, una de ellas recibió tratamiento y estaba asintomática y otra tenía malaria complicada al momento del parto. CONCLUSIONES: La MC puede causar enfermedad neonatal grave con manifestaciones clínicas inespecíficas y similares a la sepsis, el tratamiento oportuno disminuye el riesgo de malaria complicada. Es un diagnóstico diferencial en recién nacidos de mujeres con malaria durante el embarazo o gestantes que visiten o residan en áreas endémicas.

INTRODUCTION: Congenital malaria (CM) is a Plasmodium spp infection acquired in utero or during delivery with nonspecific clinical manifestations. Plasmodium falciparum can cause severe illness in pregnant wo men and newborns. OBJECTIVE: to describe two cases of CM caused by Plasmodium falciparum, di fferential diagnosis of sepsis in newborns of pregnant women who live in or have visited endemic malaria zones. CLINICAL CASES: Female neonates born in a non-endemic malaria area, diagnosed with neonatal sepsis and treated with antibiotics without clinical response. After the first week of life, the peripheral blood smear identified trophozoites of Plasmodium falciparum thus the newborns were treated with intravenous quinine, improving their condition. The mothers of the two newborns who had malaria in pregnancy, one of them received treatment and she was asymptomatic, and the other one had severe malaria at the time of delivery. CONCLUSIONS: CM can cause severe neonatal disease with non-specific, sepsis-like clinical manifestations in which early treatment decreases the risk of complicated malaria. It is a differential diagnosis in newborns of women with a history of malaria during pregnancy or pregnant women visiting or living in endemic malaria areas.

Visceral leishmaniasis in pregnant women from Rio Grande do Norte, Brazil: A case report and literature review

Abstract Visceral leishmaniasis (VL) in pregnant is considered rare. We present the case of a woman with 24 gestational weeks presenting fever, hepatosplenomegaly, pancytopenia, and inversion of albumin/globulin ratio. Anti-rK39 was positive and amastigotes were visualized on myelogram. Treatment with LAmB showed disease improvement. The newborn was born healthy at term, with delivery performed without complications. As VL in pregnancy can progress to death and complications for the mother-fetus binomial, inclusion of VL in the differential diagnosis of patients from endemic areas with compatible clinical picture is mandatory. Treatment with LAmB demonstrates safety and high cure rates in pregnancy.

Prevention of congenital Chagas through treatment of girls and women of childbearing age

It is currently unknown whether treatment of Chagas disease decreases the risk of congenital transmission from previously treated mothers to their infants. In a cohort of women with Chagas disease previously treated with benznidazole, no congenital transmission of the disease was observed in their newborns. This finding provides support for the treatment of Chagas disease as early as possible.

Uneventful benznidazole treatment of acute Chagas disease during pregnancy: a case report

This report describes the case of a patient with acute Chagas disease in Tocantins, Brazil, who was unaware of her pregnancy during benznidazole treatment. She presented with impaired cardiac function during the acute phase (pericarditis and incomplete right bundle-branch block) that resolved favorably after benznidazole therapy. Serological results also became negative, as determined by hemagglutination assays, enzyme-linked immunosorbent assays, and immunofluorescence assays. The child was born without sequelae and showed no evidence of congenital Trypanosoma cruzi infection at birth or 24 days later.

Plasmodium falciparum infection in pregnant women attending antenatal care in Luanda, Angola / Infecção por Plasmodium falciparum em mulheres grávidas em consultas pré-natal em Luanda, Angola

INTRODUCTION: Malaria during pregnancy remains a serious public health problem. The aim of this study was to establish the prevalence and possible risk factors for malaria in pregnant women attending antenatal care at Augusto Ngangula Specialized General Hospital in Luanda, Angola. METHODS: Pregnant women (679 total) who attended antenatal care from April to September 2008 were included in the study after signing informed consent. For each participant, the social-demographic profile and malaria and obstetric histories were investigated via a questionnaire. Diagnosis was made by optic microscopy, and hemoglobin concentration measured. The associations between age, parity, gestational age, residence, schooling, malaria during gravity, anemia and treatment with incidence of Plasmodium falciparum infection were analyzed through logistic regression. RESULTS: During the period of study, 74 (10.9%) out of 679 women were infected by P. falciparum. The average concentration of hemoglobin was 11.1 ± 0.07g/dL, and there were significant associations between the history of malaria during pregnancy, P. falciparum infection (p<0.01) and anemia at the time of observation (p<0.001). CONCLUSIONS: Previous history of malaria during pregnancy represents a risk factor for current infection and anemia was an important complication associated with malaria, even in women who were treated with sulfadoxine-pyrimethamine during pregnancy.

INTRODUÇÃO: A malária na gravidez continua a ser um grave problema de saúde pública. O objetivo deste estudo foi determinar a prevalência e possíveis fatores de risco para a malária, em mulheres grávidas que foram atendidas em consultas pré-natal, no Hospital Geral Especializado Augusto Ngangula, em Luanda, Angola. MÉTODOS: De abril a setembro de 2008, 679 mulheres grávidas foram envolvidas no estudo após consentimento informado. O perfil sócio demográfico e história de malária e obstetrícia foram investigados através de um questionário. O diagnóstico foi efetuado por microscopia óptica e determinou-se ainda as concentrações da hemoglobina. Através da regressão logística foi analisada a associação entre a idade, paridade, tempo de gestação, residência, escolaridade, malária durante a gravidez, anemia e tratamento com a infecção por Plasmodium falciparum. RESULTADOS: Setenta e quatro (10,9%) das 679 mulheres estavam infectadas com P. falciparum. O valor médio da concentração da hemoglobina foi de 11,1 ± 0,07g/dL, encontrando-se uma associação significativa entre história de malária na gravidez e infecção por P. falciparum (p<0,01) e anemia no momento da observação (p<0.001). CONCLUSÕES: A história de malária anterior na gravidez foi um fator de risco para uma infecção atual e a anemia uma complicação importante associada à malária, mesmo em mulheres que receberam tratamento durante a gravidez com sulfadoxina-pirimetamina.

Neurocisticercosis: una enfermedad desatendida en Chile / Neurocysticercosis: an neglected disease in Chile

Neurocysticercosis (NCC) is not a notifiable disease in Chile and has received little attention on the national medical literature. In order to evaluate the relevance and clinical features of the disease, we performed a retrospective analysis in a general hospital of five cases of NCC during a 11 years period. Age ranged from 3 to 63 years and all had history of living or visiting southern Chile. Three patients had a solitary parenchymal cyst in vesicular or granulomatous stages and presented with generalized seizures. Their outcome was favorable after anticonvulsant and albendazole therapy and cysts reduced in size and calcified during follow-up. The other 2 patients had extra-parenchymal or mixed forms, including a pregnant woman with intraventricular cysts who developed endocraneal hypertension and recurrent dysfunction of her ventriculoperitoneal shunt. This patient died after discharge despite an initial favorable evolution with steroids and high-dose albendazole. This case series showed that NCC is still an epidemiological and clinical problem in Chile, affects patients within a wide range of age including children, requires multidisciplinary therapeutic interventions, and has two clinical presentations with different prognosis including one malignant form. To control this infection, a surveillance or reporting system should be initiated.

La neurocisticercosis (NCC) no es una enfermedad de notificación obligatoria en Chile y ha recibido poca atención en la literatura médica local. Para evaluar su importancia y perfil clínico se hizo un análisis retrospectivo en un hospital general. Cinco casos de NCC fueron identificados en un período de 11 años. El rango de edad fue de 3 a 63 años y todos tenían antecedentes de visita o residencia en el sur del país. Tres pacientes tenían quistes únicos parenquimatosos en etapas granulomatosas o vesiculares y se presentaron con convulsiones generalizadas. Su evolución fue favorable con terapia anticonvulsivante y albendazol y los quistes se redujeron de tamaño y calcificaron durante el seguimiento. Los otros pacientes presentaron formas extra-parenquimatosas o mixtas e incluían a una mujer embarazada con quistes intraven-triculares quien desarrolló hipertensión endocraneana y disfunción recurrente de su válvula. Ella falleció después del alta a pesar de una evolución inicial favorable con corticoesteroides y albendazol. La NCC es un problema vigente en nuestro país pero de epidemiología desconocida, afecta a un amplio grupo etario, requiere múltiples intervenciones terapéuticas y presenta dos formas de diferente pronóstico, una de ellas maligna. Para controlarla es necesario incluirla en las enfermedades notificables.

Profile of pregnant women and children treated at a reference center for congenital toxoplasmosis in the northern state of Minas Gerais, Brazil / Perfil de mulheres grávidas e crianças atendidas em um centro de referência para toxoplasmose congênita no norte do estado de Minas Gerais, Brasil

INTRODUCTION: To describe the clinical and epidemiological profile of pregnant women and children treated at a reference outpatient clinic for congenital toxoplasmosis. METHODS: Pregnant women potentially exposed to Toxoplasma gondii were observed. Diagnoses were made using serologic tests compatible with acute toxoplasmosis. Children presenting with: Toxoplasma-specific antibodies (IgM or IgA or ascending IgG titers higher than maternal titers in the first 3 months of life) coupled with toxoplasmosis symptoms; intracranial calcifications (by transfontanelar ultrasound or cephalic segment tomography); or retinochoroiditis (by fundoscopy examination) in the first 8 months of life were also included in the study. RESULTS: Fifty-eight mother-child pairs were observed (mean age of the mothers was 22.1 years). Most patients lived in urban areas (86.2 percent) and had attended less than 8 years of school (51.7 percent). Diagnosis was made after birth in 19 (32.8 percent) children. Thirty-four (58.6 percent) women received some type of treatment during pregnancy. Most (72.4 percent) of the children did not present with clinical alterations at birth. The main findings were ophthalmological: 20 (34.5 percent) children with retinochoroiditis, 17 (29.3 percent) with strabismus, and 7 (12.1 percent) with nystagmus. Of the children with retinochoroiditis, 9 presented with subnormal vision. Ten (32.3 percent) out of 31 children presented with intracranial calcifications by cephalic segment congenital toxoplasmosis, and 9 (42.9 percent) children presented with delayed psychomotor development. CONCLUSIONS: Our results highlight a critical situation. Protocols for follow-up of pregnant women and their children must be created to improve medical care and minimize sequelae.

INTRODUÇÃO: Descrever o perfil clínico e epidemiológico de gestantes e crianças atendidas em um centro de referência para toxoplasmose congênita. MÉTODOS: Gestantes potencialmente expostas ao Toxoplasma gondii foram estudadas. Os diagnósticos foram feitos através de testes sorológicos compatíveis com toxoplasmose aguda. Crianças que apresentaram anticorpos específicos (IgM e IgA ou títulos ascendentes de IgG, superiores aos títulos maternos nos primeiros três meses de vida), juntamente com os sintomas da toxoplasmose, calcificações intracranianas (ultrassom transfontanela ou tomografia do segmento cefálico), ou retinocoroidite (fundoscopia) nos primeiros oito meses de vida, também foram estudadas. RESULTADOS: Foram estudados 58 pares mãe-filho (a média de idade das mães foi de 22,1 anos). A maioria (86,2 por cento) das mães residia em áreas urbanas e tinham até 8 anos de escolaridade (51,7 por cento). O diagnóstico foi feito após o nascimento para 19 (32,8 por cento) crianças; 34 (58,6 por cento) mulheres receberam algum tipo de tratamento durante a gravidez. A maioria (72,4 por cento) das crianças não apresentou alterações clínicas ao nascimento. Os principais achados foram oftalmológicos: 20 (34,5 por cento) crianças com retinocoroidite, 17 (29,3 por cento) com estrabismo e 7 (12,1 por cento) com nistagmo. Das crianças com retinocoroidite, 9 apresentaram visão subnormal. Calcificações intracranianas estiveram presentes em 10 (32,3 por cento) das 31 crianças que realizaram toxoplasmose congênita de segmento cefálico e 9 (42,9 por cento) crianças apresentaram atraso do desenvolvimento psicomotor. CONCLUSÕES: Os resultados mostram uma situação crítica. Protocolos para acompanhamento de gestantes e seus filhos devem ser criados para melhorar o atendimento médico e minimizar sequelas.

Áscaris lumbricoides en el corazón de una gestante / Presence of Ascaris lumbricoides in the heart of a pregnant woman

El áscaris es el nematodo de mayor tamaño que parasita al hombre; es un helminto dioico (sexos separados). Su prevalencia se debe fundamentalmente a la contaminación fecal del suelo y a la capacidad de supervivencia de los huevos. Los adultos de áscaris lumbricoides se localizan en el intestino delgado, aunque algunas veces puede haber migraciones erráticas de parásitos adultos a lugares como el hígado, peritoneo, riñones, etc. Describir la forma de presentación del parasitismo intestinal por áscaris lumbricoides en una embarazada, actualizar e informar sobre el parasitismo intestinal, mostrar la experiencia en el manejo de un caso de difícil diagnóstico y transmitir conocimientos, contribuir a la docencia médica, son los objetivos de esta presentación. Se realizó una revisión bibliográfica sobre el parasitismo intestinal, específicamente del áscaris lumbricoides partiendo de la existencia de un caso obstétrico portadora de manifestaciones cardiovasculares importantes y de difícil manejo, por lo que se revisó exhaustivamente la historia clínica de dicha paciente en los 2 hospitales en los cuales estuvo ingresada. Paciente portadora de una gestación de 12 sem que acude con manifestaciones respiratorias y cardiovasculares, la primera impresión diagnóstica fue de una miocarditis o miocardiopatías, después de concluir estudios pertinentes se concluye como portadora de áscaris lumbricoides en corazón derecho y además se complica con un tromboembolismo pulmonar. A pesar de ser infrecuente en nuestros días, debemos pensar en el parasitismo como una explicación a ciertas sintomatologías de extraña presentación clínica

The ascaris is the higher nematode to parasitizes the man; it is dioecious helminths (having separate sexes). Its prevalence is due mainly to soil fecal contamination and to survival ability of eggs. The adult Ascaris lumbricoides are located in the small bowel, although some times may be erratic migrations of adult parasites to places like the liver, peritoneum, kidneys, etc. The aim of present paper is to describe the presentation way of intestinal parasitism by Ascaris lumbricoides in a pregnant woman, to update and to inform on the intestinal parasitism, to show the experience in the management of a case of difficult diagnosis and to transmit the knowledges, and to contribute to medical teaching. A bibliographic review on the intestinal parasitism was made, specifically of Ascaris lumbricoides from the existence of a obstetric case carrier of significant cardiovascular manifestations and of a difficult management, thus we made an exhaustive review of medical record of this patient in the two hospitals where she was admitted. A patient with 12 weeks pregnancy to come to consultation due to respiratory and cardiovascular manifestations, the first diagnostic impression was a myocarditis or myocardiopathies. After conclude the pertinent studies she is classified as a Ascaris lumbricoides carrier in right heart and that also it is complicated with a pulmonary thromboembolism. Despite this condition is infrequent nowadays, we must to think about the parasitism like an explanation for some symptomatology of a rare clinical presentation

Toxoplasmose congênita em filho de mãe cronicamente infectada com reativação de retinocoroidite na gestação / Congenital toxoplasmosis from a chronically infected woman with reactivation of retinochoroiditis during pregnancy an underestimated event?

Objetivo: Apresentar um caso raro de toxoplasmose congênita de uma mãe imunocompetente com infecção crônica que teve reativação da doença ocular durante a gestação. Descrição: O recém-nascido estava assintomático no nascimento e foi identificado através de triagem neonatal (IgM anti-Toxoplasma gondii em sangue seco) entre outros 190 bebês com toxoplasmose congênita durante um período de 7 meses. Sua mãe tinha tido um episódio não tratado de reativação de retinocoroidite toxoplásmica durante a gestação, com títulos de IgG estáveis e resultados negativos para IgM. Os resultados de IgM e IgG no soro do recém-nascido e o teste de immunoblotting para IgG foram positivos, e detectou-se lesões retinocoroideanas ativas na periferia da retina. O recém-nascido foi tratado com sulfadiazina, pirimetamina e ácido folínico. Aos 14 meses de vida, a criança permanecia assintomática, com regressão das lesões retinocoroideanas e persistência de IgG. Comentários: É possível que a triagem neonatal sistemática em áreas com alta prevalência de infecção possa identificar esses casos.

Objectives: To report a rare case of congenital toxoplasmosis from an immunocompetent mother with chronic infection who had reactivation of ocular disease during pregnancy. Descriptions:The newborn was asymptomatic at birth and identified by neonatal screening (IgM anti-Toxoplasma gondii in dried blood) among other 190 infants with congenital toxoplasmosis during a 7-month period. His mother had had a non-treated episode of reactivation of toxoplasmic retinochoroiditis during pregnancy, with stable IgG titers and negative IgM results. Results of IgM and IgG in the newborn’s serum, as well as IgG immunoblotting were positive and active retinochoroidal lesions were detected in his peripheral retina. The neonate was treated with sulfadiazine, pyrimethamine and folinic acid. At 14 months of life, the child remained asymptomatic, with regression of retinochoroidal lesions and persistence of IgG. Comments: It is possible that systematic neonatal screening in areas with high prevalence of infection may identify these cases.

Etiological treatment of young women infected with Trypanosoma cruzi, and prevention of congenital transmission / Tratamento etiológico de mulheres jovens infectadas com Trypanosoma cruzi e prevenção da transmissão congênita

The objective was to detect Trypanosoma cruzi infection in 32 children in Salta, Argentina, born to 16 chronically infected young women who were treated with benznidazole. Tests were performed to assess the efficacy of treatment after 14 years. At the end of the follow up, 87.5 percent of the women were non-reactive to EIA tests, 62.5 percent to IHA and 43.8 percent to IFA. 62.5 percent of the women were non-reactive according to two or three serological tests. No infected children were detected among the newborns of mothers treated before their pregnancy.

O objetivo foi detectar a infecção do Trypanosoma cruzi em 32 crianças nacidas de 16 jovens mulheres cronicamente infectadas e tratadas com benzinadol, em Salta, Argentina. Testes foram feitos para avaliar a eficácia após 14 anos do tratamento. Ao final do seguimento 87.5 por cento das mulheres foram não reativas ao EIA, 62.5 por cento ao IHA e 43.8 por cento ao IFA. 62.5 por cento das mulheres foram não reativas de acordo a 3 ou 2 testes serológicos. Nenhuma criança infectada foi detectada entre os recém-nascidos de mães tratadas antes da gravidez.

When are we going to celebrate the centenary of the discovery of efficient treatment for congenital toxoplasmosis?

In 2008, we have celebrated the centenary of the discovery of Toxoplasma gondii.Although this ubiquitous protozoan can generate devastating damage in foetuses and newborns, its treatment is the only field in which we have made little progress, despite a huge body of research, and has not yet been validated. Pregnant women who seroconvert are generally given spiramycine in order to reduce the risk of vertical transmission. However, to date, we have no evidence of the efficacy of this treatment because no randomized controlled trials have as yet been conducted. When foetal contamination is demonstrated, pyrimethamine, in association with sulfadoxine or sulfadiazine, is normally prescribed, but the effectiveness of this treatment remains to be shown. With regard to postnatal treatment, opinions vary considerably in terms of drugs, regimens and length of therapy. Similarly, we do not have clear evidence to support routine antibiotic treatment of acute ocular toxoplasmosis. We must be aware that pregnant women and newborns are currently being given empirically potentially toxic drugs that have no proven benefit. We must make progress in this field through well-designed collaborative studies and by drawing the attention of policy makers to this disastrous and unsustainable situation.

Why prevent, diagnose and treat congenital toxoplasmosis?

Evidence that prevention, diagnosis and treatment of toxoplasmosis is beneficial developed as follows: anti-parasitic agents abrogate Toxoplasma gondiitachyzoite growth, preventing destruction of infected, cultured, mammalian cells and cure active infections in experimental animals, including primates. They treat active infections in persons who are immune-compromised, limit destruction of retina by replicating parasites and thereby treat ocular toxoplasmosis and treat active infection in the fetus and infant. Outcomes of untreated congenital toxoplasmosis include adverse ocular and neurologic sequelae described in different countries and decades. Better outcomes are associated with treatment of infected infants throughout their first year of life. Shorter intervals between diagnosis and treatment in utero improve outcomes. A French approach for diagnosis and treatment of congenital toxoplasmosis in the fetus and infant can prevent toxoplasmosis and limit adverse sequelae. In addition, new data demonstrate that this French approach results in favorable outcomes with some early gestation infections. A standardized approach to diagnosis and treatment during gestation has not yet been applied generally in the USA. Nonetheless, a small, similar experience confirms that this French approach is feasible, safe, and results in favorable outcomes in the National Collaborative Chicago-based Congenital Toxoplasmosis Study cohort. Prompt diagnosis, prevention and treatment reduce adverse sequelae of congenital toxoplasmosis.

Ocular toxoplasmosis: an update and review of the literature

Ocular toxoplasmosis is the most common cause of posterior uveitis worldwide. The infection can be acquired congenitally or postnatally and ocular lesions may present during or years after the acute infection occur. Current treatment controls ocular infection and inflammation, but does not prevent recurrences. We present a review and update on ocular toxoplasmosis and address misconceptions still found in the current medical literature.

Prenatal screening for congenital toxoplasmosis in Campania: preliminary report on activities and results

By 1997, an open cohort of 1,652 live newborn of 1,637 mothers with gestational toxoplasmosis had been recruited in the Campania region to monitor the burden of congenital toxoplasmosis (CT). Of the 1,556 mother-child pairs that completed the follow up, 92 definite cases were detected, yielding a 5.9 percent (4.8-7.1 95 percent CI) transmission rate. The onset was patent for 43 percent of patients and sensorineural complications were shown for a further 15 percent of subclinical onset patients later than two years of age. The overall prevalence of toxoplasmosis during gestation was 2.46 of 1,000 deliveries, while the prevalence of definite CT was 1.38 of 10,000 live newborns. However, there is still room for intervention, as only 23 percent of the maternal diagnoses were proven through seroconversion, 63 of the late-gestation seroconverters remained untreated, and six probable CT diagnoses were made following referrals due to patent sequelae and born during the study period. There was a positive secular trend on the rates of infant referral and definite CT diagnosis, according to the live birth rate (Ç2 for trend < 0.001). Extension of this surveillance system across the country could help to define a future strategy for prevention.

Management of malaria: recent trends.

In the present day scenario of resurgence of infectious diseases, malaria compounded with problems of multi drug resistance, assumes paramount importance. A combination of artemisinine derivatives with other effective anti-malarial drug remains the most effective form of treatment against the falciparum malaria which is most lethal form of disease. Oral chloroquin in the dose of 25 mg base/kg over 48 hours is effective in infections due to P. vivax, P. ovale P. malariae and chloroquine sensitive P. Falciparum. For chloroquine resistant P. vivax and multidrug resistant falciparum malaria, a combination of Quinine with doxycycline or clindamycin for 5-7 days, Quinine with singlt dose sulfadoxine-pyrimethamine combination. Mefloquine with artemeter or artesunate for 3 days, artesunate with doxycycline or clindamycin for 7 days and Otovaquin with proguanil for 3 days have been found to be effective. Primiquin as a hypnozoticide for 5-10 days is mandatory for preventing relapse in cases of P. vivax, P. Ovale and P. malariae. Death due to complicated malaria can be as high as 75% if case diagnosis is delayed or the patient arrives late. The artemisinine based rectal suppositories can be very effective in home/village setting in patients who can not be given oral anti malarial, though not yet approved for use in our country. In ICU settings, properly administered loading dose of quinine has proved to be effective and safe in almost all therapeutic trials including our study on Indian patients. Frequent blood glucose monitoring is mandatory. Parentral artemisinine with oral mefloquine is an effective alternative to quinine based therapy. The cerebral malaria management in the ICU setting includes monitoring fluid and electrolyte balance so as to maintain a CVP of 5 cm of water and pulmonary arterial occlusive pressure at less than 15 mm of mercury. In renal failure haemofiltration is ideal. Mefloquine is safe in second and third trimester of pregnancy. Exchange transfusion, haemopheresis and plasmapheresis are new techniques in the treatment of gravely ill patients with PF malaria especially when parasitemia exceeds 10%.

Monitoramento de gestantes com toxoplasmose em servicos públicos de saúde / Monitoring of pregnant women with toxoplasmosis in public health services

É discutido o monitoramento de 290 gestantes com suspeita de toxoplasmose aguda atendidas em servicos públicos. Em 69 por cento um único teste (Elisa-IgM) conduziu ao tratamento. De 112 tratadas, o sistema não disponibilizou medicamento para 24 por cento. Em 12,1 por cento houve aumento progressivo de IgM e IgG. Em 48,2 por cento, o tratamento foi iniciado trinta dias após o diagnóstico laboratorial.

Studies on malaria during pregnancy in a tribal area of central India (Madhya Pradesh).

In tribal villages of central India where malaria is highly prevalent (mesoendemic), this preliminary study was undertaken to determine the effects of malaria infection in a group of 456 pregnant women with or without fever. Only 96 women were found infected with malaria, of which Plasmodium falciparum accounted for 64% of the detected parasites, while P. vivax for the remaining 36%. There were no instances of cerebral malaria or death however, one abortion and four still births were recorded among 38 primigravid women. Only one neonate was found infected with P. falciparum on day 21 though parasitemia was not high. Anemia was commonly present in most of the women (80%). Failure to clear P. falciparum parasitemia after a chloroquine regimen (25 mg/kg of body weight) was commonly observed. Persistent P. falciparum parasitemia was recorded in 8% cases. Poor response to chloroquine suggests the need to change the drug policy.

Tratamento da malária em gestantes / Malaria treatment in pregnancy

Os autores fazem um estudo sobre o tratamento da malária na gestação. Comentam aspectos epidemiológicos e fisiopatológicos da doença e efeitos teratogênicos das drogas.

Transmisión congénita de toxoplasma gondii durante la fase crónica en mujeres inmunocomprometidas / Congenital transmission of toxoplasma gondii during chronicity in immunocompromised women

La transmisión congénita de T. gondii que en la embarazada inmunocompetente ocurre sólo durante la fase inicial aguda de la infección materna, puede ocurrir en mujeres con toxoplasmosis crónica,cuando éstas presentan deficiencia inmunitaria. Al respecto se dan a conocer 10 casos publicados en la literatura extranjera, correspondiente 6 de ellos a mujeres infectadas con el VIH. La mayoría de los 12 niños infectos (incluye mellizos), nacieron aparentemente sanos, pero desarrollaron una toxoplasmosis severa durante los primeros meses de la vida. Los casos demuestran que la inmunodepresión de la embarazada facilita la transmisión transplacentaria del toxoplasma y que en el RN con infección doble, la infección con VIH acelera el desarrollo de una toxoplasmosis fatal y viceversa.A raíz de los casos expuestos se recomienda aplicar controles serológicos sistemáticos para toxoplasmosis en las embarazadas inmunocom-prometidas, especialmente aquellas infectadas con el virus del SIDA. Al respecto se entrega información sobre el significado del resultado serológico y tratamiento de las mujeres infectadas por toxoplasma, para disminuir el riesgo de la transmisión congénita del parásito oportunista y sobre el control de los respectivos hijos, que debe efectuarse a partir de su nacimiento