RESUMO
La toxoplasmosis congénita es una enfermedad prevalente entre las infecciones intrauterinas. Describimos tres casos clínicos - radiológicos con diferentes formas de compromiso neurológico. Caso 1: feto con hidrocefalia detectada a las 36 semanas, cuya madre presentó anticuerpos positivos (Ig M: 2,26 UI/ml), nació por cesárea y al examen presentó macrocefalia, uveítis, hepatoesplenomegalia, hipotonía, Moro incompleto y succión débil, en suero IgM 0,95 UI/ml, en LCR se observaron taquizoítos viables, y proteínas en 1204 mg/dl. Caso 2: neonato a término, letárgico desde el nacimiento, con coriorretinitis, hemiparesia izquierda, hipotonía, hiporreflexia y midriasis derecha (síndrome de Weber). LCR con pleocitosis ( leucocitos 52 mm³), glucosa en 63mg/dl y proteínas de 300 mg/dl. IgM en sangre de 1,9 UI/ml, y múltiples lesiones parenquimales. Caso 3: lactante de 3 meses, desnutrido, con fontanela grande, hipotonía axial, hipertonía apendicular e hiperreflexia. IgM 2,1 UI/ml. Hidrocefalia por estenosis del Acueducto de Silvio y multiples lesiones parenquimales.En los tres casos el esquema de tratamiento fue sulfadiazina, pirimetamina, ácido folínico y prednisona. Se colocó drenaje ventricular a los niños con hidrocefalia. En la evolución se observó sordera, perdida de la agudeza visual y retardo del desarrollo.Se concluye que la Toxoplasmosis congénita puede tener diferentes formas de presentación neurológica dependiendo del periodo de infestación, inoculo y de la respuesta inmune del huésped.
Congenital toxoplasmosis is a prevalent disease among intrauterine infections. We describe three cases with different forms of neurological compromise. Case 1: fetus with hydrocephalus detected at 36 weeks , whose mother had positive antibodies (Ig M: 2.26 IU / ml), the patient was born by caesarean section and physical examination showed macrocephaly, uveitis, hepatosplenomegaly , hypotonia, incomplete Moro reflex and weak suction, IgM 0.95 IU / ml , CSF with viable tachyzoites were observed and 1204 mg protein / dl. Case 2: newborn lethargic at birth, with chorioretinitis, left hemiparesis, hypotonia, hyporeflexia and right mydriasis (Weber syndrome), CSF leukocytes showed 52 mm3, glucose 63mg/dl and protein 300 mg/dl, IgM 1.9 IU/ml and multiple parenchymal lesions. Case 3: patient 3 months old, malnourished , with large fontanelle, axial hypotonia, appendicular hypertonia and hyperreflexia, IgM 2.1 IU/ml, hydrocephalus due to aqueductal stenosis and diffuse parenchymal lesions . In all of them the treatment schedule was sulfadiazine, pyrimethamine, folinic acid and prednisone. Ventricular drainage was placed for children with hydrocephalus. Deafness, visual acuity loss and developmental delay was observed at follow up. We conclude that congenital toxoplasmosis can have different forms of neurological presentation depending to infestation period, inoculum and host immune response.
RESUMO
One of the greatest successes in AIDS research to date has by far been the discovery of successful interventions that interrupt the transmission of HIV from mother to child. It is however important to note that these successes have occurred largely in countries with great resources and the least burden of perinatal transmission of HIV. In the developing world wherein currently 95% of vertical transmission of HIV occurs, it is highly condemnable that still every minute an infected infant is said to be born in spite of the fact that vertical transmission is largely preventable, mainly because translating knowledge into practice is not always possible or feasible; This has led to a continuous growing numbers of children with HIV, thereby making pediatric HIV a looming problem rapidly draining the already burdened health care system of these countries. It is the need of the hour to appropriately address the challenges to achieve zero percent transmission of HIV from an infected mother to her child thereby giving a hope for an AIDS-free new generation worldwide.