Síndrome de TORCH: Enfoque racional del diagnóstico y tratamiento pre y post natal: Recomendaciones del Comité Consultivo de Infecciones Neonatales Sociedad Chilena de Infectología, 2016 / TORCH Syndrome: Rational approach of pre and post natal diagnosis.: Recommendations of the Advisory Committee on Neonatal Infections. Sociedad Chilena de Infectología, 2016

Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.

There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.

Efecto del tratamiento prenatal con espiramicina en la frecuencia de retinocoroiditis por toxoplasmosis congénita en una cohorte colombiana / Effect of antenatal spiramycin treatment on the frequency of retinochoroiditis due to congenital toxoplasmosis in a Colombian cohort

Resumen Introducción. La toxoplasmosis de la gestación es frecuente y grave. Hasta ahora no hay consenso sobre la utilidad del tratamiento para prevenir complicaciones oculares en el neonato. En la actualidad, uno de los medicamentos utilizados en las madres diagnosticadas es la espiramicina oral. Infortunadamente, en algunas mujeres gestantes no se hace el diagnóstico prenatal y, por esta u otras razones, no reciben el tratamiento. Objetivo. Describir la relación entre el tratamiento con espiramicina durante el embarazo en madres con toxoplasmosis de la gestación y la presentación de toxoplasmosis ocular en los recién nacidos. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo de serie de casos. Se evaluó una serie prospectiva de pacientes con toxoplasmosis de la gestación durante tres años de seguimiento en el Servicio de Retinología de la Clínica Universitaria Bolivariana de Medellín. Resultados. Se registraron 23 madres con diagnóstico de toxoplasmosis de la gestación. Quince de ellas (65 %) recibieron durante la gestación tratamiento con espiramicina en dosis de 3 g al día; uno de los neonatos (6,6 %) presentó toxoplasmosis ocular. De las ocho (35 %) pacientes que no recibieron tratamiento, cinco (62,5 %) tuvieron hijos con compromiso ocular por toxoplasma. La razón de momios (odds ratio, OR) del efecto protector contra dicho compromiso en los pacientes cuyas madres recibieron tratamiento fue de 0,04 (IC95% 0,00-0,67), con valor de p menor de 0,01 en la prueba exacta de Fisher. Solo se evidenció compromiso del sistema nervioso central por toxoplasmosis mediante las imágenes de tomografía o ecografía cerebral en dos (14 %) pacientes de las 14 en quienes se hicieron estos estudios. Los dos pacientes presentaron, además, compromiso ocular; ambos fueron diagnosticados en el momento del nacimiento y sus madres no habían recibido tratamiento prenatal. Conclusiones. Estos resultados evidencian que el tratamiento con espiramicina durante el embarazo en la toxoplasmosis de la gestación redujo en 96 % (IC95% 33-100 %) el riesgo relativo de presentar la enfermedad en el recién nacido.

Abstrat Introduction: Gestational toxoplasmosis is frequent and severe. There is still debate about the benefits of treatment against ocular manifestations in the newborn. Spiramycin treatment is used for this purpose, unfortunately prenatal diagnosis is sometimes delayed and pregnant women are not treated. Objective: To describe the relationship between treatment with spiramycin during pregnancy in mothers with gestational toxoplasmosis and development of ocular toxoplasmosis in newborns. Materials and methods: We conducted a descriptive study of a case series. We evaluated a prospective cohort of patients diagnosed with gestational toxoplasmosis during three years at the Retinology Service at the Clínica Universitaria Bolivariana in Medellín. Results: Gestational toxoplasmosis was found in 23 mothers; 15 (65%) were treated during pregnancy with 3 g per day of spiramycin, eight (35%) patients were untreated. In the treated group just one newborn developed ocular toxoplasmosis (6.6%), in contrast with five (62.5%) of the eight patients who did not receive treatment. These results suggest that pregnancy treatment reduces the relative risk of ocular toxoplasmosis in the newborn by 96% (95% CI: 33 - 100%). Only two (14%) of the patients who were evaluated, had nervous system involvement related to toxoplasmosis in CT scan or cerebral ultrasound. These two patients also developed ocular pathology and were diagnosed at the time of birth, so they did not received antenatal treatment. Conclusions: A protective effect was found against the ocular involvement in patients whose mother received treatment with spiramycin (OR=0.04;95% CI: 0.00-0.67), p<0.01 (Fisher's Exact Test).

Toxoplasmose e Toxoplasma gondii / Toxoplasmosis and Toxoplasma gondii

A infecção por Toxoplasma gondii é hoje muito disseminada ao redor do mundo, especialmente no Brasil. A coletânea parte da história da descoberta desse parasita e da doença por ele causada, a toxoplasmose, e visita os diferentes aspectos relacionados ao tema. São apresentados o ciclo evolutivo, a epidemiologia, o diagnóstico, o quadro clínico e o tratamento, em uma ampla revisão sobre o assunto, provavelmente a mais completa já realizada. Somente nos anos 1970 desvendou-se o ciclo de vida desse protozoário, do qual o gato é hospedeiro definitivo. Outros animais de sangue quente, entre eles o ser humano, são hospedeiros intermediários. Muitos indivíduos infectados pelo T. gondii não apresentam sintomas, mas, quando a doença se manifesta, pode ter diferentes configurações, afetando gânglios, olhos, coração, pulmões, fígado, cérebro e meninges, ou articulações. Além de uma completa revisão, a obra também traz para o leitor o que há de mais atual no conhecimento científico acerca da toxoplasmose e do T. gondii. O livro cobre praticamente todos os campos do conhecimento sobre o agente etiológico e a doença, apresentando novos aspectos, particularmente em relação à bioquímica, à interação entre o parasita e a célula hospedeira e à resposta imunológica à infecção.

Recent Advances in Toxoplasma gondii Immunotherapeutics

Toxoplasmosis is an opportunistic infection caused by the protozoan parasite Toxoplasma gondii. T. gondii is widespread globally and causes severe diseases in individuals with impaired immune defences as well as congenitally infected infants. The high prevalence rate in some parts of the world such as South America and Africa, coupled with the current drug treatments that trigger hypersensitivity reactions, makes the development of immunotherapeutics intervention a highly important research priority. Immunotherapeutics strategies could either be a vaccine which would confer a pre-emptive immunity to infection, or passive immunization in cases of disease recrudescence or recurrent clinical diseases. As the severity of clinical manifestations is often greater in developing nations, the development of well-tolerated and safe immunotherapeutics becomes not only a scientific pursuit, but a humanitarian enterprise. In the last few years, much progress has been made in vaccine research with new antigens, novel adjuvants, and innovative vaccine delivery such as nanoparticles and antigen encapsulations. A literature search over the past 5 years showed that most experimental studies were focused on DNA vaccination at 52%, followed by protein vaccination which formed 36% of the studies, live attenuated vaccinations at 9%, and heterologous vaccination at 3%; while there were few on passive immunization. Recent progress in studies on vaccination, passive immunization, as well as insights gained from these immunotherapeutics is highlighted in this review.

Prevención de la toxoplasmosis congénita en un hospital de Buenos Aires / Prevention of congenital toxoplasmosis in a Buenos Aires hospital

La prevención de la toxoplasmosis congénita se basa en la información de la mujer con medidas de prevención primaria, el diagnóstico serológico y el tratamiento de la embarazada y del niño. Se presentan los resultados de 12 años de implementación de un programa de prevención de la toxoplasmosis congénita, la tasa de madres infectadas, de transmisión vertical, de niños infectados y la gravedad de la afección causada. Se realizó un estudio observacional prospectivo sobre 12 035 gestantes atendidas en la maternidad del Hospital Alemán de Buenos Aires entre enero de 2000 y diciembre de 2011. Se observó una prevalencia de anticuerpos anti Toxoplasma gondii de 18.33% (2 206/12 035). Treinta y siete mujeres de 9 792 susceptibles tuvieron infección aguda, la tasa de incidencia de infección materna fue de 3.78 por 1 000 nacimientos. La tasa de transmisión transplacentaria de la infección fue 5.4% (2/37). Dos recién nacidos tuvieron toxoplasmosis congénita, uno no tuvo signos clínicos y el otro presentó coriorretinitis y estrabismo. Recibieron tratamiento 35 madres y los 2 niños con toxoplasmosis congénita. En conclusión: Las cifras de transmisión obtenida permiten considerar a este programa de prevención como un recurso válido para minimizar el impacto de la toxoplasmosis congénita.

The prevention of congenital toxoplasmosis is based on providing information to women, serologic diagnosis and treatment of the infected mother and child. In this article we present the results of 12 years of implementation of a congenital toxoplasmosis prevention program in which we measured the mother´s infection incidence rate, the transmission rate and the number and severity of infection in newborns. The study was performed on 12 035 pregnant women in the period 2000-2011. The prevalence rate of antibodies against Toxoplasma gondii was 18.33% (2 206/12 035). Thirty-seven out of 9 792 susceptible women presented acute infection and the mother's infection incidence rate was 3.78 per 1000 births. The transplacental transmission rate was 5.4% (2/37). Two newborns presented congenital toxoplasmosis infection, one had no clinical signs while the other presented strabismus and chorioretinitis. Thirty-five infected mothers and the two children with congenital infection were treated. The transmission rates obtained allow consider this prevention program as a valid resource to minimize the impact of congenital toxoplasmosis.

Primer acuerdo nacional de referentes para la prevención de las complicaciones y del diagnóstico y tratamiendo de la toxoplasmosis / First national agreement for prevention of complications, diagnosis and treatment of toxoplasmosis

El presente trabajo es un relato de experiencia de la reuniónrealizada en la ciudad de Alta Gracia, Córdoba, donde se llevocabo el “1er Acuerdo Nacional de Referentes para la Prevenciónde las Complicaciones y del Diagnóstico y Tratamiento de laToxoplasmosis”. Se discutieron conocimientos validados porla literatura científica como base para propuestas racionalesde diagnóstico.Los objetivos del acuerdo fueron: discutir y reflexionarsobre las prácticas y diagnóstico de la Toxoplasmosis enel sistema público nacional, consensuar y proponer unalgoritmo de diagnóstico para el sistema público, analizarla brecha entre el nivel de conocimiento y la aplicación depracticas y procedimientos en la población general y en losgrupos de riesgo, discutir y proponer actividades destinadasa identificar el riesgo de transmisión vertical con el fin deproponer estrategias de tamizaje adecuados a la prevalencianacional, proponer actividades para reducir la brechaconocimiento/aplicación de ese conocimiento en un marcode equidad.Los profesionales referentes acordaron la firma del Actade Alta Gracia que contempla para la red pública de atenciónmédica el diagnóstico de Toxoplasmosis con equidad, calidad,acceso a metodologías complejas, cooperación y asesoríatécnica y disponibilidad oportuna de insumos en casos deemergencias jurisdiccionales.

Perfil sorológico de camundongos cronicamente infectados com a cepa cistogênica ME-49 de Toxoplasma gondii antes e após terapêutica específica / Serological profile of chronically infected mice with the cystogenic ME-49 strain of Toxoplasma gondii before and after specific treatment

Neste trabalho, foi avaliado o perfil sorológico experimental, após terapêutica específica, em camundongos, BALB/c infectados com cepa cistogênica ME-49. Foram inoculados, individual e intraperitonealmente, 45 animais com dez cistos da cepa ME-49. Os camundongos foram divididos em três grupos de 15 animais e um grupo controle com cinco animais não infectados e não tratados, todos acompanhados ao mesmo tempo, diariamente, durante 20 dias. Após este período, foram subdivididos em dois grups - A e B - e submetidos a esquemas terapêuticos específicos: grupo A - pirimetamina e ácido folínico; grupo B - pirimetamina, ácido folínico e sulfadiazina por dez dias consecutivos. A partir do quinto dia de tratamento, um camundongo de cada grupo foi anestesiado para a coleta de sangue por punção cardíaca, fazendo-se a análise do soro pela técnica de imunofluorescência indireta. Os animais tratados apresentaram diminuição significativa nos títulos de anticorpos (IgG) em relação ao grupo de infectados e não tratados. Entre as amostras analisadas com diferentes esquemas terapêuticos não houve diferença significativa. Isso mostra que o tratamento precoce da toxoplasmose reduz rapidamente os níveis de IgG, sugerindo uma possível cura desta parasitose.

Congenital Toxoplasmosis: a Review of its Pathology; Immune Response and Current Treatment Options

Toxoplasmosis; caused by the protozoan parasite Toxoplasma gondii; is one of the most common parasites of man and other warm-blooded animals. Humans are infected through contaminated food; water; and blood transfusion; organ transplantation or from mother to foetus through the placenta. Severe congenital infections occur as a result of primary T. gondii infection in early pregnancy. Transmission of T.gondii to the foetus can result in serious health problems; including mental retardation; seizures; blindness and death. Frequency of foetal infection is higher when maternal infection occurs later in pregnancy and sequelae are more severe when maternal infections occur early in the first trimester of pregnancy. The ability of the parasite to survive intracellularly largely depends on the blocking of different proapoptotic signaling cascades of the host cells. During pregnancy; however; alterations in the incidence of apoptosis are associated with abnormal placental morphology and function. Both cellular and humoral immune responses control T.gondii infection. Toxoplasma is asymptomatic; infected women can only be detected by serological testing. In many instances; congenital toxoplasmosis can be prevented by educating pregnant women and women of childbearing age about the route of transmission. The need for screening suspected cases of T. gondii will help reduce transmission to the foetus

Seroprevalencia de la toxoplasmosis en una población pediátrica del municipio Mara estado Zulia / Toxoplasmosis seroprevalence in a pediatric population Mara municipality, state of Zulia

La Toxoplasmosis es una de las protozoonosis más frecuentes del ser humano. El objetivo de este estudio fue determinar la seroprevalencia de la toxoplasmosis en una población infantil del Municipio Mara, estado Zulia. Se estudiaron 119 muestras de sueros de ambos sexos (53 masculinos y 66 femeninos) con edades comprendidas entre 4-13 años. Los anticuerpos toxoplásmicos se determinaron por de la técnica de hemaglutinación indirecta. El análisis estadístico se realizó a través de la prueba de Chi cuadrado y la correlación de Spearman. La prevalencia general de infección fue de 15,9 por ciento. La frecuencia de sueros positivos fue mayor en el rango de edad de 10-13 años (8/25) con un 32,0 por ciento. Se observó que el número de casos positivos aumentó con relación al grupo de edad. No se observaron diferencias estadísticamente significativas con relación al sexo, sin embargo se apreció una mayor tendencia de positividad para el sexo femenino en el grupo de 10-13 años. La media geométrica fue de 9.479. El rango de títulos positivos fue de 1:64 a 1:2.097.512, el título más bajo fue de 1:64 con 5,26 por ciento (1/19) y el más alto 1:2.097.512 con 5,26 por ciento (1/19). Los resultados obtenidos indican que esta enfermedad es frecuente en esta población infantil.

Toxoplasmosis is one of the most frequent protozoonosis in the human being. The objective of this study was to determine toxoplasmosis seroprevalence in an infantile population from the Mara Municipality, State of Zulia. 119 serum samples from both sexes (53 male and 66 female) with ages between 4-13 years were studied. The toxoplasmic antibodies were determined by the indirect hemaglutination technique. Statistical analysis was done using the Chi square test and Spearman’s correlation. General prevalence of the infection was 15.9 percent. The positive serum frequency was greater in the 10-13 year age range (8/25) with 32.0 percent. It was observed that the number of positive cases increased in relation to the age group. No statistically significant differences related to gender were observed; nevertheless, a greater positive tendency was observed for females in the 10-13 year group. The geometric average was 9.479. The range of positive titles was from 1:64 to 1:2.097.512; the lowest title was 1:64 with 5.26 percent (1/19) and the highest was 1:2.097.512 with 5.26 percent (1/19). Results indicate that this disease is frequent in this infantile population.

Toxoplasma gondii: toxoplasmose, com ênfase no diagnóstico / Toxoplasma gondii: emphasis on diagnosis

Toxoplasmose é uma doença causada pelo protozoário Toxoplasma gondii. No Brasil, a variação de sua prevalência (10por cento-80por cento) depende da área estudada. O ser humano pode adquirir a infecção por meio de ingestão de alimentos contaminados com cistos ou oocistos, transfusão sanguínea, transplante de órgãos e transmissão congênita. Nesta última forma, o parasito atravessa a barreira placentária e infecta o feto, podendo causar-lhe graves sequelas. O diagnóstico sorológico da toxoplasmose é baseado na detecção de anticorpos anti-T.gondii. Embora a sorologia em mulheres grávidas seja eficaz em 89,5por cento dos casos, a confirmação da infecção no feto e/ou recém nascido é dificultada pela imaturidade imunológica. O advento das técnicas automatizadas possibilitou a demonstração da presença de anticorpos residuais, o que tem produzido resultados duvidosos e/ou inconclusivos, tornando necessário o uso de métodos parasitológicos, especialmente as técnicas de biologia molecular que permitem o acompanhamento das gestantes e a validação do tratamento. A prevenção da toxoplasmose congênita é de fundamental importância para um melhor controle da infecção, evitando-se, assim, as graves sequelas que podem ocorrer em fetos e recém-nascidos. Esta atualização descreve o agente etiológico T. gondii da toxoplasmose, sua epidemiologia, manifestações clínicas, diagnóstico, prevenção e tratamento.

Evaluation of pyrimethamine and mefloquine antimalarial drugs for the treatment of albino mice co-infected with toxoplasma - gondii and Schistosoma mansoni

The mainstay of this work is to elucidate the prophylactic and curative effects of using two different antimalarial drugs [Pyrimethamine+ Mefloquine] in experimental Toxoplasma gondii infection on top of chronic schistosomiasis mansoni. A group of forty Swiss albino mice chronically infected [each with 80 S. mansoni cercariae and kept for seven weeks], was used in the experiment. This group was further subdivided into three subgroups. Subgroup I: control group which is further subdivided into two smaller subgroups. Subgroup I [A]: control infected untreated animals given S. mansoni cercariae by body immersion and kept for seven weeks [the time needed for the infection to become chronic]. Subgroup I [B]: included control doubly infected untreated animals. S. mansoni infected mice were given 100 tachyzoites of T. gondii via an intraperitoneal cannula seven weeks post schistosoma mansoni infection, then sacrificed four days later. Subgroup II: prophylactic group, included chronic S. mansoni infected mice [for 7 weeks], given the oral drug combination [Pyrimethamine 25 mg/Kg body weight + Mefloquine 100 mg/ Kg body weight] single daily dose for 14 successive days before Toxoplasma infection. Subgroup III: chronic S. mansoni infected mice for 7 weeks, treated 24 hours post Toxoplasma infection with the same oral drug combination [Pyrimethamine 25 mg/Kg body weight + Mefloquine 100 mg/Kg body weight] single daily dose for 14 successive days. Sacrifice was performed two weeks post Toxoplasma infection. The efficacy of both drugs was assessed by worm and tissue egg load and oogram pattern for schistosomiasis, and animal survival, and collecting peritoneal exudates from succumbing mice, then calculation at random for the presence of Toxoplasma gondii parasites. It was found that doubly infected [chronic seven weeks old Schistosoma mansoni followed by Toxoplasma gondii infections] untreated mice died between 6 and 8 days post Toxoplasma infection, while treatment markedly prolonged the survival time of experimental animals. Again, Daraprim and Mefloquine failed to significantly reduce the total number of worms when compared to the infected untreated control group. Moreover, there was complete absence of tachyzoites in the post infection treated group, in comparison with the control infected untreated animals. These data were less conspicuous in the group treated 14 days prior to Toxoplasma infection. This study may be of value in endemic areas, where double parasitic infestation with schistosomiasis and toxoplasmosis is a common occurrence

Toxoplasma gondii infection in pregnancy

Toxoplasmosis is caused by an intracellular protozoan, Toxoplasma gondii, which has a wide geographical distribution. The main infection routes are ingestion of cysts from raw or badly-cooked meat, ingestion of oocysts from substrates contaminated with the feces of infected felines and congenital transmission by tachyzoites. The congenital form results in a severe systemic disease, because if the mother is infected for the first time during gestation, she can present a temporary parasitemia that will infect the fetus. Many of the clinical symptoms are seen in congenitally-infected children, from a mild disease to serious signs, such as mental retardation. Early diagnosis during the pregnancy is highly desirable, allowing prompt intervention in cases of infection, through treatment of pregnant women, reducing the probability of fetal infection and consequent substantial damage to the fetus. Conventional tests for establishment of a fetal diagnosis of toxoplasmosis include options from serology to PCR. Prevention of human toxoplasmosis is based on care to avoid infection, understanding the disease and serological exams during gestation. Pregnant women should be tested serologically from three months gestation, until one month after childbirth. Inclusion of serology for congenital toxoplasmosis along with the basic Guthrie test for PKU is of fundamental importance for early diagnosis of infection and so that treatment is initiated, in order to avoid possible sequels in the infant.

Acute acalculous cholecystitis in an immunocompetent patient with severe acquired toxoplasmosis

Acute acalculous cholecystitis (AAC) is an inflammatory disease of the gallbladder not associated with gallstones. It is more often seen in hospitalized patients on mechanical ventilation due to life-threatening conditions and superimposed sepsis. Occasionally, infection itself may be the only predisposing factor identified. AAC has rarely been observed in severely immunocompromised patients with reactivated Toxoplasma infection. We were able to document for the first time a case of AAC in an otherwise healthy adult with acute acquired toxoplasmosis. A prompt diagnosis and early onset of effective antiparasitic treatment allowed the resolution of the episode without further complication

Frecuencia de factores de riesgo para adquirir toxoplasmosis en embarazadas que acuden a control prenatal en el Ambulatorio Urbano I Michelena: septiembre 2005 / Frequency of risk factors for acquiring toxoplasmosis in pregnant women attending prenatal care in the Ambulatory Urban Michelena I: september 2005

La presencia de toxoplasmosis en la embarazada, representa un riesgo importante para el desarrollo de toxoplasmosis congénita, con la finalidad de prevenir esta enfermedad, se realiza un trabajo descriptivo, de diagnóstico, transversal, en el cual se realiza una encuesta a las 30 primeras embarazadas de las 62 que para septiembre de 2005 se encontraban en control prenatal en el Ambulatorio Urbano I de Michelena Estado Táchira. Y así determinar que en esta población el 49,9 por ciento tienen bajo riesgo, el 36,6 por ciento tienen riesgo intermedio y el 13,3 por ciento tienen alto riesgo. Luego esta experiencia surge una alternativa interesante, a saber, la realización de una encuesta que sirve de filtro para las madres con riesgo de infección reciente por Toxoplasma. Preguntas simples, en términos familiares, podrían descubrir una gran proporción de madres con riesgo de toxoplasmosis.

Toxoplasmose congênita / Congenital toxoplasmosis

Toxoplasmose é causada por infecção pelo parasita protozoário Toxoplasma gondii. Foram revisados aspectos da fisiopatologia da toxoplasmose congênita. As manifestações da toxoplasmose congênita no feto ou neonato são imprevisíveis, variando desde o óbito intra-uterino, retardo mental, convulsões, cegueira, hidrocefalia e coriorretinite até lesões menos severas, em que as manifestações da toxoplasmose congênita podem não ser aparentes até a segunda ou terceira décadas de vida. Testes sorológicos são utilizados para o diagnóstico da infecção aguda na gestante e na criança. A terapêutica mais utilizada e, provavelmente, mais efetiva é a combinação de pirimetamina, sulfadiazina e ácido folínico.

Toxoplasmosis is caused by the protozoan parasite Toxoplasma gondii. Some aspects of the physiopathology of the congenital toxoplasmosis were revised. Manifestations of congenital toxoplasmosis in the fetus and the newborn are unpredictable. They range from intra-uterine death, mental retardation, seizures, blindness, hydrocephalia and chorioretinitis to less severe lesions in which manifestations of congenital toxoplasmosis may not become apparent until the second or third decades of life. Serological tests are used to diagnose acute infection in pregnant women or in children. The most commonly used therapeutic regimen, and probably the most effective, is the combination of pyrimethamine with sulfadiazine and folinic acid.

Toxoplasmose na gestação e suas repercussões no feto / Toxoplasmosis in pregnancy and its effects on the fetus

O presente trabalho tem como prioridade considerar a toxoplasmose na gestante, uma vez que a infecção aguda na gravidez pode ocasionar graves repercussões no feto. Com o intuito de estudar o perfil sorológico das gestantes atendidas no Hospital Universitário Antonio Pedro (HUAP), foi realizada a análise de 1330 sorologias para toxoplasmose de gestantes atendidas no HUAP, durante o ano de 1996, pela técnica ELFA. Observou-se uma alta prevalência da infecção (80%), o que correlacionou-se com outros trabalhos nacionais e regionais. Das 1330 gestantes, 1033 (77,7%) apresentavam infecção crônica, 266 (20%) estavam desprovidas de imunidade e 31 (2,3%) eram suspeitas de apresentarem infecção aguda. Foi possível obter informações clínicas e laboratoriais de 14 gestantes que apresentavam IgM no soro e de seus respectivos filhos. Ao finalizar o trabalho foi possível concluir que o número de reações sorológicas positivas para toxoplasmose aumenta de acordo com a idade das gestantes; a toxoplasmose foi uma infecção de alta prevalência na população estudada (80%)...Foi sugerido que para maior precisão no diagnóstico da toxoplasmose, outras provas sorológicas devam ser realizadas com a avidez de IgG, a dosagem de IgA e IgE ou o teste de aglutinação diferencial. Os testes sorológicos clássicos como a hemaglutinação, a fixação de complemento e a imunofluorescência também são alternativas que auxiliam o diagnóstico da toxoplasmose quando realizados de forma complementar à investigação.

Toxoplasmosis en embarazadas de la población de Abejales: respuesta al tratamiento con espiramicina / Pregnancies in toxoplasmosis of the poblation of Abejales: response a the treatment with spiramycin

El presente estudio se realizó en el Ambulatorio Rural II de Abejales, entre los meses de mayo a julio de 1996, para determinar la prevalencia de toxoplasmosis en embarazadas controladas en ese centro, mediante la determinación de anticuerpos IgM por el método de hemaglutinación indirecta y la respuesta al tratamiento con Espiramicina. De las 72 pacientes controladas. 28 (39,9 por ciento) presentaron títulos negativos de anticuerpos contra la toxoplasmosis, 44 (61,1 por ciento) resultaron con títulos positivos, de los cuales 20 (27,77 por ciento) estuvieron por encima o igual a 1:256 diluciones lo que indica posible infección aguda, por lo que se les administró 2 gramos de Espiramicina diarios por 4 semanas, posterior a lo cual se tomaron nuevas muestras para determinar si hubo o no descenso en los títulos de IgM. Hubo una disminución de la enfermedad del 100 por ciento a un 37 por ciento, tomando un nivel de confianza del 95 por ciento, con un grado de libertad, lo que demuestra una adecuada respuesta al tratamiento

Abdomen agudo y toxoplasmosis en paciente con 13 semanas de gestación / Acute abdomen and toxoplasmosis in patient weeks of gestation

Presenta el caso de una paciente que fue admitida con un cuadro abdominal agudo de tipo obstructivo (adherencias y adenopatías mesentéricas), al momento que cursaba 13 semanas de gestación. Sometida a laparotomía, corrigiendo su problema obstructivo, es diagnosticada posteriormente de toxoplasmosis a las 18 semanas de gestación tratada con espiramicina, llega al término de su embarazo siendo el producto de características físicas y neurológicas normales.