RESUMO
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.
Assuntos
Anticorpos Antiprotozoários/sangue , Antiprotozoários/uso terapêutico , Leucovorina/uso terapêutico , Triagem Neonatal/métodos , Toxoplasma/isolamento & purificação , Toxoplasmose Congênita/epidemiologia , Brasil/epidemiologia , Humanos , Imunoglobulina M/sangue , Lactente , Recém-Nascido , Pirimetamina/uso terapêutico , Sulfadiazina/uso terapêutico , Toxoplasmose Congênita/diagnóstico , Toxoplasmose Congênita/tratamento farmacológicoRESUMO
The conjunctiva's bacterial profile at birth and 1 week after Credé's gonoccocal ophthalmic prophylaxis was evaluated over a 3-month period using culture and direct immunofluorescence. Thirty-four neonates received 10% silver vitellinate and 42 sterile saline. Chlamydia trachomatis was recovered in 7/34 and 9/42 neonates receiving silver vitellinate and saline at birth and in 8/34 and 12/42 after 1 week, respectively. Neisseria gonorrhoeae was not identified. Credé's may not be the ideal prophylactic method in areas with a low prevalence of N. gonorrhoeae.
