Castilho-Pelloso Marcela Peres, Falavigna Dina Lúcia Morais, Falavigna-Guilherme Ana Lúcia
Universidade Estadual de Maringá, Maringá, PR, Brasil.
Rev Saude Publica. 2007 Feb;41(1):27-34. doi: 10.1590/s0034-89102007000100005.
To determine the prevalence of reagent serology for suspected acute toxoplasmosis in pregnant women and to describe clinical, laboratory and therapeutic profiles of mothers and their children.
A retrospective study was conducted with IgM-anti-Toxoplasma gondii-reagent pregnant women and their children who attended the public health system in the state of Paraná, Southern Brazil, from January 2001 to December 2003. Information were obtained from clinical, laboratory (ELISA IgM/IgG) and ultrasonographic data and from interviews with the mothers. To test the homogeneity of the IgM indices in relation to the treatment used, the Pearson's Chi-square test was applied. Comparisons were considered significant at a 5% level.
Two hundred and ninety (1.0%) cases of suspected IgM-reagent infection were documented, with a prevalence of 10.7 IgM-reagent women per 1,000 births. Prenatal care started within the first 12 weeks for 214/290; 146/204 were asymptomatic. Frequent complaints included headaches, visual disturbance and myalgia. Ultrasonography revealed abnormalities in 13 of 204 pregnancies. Chemoprophylaxis was administered to 112/227; a single ELISA test supported most decisions to begin treatment. Pregnant women with IgM indices =2.000 tended to be treated more often. Among exposed children, 44/208 were serologically followed up and all were IgG-reagent, and three IgM-reagent cases showed clinical symptoms.
The existence of pregnant women with laboratorially suspected acute toxoplasmosis who were not properly followed up, and of fetuses that were not adequately monitored, shows that basic aspects of the prenatal care are not being systematically observed. There is need of implementing a surveillance system of pregnant women and their children exposed to T. gondii.
确定孕妇疑似急性弓形虫病的试剂血清学患病率，并描述母亲及其子女的临床、实验室和治疗情况。
对2001年1月至2003年12月期间在巴西南部巴拉那州公共卫生系统就诊的IgM抗弓形虫试剂阳性孕妇及其子女进行回顾性研究。从临床、实验室（ELISA IgM/IgG）和超声数据以及对母亲的访谈中获取信息。为了测试IgM指数与所用治疗方法的同质性，应用了Pearson卡方检验。比较在5%的水平上被认为具有统计学意义。
记录了290例（1.0%）疑似IgM试剂感染病例，每1000例出生中有10.7例IgM试剂阳性女性。214/290例在孕12周内开始产前检查；146/204例无症状。常见症状包括头痛、视力障碍和肌痛。超声检查显示204例妊娠中有13例异常。112/227例接受了化学预防；大多数开始治疗的决定是基于单次ELISA检测。IgM指数≥2.000的孕妇往往更常接受治疗。在暴露的儿童中，44/208例接受了血清学随访，均为IgG试剂阳性，3例IgM试剂阳性病例有临床症状。
存在实验室疑似急性弓形虫病但未得到适当随访的孕妇，以及未得到充分监测的胎儿，这表明产前护理的基本方面未得到系统遵守。需要实施对暴露于弓形虫的孕妇及其子女的监测系统。
