Diesel Amanda Andrade, Zachia Suzana de Azevedo, Müller Ana Lúcia Letti, Perez Amanda Vilaverde, Uberti Flavio Antonio de Freitas, Magalhães José Antônio de Azevedo
Fetal Medicine Group, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Pediatrics Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Rev Bras Ginecol Obstet. 2019 Sep;41(9):539-547. doi: 10.1055/s-0039-1697034. Epub 2019 Sep 23.
To describe a population of pregnant women diagnosed with toxoplasmosis and their respective newborns, describing the hospital protocol for treatment and follow-up.
Retrospective cohort of pregnant women with acute toxoplasmosis infection and risk of transplacental transmission who were sent to the Fetal Medicine Group of Hospital de Clínicas de Porto Alegre (HCPA) between - January 1, 2006 and December 31, 2016. All patients with confirmed disease were included. The diagnostic protocol and treatment were applied; a polymerase chain reaction (PCR) analysis of the amniotic fluid was used to diagnose toxoplasmosis and determine the treatment. The newborns were followed up at the pediatric outpatient clinic specializing in congenital infection. The patients who were not followed up or were not born in the HCPA were excluded.
A total of 65 patients were confirmed to have gestational toxoplasmosis; 40 performed amniocentesis, and 6 (15%) were identified as having positive PCR in the amniotic fluid. In five of those cases, this result associated with the gestational age defined the triple therapy during pregnancy, and in one case, it defined the monotherapy (advanced gestational age). A total of 4 of these newborns were treated from birth with triple therapy for 10 months, 1 was not treated (due to maternal refusal), and 1 progressed to death within the first 54 hours of life due to complications of congenital toxoplasmosis. Of the 34 remaining cases with a negative PCR, 33 were treated with monotherapy and 1 was treated with triple therapy (ultrasound findings); of these children, 9 (26.5%) presented negative immunoglobulin G (IgG), 24 (70.6%) presented positive IgG (but none presented positive immunoglobulin M [IgM]), and 1 (2,9%) presented alterations compatible with congenital disease and started treatment with the triple therapy soon after birth. Out of the total sample of 60 patients, among the 25 who did not perform amniotic fluid PCR, 5 were treated with triple therapy (ultrasound findings/prior treatment) and 20 patients were submitted to monotherapy; only two newborns underwent treatment for congenital toxoplasmosis. Among the 65 cases of gestational toxoplasmosis, 6 (9,2%) children had a diagnosis of congenital toxoplasmosis, and 2 patients with triple therapy felt severe adverse effects of the medications.
The present study suggests that research on PCR screening of the amniotic fluid may be useful to identify patients with a higher potential for fetal complications, who may benefit from the poly-antimicrobial treatment. Patients with negative PCR results must continue to prevent fetal infection with monotherapy, without risk of fetal or maternal impairment.
描述被诊断为弓形虫病的孕妇群体及其各自的新生儿情况，阐述治疗和随访的医院方案。
对2006年1月1日至2016年12月31日期间被送往阿雷格里港临床医院（HCPA）胎儿医学组的急性弓形虫感染且有经胎盘传播风险的孕妇进行回顾性队列研究。纳入所有确诊疾病的患者。应用诊断方案和治疗方法；采用羊水聚合酶链反应（PCR）分析诊断弓形虫病并确定治疗方案。新生儿在专门诊治先天性感染的儿科门诊进行随访。排除未进行随访或未在HCPA出生的患者。
共有65例患者确诊为妊娠期弓形虫病；40例进行了羊水穿刺，其中6例（15%）羊水PCR检测呈阳性。在其中5例中，该结果结合孕周确定了孕期三联疗法，1例确定为单药治疗（孕周较大）。这些新生儿中，4例出生后接受三联疗法治疗10个月，1例未治疗（因母亲拒绝），1例因先天性弓形虫病并发症在出生后54小时内死亡。在其余34例PCR检测阴性的病例中，33例接受单药治疗，1例接受三联疗法（超声检查结果）；这些儿童中，9例（26.5%）免疫球蛋白G（IgG）呈阴性，24例（70.6%）IgG呈阳性（但均无免疫球蛋白M[IgM]呈阳性），1例（2.9%）有与先天性疾病相符的改变，出生后不久开始接受三联疗法治疗。在60例患者的总样本中，25例未进行羊水PCR检测，其中5例接受三联疗法（超声检查结果/先前治疗情况），20例接受单药治疗；仅2例新生儿接受了先天性弓形虫病治疗。在65例妊娠期弓形虫病病例中，6例（9.2%）儿童被诊断为先天性弓形虫病，2例接受三联疗法的患者出现药物严重不良反应。
本研究表明，羊水PCR筛查研究可能有助于识别胎儿并发症风险较高的患者，这些患者可能从多抗菌药物治疗中获益。PCR结果阴性的患者必须继续采用单药治疗预防胎儿感染，而不会有胎儿或母体受损的风险。
