Tratar ou não crianças com toxoplasmose congênita suspeita? Contribuição de um sistema de classificação diagnóstica para decisão

Abstract

Introduction: Despite of a diagnostic classification system based on serological, parasitologi cal and clinical criteria, there are few studies evaluating if it could aid on treatment decision of infants suspected of congenital toxoplasmosis. Objective: Evaluate a modified diagnostic classification system (Lebech et al) on treatment decision of children suspected of infection, and describe characteristics of the mother/child pair. Methods: Cross-sectional study of 222 children suspected of congenital toxoplasmosis seen between 2008-2011. In current prac tice, some professionals use the diagnostic classification system to aid decision treatment of children suspected of infection, and others not. The association between the diagnostic classification applied at birth and at three months of age and the confirmation of congenital toxoplasmosis was evaluated. The two groups of professionals were compared regarding the decision of treating toxoplasmosis. The project was approved by the Ethics Committee of UFMG. Results: Congenital toxoplasmosis was confirmed in 44 of 222 children; 84.1% of them presented with rethinochoroidits, and 77.3% with intracranial calcifications and/or ventricular dilatation. Mothers with fewer prenatal care visits underwent fewer tests for toxoplasmosis (p=0,05) and many only had one serologic test, which made classification impossible. Repeated maternal post-partum serology, alongside neonatal testing, reduced the number of non-classified pair. Both group of professionals treated all children with confirmed congenital toxoplasmosis, and the group that used of the protocol was less likely to treat the non-infected children (p<0,001). Conclusions: Application of diagnostic classification allowed treatment of all infected children and reduced the use of medication in non-infected children.