Estudo de 114 casos de toxoplasmose congênita acompanhados do setor de infectologia pediátrica do departamento de pediatria FM-UFMG, no período de 1982 - 1996.

Abstract

The congenital toxoplasmosis, frequent in Brazil, generally is asymptomatic in the newborn. But, when symptomatic, it can seriously affect the child, presenting ocular and neurological lesions. Non-controlled, observational studies demonstrate advantages on the treatment of affected children during their first year of life: diminution of the occurrence of visual reactivation, neurological sequels and hearing deficiencies. This study aims: to evaluate the clinical and laboratorial aspects of congenital toxoplasmosis, emphasizing the time pf appearance and duration of clinical manifestations; to compare the clinical, ophthalmologic, hearing and neurological outcomes of children treated during the first year of as opposed to non-treated children and children treated for less than six months; to evaluate the possible determinant factors of poor prognosis. A historical cohort was performed with 114 children from zero years old presenting congenital infection with Toxoplasmosa gondii and followed in the pediatric infectious disease ambulatory of the Clinical Hospital of the Federal University of the State of Minas Gerais (UFMG), in the city of Belo Horizonte, M. G., Brazil, from 1982 to 1996. A revision of medical data was done. After that, 51 of these children were submitted to clinical, ophthalmologic and hearing evaluation in 1999. The data colleted was analyses by Epi-Info 6.04. In 90,4% of the cases the infection was not detected during pregnancy. The majority of the children (61,4%) were admitted to the pediatric infectious diseases’ clinic in their year of life. Ocular alterations were the most common cause for researching medical attention. The most common clinical manifestations were: chorioretinitis (93,7%), strabismus (64,9%), hepatosplenomegaly (51,8%), convulsions (28,6%) and prematurity (23,2%). The diagnosis was defined through the association of clinical findings with positive IgG antibodies anti- T.gondii, because the detection of IgM antibodies was carried out only in a few numbers of cases. The majority of patients who followed throughout the first year of were treated with sulfadiazine associated to pyrimethamin and folinic acid, during variable time periods, according to their admission in the clinic. Reactivation of ocular lesions was observed in 12,3% of the patients. Significant statistics associations between the treatment during the first year of life (regardless of its duration) and the frequency of ocular reactivation, ophthalmologic complications, hearing deficiencies and school performance, were not observed. Significant statistics association between poor school performance and microcephaly (p< 0,000) or hydrocephalus (p=0,007) was observed through univariable analysis. Nevertheless, when this data was submitted to a multivariable logistic regression, only microcephaly was associated with school difficulties