Evolução ocular na toxoplasmose congênita

Detalhes bibliográficos
Autor(a) principal: Endres, Mariana Miranda
Data de Publicação: 2019
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_RS
Texto Completo: http://tede2.pucrs.br/tede2/handle/tede/9928
Resumo: Objectives: To describe the ocular evolution and to investigate antecedents and clinical aspects that may influence the visual prognosis in congenital toxoplasmosis. Methodology: Retrospective cohort including patients seen between 1996 and 2017 in the public and private outpatient sectors of the São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil, with confirmed diagnosis of congenital toxoplasmosis and follow-up to at least one year old. Results: Among the 77 patients included, congenital toxoplasmosis was suspected by routine screening in 65 (84.5%). Seventy-three patients (94.8%) received treatment in the first year of life with pyrimethamine, sulfadiazine and folinic acid. The median age at the end of follow-up was 10 years (minimum 2, maximum 25). The number of patients with retinochoroiditis was 39 (70.9%) in the first year of life and 55 (71.4%) at the end of follow-up. There was a peak incidence of new retinochoroiditis lesions between 4 and 5 years and another between 9 and 14 years, the latter only in girls. New retinochoroiditis lesions appeared after the first year of life in 77.8% of patients who started treatment after the fourth month of life, vs. 35.2% of those who started it within the first four months (RR=0.45, 95%CI 0.27-0.75, p=0.02) and 33.3% of those who started it within the first two months (RR=0.42, 95%CI 0.25-0.72, p=0.01). In eight eyes with macular lesion the visual acuity was between 10% and 40% and in 10 eyes with paramacular lesion the acuity was between 5% and 100%. Thirty-four patients with retinochoroiditis were followed for 10 years or more, among which school performance was considered adequate in 28 (82.4%). Conclusions: The high incidence of new retinochoroiditis lesions during follow-up indicates the importance of long-term follow-up of patients with congenital toxoplasmosis. Starting the treatment within the first four months of life, specially within the first two months, was a protective factor for later onset of retinochoroiditis. Eyes with macular and paramacular retinochoroiditis lesions had a better than expected outcome in terms of visual function. Despite the general favorable prognosis, the marked morbidity of congenital toxoplasmosis in Brazil was confirmed.
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spelling Fiori, Humberto Holmerhttp://lattes.cnpq.br/2201434748530559Lago, Eleonor Gastalhttp://lattes.cnpq.br/6806630864697856http://lattes.cnpq.br/2159917011317623Endres, Mariana Miranda2021-10-25T17:37:25Z2019-08-28http://tede2.pucrs.br/tede2/handle/tede/9928Objectives: To describe the ocular evolution and to investigate antecedents and clinical aspects that may influence the visual prognosis in congenital toxoplasmosis. Methodology: Retrospective cohort including patients seen between 1996 and 2017 in the public and private outpatient sectors of the São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil, with confirmed diagnosis of congenital toxoplasmosis and follow-up to at least one year old. Results: Among the 77 patients included, congenital toxoplasmosis was suspected by routine screening in 65 (84.5%). Seventy-three patients (94.8%) received treatment in the first year of life with pyrimethamine, sulfadiazine and folinic acid. The median age at the end of follow-up was 10 years (minimum 2, maximum 25). The number of patients with retinochoroiditis was 39 (70.9%) in the first year of life and 55 (71.4%) at the end of follow-up. There was a peak incidence of new retinochoroiditis lesions between 4 and 5 years and another between 9 and 14 years, the latter only in girls. New retinochoroiditis lesions appeared after the first year of life in 77.8% of patients who started treatment after the fourth month of life, vs. 35.2% of those who started it within the first four months (RR=0.45, 95%CI 0.27-0.75, p=0.02) and 33.3% of those who started it within the first two months (RR=0.42, 95%CI 0.25-0.72, p=0.01). In eight eyes with macular lesion the visual acuity was between 10% and 40% and in 10 eyes with paramacular lesion the acuity was between 5% and 100%. Thirty-four patients with retinochoroiditis were followed for 10 years or more, among which school performance was considered adequate in 28 (82.4%). Conclusions: The high incidence of new retinochoroiditis lesions during follow-up indicates the importance of long-term follow-up of patients with congenital toxoplasmosis. Starting the treatment within the first four months of life, specially within the first two months, was a protective factor for later onset of retinochoroiditis. Eyes with macular and paramacular retinochoroiditis lesions had a better than expected outcome in terms of visual function. Despite the general favorable prognosis, the marked morbidity of congenital toxoplasmosis in Brazil was confirmed.Objetivos: Descrever a evolução ocular e investigar antecedentes e aspectos clínicos que possam influenciar o prognóstico visual na toxoplasmose congênita. Metodologia: Coorte retrospectiva incluindo pacientes atendidos entre 1996 e 2017 nos setores ambulatoriais público e privado do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, em Porto Alegre, RS, Brasil, com diagnóstico confirmado de toxoplasmose congênita e seguimento até pelo menos um ano de idade. Resultados: Dentre os 77 pacientes incluídos, a suspeita de toxoplasmose congênita ocorreu por triagem de rotina em 65 (84,5%). Setenta e três pacientes (94,8%) receberam tratamento no primeiro ano de vida com pirimetamina, sulfadiazina e ácido folínico. A mediana da idade ao final do acompanhamento foi de 10 anos (mínimo 2, máximo 25). O número de pacientes com retinocoroidite era de 39 (70,9%) no primeiro ano de vida e de 55 (71,4%) ao final do acompanhamento. Houve um pico de incidência de novas lesões de retinocoroidite entre os 4 e 5 anos e outro entre os 9 e os 14 anos, este último apenas nas meninas. Novas lesões de retinocoroidite surgiram após o primeiro ano de vida em 77,8% dos pacientes que iniciaram o tratamento após o quarto mês de vida, vs. 35,2% dos que o iniciaram dentro dos quatro primeiros meses (RR=0,45, IC95% 0,27-0,75, p=0,02) e 33,3% dos que o iniciaram dentro dos dois primeiros meses (RR=0,42, IC95% 0,25-0,72, p=0,01). Em oito olhos com lesão macular a acuidade visual foi entre 10% e 40% e em 10 olhos com lesão paramacular a acuidade foi entre 5% e 100%. Trinta e quatro pacientes com retinocoroidite foram acompanhados por 10 anos ou mais, entre os quais o desempenho escolar foi considerado adequado em 28 (82,4%). Conclusões: A alta incidência de novas lesões de retinocoroidite ao longo do acompanhamento indica a importância do seguimento a longo prazo dos pacientes com toxoplasmose congênita. O início do tratamento dentro dos quatro primeiros meses de vida, especialmente dentro dos dois primeiros meses, foi fator protetor para surgimento posterior de retinocoroidite. Olhos com lesões de retinocoroidite macular e paramacular tiveram um desfecho melhor que o esperado em termos de função visual. Apesar do prognóstico em geral favorável, confirmou-se a acentuada morbidade da toxoplasmose congênita no Brasil.Submitted by PPG Pediatria e Saúde da Criança (pediatria-pg@pucrs.br) on 2021-10-25T13:40:53Z No. of bitstreams: 1 Dissertação Mariana Endres final.pdf: 2123851 bytes, checksum: b15e5d1fb48bfcab3f70d31b260dede8 (MD5)Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2021-10-25T17:27:35Z (GMT) No. of bitstreams: 1 Dissertação Mariana Endres final.pdf: 2123851 bytes, checksum: b15e5d1fb48bfcab3f70d31b260dede8 (MD5)Made available in DSpace on 2021-10-25T17:37:25Z (GMT). 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dc.title.por.fl_str_mv Evolução ocular na toxoplasmose congênita
title Evolução ocular na toxoplasmose congênita
spellingShingle Evolução ocular na toxoplasmose congênita
Endres, Mariana Miranda
Toxoplasmose
Infecções Congênitas
Toxoplasmose Ocular
Coriorretinite
Acuidade Visual
Fatores de Risco
Toxoplasmosis
Congenital Infections
Ocular Toxoplasmosis
Chorioretinitis
Visual Acuity
Risk Factors
CIENCIAS DA SAUDE::MEDICINA
MEDICINA::SAUDE MATERNO-INFANTIL
title_short Evolução ocular na toxoplasmose congênita
title_full Evolução ocular na toxoplasmose congênita
title_fullStr Evolução ocular na toxoplasmose congênita
title_full_unstemmed Evolução ocular na toxoplasmose congênita
title_sort Evolução ocular na toxoplasmose congênita
author Endres, Mariana Miranda
author_facet Endres, Mariana Miranda
author_role author
dc.contributor.advisor1.fl_str_mv Fiori, Humberto Holmer
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/2201434748530559
dc.contributor.advisor-co1.fl_str_mv Lago, Eleonor Gastal
dc.contributor.advisor-co1Lattes.fl_str_mv http://lattes.cnpq.br/6806630864697856
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/2159917011317623
dc.contributor.author.fl_str_mv Endres, Mariana Miranda
contributor_str_mv Fiori, Humberto Holmer
Lago, Eleonor Gastal
dc.subject.por.fl_str_mv Toxoplasmose
Infecções Congênitas
Toxoplasmose Ocular
Coriorretinite
Acuidade Visual
Fatores de Risco
topic Toxoplasmose
Infecções Congênitas
Toxoplasmose Ocular
Coriorretinite
Acuidade Visual
Fatores de Risco
Toxoplasmosis
Congenital Infections
Ocular Toxoplasmosis
Chorioretinitis
Visual Acuity
Risk Factors
CIENCIAS DA SAUDE::MEDICINA
MEDICINA::SAUDE MATERNO-INFANTIL
dc.subject.eng.fl_str_mv Toxoplasmosis
Congenital Infections
Ocular Toxoplasmosis
Chorioretinitis
Visual Acuity
Risk Factors
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE::MEDICINA
MEDICINA::SAUDE MATERNO-INFANTIL
description Objectives: To describe the ocular evolution and to investigate antecedents and clinical aspects that may influence the visual prognosis in congenital toxoplasmosis. Methodology: Retrospective cohort including patients seen between 1996 and 2017 in the public and private outpatient sectors of the São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil, with confirmed diagnosis of congenital toxoplasmosis and follow-up to at least one year old. Results: Among the 77 patients included, congenital toxoplasmosis was suspected by routine screening in 65 (84.5%). Seventy-three patients (94.8%) received treatment in the first year of life with pyrimethamine, sulfadiazine and folinic acid. The median age at the end of follow-up was 10 years (minimum 2, maximum 25). The number of patients with retinochoroiditis was 39 (70.9%) in the first year of life and 55 (71.4%) at the end of follow-up. There was a peak incidence of new retinochoroiditis lesions between 4 and 5 years and another between 9 and 14 years, the latter only in girls. New retinochoroiditis lesions appeared after the first year of life in 77.8% of patients who started treatment after the fourth month of life, vs. 35.2% of those who started it within the first four months (RR=0.45, 95%CI 0.27-0.75, p=0.02) and 33.3% of those who started it within the first two months (RR=0.42, 95%CI 0.25-0.72, p=0.01). In eight eyes with macular lesion the visual acuity was between 10% and 40% and in 10 eyes with paramacular lesion the acuity was between 5% and 100%. Thirty-four patients with retinochoroiditis were followed for 10 years or more, among which school performance was considered adequate in 28 (82.4%). Conclusions: The high incidence of new retinochoroiditis lesions during follow-up indicates the importance of long-term follow-up of patients with congenital toxoplasmosis. Starting the treatment within the first four months of life, specially within the first two months, was a protective factor for later onset of retinochoroiditis. Eyes with macular and paramacular retinochoroiditis lesions had a better than expected outcome in terms of visual function. Despite the general favorable prognosis, the marked morbidity of congenital toxoplasmosis in Brazil was confirmed.
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