Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ

Detalhes bibliográficos
Autor(a) principal: Bartholo, Barbara Beatriz Garcia Raskovisch
Data de Publicação: 2017
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
Texto Completo: http://www.bdtd.uerj.br/handle/1/8833
Resumo: Acute toxoplasmosis in pregnancy is caused by Toxoplasma gondii transmitted by ingestion of infected food, blood transfusion, organ transplantation and by vertical transmission (VT). The VT occurs during the acute phase of the disease in pregnancy and may cause fetal malformations such as cerebral calcifications, chorioretinitis, seizure, hydrocephalus or microcephaly, in addition to other gestational complications. It is estimated that 25-30% of the world population is infected by T.gondii approximately and the prevalence of congenital infection is around 0.2 to 2 per 1,000 live births. Ministry of Health in Brazil establishes a clear guideline on the screening and treatment of acute toxoplasmosis during pregnancy. However, the national and international literature presents controversies regarding the conduct of the disease, and there is no concrete evidence on the efficacy of the treatment and the validity of prenatal screening. The aim of this study was to evaluate the VT rate and other unfavourable gestational outcomes in pregnant women with acute T.gondii infection, as well as the sociodemographic variables of these patients. A concurrent cohort study was performed with a sample of 26 patients with acute toxoplasmosis. Pregnant women diagnosed or suspected of acute toxoplasmosis were clinically evaluated, have answered to a sociodemographic questionnaire and treated according to the Ministry of Health in Brazil protocol. These patients were submitted to PCR in amniotic fluid and monthly fetal US for the establishment of fetal infectious status. At the conclusion of the study, the EPI-INFO 3.5.2 program and SPSS version 20 were used for statistical analysis. There was a high intake of non-potable water, inadequate basic sanitation and a high number of felines contacts in our sample. Twenty-three patients were carefully treated in the prenatal setting, presenting a vertical transmission rate (VT) of the disease of 17.4%. The remaining patients (three) were not treated, evolving with a VT rate of 33.3%. Congenital toxoplasmosis was diagnosed in 19.2% (5/26) of cases. There was a higher vertical transmission of the disease in infected patients in the third trimester (p <0.05). PCR was performed in amniotic fluid in 15 patients with positive results in only one pregnant woman, and the fetus submitted to triple intrauterine treatment, presenting as asymptomatic and without alterations in complementary tests at birth. The other infected concepts (4/26) presented hydrocephalus (2), intracranial calcifications (1) and chorioretinitis (1). CSF (pleocytosis and hyperproteinorrachy) occurred in 3/5 new-borns with congenital toxoplasmosis. There was a fetal death without confirmation of the congenital infection. Therefore, there was a direct correlation between toxoplasmosis during gestation and the low socioeconomic level / inadequate sanitary hygiene conditions, higher vertical transmission of the disease in infected patients in the third trimester (p <0.05), in agreement with other studies. There was also a higher rate of vertical transmission of the disease in inappropriately treated patients. Among the new-borns with congenital toxoplasmosis, 80% were symptomatic with intracranial calcifications, chorioretinitis and hydrocephalus. There was a change in cerebrospinal fluid alteration (pleocytosis and hyperproteinorraquia) in 60% of the concepts with congenital toxoplasmosis. The disease was not correlated with an increase in the rate of preterm birth and caesarean sections and / or decrease in Apgar.
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spelling Monteiro, Denise Leite Maiahttp://lattes.cnpq.br/6838883176920573Trajano, Alexandre José Baptistahttp://lattes.cnpq.br/6769984760496243Rodrigues, Nádia Cristina Pinheirohttp://lattes.cnpq.br/4092510874563802Souza, Flavio Monteiro dehttp://lattes.cnpq.br/0763945584541834Braga Neto, Antônio Rodrigueshttp://lattes.cnpq.br/7557971069321691http://lattes.cnpq.br/6395078192210283Bartholo, Barbara Beatriz Garcia Raskovisch2021-01-05T19:43:37Z2018-08-232017-05-10BARTHOLO, Barbara Beatriz Garcia Raskovisch. Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ. 2017. 68 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2017.http://www.bdtd.uerj.br/handle/1/8833Acute toxoplasmosis in pregnancy is caused by Toxoplasma gondii transmitted by ingestion of infected food, blood transfusion, organ transplantation and by vertical transmission (VT). The VT occurs during the acute phase of the disease in pregnancy and may cause fetal malformations such as cerebral calcifications, chorioretinitis, seizure, hydrocephalus or microcephaly, in addition to other gestational complications. It is estimated that 25-30% of the world population is infected by T.gondii approximately and the prevalence of congenital infection is around 0.2 to 2 per 1,000 live births. Ministry of Health in Brazil establishes a clear guideline on the screening and treatment of acute toxoplasmosis during pregnancy. However, the national and international literature presents controversies regarding the conduct of the disease, and there is no concrete evidence on the efficacy of the treatment and the validity of prenatal screening. The aim of this study was to evaluate the VT rate and other unfavourable gestational outcomes in pregnant women with acute T.gondii infection, as well as the sociodemographic variables of these patients. A concurrent cohort study was performed with a sample of 26 patients with acute toxoplasmosis. Pregnant women diagnosed or suspected of acute toxoplasmosis were clinically evaluated, have answered to a sociodemographic questionnaire and treated according to the Ministry of Health in Brazil protocol. These patients were submitted to PCR in amniotic fluid and monthly fetal US for the establishment of fetal infectious status. At the conclusion of the study, the EPI-INFO 3.5.2 program and SPSS version 20 were used for statistical analysis. There was a high intake of non-potable water, inadequate basic sanitation and a high number of felines contacts in our sample. Twenty-three patients were carefully treated in the prenatal setting, presenting a vertical transmission rate (VT) of the disease of 17.4%. The remaining patients (three) were not treated, evolving with a VT rate of 33.3%. Congenital toxoplasmosis was diagnosed in 19.2% (5/26) of cases. There was a higher vertical transmission of the disease in infected patients in the third trimester (p <0.05). PCR was performed in amniotic fluid in 15 patients with positive results in only one pregnant woman, and the fetus submitted to triple intrauterine treatment, presenting as asymptomatic and without alterations in complementary tests at birth. The other infected concepts (4/26) presented hydrocephalus (2), intracranial calcifications (1) and chorioretinitis (1). CSF (pleocytosis and hyperproteinorrachy) occurred in 3/5 new-borns with congenital toxoplasmosis. There was a fetal death without confirmation of the congenital infection. Therefore, there was a direct correlation between toxoplasmosis during gestation and the low socioeconomic level / inadequate sanitary hygiene conditions, higher vertical transmission of the disease in infected patients in the third trimester (p <0.05), in agreement with other studies. There was also a higher rate of vertical transmission of the disease in inappropriately treated patients. Among the new-borns with congenital toxoplasmosis, 80% were symptomatic with intracranial calcifications, chorioretinitis and hydrocephalus. There was a change in cerebrospinal fluid alteration (pleocytosis and hyperproteinorraquia) in 60% of the concepts with congenital toxoplasmosis. The disease was not correlated with an increase in the rate of preterm birth and caesarean sections and / or decrease in Apgar.A toxoplasmose aguda na gestação é causada pelo Toxoplasma gondii transmitido pela ingesta de alimentos infectados, hemotransfusão, transplante de órgãos e pode evoluir com transmissão vertical (TV). A TV ocorre durante a fase aguda da doença na gestação e pode provocar malformações fetais como calcificações cerebrais, coriorretinite, convulsões, hidrocefalia ou microcefalia, além de outras complicações fetais. Estima-se que 25-30% da população mundial seja infectada pelo T.gondii aproximadamente e a prevalência da infecção congênita é em torno de 0,2 a 2 por 1.000 nascidos vivos. O Ministério da Saúde (MS) estabelece clara diretriz sobre a triagem e tratamento da toxoplasmose aguda na gestação. Entretanto, a literatura nacional e internacional apresenta controvérsias sobre conduta diante da doença, não havendo evidências concretas sobre a eficácia do tratamento e a validade da triagem no pré-natal. O estudo objetiva avaliar a taxa de TV e os demais desfechos gestacionais desfavoráveis em gestantes com infecção aguda pelo T.gondii, assim como as variáveis sociodemográficas dessas pacientes. Foi realizado estudo de coorte concorrente com amostra constituída por 26 pacientes com toxoplasmose aguda. As gestantes diagnosticadas ou com suspeita de toxoplasmose aguda foram avaliadas clinicamente, responderam a questionário sociodemográfico e tratadas de acordo com o protocolo do MS. Tais pacientes foram submetidas a exame de PCR no líquido amniótico (LA) e USG fetal mensal para o estabelecimento do status infeccioso fetal. Foi utilizado para análise estatística, à conclusão do estudo. Verificou-se elevada ingesta de água não-potável, saneamento básico inadequado e número elevado de contactantes com felinos em nossa amostra. Vinte e três pacientes foram dequadamente tratadas no prenatal, apresentando taxa de TV da doença de 17,4%. As demais pacientes (três) não foram tratadas, evoluindo com taxa de TV de 33,3%. Diagnosticou-se toxoplasmose congênita em 19,2% (5/26) dos casos. Houve maior TV da doença em pacientes infectadas no terceiro trimestre (p<0,05). Foi realizado PCR em LA em 15 pacientes com resultado positivo em apenas uma gestante, sendo o feto submetido a tratamento durante o período gestacional com esquema tríplice, apresentando-se assintomático e sem alterações em exames complementares ao nascimento, exceto pela presença de anemia leve. Os demais conceptos infectados (4/26) apresentaram hidrocefalia (2), calcificações intracranianas (1) e coriorretinite (1). Houve alteração liquórica (pleocitose e hiperproteinorraquia) em 3/5 recém-nascidos com toxoplasmose congênita. Ocorreu um óbito fetal sem confirmação da infecção congênita. Assim, observou-se correlação direta entre toxoplasmose na gestação e o baixo nível sócio-econômico/condições higiênico sanitárias inadequadas, maior transmissão vertical da doença em pacientes infectadas no terceiro trimestre (p<0,05), em concordância com demais estudos. Houve, ainda, maior taxa de transmissão vertical da doença em pacentes inadequadamente tratadas. Entre os recém-nascidos com toxoplasmose congênita, 80% apresentaram-se sintomáticos com calcificações intracranianas, coriorretinite e hidrocefalia. Encontrou-se alteração liquória (pleocitose e hiperproteinorraquia) em 60% dos conceptos com toxoplasmose congênita. Não correlacionamos a doença com aumento na taxa de partos prematuros e de cesarianas e/ou queda no Apgar.Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:43:37Z No. of bitstreams: 1 Barbara Beatriz Garcia Raskovisch Bartholo Dissertacao completa.pdf: 1483891 bytes, checksum: 8e28d43e238bad8d3167f290d6fa322c (MD5)Made available in DSpace on 2021-01-05T19:43:37Z (GMT). No. of bitstreams: 1 Barbara Beatriz Garcia Raskovisch Bartholo Dissertacao completa.pdf: 1483891 bytes, checksum: 8e28d43e238bad8d3167f290d6fa322c (MD5) Previous issue date: 2017-05-10application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Ciências MédicasUERJBRCentro Biomédico::Faculdade de Ciências MédicasToxoplasmosisCongenital toxoplasmosisGestationTherapy combined modalityToxoplasmoseToxoplasmose congênitaGestaçãoTerapia modalidade combinadaToxoplasmoseGravidezToxoplasmose CongênitaTransmissão vertical da doençaCNPQ::CIENCIAS DA SAUDE::MEDICINAAvaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJEvaluation of vertical transmission of toxoplasmosis in pregnant women with acute infection in HUPE / UERJinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALBarbara Beatriz Garcia Raskovisch Bartholo Dissertacao completa.pdfapplication/pdf1483891http://www.bdtd.uerj.br/bitstream/1/8833/1/Barbara+Beatriz+Garcia+Raskovisch+Bartholo+Dissertacao+completa.pdf8e28d43e238bad8d3167f290d6fa322cMD511/88332024-02-26 16:00:10.714oai:www.bdtd.uerj.br:1/8833Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T19:00:10Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false
dc.title.por.fl_str_mv Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ
dc.title.alternative.eng.fl_str_mv Evaluation of vertical transmission of toxoplasmosis in pregnant women with acute infection in HUPE / UERJ
title Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ
spellingShingle Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ
Bartholo, Barbara Beatriz Garcia Raskovisch
Toxoplasmosis
Congenital toxoplasmosis
Gestation
Therapy combined modality
Toxoplasmose
Toxoplasmose congênita
Gestação
Terapia modalidade combinada
Toxoplasmose
Gravidez
Toxoplasmose Congênita
Transmissão vertical da doença
CNPQ::CIENCIAS DA SAUDE::MEDICINA
title_short Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ
title_full Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ
title_fullStr Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ
title_full_unstemmed Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ
title_sort Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ
author Bartholo, Barbara Beatriz Garcia Raskovisch
author_facet Bartholo, Barbara Beatriz Garcia Raskovisch
author_role author
dc.contributor.advisor1.fl_str_mv Monteiro, Denise Leite Maia
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/6838883176920573
dc.contributor.advisor-co1.fl_str_mv Trajano, Alexandre José Baptista
dc.contributor.advisor-co1Lattes.fl_str_mv http://lattes.cnpq.br/6769984760496243
dc.contributor.referee1.fl_str_mv Rodrigues, Nádia Cristina Pinheiro
dc.contributor.referee1Lattes.fl_str_mv http://lattes.cnpq.br/4092510874563802
dc.contributor.referee2.fl_str_mv Souza, Flavio Monteiro de
dc.contributor.referee2Lattes.fl_str_mv http://lattes.cnpq.br/0763945584541834
dc.contributor.referee3.fl_str_mv Braga Neto, Antônio Rodrigues
dc.contributor.referee3Lattes.fl_str_mv http://lattes.cnpq.br/7557971069321691
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/6395078192210283
dc.contributor.author.fl_str_mv Bartholo, Barbara Beatriz Garcia Raskovisch
contributor_str_mv Monteiro, Denise Leite Maia
Trajano, Alexandre José Baptista
Rodrigues, Nádia Cristina Pinheiro
Souza, Flavio Monteiro de
Braga Neto, Antônio Rodrigues
dc.subject.eng.fl_str_mv Toxoplasmosis
Congenital toxoplasmosis
Gestation
Therapy combined modality
topic Toxoplasmosis
Congenital toxoplasmosis
Gestation
Therapy combined modality
Toxoplasmose
Toxoplasmose congênita
Gestação
Terapia modalidade combinada
Toxoplasmose
Gravidez
Toxoplasmose Congênita
Transmissão vertical da doença
CNPQ::CIENCIAS DA SAUDE::MEDICINA
dc.subject.por.fl_str_mv Toxoplasmose
Toxoplasmose congênita
Gestação
Terapia modalidade combinada
Toxoplasmose
Gravidez
Toxoplasmose Congênita
Transmissão vertical da doença
dc.subject.cnpq.fl_str_mv CNPQ::CIENCIAS DA SAUDE::MEDICINA
description Acute toxoplasmosis in pregnancy is caused by Toxoplasma gondii transmitted by ingestion of infected food, blood transfusion, organ transplantation and by vertical transmission (VT). The VT occurs during the acute phase of the disease in pregnancy and may cause fetal malformations such as cerebral calcifications, chorioretinitis, seizure, hydrocephalus or microcephaly, in addition to other gestational complications. It is estimated that 25-30% of the world population is infected by T.gondii approximately and the prevalence of congenital infection is around 0.2 to 2 per 1,000 live births. Ministry of Health in Brazil establishes a clear guideline on the screening and treatment of acute toxoplasmosis during pregnancy. However, the national and international literature presents controversies regarding the conduct of the disease, and there is no concrete evidence on the efficacy of the treatment and the validity of prenatal screening. The aim of this study was to evaluate the VT rate and other unfavourable gestational outcomes in pregnant women with acute T.gondii infection, as well as the sociodemographic variables of these patients. A concurrent cohort study was performed with a sample of 26 patients with acute toxoplasmosis. Pregnant women diagnosed or suspected of acute toxoplasmosis were clinically evaluated, have answered to a sociodemographic questionnaire and treated according to the Ministry of Health in Brazil protocol. These patients were submitted to PCR in amniotic fluid and monthly fetal US for the establishment of fetal infectious status. At the conclusion of the study, the EPI-INFO 3.5.2 program and SPSS version 20 were used for statistical analysis. There was a high intake of non-potable water, inadequate basic sanitation and a high number of felines contacts in our sample. Twenty-three patients were carefully treated in the prenatal setting, presenting a vertical transmission rate (VT) of the disease of 17.4%. The remaining patients (three) were not treated, evolving with a VT rate of 33.3%. Congenital toxoplasmosis was diagnosed in 19.2% (5/26) of cases. There was a higher vertical transmission of the disease in infected patients in the third trimester (p <0.05). PCR was performed in amniotic fluid in 15 patients with positive results in only one pregnant woman, and the fetus submitted to triple intrauterine treatment, presenting as asymptomatic and without alterations in complementary tests at birth. The other infected concepts (4/26) presented hydrocephalus (2), intracranial calcifications (1) and chorioretinitis (1). CSF (pleocytosis and hyperproteinorrachy) occurred in 3/5 new-borns with congenital toxoplasmosis. There was a fetal death without confirmation of the congenital infection. Therefore, there was a direct correlation between toxoplasmosis during gestation and the low socioeconomic level / inadequate sanitary hygiene conditions, higher vertical transmission of the disease in infected patients in the third trimester (p <0.05), in agreement with other studies. There was also a higher rate of vertical transmission of the disease in inappropriately treated patients. Among the new-borns with congenital toxoplasmosis, 80% were symptomatic with intracranial calcifications, chorioretinitis and hydrocephalus. There was a change in cerebrospinal fluid alteration (pleocytosis and hyperproteinorraquia) in 60% of the concepts with congenital toxoplasmosis. The disease was not correlated with an increase in the rate of preterm birth and caesarean sections and / or decrease in Apgar.
publishDate 2017
dc.date.issued.fl_str_mv 2017-05-10
dc.date.available.fl_str_mv 2018-08-23
dc.date.accessioned.fl_str_mv 2021-01-05T19:43:37Z
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dc.identifier.citation.fl_str_mv BARTHOLO, Barbara Beatriz Garcia Raskovisch. Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ. 2017. 68 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2017.
dc.identifier.uri.fl_str_mv http://www.bdtd.uerj.br/handle/1/8833
identifier_str_mv BARTHOLO, Barbara Beatriz Garcia Raskovisch. Avaliação da transmissão vertical da toxoplasmose em gestantes com infecção aguda no HUPE/UERJ. 2017. 68 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2017.
url http://www.bdtd.uerj.br/handle/1/8833
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