CONGENITAL TOXOPLASMOSIS AND ITS RELEVANCE IN THE NATIONAL CONTEXT: A BIBLIOGRAPHIC REVIEW
Toxoplasmosis is infection caused by the Toxoplasma gondii protozoan, which is acquired by fecal-oral transmission, badly cooked meat consummation of intermediate or vertical hosts. It is one of the most frequent zoonosis, with wide distribution and high prevalence in Brazil, being relevant for the worldwide public health. In immunocompetent individuals, the infection uses to be asymptomatic. The transplacental transmission comes from the first infection of the pregnant, and in face of the variable seriousness of the congenital disease, the pre-natal selection to avoid or reduce manifestations and sequels becomes fundamental for the newborn to his or her birth and future life. This review aimed to join and to present updates about congenital toxoplasmosis (TC), its selection tests/available diagnosis, and its importance for the prenatal and neonatal diagnosis, besides to evidence the effectivity cost of the sorting programs verified in European countries. A bibliographic search based on the data from August July 2020 was realized, by using the following descriptors: toxoplasmosis, congenital, neonatal, prenatal, diagnosis and their respective English translation. Articles in English and Portuguese, published between 2016 and 2020 were selected, and the ones that didn’t frame into the study theme were excluded. Materials from the Health Ministry and the Brazilian Pediatric Society were also consulted. Among all the works found, nine were selected for a discussion. As in other countries around the world, Brazil has a prenatal tracking program based on a serologic test (IgM and IgG anti toxoplasma). The serial ultrasound exams during the pregnancy period can evidence changings and malformations suggestive of the infection, but they don’t confirm the diagnosis. Among the methods used for the TC, the method of PCR, by using samples of amniotic liquid (LA), blood and or fetal tissues, is the most employed one. The LA collection by the amniocentesis demonstrated safety when it was realized in a pregnancy age over 15 weeks. Other technics employed are the genotyping, microscopy, dye test and tests by using species of mice. For the postnatal diagnosis, the combination of several serologic tests aggregates a larger sensibility, and the ELISA e ISAGA technics can be used. During the last years, the developing countries have presented stability or rising of their seroprevalence. In this context Brazil occupies an important position, due to factors like lack of infrastructure and the late beginning of the prenatal sorting. The dosage of IgA demonstrated to be useful for the inconclusive serology confirmation and acute infection, yet is little available. European studies verified that the prenatal sorting of pregnant people saved costs in regions with high prevalence of the disease, and this one demonstrated to be more effective than the neonatal. Most of the studies proved that the diagnosis and previous treatment of the maternal infection reduce the vertical transmission significantly and improve the TC prognosis. The reality found in Brazil impeaches the nullification of the prenatal sorting program. So, the need of financing which enlarge the availability and the agility of tests of the tests to permit the previous diagnosis of the infection and health of the newborn are necessary. With the insertion of the neonatal tracking through the Newborn Screening Program, the expectancy is that this become more effective.
KEYWORDS: zoonosis, vertical transmission, prenatal, diagnosis, neonatology
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