Thursday, June 23, 2011

Neonatal infections - Congenital Toxoplasmosis

The risk of fetal infection is in relation to gestational age at which infection occurred, the risk is less when maternal infection occurs in early pregnancy, but the severity of fetal infection is inversely proportional to gestational age who develop:- In the first quarter rate of transmission is 14%;- In the second quarter rate of transmission is 29%;- In the third quarter is 59% transmission rate.The rate of occurrence of severe sequelae in infants infected is- 41% if infection has occurred in the first quarter;- 8% if the infection has occurred in the second quarter;- 0% if the infection has occurred in the third quarter.
Clinical signs:
A percentage of 60-70% of neonatal infections show no clinical evidence. Theasymptomatic may be one or more anomalies: pleocytosis, proteinorahie, chorioretinitis, intracranial calcifications, late-onset neurological deficits, especially visual disturbances after months or years after birth. In children followed up to 7 years to double the frequency found deafness, 60% increased incidence microcefaliei and 30% more children with low IQ, less than 70. Hydrocephalus started even after seven years in a child with subclinical infection in the perinatal periodMost children with subclinical infection will develop chorioretinitis.Symptomatic infection of moderate nonspecific symptoms, such as: early and prolonged jaundice, hepatosplenomegaly, anemia, hydrocephalus, microcephaly.Only 10% of newborns with congenital infection presents severe manifestations through different combinations fever, hepatosplenomegaly, hydro or microcephaly, direct hyperbilirubinemia, chorioretinitis, anemia, lymphadenopathy, abnormal spinal cerebrospinal fluid (CSF), seizures, intracranial calcification.
10% of newborns may develop fatal disease. Premature birth is 25-50% in infections with Toxoplasma gondii.
Positive diagnosis:
Serological diagnosis consists of: detection of specific antibodies in the blood type Ig M, Ig A, Ig G, Ig E. spcifice make a series of reactions: Sabin-Feldman reaction imunfluorescenta indirect reaction. Both are reference today in determining antitoxoplasma specific antibodies.Are important in a positive diagnosis: sensitized agglutination reaction, ELISA, which is specific and sensitive determination of Ig G.Immunosorbent Agglutination Assay Reactino (ISAGA) and ELISA, double sandwich "are most sensitive in determining Ig M and Ig A.
Parasite isolation make a diagnosis of certainty, but the chance to highlight the parasite using direct techniques are reduced. Can be isolated from: fragments of placenta, umbilical cord, cord blood, and brain tissue fragments, skeletal muscles to necropsy.Parasite isolation rate of peripheral blood and cerebrospinal fluid (CSF) at about 50% of asymptomatic and symptomatic babies grow in the first week and decreases thereafter.
Prophylactic treatment is to prevent acute acquired toxoplasma during pregnancy seronegative pregnant. Preventing transmission from mother to child birth is a method of secondary prevention.Is screening in pregnant women.
Newborn treatment is oral: 2 mg pyrimethamine in / kg / day, sulfadiazine at a dose of 50 mg / kg / day spiramycin in 100 mg / kg / day in 2 divided doses orally.

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