Perfil e manejo clínico laboratorial dos binômios mãe-filhos acometidos com Sífilis e Toxoplasmose

Abstract

Syphilis and toxoplasmosis are diseases that compose the group of vertical transmission infections with potential damage to the fetus and differing severity on those affected. The relevance of studying these diseases lies in their potential to cause lesions involving the central nervous system of the fetus, although there are interventions capable of avoiding such outcomes. The aim of this study was to evaluate the profile and management of clinical laboratory approach to mother-child binomials affected with syphilis and toxoplasmosis. The study was conducted in Montes Claros, north of Minas Gerais, and considered two distinct investigations. The first investigation aimed to characterize the profile of mothers and children assisted at a follow-up outpatient clinic for congenital syphilis and to identify the factors associated with the confirmation of the diagnosis. It is a prospective cohort study conducted from 2016 to 2019, with analysis of maternal haracteristics such as sociodemographic, behavioral, lifestyle habits as well as characteristics related to access to health care and health care services. For the maternal risk behavior outcome, the use of illicit drugs, alcohol consumption and number of partners were taken into account. For purposes of diagnosis in the child, the criteria for congenital syphilis provided for by the Ministry of Health (Brazil) in 2017 were used (Children of untreated or inadequately treated mothers, regardless of the results of the clinical evaluation or complementary tests of the newborn , clinical manifestations or changes in CSF or radiological changes and reactive TNT, regardless of maternal history and TNT titration, TNT in the NB greater than the maternal at least in two dilutions, persistence of reactive TNT after six months of age or reactive TT after 18 months of age without prior treatment), excluding abortions and stillbirths. Chi-square test or Fischer's exact test was used to verify associated variables selected for multiple analysis, using hierarchical Poisson regression. A total of 200 binomials, who attended to at least one appointment as part of the follow-up after discharge from the maternity ward, were included. The diagnosis of congenital syphilis was confirmed for 116 children. The factors associated with the diagnosis of congenital syphilis were low maternal schooling level (PR=1.30; CI 95%=1.05-1.60), maternal risk behavior (PR=1.34; CI 95%=1.07-1.66), inadequate treatment of the mother (PR=3.16; CI 95%=2.42-4.47) and lack of treatment of the partner (PR=1.44; CI 95%=1.18-1.81). The second investigation aimed to evaluate the profile of pregnant women and neonates followed-up at a reference center for infectious-parasitic diseases, after exposure to T. gondii, establishing comparisons with a study previously conducted at the same site ten years ago. Mothers, who during prenatal care presented tests suggestive of seroconversion for the disease, and their respective concepts followed-up over a year, were included. Chi-square test was used, assuming a significance level of 5%, in order to compare data from the two studies. During the period from 2016 to 2020, 79 binomials were studied, while in the previous period (2002-2010) 58 binomials were followed-up. In relation to mothers, lower percentage of adolescent (p<0.001), with low schooling (p<0.001), with low serological tests (p<0.001) and with late or postnatal diagnosis (p<0.001) were recorded. In relation to children, lower percentage of changes in fundoscopy (p<0.001), strabismus (p=0.002), hepatomegaly (p=0.026) and any sequelae (p<0.001) were observed. The results highlight the social inequities especially associated with congenital syphilis and the lack of adequate management of the pregnant women and their partners. There is a positive advance regarding the care for the mother-child binomial affected by T. gondii, but health education should advance so as to provide the pregnant women and family members with greater knowledge about diseases. For both studies, the results represent a warning to managers and healthcare professionals, highlighting the need to intensify prophylactic actions in communities, in addition to educational activities to broaden understanding and improve the management of diseases among healthcare professionals.