Congenital toxoplasmosis in a Portuguese tertiary hospital – report of 4 cases

Toxoplasma gondii is an intracellular parasite responsible for toxoplasmosis, a zoonosis with a worldwide distribution. Congenital toxoplasmosis occurs when a pregnant woman becomes infected during the gestation or when there is reactivation in an immunocompromised pregnant woman of a previous latent infection. Clinical manifestations of congenital infection can vary in severity, ranging from asymptomatic infection to abortion and still-birth. We are not aware of any published cases neither of confirmed congenital toxoplasmosis nor of any of its complications in Portugal. The incidence of congenital toxoplasmosis estimated in 2013 by the World Health Organization was of 5/10,000 live births for the region where Portugal is inserted (European region A). In this study, we aimed to describe the cases of congenital toxoplasmosis in Centro Hospitalar Universitario de Sao Joao (CHUSJ) between January of 1999 and December of 2018. For that, we worked with the records of the Neonatology and Obstetrics Departments. Records of 4 patients with confirmed congenital toxoplasmosis were found, 3 of which born in our hospital. The 4 cases are described in this paper. In 2 out of the 4 cases, infants developed complications secondary to congenital toxoplasmosis such as microphthalmia, chorioretinitis, congenital hydrocephalus, diabetes insipidus, seizures, intracranial calcifications, central apnea and disturbances of the thermal regulation. The found cases reflect an incidence of 0.6/10,000 births. This low incidence can be explained by the precautions taken by pregnant women to avoid the infection, the early therapy administrated when seroconversion is detected and by the changes in food habits and improved hygiene practices that have taken place in Portugal in the last years.