Manejo da toxoplasmose congênita e gestacional: uma revisão sistemática com meta-análise

Abstract

Toxoplasmosis is a globally prevalent zoonotic parasitic disease caused by a protozoan parasite, Toxoplasma gondii. Neonates with congenital infection can develop severe long-term sequelae, which can be mitigated or prevented through early diagnosis and therapeutic approaches. The main objective of this study was to compare previous transdisciplinary and integrative studies within the scope of globally recommended treatment protocols for congenital toxoplasmosis. This systematic review with meta-analysis searched digital databases (PUBMED, SCOPUS, WEB OF SCIENCE, EMBASE, and COCHRANE) for articles published from 2013 to 2023 focusing on the treatment of congenital and gestational toxoplasmosis. The study quality was assessed following the Joanna Briggs Institute protocol. Among the 1,089 identified studies, 52 studies were selected, meeting the inclusion criteria, focusing on the treatment of congenital and gestational toxoplasmosis. A total of 10,304 pregnant women and 3,877 children exposed to toxoplasmosis from 12 countries participated. 38% of the studies were conducted in Brazil, followed by France and Italy. Only 9% of the studies indicated knowledge of the serological status of the pregnant woman before the gestational stage. 9,401 women were diagnosed with confirmed toxoplasmosis, and 2,394 children were infected with Toxoplasma, of which 1,000 children were diagnosed with confirmed congenital toxoplasmosis. Of the pregnant women diagnosed with toxoplasma, 7,922 received some form of treatment, resulting in 1,524 (19%) toxoplasma-positive children. Additionally, 870 children out of 1,479 untreated mothers were infected with T. gondii (59%). The meta-analysis revealed that treatment reduces the risks of infection (RR = 0.42 [0.22; 0.80]) and clinical manifestations (RR = 0.40 [0.18; 0.88]). The comparative analysis between treatments showed similar effects between mothers treated with spiramycin or with treatments that include isolated or alternated triple therapy. However, the lower heterogeneity in studies including triple therapy (I² = 39%; 95% CI = 7.10; 13.89) compared to studies with isolated spiramycin (I² = 83%; 95% CI = 6.30; 26.40) indicates more consistent treatment effects in mothers treated with triple therapy. In conclusion, treatments for congenital or gestational toxoplasmosis have proven to be effective in reducing the risk of infection and clinical manifestations in neonates. Regarding the type of treatment, although they have similar responses, the use of triple therapy shows more consistent responses than isolated spiramycin.