Difficulties observed in a reference center in the diagnosis and management of pregnant women with toxoplasmosis

Aims: To evaluate the difficulties met in the care of pregnant women with toxoplasmosis diagnosis in antenatal care services. Methods: Longitudinal prospective study with 262 pregnant women referred to the Toxoplasmosis Clinic at Instituto de Pesquisa Clinica Evandro Chagas-Fundacao Oswaldo Cruz, between January 2005 and July 2009. Results: Most women (91.2%) were in the second and third trimesters of pregnancy, and 81.3% were referred by public health services. The average delay was 113.4 days in the collection of the first sample for serological tests in antenatal care, 52.1 days for referral and 160.6 days in starting treatment. Younger women (P=0.03) and those from the public health system were referred later (P<0.05). Treatment was initiated at the origin for only 16% of the pregnant women, and 5% of these did not receive the recommended dose of spiramycin. At the Reference Center there was a low rate of confirmation of the serological tests performed in the health services of origin. It was found that 12.6% of pregnant women with an initial diagnosis of acute toxoplasmosis were susceptible to infection by Toxoplasma gondii. These tests were considered false positives. Conclusions: This study highlights the difficulties met in the management of pregnant women with toxoplasmosis in the antenatal care, including the quality of diagnostic tests and the need for greater emphasis on continuing education of health professionals.