Background: Population seroprevalence and rates of mother-to-child transmission are important in determining the incidence of congenital toxoplasmosis. (CT) Mother-to-child transmission depends on the timing of acute maternal infection and treatment during pregnancy. The incidence of CT varies widely across geographic regions, ranging from 1 to 10 cases per 10,000 live births. The incidence of symptomatic disease varies from 0.15 to 0.34 cases per 10,000. Methods: This is a review of patients treated at a pediatric CT clinic at a university hospital in the south of Brazil, from 2004 to 2014. Results: The annual incidence of CT varied from 0 to 14 cases per 10,000 live births, with a mean incidence of 6 cases per 10,000 during the 10 years studied (CI 95%: 3.02–8.91). The incidence of symptomatic CT varied from 0 to 9 cases per 10,000 live births, with a mean incidence of 5 per 10,000 (CI 95%: 2.44–6.94). There were 5 (14.3%) asymptomatic cases. The main findings were retinochoroiditis (54%), intracranial calcifications (37.5%) and altered cerebrospinal fluid (37.5%). Conclusions: The incidence of CT and the rate of symptomatic cases were in accordance with the previous data from other studies in Brazil, being significantly higher than in previous North American and European studies.

The association between the virus prenatal infection by Zika virus (ZIKV) and central nervous system disorders has been well established and it has been described as the Congenital Syndrome Associated to the Zika Virus (CSZ). However, the neurological development in those patients is still an object of study. The main differential diagnosis is the Cytomegalovirus (CMV). Describe the involvement of microcephalic patients affected by the congenital infection by the Zika Virus or CMV. Data has been collected from microcephalic patients whose birth took place after 2016 and which also had the congenital infection confirmed or presumed. The researched data consists in: congenital infection, head circumference from birth, presence of epilepsy, treatment by mono or polytherapy, electroencephalographic patterns, neurological physical examination and evaluation of gross motor development. 21 microcephalic children have been included showing the following congenital infectious syndromes: 9 were affected by cytomegalovirus (43%), 6 by the Zika virus (29%) and 6 ones by presumed infection due to the Zika virus (29%). From those ones, 13 (62%) presented epilepsy diagnosis including generalized crises and 9 (69%) were in current use of polytherapy. All of them also showed disorganized and asymmetrical base rhythms. Concerning the epileptiform activity, 5 presented multifocal activity and 3 ones hypsarrhythmia. All of the patients went under neuroimaging: 12 (57%) of them presented calcifications and 5 (24%) hydrocephalus. On the neurological exam, 17% presented a decreased axial tone and an enlarged appendicular. Smaller head circumference children had greater motor impairment and severity in the epilepsy. There was no difference in the frequency of epilepsy between children with CSZ and CMV. Epilepsy is confirmed as one of the most important complications of congenital infections by CSZ and CMV.

Background: Congenital syphilis (CS) is a transplacental infection that can lead to many long-term sequelae when not adequately treated; however, knowledge about the motor and neurological signs that newborns (NBs) with CS may present is scarce. Objective: The aim of this study was to describe the results of neurological assessment scales and general movements in NBs with CS in the first days of life. Methods: In this case-series, the Hammersmith Neonatal Neurological Examination (HNNE) and General Movements Assessment (GMA) scales were used to evaluate NBs under treatment for CS in a public Brazilian hospital in the first days of life. Results: The sample consisted of 11 NBs, with a mean birth weight of 3140.5 g, and an Apgar score at 5 min of 8.3. Among the 11 mothers, 4 (36.4%) had fewer than six prenatal visits and 5 (45.5%) did not receive any syphilis treatment. All NB (100%) were asymptomatic, with normal long bone X-rays and cerebrospinal fluid analysis. The mean score on the HNNE was 22 (suboptimal/abnormal). Eight NBs (72.7%) showed abnormalities on GMA scale (with six [54.5%] being mildly abnormal and two [18%] definitely abnormal). Only three NBs (27.3%) returned for outpatient follow-up. Conclusions: Neurological and motor evaluations were abnormal in most of the asymptomatic NBs under treatment for CS in the first days of life, when assessed through specific scales (HNNE and GMA). Most mothers did not receive adequate treatment for syphilis during pregnancy, and there were important deficiencies in post-discharge follow-up. Further studies are needed to confirm these findings and investigate whether the observed abnormalities are linked to biological or environmental factors during pregnancy.

INTRODUCTION: The current epidemiological situation in Porto Alegre is worrying due to the high rates of vertical transmission of HIV, syphilis in pregnant women and congenital syphilis, making the evaluation of the prevalence of congenital syphilis in newborns exposed to HIV relevant. It is estimated that an analysis of the data found may lead to measures capable of assisting in the prevention of both infections. OBJECTIVES: To describe pregnancy coinfection HIV/syphilis data and the consequences to their newborns. METHODS: A retrospective cohort study of live births of HIV-positive mothers with and without gestational syphilis, born at Hospital de Clínicas of Porto Alegre from January 1st, 2013 to December 31th, 2017. RESULTS: A total of 440 newborns from HIV-positive mothers were divided into two groups: the first, with 392 infants of HIV-positive mothers without gestational syphilis, resulting in 3 HIV-infected infants (vertical transmission 0,7%); the second group, with 48 infants born from mothers with HIV/syphilis coinfection (prevalence of gestational syphilis 10,9%), with 64,6% needing hospitalization for congenital syphilis treatment, and 4 HIV-infected newborns (vertical transmission 8,3%). When compared the two groups, it was verified that this difference was statistically significant. CONCLUSIONS: The gestational and congenital syphilis prevalence in our hospital is alarming, and coinfection HIV/syphilis seems to be an independent risk factor to the vertical transmission of HIV.

Background: Among the complications caused directly or indirectly by the Human Immunodeficiency Virus (HIV) are alterations in the auditory system. Children who are HIV-exposed but uninfected (HEU) appear to have a higher risk of hearing loss (HL) compared to their unexposed peers, but a lower risk than those infected with HIV. However, the literature remains inconclusive regarding this association. This study aims to evaluate the hearing function of HEU infants during the first months of life and to correlate these findings with maternal, gestational, and neonatal variables. Methods: This prospective cohort study included all HIV-exposed infants born in a quaternary hospital in southern Brazil between 2021 and 2023. Maternal, gestational, and neonatal data were collected, as well as the results of neonatal auditory screening. At approximately 6 months of age, otolaryngological and audiological assessments were performed, including wideband tympanometry and electrophysiological evaluation using Auditory Brainstem Response with frequency-specific stimuli. The prevalence of hearing loss refers to the number of infants affected. Results: Thirty-eight infants, with a mean age of 8 months (±3.3), completed the study. Of these, 1 (2.6%) presented with bilateral sensorineural HL, and 13 (34.2%) presented with conductive HL, with 6 cases being unilateral and 7 bilateral. No associations were found between hearing loss and maternal, gestational, or neonatal variables, except for maternal CD4 count, where higher CD4 cell counts were associated with an increased risk of conductive HL. Conclusion: The findings provide relevant data on auditory alterations in HEU infants, demonstrating a high prevalence of conductive HL. These results highlight the importance of monitoring the hearing of these children during the first years of life.