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Background: Neonatal sepsis is associated with high mortality, but there is limited clinical data on outcomes in hospital facilities in low and middle income countries (LMIC). The NeoOBS study aimed to determine the clinical features, pathogens and clinical outcomes of infants presenting with neonatal sepsis in hospitals globally. Methods: Infants

Objectives To estimate, by neonatal screening, the birth prevalence of congenital toxoplasmosis among live-born infants in Sergipe state, Brazil, and to investigate the clinical features of affected infants. Methods Dried blood spot specimens obtained from 15 204 neonates were assayed for the presence of anti-T. gondii IgM antibodies. Duplicate retesting was done in infants with positive and borderline results. Confirmatory testing in peripheral blood samples consisted of testing for anti-T. gondii IgG and IgM in infants and mothers. Those with possible congenital toxoplasmosis were evaluated and followed up to a median age of 20 months. Congenital infection was confirmed in the presence of persisting anti-T. gondii IgG antibodies beyond 12 months of age. All infants with confirmed infection were treated with pyrimethamine, sulfadiazine and folinic acid for 1 year. Results Fifty-three infants had detectable IgM in dried blood spot specimens. Confirmatory testing was reactive in 39/50, of which, 38 completed follow-up. Six of 15 204 newborns were diagnosed with congenital toxoplasmosis, resulting in an estimated birth prevalence of four per 10 000 [CI 95% 1.4–8.0]. Four infants (67%) showed signs of congenital toxoplasmosis in their first year of life; three (75%) had retinochoroidal scars, and one had cerebral calcifications. Two infants remained asymptomatic until 20 months of age. Conclusions The birth prevalence of congenital toxoplasmosis is high in the Brazilian state of Sergipe, with most of the infants showing ocular lesions. Preventive measures are strongly warranted. Objectifs: Estimer par le depistage neonatal, la prevalence a la naissance de la toxoplasmose congenitale chez les enfants nes vivants dans l’etat de Sergipe, au Bresil et etudier les caracteristiques cliniques des nourrissons atteints. Methodes: Des specimens seches de goutte de sang obtenus a partir de 15.204 nouveau-nes ont ete testes pour la presence d’anticorps IgM anti T. gondii. Un second test a ete effectue chez les nourrissons ayant des resultats positifs et intermediaires. Les tests de confirmation sur les echantillons de sang peripherique ont consistea tester pour les anticorps IgG et IgM anti T. gondii chez les nourrissons et les meres. Ceux atteints d’une eventuelle toxoplasmose congenitale ont eteevalues et suivis jusqu’a un âge median de 20 mois. L’infection congenitale a ete confirmee dans la presence de la persistance d’anticorps IgG anti T. gondii au dela de l’âge de 12 mois. Tous les nourrissons atteints d’une infection confirmee ont ete traites avec la pyrimethamine, la sulfadiazine et l’acide folinique pendant un an. Resultats: 53 enfants avaient des IgM detectables dans les echantillons seches de goutte de sang. Les tests de confirmation ont ete positifs dans 39/50 cas, dont 38 ont complete le suivi. Six des 15.204 nouveaux-nes ont ete diagnostiques avec une toxoplasmose congenitale, resultant en une prevalence a la naissance estimee a 4 pour 10.000 [IC95%: 1,4 a 8,0]. Quatre nourrissons (67%) presentaient des signes de la toxoplasmose congenitale au cours de leur premiere annee de vie, trois (75%) presentaient des cicatrices retinochoroidales et un presentait des calcifications cerebrales. Deux nourrissons sont restes asymptomatiques jusqu’a l’âge de 20 mois. Conclusions: La prevalence a la naissance de la toxoplasmose congenitale est elevee dans l’etat bresilien de Sergipe, avec la plupart des nourrissons presentant des lesions oculaires. Des mesures preventives sont fortement justifiees. Objetivos: Calcular, mediante un cribado neonatal, la prevalencia de nacimientos con toxoplasmosis congenita entre ninos nacidos vivos en el estado de Sergipe, en Brasil, e investigar las caracteristicas clinicas de los neonatos afectados. Metodos: Se obtuvieron muestras de sangre seca de 15,204 neonatos y se les realizaron pruebas para evaluar la presencia de anticuerpos IgM anti-T.gondii. Se realizo una prueba confirmatoria a los neonatos con resultados positivos y dudosos. Las pruebas confirmatorias en muestras de sangre periferica consistian en detectar las IgG e IgM especificas para T.gondii en neonatos y madres. Se evaluaron aquellos con una posible toxoplasmosis congenita y se les realizo un seguimiento hasta que tenian una edad media de 20 meses. Se confirmo una infeccion congenita en presencia anticuerpos IgG anti-T.gondii persistentes mas alla de los 12 meses de edad. Todos los neonatos con una infeccion confirmada eran tratados con pirimetamina, sulfadiazina y acido folinico durante un ano. Resultados: 53 neonatos tenian IgM detectables en las muestras de sangre seca. Las pruebas confirmatorias eran reactivas en 39/50 neonatos, de los cuales 38 cumplieron con el seguimiento. A seis de 15,204 neonatos se les diagnostico una toxoplasmosis congenita, resultando en una prevalencia estimada de nacimiento de 4 por 10,000 [IC 95% 1.4-8.0]. Cuatro neonatos (67%) presentaron signos de toxoplasmosis congenita durante su primer ano de vida; tres (75%) tenian cicatrices retinocoroideas, y uno tenia calcificaciones cerebrales. Dos neonatos se mantuvieron asintomaticos hasta los 20 meses de edad. Conclusiones: La prevalencia de nacimientos con toxoplasmosis congenita es alta en el estado Brasilero de Sergipe, con la mayoria de los neonatos presentando lesiones oculares. Las medidas preventivas estan ampliamente justificadas.

Congenital toxoplasmosis is rarely identified by routine clinical examination. The aim of this study was to estimate the incidence of the disease in the region of Ribeirão Preto, south-eastern Brazil. A definitive diagnosis was made on the basis of the persistence of anti-Toxoplasma IgG antibodies beyond 1 year of age. Blood samples obtained from 15162 neonates and adsorbed onto filter paper were tested for anti-Toxoplasma IgM antibodies. Fifteen samples gave positive results. A definitive diagnosis was confirmed in five of the 13 infants (38·5%) who completed follow-up. These five infants presented with serum IgM and/or IgA antibodies, and clinical abnormalities. Disease incidence was estimated to be 3·3/10000 (95% CI 1·0–7·7), indicating the need for preventive measures. Neonatal screening is feasible, but screening tests with a better performance are required; positive screening results must be carefully confirmed.

To estimate, by neonatal screening, the birth prevalence of congenital toxoplasmosis among live-born infants in Sergipe state, Brazil, and to investigate the clinical features of affected infants.Dried blood spot specimens obtained from 15 204 neonates were assayed for the presence of anti-T. gondii IgM antibodies. Duplicate retesting was done in infants with positive and borderline results. Confirmatory testing in peripheral blood samples consisted of testing for anti-T. gondii IgG and IgM in infants and mothers. Those with possible congenital toxoplasmosis were evaluated and followed up to a median age of 20 months. Congenital infection was confirmed in the presence of persisting anti-T. gondii IgG antibodies beyond 12 months of age. All infants with confirmed infection were treated with pyrimethamine, sulfadiazine and folinic acid for 1 year. Fifty-three infants had detectable IgM in dried blood spot specimens. Confirmatory testing was reactive in 39/50, of which, 38 completed follow-up. Six of 15 204 newborns were diagnosed with congenital toxoplasmosis, resulting in an estimated birth prevalence of four per 10 000 [CI 95% 1.4-8.0]. Four infants (67%) showed signs of congenital toxoplasmosis in their first year of life; three (75%) had retinochoroidal scars, and one had cerebral calcifications. Two infants remained asymptomatic until 20 months of age.The birth prevalence of congenital toxoplasmosis is high in the Brazilian state of Sergipe, with most of the infants showing ocular lesions. Preventive measures are strongly warranted.