In

the present study, it was observed that, in 20% of newborns, Toxo-IgM was already negative at 1 month of age, when serum confirmatory tests are performed in most patients with positive Toxo-IgM at the neonatal screening. Although not included in the national program, neonatal SB431542 screening for congenital toxoplasmosis is a reality in Brazil, where most health insurance plans provide for its performance.19, 20 and 21 At least six patients in this cohort would be diagnosed only after months or years, after symptom onset, if the neonatal screening test had been considered a false positive due to the early negative Toxo–IgM test, preventing the indication for full clinical investigation, as well as the monitoring of Toxo-IgG. Pediatricians should be warned to not to consider a ISRIB nmr negative Toxo-IgM result in infants as evidence of absence of congenital infection. These infants should undergo

a thorough medical investigation; and when this is normal, Toxo–IgG should be monitored monthly until a total negative result or confirmatory diagnosis is attained. Other tests, such as specific IgA test (which, together with Toxo-IgM screening, moderately increase sensitivity) and molecular biology tests, can be performed to attempt confirmation of the diagnosis as early as possible.1, 10, 11 and 15 Although it is well known that treatment in infants decreases Toxo-IgG levels,1 and 2 this study indicated that the same does not occur with Toxo-IgM levels. The analyses showed no influence of the treatment on Toxo-IgM duration. Some clinical data were collected aiming to investigate their association with the dynamics of Toxo-IgM in the infant. Although the present study did not aim Oxymatrine to assess the prevalence of clinical manifestations in congenital toxoplasmosis,

and subjected to the biases inherent to the inclusion criteria employed, the authors believe the fact that the study did not include patients with diagnostic suspicion due to symptom onset and used a strict diagnostic confirmation criterion makes this a representative investigation of the studied population by offering relevant information, provided that its limitations are taken into account. The prevalence of clinical manifestations in this sample of patients (more than 60% with retinochoroiditis and/or cerebral calcifications) appears to confirm the higher morbidity of the infection in Brazilian and South American children in general, when compared to children from other continents, such as Europe and North America, where clinical manifestations are described at birth in approximately 40% of infected newborns.20, 22, 23, 24, 25 and 26 Vasconcelos-Santos et al.20 observed a higher prevalence of retinochoroiditis, 79.8% (95% CI: 73.4% to 85.