Real-time PCR in the diagnosis of congenital toxoplasmosis

ABSTRACT The diagnosis of congenital toxoplasmosis presents limitations and therefore new options are necessary. The analysis of amniotic fluid by real-time PCR has already proved effective for confirmation of fetal infection. However, its performance in other biological samples is not clear yet. The aim of this study is to better understand the role of real-time PCR in the blood of the mother and newborn as well as in the amniotic fluid and placenta in the diagnosis of congenital toxoplasmosis. This is a descriptive cohort study of pregnant women with toxoplasmosis followed up in Rio de Janeiro, Brazil. Real-time PCR was performed in samples of maternal blood, amniotic fluid, placenta, and blood of newborns. In addition, histopathological examination of placentas was performed, and data collected from babies were collected. 116 pregnant women were followed up and 298 samples were analyzed. One (0.9%) pregnant woman presented positive PCR in the blood, 3 (3.5%) in the amniotic fluid, 1 (2.3%) in the placenta and no newborn had positive PCR in the blood. Histopathological study was suggestive of toxoplasmosis infection in 24 (49%) placentas. Six (5.2%) newborns were diagnosed with congenital toxoplasmosis, and only cases with positive PCR in the amniotic fluid had correlation of the PCR result with the diagnosis of congenital infection. Both maternal and blood samples of new-borns and placenta did not prove to be promising in the diagnosis of congenital toxoplasmosis. Further studies are needed to evaluate the real role of molecular diagnosis in other biological materials rather than the amniotic fluid.

Toxoplasmosis in pregnancy: a clinical, diagnostic, and epidemiological study in a referral hospital in Rio de Janeiro, Brazil

ABSTRACT Toxoplasmosis in pregnant women can cause significant morbidity and mortality in the fetus, which may be mitigated by early diagnosis and treatment. Social factors have also been related to the risk of developing the congenital form of toxoplasmosis, since some of these factors interfere directly in the quality of prenatal care. This study aimed to describe the clinical, laboratory, and epidemiological data of pregnant women diagnosed with toxoplasmosis and their newborns followed up at a referral hospital in Rio de Janeiro, Brazil. This was descriptive cohort study of 334 pregnant women with toxoplasmosis followed from May 2014 to December 2017. We conducted interviews to assess knowledge about the disease and its preventive measures, analyzed clinical and laboratory data during antenatal visits, and collected data from the newborns' medical charts. Results: This was a predominantly low-income women cohort study, with little schooling, mainly referred from public health services late in pregnancy (178; 53.3%), in the second and third trimesters (286; 85.6%). Diagnosis of acute toxoplasmosis had not been confirmed in 171 cases (51.2%). Out of 183 (54.9%) women who had initiated treatment at the original health services, 45 (24.6%) received an incorrect prescription. Seventy-two amniocenteses were performed, with positive real-time polymerase chain reaction (qPCR) in the amniotic fluid in two cases (2.8%). Congenital toxoplasmosis at birth was identified in eight newborns (5.4%). Conclusion: Late referral to specialized medical services, inadequate toxoplasmosis management at the original prenatal care services, and social vulnerabilities are contributing factors to the persistent occurrence of congenital toxoplasmosis cases.

Addressing travelers' perception of risk in pre-travel care: Reports from a travel clinic in Rio de Janeiro, Brazil

Abstract INTRODUCTION: Travel medicine is aimed at promoting health risk reduction. However, travelers' perception of risk is subjective and may influence implementation of recommendations. This study reports on travelers' perception of risk, pre-travel characteristics, and recommended interventions. METHODS: This is a descriptive cross-sectional study. RESULTS: This study included 111 individuals. Most travelers (74%) perceived their risk as low. Significant differences in travel-related risk perception between practitioners and travelers were observed (Gwet's agreement coefficient [AC1] 0.23; standard error 0.10; 95% confidence interval 0.02-0.44). CONCLUSIONS: Future studies should investigate the relationship between travelers' perception of risk and implementation of recommendations.

Genetic polymorphism for IFNγ +874T/A in patients with acute toxoplasmosis / Polimorfismo genético para IFNγ +874T/A em pacientes com toxoplasmose aguda

INTRODUCTION: A single nucleotide polymorphism (SNP) in the gene encoding gamma interferon influences its production and is associated with severity of infectious diseases. This study aimed to evaluate the association of IFNγ+874T/A SNP with duration of disease, morbidity, and development of retinochoroiditis in acute toxoplasmosis. METHODS: A case-control study was conducted among 30 patients and 90 controls. RESULTS: Although statistical associations were not confirmed, A-allele was more common among retinochoroiditis cases and prolonged illness, while T-allele was more frequent in severe disease. CONCLUSIONS: Despite few cases, the results could indicate a relation between IFNγ+874T/A single nucleotide polymorphism and clinical manifestations of toxoplasmosis.

INTRODUÇÃO: Um polimorfismo de nucleotideo único (SNP) no gene codificante para interferon gama influencia a sua produção e pode estar associado à gravidade de diversas doenças infecciosas. O objetivo deste estudo foi avaliar a associação entre SNP para IFNγ+874T/A com a duração da doença, a morbidade e o desenvolvimento de retinocoroidite na toxoplasmose aguda. MÉTODOS: Estudo de caso-controle incluindo 30 pacientes e 90 controles. RESULTADOS: Apesar da ausência de associação estatística, o alelo A foi mais comum entre os casos com retinocoroidite e doença prolongada e o alelo T nas formas mais severas. CONCLUSÕES: Os dados encontrados sugerem uma relação entre o polimorfismo de base única em IFNγ+874T/A com a morbidade e com o desenvolvimento de retinocoroidite por toxoplasmose.

Dificuldades observadas em um centro de referência no diagnóstico e manejo de gestantes com toxoplasmose / 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 Clínica Evandro Chagas-Fundação 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.

Objetivos: avaliar as dificuldades encontradas no atendimento de gestantes com diagnóstico de toxoplasmose por parte de serviços de atendimento pré-natal. Métodos: estudo longitudinal, prospectivo, com 262 gestantes encaminhadas ao Ambulatório de Toxoplasmose do Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, entre janeiro de 2005 e julho de 2009. Resultados: a maioria das gestantes foram encaminhadas no segundo ou terceiro trimestre de gestação (91,2%) e por serviços públicos de saúde (81,3%). O tempo médio de demora na coleta de sangue para os testes sorológicos no pré-natal foi de 113,4 dias. Houve demora média de 52,1 dias para o encaminhamento e 160,6 dias para o início do tratamento. Mulheres mais jovens (P=0,03) e aquelas provenientes do sistema público de saúde (P<0,000) foram encaminhadas mais tardiamente. O tratamento foi iniciado na origem em apenas 16% das gestantes, e 5% destas não receberam a dose preconizada de espiramicina. No Centro de Referência houve baixa confirmação dos testes sorológicos realizados nos serviços de saúde de origem. Constatou-se que 12,6% das gestantes com diagnóstico inicial de toxoplasmose aguda eram suscetíveis à infecção por Toxoplasma gondii, sendo os testes considerados falso-positivos. Conclusões: este estudo destaca dificuldades observadas no manejo de gestantes com toxoplasmose por parte do atendimento pré-natal da rede básica de saúde, incluindo a atenção quanto à qualidade dos testes diagnósticos e a necessidade de maior ênfase na educação continuada dos profissionais de saúde.

Toxoplasmose aguda adquirida: aspectos clínico - laboratoriais, avaliação oftalmológica e estudo do polimorfismo genético para IFNG (+874) em pacientes acompanhados no IPEC/Fiocruz (2006 a 2009) / Acute acquired toxoplasmosis: clinical - laboratory, ophthalmologic evaluation and study of the genetic polymorphism for IFNG (+874) in patients followed in IPEC / Fiocruz (2006-2009)

Uma das zoonoses de maior prevalência no mundo, a toxoplasmose apresenta espectro clínico variável, sendo suas formas mais graves associadas a casos de transmissão congênita e à infecção em indivíduos imunocomprometidos. Estima-se que a maioria dos casos de toxoplasmose adquirida pós-natal em indivíduos imunocompetentes seja sub-clínica, ou oligossintomática. Quadros apresentando o envolvimento de múltiplos órgãos são considerados manifestações pouco usuais da infecção. Retinocoroidite, classicamente associada à forma congênita da protozoonose, é hoje reconhecida como complicação da toxoplasmose aguda adquirida. Diversos aspectos das manifestações da toxoplasmose aguda adquirida são ainda pouco esclarecidos, como as suas manifestações mais freqüentes, a intensidade e duração dos sintomas assim como a sua associação com o surgimento de retinocoroidite. IFN-y proteção contra patógenos intracelulares, restringindo a multiplicação do parasito durante a fase aguda e acelerando a evolução para a fase crônica. Variações alélicas em regiões regulatórias dos genes que codificam esta citocina vêm sendo associadas à susceptibilidade ou resistência a diversas doenças infecciosas e podem ter influência na gravidade e no surgimento das complicações da toxoplasmose...

O presente trabalho teve como objetivo investigar o acometimento sistêmico na toxoplasmose aguda adquirida, o surgimento de lesões oculares e a ocorrência de polimorfismo no gene que codifica para IFN-y na posição +874 nesta população e assim, identificar potenciais marcadores prognósticos para o desenvolvimento de formas graves e das complicações oculares desta zoonose. Trinta e sete pacientes com toxoplasmose aguda adquirida foram acompanhados prospectivamente e submetidos ao mesmo protocolo de investigação clínico-laboratorial e oftalmológico por um mínimo de dois anos. Paralelamente, foi realizado o estudo de polimorfismo no gene que codifica para IFN-y na posição +874 em 30 indivíduos desta coorte, maiores de 18 anos e em 90 controles pareados por sexo e faixa etária. Os achados clínicos mais freqüentes foram linfonodomegalia, (94,6 por cento), astenia (86,5 por cento), cefaléia (70,3 por cento), febre (67,6 por cento) e perda de peso (62,2 por cento). Hepatomegalia e/ou esplenomegalia ocorreu em 21,6 por cento dos casos. Transaminases estavam aumentadas em 29,7 por cento e desidrogenase láctica em 45,9 por cento dos pacientes. Quatro pacientes (10,8 por cento) apresentaram retinocoroidite. Uma escala de morbidade baseada na freqüência das alterações observadas no primeiro atendimento mostrou associação com evolução mais prolongada da doença, mas não com o surgimento de retinocoroidite...

Apesar de não ter sido estatisticamente significante, observamos maior freqüência do alelo A (associado a baixo produtores de IFN-y) entre os pacientes que desenvolveram lesão ocular e doença prolongada, e maior freqüência do alelo T (associado a alto produtores de IFN-y) entre os pacientes com formas mais graves da doença. Os resultados indicam que uma escala de morbidade construída a partir de dados obtidos na primeira avaliação pode tornar-se uma ferramenta útil quanto à tomada de decisão de indicação de tratamento e sugerem haver associação entre polimorfismo genético para IFN-y com as manifestações clínicas na toxoplasmose aguda adquirida...

Postnatal acquired toxoplasmosis patients in an infectious diseases reference center

Infection caused by Toxoplasma gondii, toxoplasmosis, is one of the most frequent zoonoses in the world; it normally affects both genders equally. Humans are one of several possible intermediate hosts, and the disease is oligosymptomatic in most cases. Vertical transmission is an important cause of fetal malformation and sequels in newborns. Approximately 10 percent of postnatal cases present multiple manifestations, ranging from low fever and mild lymphadenopathy to severe encephalitis. In moderate cases, lesions such as retinochoroiditis may emerge during acute infection or even years later. We analyzed 313 cases of toxoplasmosis from 1992 to 2004, including 261 acute cases. Most patients were women (68.1 percent), and 39 percent of these were pregnant. Among acute infection cases, 64.8 percent presented symptomatic disease; the most frequent manifestations were lymphadenomegaly (59.8 percent), fever (27.2 percent), headache (10.7 percent), asthenia (10 percent), weight loss (8.4 percent), myalgia (8 percent), retinochoroiditis (3.4 percent) and hepatosplenomegaly (1.5 percent). Although ocular lesions by T. gondii are well documented as a possible consequence of postnatal infection, two patients developed retinochoroiditis only two years after primary infection. This demonstrates the need for toxoplasmosis case surveillance, even long after acute manifestations.

Leptospirosis patient with AIDS: the first case reported

A case of renal icterohemorrhagic leptospirosis involving a patient with acquired immunodeficiency syndrome (AIDS) is reported. Despite the low levels of CD4+ T lymphocytes, the clinical course of leptospirosis was similar to that observed in non-immunodepressed patients, and no worsening of AIDS occurred due to the infection by the spirochete. Serologic conversion was observed in the microscopic agglutination test, with maximum titer of 1:3,200. The patient had positive urine cultures for Leptospira interrogans for two months, whereas blood cultures were negative