Neospora caninum e toxoplasma gondii: revisão de literatura / Neospora caninum and toxoplasma gondii: review of literature / Neospora caninum y toxoplasma gondii: revisión de literatura

A Neospora caninum e a Toxoplasma gondii são os agentes etiológicos que causam a Neosporose e a Toxoplasmose, respectivamente. Estas duas doenças são consideradas de grande importância econômica e de distribuição mundial, que acometem tanto animais de produção quanto animais domésticos. Apresentam sinais clínicos inespecíficos, sendo a Neosporose frequentemente associada ao abortamento em fêmeas. Ambas enfermidades costumavam ser confundidas, dificultando o diagnóstico. São causadas por protozoários cosmopolitas de ciclos biológicos heteróxenos. O Toxoplasma gondii é responsável por doença clínica em cães e gatos, enquanto o Neospora caninum acomete somente cães. Além disso, não há, até o momento, relatos de Neosporose em humanos, diferente da Toxoplasmose. Ocasionalmente esta pode ocorrer em coiotes, suínos, ovinos, caprinos, equinos, cervídeos e bubalinos. Anticorpos contra Neospora tem sido descrito em raposas, camelos e felídeos. O objetivo da presente revisão, é elucidar a forma de transmissão, sinais clínicos, diagnóstico, tratamento e controle de ambas as doenças, mostrando suas semelhanças, afim de que se possa diagnosticá-las corretamente.(AU)

Neospora caninum and toxoplasma gondii are agents of great economic importance and worldwide distribution that affect production and domestic animals. They present nonspecific clinical signs, and neosporosis is a disease that frequently causes abortion in females, which is considered current, because both used to be confused, making diagnosis difficult. They are protozoan, cosmopolitan, of heterogeneous biological cycles. Toxoplasma gondii is responsible for clinical disease in dogs and cats, while Neospora caninum affects only dogs. Furthermore, there are no reports to date of neosporosis in humans, other than toxoplasmosis. Occasionally it may occur in coyotes, pigs, sheep, goats, horses, deer, and bubaline. Antibodies to Neospora have been described in foxes, camels, and felids. This review aims to elucidate the transmission, clinical signs, diagnosis, treatment, and control of both diseases, showing their similarities, so that they can be correctly diagnosed.(AU)

Neospora caninum y Toxoplasma gondii son los agentes etiológicos que causan Neosporosis y Toxoplasmosis, respectivamente. Estas dos enfermedades se consideran de gran importancia económica y de distribución mundial, afectando tanto al ganado como a los animales domésticos. Presentan signos clínicos inespecíficos y la neosporosis se asocia con frecuencia al aborto en mujeres. Ambas dolencias solían ser erróneas, lo que hacía difícil el diagnóstico. Son causados por protozoos cosmopolitas de ciclos biológicos heterogéneos. Toxoplasma gondii es responsable de enfermedades clínicas en perros y gatos, mientras que Neospora caninum sólo ataca a perros. Además, no se han notificado casos de Neosporosis en humanos hasta el momento, diferente de Toxoplasmosis. Ocasionalmente esto puede ocurrir en coyotes, cerdos, ovejas, cabras, caballos, ciervos y bubalinos. Se han notificado anticuerpos contra la Neospora en zorros, camellos y felinos. El propósito de esta revisión es dilucidar la forma de transmisión, los signos clínicos, el diagnóstico, el tratamiento y el control de ambas enfermedades, mostrando sus similitudes, de manera que puedan ser diagnosticadas correctamente.(AU)

Transmisión vertical de Toxoplasma gondii asociado a la edad gestacional / Vertical transmission of Toxoplasma gondii associated with gestational age

Una de las principales consecuencias de la infección por Toxoplasma gondii en mujeres embarazadas es la transmisión vertical al feto. Aunque es poco frecuente, la toxoplasmosis congénita puede causar enfermedades neurológicas u oculares graves. La infección primaria por T. gondii durante el embarazo puede tener consecuencias peligrosas, como retinocoroiditis, hidrocefalia, calcificaciones cerebrales, encefalitis, esplenomegalia, pérdida de audición, ceguera y muerte. La atención prenatal debe incluir educación sobre la prevención de la toxoplasmosis. Se trata de un estudio observacional, analítico y transversal. Se evaluaron 209 mujeres gestantes e igual número de recién nacidos; 136 de las mujeres embarazadas resultaron con infección aguda positiva a IgM. De estas 51,20% y 64,71% resultaron primoinfectadas según la determinación de IgA e IgG avidez, respectivamente. 20 de los 35 neonatos provenientes de madres primoinfectadas, adquirieron la infección congénita en el tercer trimestre de la gestación. La conciencia sobre la prevención y el control de la toxoplasmosis es baja entre las poblaciones de alto riesgo. Es necesario fortalecer la educación en salud relacionada con la prevención y el control de la toxoplasmosis en las mujeres en edad reproductiva para prevenir la transmisión vertical a sus productos de gestación y evitar los efectos negativos y hasta mortales de la inefcción por el parásito(AU)

One of the main consequences of Toxoplasma gondii infection in pregnant women is vertical transmission to the fetus. Although rare, congenital toxoplasmosis can cause serious neurological or ocular disease. Primary T. gondii infection during pregnancy can have dangerous consequences, including retinochoroiditis, hydrocephalus, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Prenatal care should include education on the prevention of toxoplasmosis. This is an observational, analytical and cross-sectional study. 209 pregnant women and the same number of newborns were evaluated; 136 of the pregnant women were acutely infected with IgM. Of these, 51.20% and 64.71% were primary infected according to the determination of IgA and IgG avidity, respectively. 20 of the 35 neonates from mothers with primary infection acquired the congenital infection in the third trimester of pregnancy. Awareness of toxoplasmosis prevention and control is low among high-risk populations. It is necessary to strengthen health education related to the prevention and control of toxoplasmosis in women of reproductive age to prevent vertical transmission to their gestational products and avoid the negative and even fatal effects of infection by the parasite(AU)

Recomendaciones para el diagnóstico y tratamiento de la infección por Toxoplasma gondii / Recommendations for the diagnosis and treatment of infection by Toxoplasma gondii

Resumen La toxoplasmosis es una de las parasitosis con mayor prevalencia en el mundo. Se asocia a morbimortalidad perinatal y en población inmunocomprometida. Actualmente se cuenta con varias pruebas diagnósticas, tanto serológicas como moleculares, que pueden ayudar a confirmar el diagnóstico y diferenciar una infección reciente de una pasada. Proponemos algunas recomendaciones para el diagnóstico y tratamiento de la toxoplasmosis en distintos escenarios clínicos basados en la evidencia actualmente disponible.

Abstract Toxoplasmosis is one of the most prevalent parasitosis in the world. It is associated with perinatal morbidity and in immunocompromised population. Currently, there are several diagnostic tests, both serological and molecular, that can help confirm the diagnosis and differentiate a recent infection of a pass. We propose some recommendations for the diagnosis and treatment of toxoplasmosis in different clinical scenarios based on the currently available evidence.

Prevalence of syphilis, HIV and toxoplasmosis in prenatal screening in the population of the northern region of the state of Rio de Janeiro, Brazil / Prevalência de Sífilis, HIV e Toxoplasmose no pré-natal em uma população no Norte Fluminense

Introduction: There is a need for studies to know the real situation and outline measures to guarantee a reduction in the rates of pregnant women diagnosed with HIV, Syphilis and Toxoplasmosis. Objective: To determine the prevalence of Syphilis, HIV and toxoplasmosis in puerperal women assisted at the largest public maternity hospital in Campos dos Goytacazes in 2016. Methods: Cross-sectional study, using secondary data from the puerperal women assisted at the largest maternity hospital in the northern region of the State of Rio de Janeiro, in the year 2016. Results: There were 970 puerperal women, with a prevalence of HIV, Syphilis and Toxoplasmosis in pregnancy of 1.6, 2.7 and 2%, respectively. Most pregnant women were diagnosed at delivery due to low serological coverage during pregnancy. Conclusion: The high prevalence of Syphilis, HIV and Toxoplasmosis in pregnancy requires efficient prenatal care for its identification and approach.

Introdução: São necessários estudos para conhecer a real situação e delinear medidas que garantam a redução dos índices de gestantes com diagnóstico de vírus da imunodeficiência humana, sífilis e toxoplasmose. Objetivo: Determinar a prevalência de sífilis, vírus da imunodeficiência humana e toxoplasmose em puérperas atendidas na maior maternidade pública de Campos dos Goytacazes (RJ) no ano de 2016. Métodos: Estudo transversal, utilizando dados secundários das puérperas atendidas na maior maternidade do Norte Fluminense no ano de 2016. Resultados: Foram 970 puérperas, com prevalência de vírus da imunodeficiência humana, sífilis e toxoplasmose na gestação de 1,6, 2,7 e 2%, respectivamente. A maioria das gestantes foi diagnosticada no momento do parto em razão da baixa cobertura sorológica durante a gestação. Conclusão: A alta prevalência de sífilis, vírus da imunodeficiência humana e toxoplasmose na gravidez requer um pré-natal eficiente para sua identificação e abordagem.

Comparison between Enzyme Immunoassays Performed on Samples of Dried Blood and Serum for Toxoplasmosis Prenatal Screening: Population-based Study / Comparação entre ensaios imunoenzimáticos realizados em amostras de sangue seco e soro para triagem prénatal da toxoplasmose: Estudo populacional

Abstract Objective Most prenatal screening programs for toxoplasmosis use immunoassays in serum samples of pregnant women. Few studies assess the accuracy of screening tests in dried blood spots, which are of easy collection, storage, and transportation. The goals of the present study are to determine the performance and evaluate the agreement between an immunoassay of dried blood spots and a reference test in the serum of pregnant women from a population-based prenatal screening program for toxoplasmosis in Brazil. Methods A cross-sectional study was performed to compare the immunoassays Imunoscreen Toxoplasmose IgM and Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil)in dried blood spots with the enzymelinked fluorescent assay (ELFA, BioMérieux S.A., Lyon, France) reference standard in the serum of pregnant women from Minas Gerais Congenital Toxoplasmosis Control Program. Results The dried blood spot test was able to discriminate positive and negative results of pregnant women when comparedwith the reference test, with an accuracy of 98.2% for immunoglobulin G (IgG), and of 95.8% for immunoglobulin M (IgM). Conclusion Dried blood samples are easy to collect, store, and transport, and they have a good performance,making this a promisingmethod for prenatal toxoplasmosis screening programs in countries with continental dimensions, limited resources, and a high prevalence of toxoplasmosis, as is the case of Brazil.

Resumo Objetivo A maioria dos programas de triagem pré-natal para toxoplasmose utiliza imunoensaios em amostras de soro de gestantes. Poucos estudos avaliam a acurácia dos testes de triagem em amostras de sangue seco, que são de fácil coleta, armazenamento e transporte. Este estudo teve como objetivo determinar o desempenho e avaliar a concordância entre um imunoensaio em sangue seco e um teste de referência em soro de gestantes de um programa de rastreamento pré-natal de base populacional para toxoplasmose no Brasil. Métodos Realizou-se um estudo transversal para comparar os imunoensaios Imunoscreen Toxoplasmose IgM e Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil) em sangue seco com o padrão de referência ensaio fluorescente ligado a enzimas (enzyme-linked fluorescent assay, ELFA, BioMérieux S.A., Lion, França) no soro de gestantes do Programa de Controle de Toxoplasmose Congênita de Minas Gerais. Resultados O exame em sangue seco foi capaz de discriminar os resultados positivos e negativos das gestantes quando comparado ao teste de referência, com acurácia de 98,2% para imunoglobulina G (IgG), e de 95,8% para imunoglobulina M (IgM). Conclusão O sangue seco apresenta bom desempenho e é uma amostra de fácil coleta, armazenamento e transporte, o que o torna um método promissor para programas de triagem pré-natal de toxoplasmose em países com dimensões continentais, recursos limitados, e alta prevalência de toxoplasmose, como é o caso do Brasil.

Toxoplasmose sistêmica associada à forma ocular bilateral atípica mimetizando necrose retiniana aguda / Systemic toxoplasmosis associated to the atypical bilateral ocular involvement mimicking acute retinal necrosis

RESUMO A toxoplasmose ocular pode se manifestar de forma atípica, rara, bilateral e associada à necrose retiniana aguda. É apresentada em pacientes imunossuprimidos, resultando em grave perda visual, se não for solucionada rapidamente. Relata-se um caso atípico de toxoplasmose ocular em paciente diabético, que, em sua internação prévia, já evidenciava aspecto sistêmico, o qual foi elucidado pelo exame clínico oftalmológico e pela anamnese. Além disso, a rotina do setor de uveítes, ao solicitar as sorologias de forma direcionada e criteriosa, foi imprescindível para o diagnóstico da toxoplasmose sistêmica associado à lesão ocular atípica bilateral, mimetizando necrose retiniana aguda com desfecho favorável.

Abstract Ocular toxoplasmosis can present with an atypical, rare, bilateral involvement, and associated with acute retinal necrosis. It occurs in immunosuppressed patients, resulting in severe visual loss, if not quickly solved. We report an atypical case of ocular toxoplasmosis in a diabetic patient, who already showed a systemic aspect in a previous hospitalization, which was elucidated by the ophthalmologic examination and history. In addition, the routine of the uveitis sector requesting serology in a directed and careful way was essential for the diagnosis of systemic toxoplasmosis associated with atypical bilateral ocular lesion, mimicking acute retinal necrosis with good outcome.

Prevalência e fatores associados à toxoplasmose em gestantes de um município do interior do estado de São Paulo / Prevalence and factors associated with toxoplasmosis in pregnant women in a municipality in the state of São Paulo

Introdução: A Toxoplasmose afeta entre 7% a 80% da população mundial, variando de um país para outro em função dos grupos étnicos que se caracterizam pelos hábitos alimentares e condições de higiene. Estima-se que na América do Norte, Grã-Bretanha, Escandinávia e Sul da Ásia a população infectada seja de 30%, com um aumento consideravelmente superior a 60% na África e América Latina. A infecção é, em sua maioria, assintomática ou associada com sintomas autolimitados em adultos saudáveis. Entretanto, a toxoplasmose é uma infecção de grande relevância clínica em dois grupos bem definidos: indivíduos imunossuprimidos e gestantes, em virtude de sua gravidade e morbidades associada. Objetivos: Estimar a prevalência e fatores associados para Toxoplasmose em gestantes com referência aos grupos diagnósticos na gestação, do Ministério da Saúde, que realizavam acompanhamento de pré-natal nas unidades básicas de saúde do município de Ribeirão Preto-SP. Método: Estudo epidemiológico, analítico transversal, com coleta de informações por meio de resultados de exames sorológicos para Toxoplasmose, bem como da aplicação de um questionário, validado em conteúdo por especialistas na área de saúde da mulher. No sentido de enaltecer os resultados obtidos, este estudo salientou as evidências científicas mediante revisão integrativa de literatura, desenvolvida segundo método PRISMA, PICO e a questão norteadora "Quais são as possíveis evidências acessíveis sobre a prevalência e suscetibilidade da Toxoplasmose durante a gestação e as principais variáveis associadas?". Para composição do modelo logístico foram realizadas análises bivariadas. A seleção das variáveis independentes foi feita por meio dos testes Exato de Fisher ou Qui-quadrado, com correção de Yates e teste t de Student. Para o modelo logístico final ajustado, além dos parâmetros, também foram calculadas as respectivas razões de chance (OR) ajustadas, com Intervalos de 95% de Confiança (IC). Em todas as análises o nível de significância adotado foi de 5% (α= 0.05). O programa utilizado para as análises estatísticas foi o R Core Team, 2018, versão 3.6.1. Resultados: Na Revisão de Literatura foram identificados 31 artigos, com ênfase em fatores ambientais, comportamentais, padrões alimentares e de higiene encontrados nas diversas culturas e localizações geográficas a nível continental. As dificuldades impostas pelas características geográficas também foram apontadas como uma limitação de acesso aos serviços de saúde, favorecendo o desconhecimento das formas de contágio do protozoário, também associados às maiores prevalências da doença na gestação. O rastreamento sorológico e a vigilância da Toxoplasmose Congênita foram contemplados como ações para a redução da soroprevalência e suscetibilidade na população de gestantes para Toxoplasmose. Na análise quantitativa, foram incluídas 165 gestantes com idade entre 14 e 44 anos. Em relação à soroprevalência total, 57 (34,5%), IC [95%]: [27,3; 41,8], foram reagentes para IgG, sendo soroprevalentes 54 (32,7%) e 3 (1,8%) sororeativas. Dentre as gestantes, 108 (65,5%) apresentaram suscetibilidade para ausência dos anticorpos antitoxoplasma IgG e IgM. Nenhum dos exames foi inconclusivo, ou seja, positivo para IgM exclusivamente. A análise de regressão logística multivariada mostrou que a chance de ser reagente ao anticorpo antitoxoplasma IgG é 1,09 vezes maior ODDS =1,09; IC [1,03 ; 1,16] (p = 0,004); ensino fundamental incompleto, aumenta a chance em 19,68 vezes da gestante ser classificada com IgG reagente em relação às participantes com ensino técnico ou superior ODDS = 19,68; IC [1,47 ; 262,82] (p = 0,024), sendo 12,34 para as participantes com ensino fundamental completo I ODDS = 12,34; IC [1,19 ; 128,19] (p = 0,035) e 12,13 vezes maior para aquelas com escolaridade do ensino fundamental completo II ODDS = 12,13; IC [1,17 ; 125,38] (p = 0,036). O contato direto com a terra apresentou 4,41 vezes mais chance de classificar as gestantes com IgG reagente do que em relação as que não tinham contato direto ODDS = 4,41; IC [1,24; 15,73] (p = 0,022). Conclusões: O conhecimento sobre a prevalência e variáveis associadas para Toxoplasmose na gestação, no município de Ribeirão Preto, pode contribuir para reflexão e análise da efetividade das ações de saúde direcionadas a qualidade de assistência no pré-natal para redução dessa infecção na população de gestantes, como também para prevenção da Toxoplasmose Congênita.

Introduction: Toxoplasmosis affects between 7% and 80% of the world population, varying from one country to another depending on the ethnic groups that are characterized by eating habits and hygiene conditions. It is estimated that in North America, Great Britain, Scandinavia and South Asia the infected population is 30%, with a considerable increase of more than 60% in Africa and Latin America. Infection, is mostly asymptomatic or associated with self-limited symptoms in healthy adults. However, toxoplasmosis is an infection of great clinical relevance in two well-defined groups: immunosuppressed individuals and pregnant women, due to its severity and associated morbidities. Objectives: To estimate the prevalence and associated factors for Toxoplasmosis in pregnant women with reference to the diagnostic groups during pregnancy, of the Ministry of Health, who performed prenatal care in the basic health units of the city of Ribeirão Preto-SP. Method: This is an epidemiological, cross-sectional analytical study, with information collection through the results of serological tests for Toxoplasmosis, as well as the application of a questionnaire, validated in content by specialists in the area of women's health. In order to enhance the results obtained, this study highlighted the scientific evidence through an integrative literature review, developed according to prisma, PICO and the fundamental question about What are the possible accessible evidences on the prevalence and susceptibility of Toxoplasmosis during pregnancy and the main associated variables?". For the composition of the logistic model, bivariate analyses were performed. The selection of independent variables was made by fisher's exact or chi-square tests, with Yates correction and Student's t-test. For the adjusted final logistic model, in addition to the parameters, the respective adjusted chance ratios (OR) were also calculated, with 95% Confidence Intervals (CI). In all analyses the level of significance 5% (α = 0.05). The program used for statistical analysis was the R Core Team, 2018, version 3.6.1. Results: In the Literature Review, 31 articles were identified, with emphasis on environmental, behavioral, dietary and hygiene patterns found in the various cultures and geographical locations at the continental level. The difficulties imposed by geographic characteristics were also pointed out as a limitation of access to health services, favoring the ignorance of the forms of protozoan contagion, also associated with the higher prevalence of the disease during pregnancy. Serological screening and surveillance of Congenital Toxoplasmosis were included as actions to reduce seroprevalence and susceptibility in the population of pregnant women for Toxoplasmosis. In the quantitative analysis, 165 pregnant women aged between 14 and 44 years were included. Regarding total seroprevalence, 57 (34.5%), CI [95%]: [27.3; 41.8], were reagents for IgG, being seroprevalent 54 (32.7%) and 3 (1.8%) seroreactive. Among the pregnant women, 108 (65.5%) susceptibility to the absence of IgG and IgM antitoxoplasma antibodies. None of the tests were inconclusive, i.e., positive for IgM exclusively. Multivariate logistic regression analysis showed that the chance of being reagent to antitoxoplasma IgG antibody is 1.09 times higher ODDS =1.09; CI [1.03; 1.16] (p = 0.004); incomplete elementary school increases the chance of the pregnant woman being classified as being classified as reagent IgG in relation to participants with technical or higher education ODDS = 19.68; CI [1.47 ; 262.82] (p = 0.024), 12.34 for participants with complete elementary school I ODDS = 12.34; CI [1.19 ; 128.19] (p = 0.035) and 12.13 times higher for those with complete elementary school II ODDS = 12.13; CI [1.17 ; 125.38] (p = 0.036). Direct contact with the land presented 4.41 times more likely to classify pregnant women with reagent IgG than in those who had no direct contact ODDS = 4.41; CI [1.24; 15.73] (p = 0.022). Conclusions: Knowledge about the prevalence and associated variables for Toxoplasmosis during pregnancy, in the city of Ribeirão Preto, may contribute to reflection and analysis of the effectiveness of health actions directed to the quality of prenatal care to reduce this infection in the population of pregnant women, as well as to prevent Congênita Toxoplasmosis.

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.

Pneumonia por toxoplasmose em paciente imunocompetente / Toxoplasma pneumonia in an immunocompetent patient: case repor

Com grande distribuição mundial e incidência significativa, a toxoplamose é uma doença comum em mamíferos e pássaros, causada pelo protozoário Toxoplasma gondii. No homem, o parasitismo na fase proliferativa intracelular pode se apresentar sem sintomas, ou causar clínica transitória caracterizada por febre, fadiga e linfadenopatia. Por se tratar de patologia com sintomas inespecíficos e comuns a muitas outras, é fundamental a correta pesquisa de diagnósticos diferenciais, como citomegalovírus e Epstein-Barr. Relatamos o caso de um jovem e hígido, que desenvolveu pneumonia e, após confirmação sorológica para toxoplasmose e o tratamento adequado, apresentou melhora clínica.

With great worldwide distribution and significant incidence, toxoplamosis is a common disease in mammals and birds, caused by the protozoan Toxoplasma gondii. In humans, the parasitism in its intracellular proliferative phase may present no symptoms, or cause a transient condition characterized by fever, fatigue, and lymphadenopathy. Because it is a pathology with nonspecific symptoms that are common to many other conditions, it is fundamental to find the correct research of differential diagnoses, such as for Cytomegalovirus and Epstein Barr. We report a case of a young and healthy man who developed pneumonia and, after serological confirmation for toxoplasmosis and the appropriate treatment, presented clinical improvement

Seroprevalence of toxoplasmosis in pregnant women and its associated factors among hospital and community populations in Lambayeque, Peru

Abstract INTRODUCTION Toxoplasmosis is a zoonosis caused by Toxoplasma gondii. This study investigated the prevalence and factors associated with toxoplasmosis among pregnant women. METHODS We followed an analytical observational study. From July 2016 to June 2017, 218 pregnant women were selected. The infection was detected through serological dosage of anti-T.gondii Immunoglobulin(Ig) M and IgG antibodies. RESULTS The seroprevalence was 35.8%; the factors associated with infection were consumption of non-drinking water, residence in an urban area, and threatened abortion during the current pregnancy. CONCLUSIONS The seroprevalence of toxoplasmosis among pregnant women is high. The risk factors are dependent on environmental determinants.

Follow-up of toxoplasmosis during pregnancy: ten-year experience in a University hospital in southern Brazil / Acompanhamento da toxoplasmose durante a gravidez: uma década de experiência em um hospital universitário no Sul do Brasil

Abstract Objective To describe a population of pregnant women diagnosed with toxoplasmosis and their respective newborns, describing the hospital protocol for treatment and follow-up. Methods Retrospective cohort of pregnant women with acute toxoplasmosis infection and risk of transplacental transmission who were sent to the Fetal Medicine Group of Hospital de Clínicas de Porto Alegre (HCPA) between - January 1, 2006 and December 31, 2016. All patients with confirmed disease were included. The diagnostic protocol and treatment were applied; a polymerase chain reaction (PCR) analysis of the amniotic fluid was used to diagnose toxoplasmosis and determine the treatment. The newborns were followed up at the pediatric outpatient clinic specializing in congenital infection. The patients who were not followed up or were not born in the HCPA were excluded. Results A total of 65 patients were confirmed to have gestational toxoplasmosis; 40 performed amniocentesis, and 6 (15%) were identified as having positive PCR in the amniotic fluid. In five of those cases, this result associated with the gestational age defined the triple therapy during pregnancy, and in one case, it defined the monotherapy (advanced gestational age). A total of 4 of these newborns were treated from birth with triple therapy for 10months, 1 was not treated (due to maternal refusal), and 1 progressed to death within the first 54 hours of life due to complications of congenital toxoplasmosis. Of the 34 remaining cases with a negative PCR, 33 were treated with monotherapy and 1 was treated with triple therapy (ultrasound findings); of these children, 9 (26.5%) presented negative immunoglobulin G (IgG), 24 (70.6%) presented positive IgG (but none presented positive immunoglobulin M [IgM]), and 1 (2,9%) presented alterations compatible with congenital disease and started treatment with the triple therapy soon after birth. Out of the total sample of 60 patients, among the 25 who did not perform amniotic fluid PCR, 5 were treated with triple therapy (ultrasound findings/prior treatment) and 20 patients were submitted to monotherapy; only two newborns underwent treatment for congenital toxoplasmosis. Among the 65 cases of gestational toxoplasmosis, 6 (9,2%) children had a diagnosis of congenital toxoplasmosis, and 2 patients with triple therapy felt severe adverse effects of the medications. Conclusions The present study suggests that research on PCR screening of the amniotic fluid may be useful to identify patients with a higher potential for fetal complications, who may benefit from the poly-antimicrobial treatment. Patients with negative PCR results must continue to prevent fetal infection with monotherapy, without risk of fetal or maternal impairment.

Resumo Objetivo Descrever uma população de pacientes diagnosticadas com toxoplasmose na gestação e seus respectivos recém-nascidos, relatando o protocolo do hospital durante o tratamento e seguimento. Métodos Coorte retrospectiva de gestantes com infecção aguda por toxoplasmose e risco de transmissão transplacentária, encaminhadas para acompanhamento pelo Grupo deMedicina Fetal doHospital de Clínicas de Porto Alegre (HCPA) entre 1o de janeiro de 2006 e 31 de dezembro de 2016. Todas as pacientes comdoença confirmada foram incluídas. O protocolo de diagnóstico e tratamento foi aplicado; uma análise da reação em cadeia da polimerase (RCP) no líquido amniótico foi utilizada para diagnosticar a toxoplasmose e determinar o tratamento. Os recém-nascidos foram acompanhados no ambulatório de pediatria especializadoeminfecções congênitas. Pacientes que não foramseguidas ou cujo parto não foi feito no hospital foram excluídas. Resultados A toxoplasmose gestacional foi confirmada em 65 pacientes; 40 realizaram amniocentese, e 6 (15%) foram identificadas com RCP positiva no líquido amniótico. Este resultado associado à idade gestacional definiu a terapia tríplice durante a gestação em 5 casos, e a monoterapia em 1 caso (por idade gestacional avançada). Quatro destas crianças foram tratadas desde o nascimento com terapia tríplice por 12 meses, 1 não foi tratada (por recusa materna), e 1 evoluiu com óbito dentro das primeiras 54 horas de vida devido a complicações da toxoplasmose congênita. Dos 34 casos remanescentes com RCP negativa, 33 foram tratados com monoterapia, e 1 foi tratado com terapia tríplice (por achados ultrassonográficos); destes recém-nascidos, 9 (26,5%) tiveram imunoglobulina G (IgG) negativa, 24 (70,6%) tiveram IgG positiva, mas nenhum apresentou imunoglobulina M (IgM) positiva, e 1 (2,9%) apresentou alterações compatíveis comdoença congênita e iniciou a terapia tríplice logo após o nascimento. Entre as 25 pacientes que não fizeram RCP no líquido amniótico, 5 foram tratadas com terapia tríplice (por achados ultrassonográficos/ tratamento prévio) e 20 receberam monoterapia; somente 2 recém-nascidos receberam tratamento para toxoplasmose congênita. Entre os 65 casos de toxoplasmose gestacional, 6 (9,2%) recém-nascidos tiveram o diagnóstico de toxoplasmose congênita. Um total de 2 pacientes submetidas à terapia tríplice apresentaram efeitos adversos severos das medicações utilizadas. Conclusão Este estudo sugere que a triagem da RCP para toxoplasmose do líquido amniótico pode ser útil no rastreamento de pacientes com maior potencial para complicações fetais, que podem se beneficiar do tratamento poli antimicrobiano. Pacientes com RCP negativa devem continuar a prevenir a infecção fetal com monoterapia, sem risco de comprometimento fetal ou materno.

Validação do teste sorológico para toxoplasmose em papel filtro / Validation of serological test for toxoplasmosis in filter paper

Objetivo: Validar o uso do teste sorológico para toxoplasmose em papel filtro em amostras de sangue de gestantes do município de Goiânia e região metropolitana. Métodos: Trata-se de um estudo prospectivo, onde foram coletadas 1.006 amostras de sangue em gestantes no município de Goiânia e região metropolitana. Todas as gestantes que concordaram participar da pesquisa assinaram um Termo de Consentimento Livre e Esclarecido. A avaliação do perfil sorológico foi realizada pela técnica de ELISA (ensaio imunoenzimático), com amostras de soro e papel filtro, para pesquisa de anticorpos anti-Toxoplasma gondii das classes IgM e IgG, sendo que o kit utilizado não é padronizado para a pesquisa de anticorpos IgM no papel filtro. A análise estatística foi processada no banco de dados do programa EpiInfo® versão 3.2.1, que avaliou a prevalência de soropositividade, frequência de positividade no soro, frequência de positividade no papel filtro, sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e índice kappa. Resultados: Na análise realizada no soro obtiveram-se 421 amostras positivas para anticorpos da classe IgG e três positivas para anticorpos da classe IgM. Em papel filtro obtiveram-se 443 positivas para anticorpos da classe IgG e uma positiva para anticorpos da classe IgM. Conclusão: O estudo permitiu identificar a semelhança de amostras positivas tanto com o uso do soro como no papel filtro para pesquisas de anticorpos da classe IgG, porém, para a pesquisa de anticorpos da classe IgM, o uso do soro apresentou maior sensibilidade quando comparado ao exame realizado com o papel filtro.

Objective: To validate the use of the serological test for toxoplasmosis in filter paper in blood samples from pregnant women from the city of Goiânia and the metropolitan region. Methods: This is a prospective study in which 1,006 blood samples were collected in pregnant women in the city of Goiânia and in the metropolitan region. All pregnant women who agreed to participate in the study signed a Free and Informed Consent Form. Serological profile evaluation was performed using ELISA (immunoenzymatic assay), with serum and filter paper samples, to investigate anti-Toxoplasma gondii antibodies of the IgM and IgG classes, and the kit used is not standardized for the research of IgM antibodies on the filter paper. Statistical analysis was performed in the database of the EpiInfo® version 3.2.1 program, which evaluated the prevalence of seropositivity, frequency of serum positivity, filter paper positivity frequency, sensitivity, specificity, positive predictive value, negative predictive value and index the kappa. Results: In the serum analysis, 421 samples were positive for antibodies of the IgG class and three were positive for antibodies of the IgM class. In the filter paper yielded 443 positive for antibodies of the IgG class and one positive for IgM class antibodies. Conclusion: The study allowed to identify the similarity of positive samples both with the use of serum and in the filter paper for IgG class antibodies. However, for serum IgM antibodies, the use of serum was more sensitive when compared to serum IgG. taken with the filter paper

Frequency and factors associated with Toxoplasma gondii infection in pregnant women and their pets in Ilhéus, Bahia, Brazil

Abstract INTRODUCTION: Toxoplasmosis is an asymptomatic disease that can lead to systemic disease in the fetus of pregnant women with primary infection. This study aimed to determine the prevalence of toxoplasmosis, associated factors, and correlation between the serology of pregnant women and their pets, in the municipality of Ilhéus, Bahia, Brazil. METHODS: This cross-sectional study was conducted in 196 pregnant women and their cats or dogs (n=89). Semi-structured interviews were conducted and serum samples from the pregnant women were tested to detect IgM and IgG antibodies against Toxoplasma gondii, and avidity tests were performed for IgM-positive samples. The serum collected from pets were tested for IgG antibodies, and IgM antibodies in cats. A non-conditional logistic regression analysis was performed to identify infection-associated factors. RESULTS: IgG and IgM antibodies were detected in 67.9% (133/196) and 1.5% (3/196) samples, respectively, for women with an avidity of over 60%. Age ≥ 25 and the presence of cats in the vicinity were found to be associated with infection, while the level of education and previous orientation toward prevention of toxoplasmosis were protective factors in pregnant women. IgG antibodies were detected in 46.1% (41/89) of the animals, and cats were found to be negative for IgM. For the animals, age ≥ 1 year was a factor associated with infection. There was no correlation between serology of the pregnant women and the animals (p=0.15). CONCLUSIONS: An elevated prevalence of toxoplasmosis was detected in the region. Therefore, the adoption of preventive measures by public healthcare bodies is recommended.

Serological status of childbearing-aged women for Toxoplasma gondii and cytomegalovirus in northern Kosovo and Metohija

Abstract INTRODUCTION: Toxoplasma gondii and cytomegalovirus (CMV) are pathogens associated with congenital anomalies. METHODS: Serum was collected from 79 reproductive-age women and tested for IgM and IgG antibodies to T. gondii and CMV. RESULTS: Seropositivity for T. gondii was detected in 24.1% of women and CMV in 96.2%. High seropositivity for CMV was found for all ages. The highest seropositivity for T. gondii was observed among older participants. CONCLUSIONS: T. gondii remains an important pathogen owing to low seropositivity.

Perfil antigénico en fase aguda y crónica de toxoplasmosis en embarazadas por la técnica de Western Blot / Antigenic profile in the acute and chronic phase of toxoplasmosis in pregnant women using the Western Blot technique

La toxoplasmosis es una enfermedad endémica con prevalencia mundial variable, cuyo agente causal es el parásito Toxoplasma gondii. Para un diagnóstico certero de la infección por T. gondii son necesarias combinaciones de métodos serológicos. Estudios recientes han reportado que la técnica de Western Blot permite evidenciar proteínas antigénicas como marcadores de la infección, así como ciertos perfiles proteicos como posibles indicadores de las fases de la infección, aguda y crónica. El objetivo del estudio fue identificar el perfil antigénico específico asociado a las diferentes fases de la toxoplasmosis. Fueron incluidos en el estudio 55 sueros de embarazadas con toxoplasmosis, diferenciados en fase aguda y crónica de la enfermedad por medio del método de ELISA de Avidez de IgG. Mediante el método de Western Blot se observó que las proteínas antigénicas p35, p43, p45, p56 y p107 fueron reconocidas por el 20- 60% de los sueros de pacientes en fase aguda, mientras que p65, p95, p98 y p113 fueron reconocidas por el 17-35% de sueros de pacientes en fase crónica. Se observó que seis proteínas antigénicas, p32, p38, p41, p48, p59 y p72, fueron reconocidas por más del 60% de los sueros de pacientes tanto en fase aguda como crónica. Los resultados obtenidos sugieren que estas seis proteínas podrían ser consideradas como marcadores diagnósticos de la enfermedad(AU)

Toxoplasmosis is an endemic disease with variable global prevalence, being the causative agent the parasite Toxoplasma gondii. For an accurate diagnosis of a T. gondii infection, combinations of serological methods are required. Recent studies have reported that the Western Blot technique allows the detection of antigenic proteins as markers of infection, as well as certain protein profiles as possible indicators of acute and chronic phases of infection. The objective of the study was to identify the specific antigenic profile associated with different phases of toxoplasmosis. Fifty five sera from pregnant women with toxoplasmosis were included in the study, differentiated in acute and chronic phase of the disease by an IgG Avidity ELISA. By using the Western Blot method it was observed that antigenic proteins p35, p43, p45, p56 and p107 were recognized by 20-60% of sera from patients in acute phase, while p65, p95, p98 and p113 were recognized by 17-35% of sera from patients in chronic phase. It was observed that six antigenic proteins, p32, p38, p41, p48, p59 and p72, were recognized by more than 60% of sera from patients in both acute and chronic phases. The results obtained in this study suggest that these six proteins could be considered as diagnostic markers of the disease(AU)

Prevalence and risk factors of toxoplasmosis among adults in a small Brazilian city

Abstract INTRODUCTION: The prevalence of Toxoplasma gondii infection varies markedly among different populations, especially depending on factors related to socioeconomic development and eating habits. Cássia dos Coqueiros is a small city in Brazil with rural characteristics and increased risk factors traditionally associated with T. gondii infection. METHODS: We carried out a cross-sectional study involving 970 inhabitants aged 18 years or more, selected from patients of the local health unit and home visits in urban and rural areas. Each participant completed a survey with questions regarding demographic, socioeconomic, and risk factors for toxoplasmosis. Blood samples from participants were tested for presence of IgG and IgM antibodies against T. gondii using a chemiluminescent microparticle immunoassay. RESULTS: The prevalence of IgG and IgM antibodies was 62.3% and 2.5%, respectively. Variables that proved to be independent predictors of infection were age, low levels of education, and previous diagnosis of toxoplasmosis. CONCLUSIONS: The high prevalence of toxoplasmosis serological markers in this adult population highlights the need to promote preventive practices, especially those directed toward women of childbearing age, in this part of Brazil.

Manifestaciones clínicas asociadas al síndrome de TORCH / Clinical manifestations associated to the TORCH syndrome

Las infecciones neonatales se adquieren comúnmente por la vía intrauterina o durante el parto. El acrónimo TORCH fue designado para un grupo de infecciones comunes, y se utiliza de forma universal para caracterizar el cuadro clínico que presenta el feto o el recién nacido compatible con una infección congénita que incluye rash, hepatoesplenomegalia, hidrocefalia o microcefalia, alteraciones cardiovasculares, auditivas y oculares. Las siglas TORCH comprenden toxoplasmosis, otros (sífilis y HIV), rubeola, citomagalovirus y herpes simple. Lo más importante de este término es que dota al médico de las herramientas para hacer un enfrentamiento racional, tanto diagnóstico como terapéutico, y establecer un plan de acción para minimizar los daños producidos por estas infecciones. Con esta revisión nos proponemos destacar las manifestaciones clínicas más importantes asociadas al síndrome de TORCH, así como sus vías de transmisión, diagnóstico y tratamiento de las infecciones que lo comprenden, teniendo en cuenta que con relativa frecuencia en nuestra institución son interconsultados estos pacientes y que de su evaluación correcta y oportuna puede depender un diagnóstico certero, con un tratamiento adecuado, y una mejor evolución de estos(AU)

Neonatal infections are often acquired during pregnancy or childbirth. The acronym TORCH refers to a group of common infections, and is universally used to characterize a clinical status of fetuses or newborns which is compatible with a congenital infection, including rash, hepatosplenomegaly, hydrocephalus or microcephaly, as well as cardiovascular, hearing or sight disorders. The initials TORCH stand for Toxoplasmosis, Other infections (such as syphilis or HIV), Rubella, Cytomegalovirus and Herpes simplex. The term is especially useful because it provides doctors with the tools required for a rational diagnostic and therapeutic response and the development of an action plan aimed at minimizing the damage caused by these infections. The purpose of this review is to present the most important clinical manifestations of the TORCH syndrome, as well as its routes of transmission, diagnosis and treatment of the infections making it up(AU)

Epidemiological factors associated with Toxoplasma gondii infection in postpartum women treated in the public healthcare system of Goiânia, State of Goiás, Brazil

Abstract INTRODUCTION: Knowledge of the epidemiological profile and risk factors for Toxoplasma gondii infection among postpartum women is a relevant issue, because this protozoan can be vertically transmitted to the developing fetus, which can cause severe and debilitating disease. The aim of this study was to assess the risk factors associated with T. gondii infection in postpartum women in Goiânia, GO, Brazil. METHODS: This cross-sectional study comprised 229 postpartum women, among whom 204 were chronically infected (IgG+/IgM-), and 25 were seronegative (IgG-/IgM-; control group). All the patients were asked to complete a form to provide sociodemographic, clinical, dietary, and cultural information. The data were analyzed to compare seropositivity and risk factors based on the odds ratio (OR) thereof. RESULTS: The sociodemographic characteristics associated with the risk for toxoplasmosis were: education ≤ 8 years [OR: 2.521, confidence interval (CI): 1.01-6.301, p=0.049], and age ≥ 30 years (OR: 4.090; CI: 1.180-14.112, p=0.023). Clinical and behavioral characteristics related to eating raw and undercooked meat, were not found to be risk factors associated with a positive test for toxoplasmosis. CONCLUSIONS: Our findings concur with the results of other studies conducted in Brazil and abroad, where variables such as low levels of schooling, and advanced age (≥ 30 years) are major risk factors for pregnant women to become infected with T. gondii.