Fatal outbreak of human toxoplasmosis along the Maroni River: epidemiological, clinical, and parasitological aspects.

BACKGROUND: Well-documented outbreaks of human toxoplasmosis infection are infrequently reported. Here, we describe a community outbreak of multivisceral toxoplasmosis that occurred in Patam, a Surinamese village near the French Guianan border. METHODS: From the end of December 2003 through the middle of January 2004, 5 adult patients in Patam, including 2 pregnant women, were initially hospitalized for multivisceral toxoplasmosis. A French-Surinamese epidemiological investigation was conducted in the village; inquiries and clinical examinations were performed, and blood and environmental samples were obtained. For all serologically confirmed cases of toxoplasmosis, molecular analysis and mouse inoculations were performed for diagnosis and genetic characterization of Toxoplasma gondii. RESULTS: The hospitalized patients, who did not have any immunodeficiencies, presented with an infectious disease with multivisceral involvement. Serological examination confirmed acute toxoplasmosis. One adult died, and a neonate and a fetus with congenital toxoplasmosis also died. During the investigation, 4 additional acute cases of toxoplasmosis were diagnosed among the 33 villagers. Only 3 inhabitants had serological evidence of previous T. gondii infection. In total, we reported 11 cases of toxoplasmosis: 8 multivisceral cases in immunocompetent adults, resulting in 1 death; 2 cases of lethal congenital toxoplasmosis in a neonate and a fetus; and 1 symptomatic case in a child. Molecular analysis demonstrated that identical isolates of only 1 atypical strain were responsible for at least 5 of the 11 cases of toxoplasmosis in the outbreak. No epidemiological sources could be linked to this severe community-wide outbreak of toxoplasmosis. CONCLUSION: This report is in agreement with the particular features of toxoplasmosis involving atypical strains that were recently described in French Guiana.

Doodsoorzaken in Suriname 1995-1996

The devision of epidemiology at the Bureau of Public Health (BOG) analyzes death certificates, gathered through formal channels. Poor completion of death certificate and inadequate cooperation between the BOG and the registration?s office of the government (CBB) results in poor data. From 1992 the coverage of the death certificates to reported deaths has been less tha 70 percent. In 1995 the coverage was 58 percent and in 1996 63 percent.. For the analysis of death certificates the coding-system of the International Classicifation of Diseases(ICD) of the WHO is used. This report covers the death certificates gathered over the years 1995-1996. For 1995 the coding of the 9th edition(ICD-9) is used and for 1996 the 10th edition(IDC-10); revised in 1993. Using different coding systems makes some comparisons inadequate, recording with the 10the edition for 1995 is suggested. From the available data the most important causes of deaths follow the same pattern as in former years with hypertension, heart disease, cardiovascular accidents, cancer, eprinatal causes, traumas, diabetes and gastrointestinal and respiratory infections as the main causes of death. It is striking that in 1996 HIV/AIDS was among the first 10 causes of death on the first place for women of the age group 15-44 years. In 1995 as well as in 1996 urogenital diseases had a higher rank among the most important causes of death. Maternal, perinatal and infant mortality numbers appear to have declined in these years but since these fields are known to be the groups mostly affected by under coverage this data should be considered with the utmost care. To correct for these data a retrospective study is to be done. A review is given of the most important causes of death by age and sex since 1986. Finally some recommendations are given in order to achieve a higher coverage of certified deaths, better cooperation between the authorities, revising of the law concerning reporting of stillbirth and proper training of personel of the division of epidemiology of the BOG. These problems are being discussed in order to get a higher coverage thus a better representation of causes of death in Suriname