CD8+ T-cell Exhaustion Phenotype in Human Asymptomatic and Ocular Toxoplasmosis.

This work analyzed exhaustion markers in CD8+ T-cell subpopulations in 21 samples of peripheral blood mononuclear cells (PBMCs) from individuals with ocular toxoplasmosis (n = 9), chronic asymptomatic toxoplasmosis (n = 7), and non-infected people (n = 5) by using RT-qPCR and flow cytometry techniques. The study found that gene expression of PD-1 and CD244, but not LAG-3, was higher in individuals with ocular toxoplasmosis versus individuals with asymptomatic infection or uninfected. Expression of PD1 in CD8+ central memory (CM) cells was higher in nine individuals with toxoplasmosis versus five uninfected individuals (p = .003). After ex vivo stimulation, an inverse correlation was found between the exhaustion markers and quantitative clinical characteristics (lesion size, recurrence index, and number of lesions). A total exhaustion phenotype was found in 55.5% (5/9) of individuals with ocular toxoplasmosis. Our results suggest that the CD8+ exhaustion phenotype is involved in the pathogenesis of ocular toxoplasmosis.

Evaluation of the acceptability of point of care diagnostic test for prenatal toxoplasmosis (translational research phase III).

BACKGROUND: A new point of care test (POC) was developed that is promising as a tool to enhance impact of prenatal care programs for toxoplasmosis, however, no reports exist about its use or acceptability for healthcare personnel and mothers in Colombia. METHODS: This was a translational research - phase III study of the acceptability of a new POC test (Toxoplasma ICT IgG-IgM, LDBio) for qualitative diagnosis of toxoplasmosis in 783 pregnant women and 30 health personnel in primary health care sites in the city of Armenia, Quindío (Colombia). Along with collection of the results of diagnostic POC and confirmatory test and demographic information, we evaluated acceptability through measure of the willingness, credibility, and satisfaction by using questionnaires with a Likert scale during routine prenatal care visits. RESULTS: POC positivity was 46.5% among pregnant participants and was significantly related to socioeconomic factors, including education level (p = 0.00000000) and insurance status (p = 0.00000015). A total of 93-97% of healthcare personnel indicated agreement to positive statements regarding total satisfaction and total credibility of the LDBio test, but qualitative questions identified "Difficulty in the test procedure" as the most common response about barriers to apply the test. Greater than 90% of pregnant participants agree that POC test should be routine for all pregnant woman and permanently implemented. CONCLUSIONS: The test had near complete acceptability. In future studies it is necessary to examine the effect of non-differentiation between IgG and IgM isotypes.

Frequency of natural antibodies and concordance analysis for anti-TOXOPLASMA IgM tests in Colombian sera of pregnant women.

Interpretation of IgM anti-Toxoplasma can be problematic given the phenomena of "natural" IgM. We analyzed 1,503 sera obtained during prenatal care program, and we established natural and false-positive results by doing follow-up. In 101 samples the concordance between enzyme linked immunosorbent assay (ELISA) and two semi-automatized systems: electro-chemiluminescence immunoassay (ELECSYS) and vitek immunodiagnostic assay system (VIDAS) was calculated. In 1,503 serum, 71 (4,7%) had ELISA IgG negative and ELISA IgM positive results and in 44 of these had a second sample 4 weeks later. In second samples, 27 (61,3 %) were IgM and IgG negative (false positive result in the first sample) and 13 (29,5%) were ELISA IgM positive and IgG negative (natural IgM). ELISA assay had a poor concordance with enzyme-linked fluorescent immunoassay as well as ELECSYS tests, contrarily, enzyme-linked fluorescent immunoassay and ELECSYS had optimal concordance, with 100 of 101 sera obtaining the same result by both tests. We recommended to use automatized assays to measure IgM anti-Toxoplasma.

Conocimientos, actitudes y prácticas sobre toxoplasmosis en dos comunas de Armenia, Quindío, con alta prevalencia de la infección / Knowledge, attitudes, and practices related to toxoplasmosis in two districts of high prevalence in Armenia, Quindío / Conhecimentos, atitudes e práticas sobre toxoplasmose em duas comunas de Armenia, Quindío, com alta prevalência de infecção

Resumen Objetivo: Describir los conocimientos, las actitudes y las prácticas acerca de la toxoplasmosis en dos comunas de Armenia, Quindío, con alta prevalencia de la infección. Metodología: Estudio descriptivo con población de dos comunas de Armenia, Quindío. Se aplicó un cuestionario autodiligenciado tipo conocimientos, actitudes y prácticas. Esta herramienta incluyó elementos sobre el parásito Toxoplasma gondii, sus vías de transmisión, aspectos clínicos, diagnósticos y de tratamiento generales, así como prácticas para evitar la infección. El instrumento se aplicó antes y después de una intervención educativa. Se describieron las frecuencias en el número de respuestas correctas antes y después de la intervención para cada comuna. Resultados: Participaron 27 personas, con una media de edad de 57 años. El 59 % fueron mujeres. El 48% había completado la educación media y el 40,7 % la primaria. El conocimiento del agente causal antes de la intervención fue del 22 %, mientras que posterior a la intervención fue del 92,3 % en la comuna 1 y del 81,8 % en la comuna 6. Posterior a la intervención, cerca del 90 % de los encuestados reconoció la retina como la principal estructura afectada y todos los encuestados reconocieron el consumo de agua hervida como factor protector. Conclusión: Los conocimientos sobre la toxoplasmosis en las dos comunas eran limitados. Luego de la intervención educativa, se evidenció un aumento en el porcentaje de respuestas correctas en la mayoría de las preguntas. Se recomienda realizar nuevas intervenciones educativas y en salud pública, para evaluar los efectos de estas a largo plazo.

Abstract Objective: To describe knowledge, attitudes and practices related to toxoplasmosis in two districts of high prevalence in Armenia, Quindío. Methodology: descriptive study; the population of two districts of Armenia, Quindío were engaged. A self-administered questionnaire regarding knowledge, attitudes, and practices was applied. This tool included elements related to Toxoplasma gondii, its transmission pathways, general clinical, diagnostic and treatment aspects, as well as practices to prevent infection. The instrument was applied before and after an educational intervention. Frequencies were described as the number of correct answers before and after the intervention for each district. Results: 27 people participated, with an average age of 57 years. 59 % were women; 48 % had completed high school and 40.7 % had completed elementary school. Before the intervention, the knowledge of the causal agent was 22 %, while after the intervention, it was 92.3 % in district 1 and 81.8 % in district 6. After the intervention, about 90 % of participants recognized the retina as the main compromised structure and all participants recognized the consumption of boiled water as a protective factor. Conclusion: The knowledge regarding toxoplasmosis in the two districts was limited. After the educational intervention, there was an increase in the percentage of correct answers in most of the questions. New educational and public health interventions are recommended to assess the long-term effects of these interventions.

Resumo Objetivos: O objetivo deste estudo é descrever os problemas, as ações e as práticas sobre a toxoplasmose nas comunidades da Armênia, Quindío, onde se nota alta prevalência da infecção. Metodologia: Este é um estudo descritivo que abrange uma população de duas comunas na Armênia, Quindío. Foi implementada uma ferramenta, que consiste em questionários destinados àquela população e aplicáveis pelos seus próprios membros, que correspondem a conhecimentos, atitudes e práticas. Essa ferramenta inclui elementos sobre o parasito Toxoplasma gondii, suas vias de transmissão, aspectos clínicos gerais, diagnósticos e tratamento, e práticas de prevenção. O instrumento foi aplicado antes e após uma intervenção educativa exata. Foram descritas as frequências do número de acertos, antes e depois da intervenção para cada comuna. Resultados: participaram 27 pessoas, com média de idade de 57 anos, das quais 59 % eram mulheres e 48 % tinham ensino médio completo e 40,7 % ensino primário. O conhecimento do agente causal antes da intervenção havia em 22 %, enquanto que após a intervenção, passou para 92,3 % na comuna 1, e 81,8 % na comuna 6. Após a intervenção, cerca de 90 % dos entrevistados reconheceram a retina como a estrutura mais afetada e todos os entrevistados reconheceram que o consumo de água fervida é um fator de proteção. Conclusão: Desconhecimento sobre a toxoplasmose nas duas comunas. Após a intervenção educativa, houve evidência de aumento do percentual de acertos na maioria das questões. Recomenda-se a realização de novas intervenções educacionais e de saúde pública, para avaliar os efeitos destas a longo prazo na populacão.

High frequency of ocular toxoplasmosis in Quindío, Colombia and risk factors related to the infection.

OBJECTIVES: To determine the frequency of retinochoroidal lesions by ocular toxoplasmosis and their relationships with risk factors, in residents of two districts with high exposure to Toxoplasma, in Armenia-Quindío, Colombia. METHODS: Cross-sectional analyses of fundoscopy screening, serological tests, and questionnaires were performed to determine risk factors associated with ocular toxoplasmosis retinochoroidal lesions. Differences in proportions were analyzed using the chi-squared test. RESULTS: Of 161 individuals examined, 17 (10.5%) exhibited retinochoroidal scars suggestive of old inactive Toxoplasma gondii infection. All 17 individuals were seropositive for T. gondii antibodies. Consumption of bottled water was protective against T. gondii infection among individuals in this study. There were no specific epidemiological risk factors associated with ocular toxoplasmosis retinochoroidal lesions. CONCLUSION: Ocular toxoplasmosis is an important cause of visual impairment in Armenia-Quindío, Colombia. The consumption of boiled or bottled water is a major preventive public health measure to reduce infection by T. gondii and the subsequent onset of OT.

Clinical, Socio-economic and Environmental Factors Related with Recurrences in Ocular Toxoplasmosis in Quindío, Colombia.

PURPOSE: To identify the sociodemographic, clinical, and environmental factors associated with recurrences in ocular toxoplasmosis (OT). METHODS: Retrospective analysis of clinical records of patients who consulted in the Health Centre at Universidad del Quindío between 2004 and 2017. Patients with retinochoroiditis due to Toxoplasma gondii infection and follow up >12 months were included. Comparisons were made with a recurrence index adjusted for months of follow up. For the statistical analysis, the Kruskal-Wallis test and analysis of variance (ANOVA) tests were performed in Epi Info 7.2 and SPSS 14.0. A statistical significance is shown if p ≤ 0.05. RESULTS: A total of 58 patients were included, with median age of 28 years (range 1-61) and 55.1% were women. The median of recurrences was 1.4 (range 0.6-16.6). High recurrence index was present in 43.1% of the patients. A higher size of lesions was observed in low socioeconomic groups (p = .016) and patients with congenital infection had more bilateral compromise (p = .002). Intake of boiled water was related to a lower recurrence index (p = .04). CONCLUSIONS: Low socioeconomic level was associated with bigger lesions and congenital infection was related with higher frequency of bilateral OT. Finally, intake of boiled water is related to a lower recurrence index of OT.

Niveles de 25-hidroxivitamina D y riesgo cardiovascular en una población estudiantil universitaria de Armenia-Colombia / 25-hydroxyvitamin D levels and cardiovascular risk in a university student population of Armenia-Colombia

RESUMEN Objetivo: Describir la relación entre los niveles de 25-hidroxivitamina D y el riesgo cardiovascular en universitarios de Armenia- (Colombia). Materiales y métodos: Estudio descriptivo de corte transversal, durante 2017-2018. Se calculó el riesgo cardiovascular mediante las escalas Framingham, Framingham Colombia y OMS/ISH. Se determinaron los niveles de lípidos, insulina, citocinas y 25-hidroxivitamina D. Posteriormente se realizaron pruebas de Anova, regresión múltiple y prueba chi cuadrado. Se consideró un nivel de significancia cuando p<0,05. Resultados: La edad promedio fue 21,05 años (IC95: 20,62 - 21,48) y el promedio de vitamina D fue 27,7 ng/ml (IC95: 26,52 - 28,88). Hubo diferencias estadísticamente significativas por sexo (p=0,009), siendo más frecuente la deficiencia e insuficiencia en el sexo femenino. El promedio de Puntaje Framingham fue -4,02±3,7. La variación explicada (R2) del Puntaje Framingham tiene relación con colesterol (p<0,001), cHDL (p<0,001) y vitamina D (p=0,039). El Porcentaje Framingham se relaciona con edad (p=0,031), perímetro abdominal (p=0,005), interferón-y (p<0,001) e interleucina-6 (p=0,050). Conclusión: La deficiencia e insuficiencia de vitamina D fueron condiciones prevalentes en esta población. La variación explicada del modelo de puntaje Framingham se asoció con colesterol, cHDL y vitamina D. El porcentaje de Framingham tuvo relación con la edad, el perímetro abdominal, interferón-y e interleucina-6.

ABSTRACT Objective: To describe the correlation between 25-hydroxyvitamin D levels and cardiovascular risk in Armenia-Colombia. Materials and methods: During 2017-2018 was conducted a descriptive cross-sectional study. The cardiovascular risk was determined by Framingham, Framingham Colombia and OMS/ISH scores. Lipids, insulin, cytokines and 25-hydroxyvitamin D were measured. Then Anova test, multiple regression and Chi-square test were performed. Values below p<0.05 were considered statistically significant. Results: The average age was 21.05 years old (CI95: 20,62 - 21,48) and the average vitamin D levels was 27.7 ng/ml (CI95: 26,52 - 28,88). Statistically significant differences were also found by sex (p=0,009), deficiency and insufficient vitamin D were more frequent in women. The Framingham score was -4.02±3.7. There is a relation between the explained variation (R2) of the score with cholesterol (p<0.001), HDL cholesterol (p<0.001) and vitamin D (p=0.039). Framingham percentage is related to age (p=0.031), abdominal perimeter (p=0.005), interferon-Y (p<0.001) and interleukin-6 (p=0.050). Conclusion: Vitamin D deficiency and insufficiency were prevalent conditions. The explained variation of the Framingham score model is associated with cholesterol, HDL cholesterol and vitamin D. And the Framingham percentage with age, abdominal perimeter, interferon-Y and interleukin-6.