Análise do controle da toxoplasmose gestacional e ocular nos serviços de Atenção Primária da 15ª Regional de Saúde do Paraná / Control analysis of pregnancy and ocular toxoplasmosis in Primary Care centers of the 15th Health Division of the state of Parana

Introdução: A primo-infecção pelo Toxoplasma gondii na gestação causa um risco de transmissão fetal entre 10% e 100%. Em 2006, a 15ª Regional de Saúde do Paraná criou a Rede de Controle da Toxoplasmose Gestacional e Congênita com referência para o Hospital Universitário de Maringá. Objetivo: avaliar as medidas adotadas pelos profissionais da Atenção Primária, para o controle da toxoplasmose gestacional e ocular. Método: Foram sorteadas 20% das 39 Unidades Básicas de Saúde de quatro municípios pertencentes à 15ª Regional de Saúde. A abordagem aos profissionais que assistiam as gestantes foi mediada por um questionário estruturado. Os dados coletados foram sobre as medidas realizadas: com gestantes soro não reagentes, com suspeita aguda, e com toxoplasmose ocular. Resultados: A maioria dos profissionais desconhecia a rede de controle, maneiras de infecção e medidas profiláticas para toxoplasmose. Conclusão: Isto mostra a importância da atualização profissional e perseverança da educação continuada (AU)

INTRODUCTION The primary infection by Toxoplasma gondii in pregnancy leads to a 10%--100% risk of fetal transmission. In 2006, the15th Health Division of the state of Paraná created the Network for Gestational and Congenital Toxoplasmosis Control with reference to the University Hospital of the city of Maringá. OBJECTIVE to evaluate the measures taken by primary care professionals regarding the control of gestational and ocular toxoplasmosis. METHOD Twenty percent of the 39 Basic Health Units in four municipalities belonging to the 15th Health Division of Paraná. The professionals who attended the pregnant women were interviewed through structured questionnaires. Data were collected on the measures carried out with non-reactive pregnant women, with acute suspicion, and ocular toxoplasmosis. RESULTS Most professionals were unaware of this control network, of the mode of infection, and the toxoplasmosis prophylactic measures. CONCLUSION This shows the importance of professional updating, and perseverance in continuing education (AU)

Genotyping of Giardia duodenalis in vegetables cultivated with organic and chemical fertilizer from street markets and community vegetable gardens in a region of Southern Brazil.

Background: In order to investigate the occurrence of Giardia duodenalis and its genotypes in vegetables that are consumed raw, we analyzed samples cultivated with organic or chemical fertilizer, sold in street markets and from community vegetable gardens in an urban area located in Southern Brazil. Methods: We analyzed 130 samples of vegetables such as crisp lettuce, regular lettuce, kale, chicory and rocket, from street markets, and 130 from community gardens. From each sample, 50 g were washed in Tween 80 solution (1%) and the solution obtained was filtered through a cellulose acetate membrane. The retained material was used for DNA extraction with the commercial kit Purelink®. GDH gene was amplified by semi-nested PCR using the GDHeF, GDHiR and GDHiF primers. Positive samples were genotyped using the PCR-RFLP technique with the restriction enzyme NlaIV. Results: We obtained 7.3% (19/260) positive samples for G. duodenalis, both from street markets (10/130) and from community gardens (9/130), including organic and non-organic products. The assemblage AI was predominant, but assemblages B and E were also found. Conclusions: The molecular technique revealed genotypes with zoonotic potential, evidencing the importance of investigating commercialized vegetables that are consumed raw and establishing a more rigid quality control.

First Detection of Toxoplasma gondii DNA in the Fresh Leafs of Vegetables in South America.

Despite the high dispersion of Toxoplasma gondii oocysts in the environment, there are few studies investigating their presence in vegetables consumed by the general population. This has led us to investigate its occurrence in raw vegetables. A total of 238 samples of vegetables were collected, including crisp lettuce, regular lettuce, chicory, rocket, and parsley, both organic and nonorganic, locally in northwestern Parana, Southern Brazil. Each sample (50 g) was washed and filtered separately. A PCR was performed to detect the parasite DNA from the sediment of each sample, using B1 (B22-23) and Toxo4-5 primers. We found contamination in 3.8% of the samples, 0.8% with the primer Toxo4-5 and 2.9% with B22-B23. The results were positive in 0.6% (1/62) of the samples of smooth lettuce, 3.7% (4/106) of crisp head lettuce, 5.0% (2/40) of chicory, 14.3% (1/7) of rocket, and 20% (1/5) of parsley. These data show the contamination by T. gondii in raw vegetables directly from production sites and stores, in both organic and nonorganic samples.

Toxoplasma gondii genotypes isolated from pregnant women with follow-up of infected children in southern Brazil.

BACKGROUND: Toxoplasma gondii populations that perpetuate in South America's natural ecosystems display broad genetic diversity, but the impact of this diversity on humans is generally unknown. In this short communication, we depict the genotypic traits of four isolates related to congenital parasitism as it emerges in Southern Brazil. METHODS: Using the PCR-restriction fragment length polymorphism markers SAG1, 5'3'SAG2, alt. SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, Apico, and CS3. Three of the four strains (TgCTBral, TgCTBrv, and TgCTBrac) were identified as ToxoDB genotype #166. RESULTS: Three children displayed normal cognitive/psychomotor development, and one child displayed Sabin's tetrad (TgCTBral). CONCLUSION: Vertical transmission of the two genotypes was observed and contributes to knowledge of T. gondii strains isolated from humans in Brazil.

Identification of public areas with potential toxocariasis transmission risk using geographical information systems.

UNLABELLED: Geographic information system (GIS) or Health geography is a geographical identification of the spatial variation of contagion disease and zoonosis risk in certain conditions. OBJECTIVE: Comparing the variation of environmental contamination of Toxocara spp. sands of lawns and public areas through the Geographic Information System. MATERIALS AND METHODS: Were investigated 98% of Parana recreational urban areas such as, schools, public parks and squares filled with sand and/or lawn. Samples were analyzed using zinc sulphate solution centrifuge-flotation, density 1.420, and water sedimentation. Maps were developed by ESRI Arc GIS 9.2. RESULTS: Total 77/98 (78,6%) of public spaces shown Toxocara spp. eggs presence. No significant difference was observed (p = 0,9999) between eggs prevalence in sand 44/56 (78,6%), and lawn 33/42 (78,6%), at school (p = 0,6898) and squares (p = 0,0616). Egg contamination prevailed in periphery areas in the sand 20/27 (74%) and lawn 18/21 (86%). However, no significant difference was observed between sand and lawn contamination from schools and parks to central and peripheral areas. Although schools 62/66 (93,9%) presented a higher number of enclosed spaces, did not provide a lower frequency of pollution (p = 0,3327). CONCLUSION: GIS observed a scattered pattern of zoonosis among schools and public squares sand and lawns, with predominance of contamination in the peripheral areas with presence of dogs/cats.

Association between contamination of public squares and seropositivity for Toxocara spp. in children.

A concomitant study was carried out, of the association of positive serology for Toxocara spp. in 90 children who played in public squares used for leisure, with the frequency with which each child used these areas, and the presence of eggs of Toxocara spp. in the sand or grass in these locations. The sand and grass of their peridomiciles and school playgrounds, as well as the feces of their dogs were also analyzed for Toxocara. Serum samples were tested for IgG antibodies to Toxocara canis excreted-secreted larval antigens by ELISA, and blood samples for eosinophilia. The water-sedimentation technique was used to evaluate the presence of parasite eggs in the sand and grass turfs, and in feces of the dogs that also frequented these locations. 16/90 (17.8%) of the children were seropositive for Toxocara spp. There was a positive association between seropositivity in children who played in the public squares six or seven times a week, with a parasite load above 1.1 eggs/g of sand, as well as with contamination of the peridomicile, even at less than 1.0 egg/g of sand. Eosinophilia, the habit of geophagy, age from one to four years, and the presence of parasitized pet dogs were also positively correlated with seropositivity in the children. Eggs were found in 15/15 (100%) of the public squares, 17/90 (18.9%) of the peridomiciles, 3/13 (23.1%) of the schools, and 12/41 (29.3%) of the dogs living in the peridomiciles investigated.

Serological, clinical and epidemiological evaluation of toxocariasis in urban areas of south Brazil.

Toxocariasis is a worldwide public-health problem that poses major risks to children who may accidentally ingest embryonated eggs of Toxocara. The objectives of this study were to investigate the occurrence of anti-Toxocara spp. antibodies in children and adolescents and the variables that may be involved, as well as environmental contamination by Toxocara spp. eggs, in urban recreation areas of north central mesoregion, Paraná State, Brazil. From June 2005 to March 2007. a total of 376 blood samples were collected by the Public Health Service from children and adolescents one to 12 years old, of both genders. Samples were analyzed by the indirect ELISA method for detection of anti-Toxocara antibodies. Serum samples were previously absorbed with Ascaris suum antigens, and considered positive with a reagent reactivity index >1. Soil samples from all of the public squares and schools located in the four evaluated municipalities that had sand surfaces (n = 19) or lawns (n = 15) were analyzed. Of the 376 serum samples, 194 (51.6%) were positive. The seroprevalence rate was substantially higher among children aging one to five years (p = 0.001) and six to eight years (p = 0.022). The clinical signs and symptoms investigated did not show a statistical difference between seropositive and seronegative individuals (p > 0.05). In 76.5% of the investigated recreation places, eggs of Toxocara were detected in at least one of the five collected samples. Recreation areas from public schools were 2.8 times more contaminated than from public squares. It is important to institute educational programs to inform families and educators, as well as to improve sanitary control of animals and cleaning of the areas intended for recreation in order to prevent toxocariasis.

Serological, clinical and epidemiological evaluation of toxocariasis in urban areas of south Brazil / Avaliação sorológica, clínica e epidemiológica da toxocaríase em áreas urbanas do sul do Brasil

Toxocariasis is a worldwide public-health problem that poses major risks to children who may accidentally ingest embryonated eggs of Toxocara. The objectives of this study were to investigate the occurrence of anti-Toxocara spp. antibodies in children and adolescents and the variables that may be involved, as well as environmental contamination by Toxocara spp. eggs, in urban recreation areas of north central mesoregion, Paraná State, Brazil. From June 2005 to March 2007. a total of 376 blood samples were collected by the Public Health Service from children and adolescents one to 12 years old, of both genders. Samples were analyzed by the indirect ELISA method for detection of anti-Toxocara antibodies. Serum samples were previously absorbed with Ascaris suum antigens, and considered positive with a reagent reactivity index >1. Soil samples from all of the public squares and schools located in the four evaluated municipalities that had sand surfaces (n = 19) or lawns (n = 15) were analyzed. Of the 376 serum samples, 194 (51.6 percent) were positive. The seroprevalence rate was substantially higher among children aging one to five years (p = 0.001) and six to eight years (p = 0.022). The clinical signs and symptoms investigated did not show a statistical difference between seropositive and seronegative individuals (p > 0.05). In 76.5 percent of the investigated recreation places, eggs of Toxocara were detected in at least one of the five collected samples. Recreation areas from public schools were 2.8 times more contaminated than from public squares. It is important to institute educational programs to inform families and educators, as well as to improve sanitary control of animals and cleaning of the areas intended for recreation in order to prevent toxocariasis.

A toxocaríase é um problema de saúde pública mundial, com maior risco para crianças que podem, acidentalmente, ingerir ovos embrionados de Toxocara spp.. Os objetivos deste estudo foram avaliar a ocorrência de anticorpos anti-Toxocara spp. em crianças e adolecentes e as variáveis que podem estar envolvidas, bem como a contaminação ambiental por ovos de Toxocara spp., em locais de recreação, em áreas urbanas da mesorregião norte central, Paraná, Brasil. De junho de 2005 a março de 2007 foram coletadas 376 amostras de sangue de crianças e adolescentes de um a doze anos, de ambos os sexos, atendidas pelo Sistema Único de Saúde. As amostras foram analisadas pelo método de ELISA indireto para detecção de IgG anti-Toxocara e previamente absorvidas com antígeno de Ascaris suum. Foram consideradas reagentes as amostras com índice de reatividade > 1. A análise das amostras de areias (n = 19) e gramados (n = 15) de cada município foi realizada em todas as praças e escolas públicas. Das 376 amostras de soro, 194 (51,6 por cento) foram positivas. A taxa de soroprevalência foi substancialmente mais elevada entre as crianças na faixa etária de até um a cinco (p = 0.001) e de seis a oito anos de idade (p = 0,022). Os sinais e sintomas clínicos investigados não mostraram diferenças estatísticas entre soropositivos e soronegativos (p > 0,05). Em 76,5 por cento dos locais de recreação investigados, ovos de Toxocara foram detectados em pelo menos uma das cinco amostras. Os locais de recreação das escolas públicas estavam 2,8 vezes mais contaminados do que as praças. É importante a realização de programas educativos junto às famílias e educadores, o controle sanitário de animais e a higienização dos locais destinados à recreação para prevenção da toxocaríase.

A prospective study of Toxoplasma-positive pregnant women in southern Brazil: a health alert.

We evaluated anti-Toxoplasma gondii IgM-reactive pregnant women seen at a high-risk pregnancy outpatient clinic. From March 2005 to January 2008 in Paraná, Brazil, pregnant women seen by the Brazilian Public Health System, in any gestational period, who were anti-T. gondii IgM-positive, were followed. Clinical symptoms were noted, and tests performed including IgA, IgG avidity, ultrasonogram, and amniocentesis (PCR/inoculation in mice). Of 75 patients, 8 showed low, 3 intermediate and 31 high IgG avidity. Of those who underwent the avidity test, 31 (70.5%) were in the second trimester of pregnancy. Thirty-two (42.7%) pregnant women received specific treatment. Six received triple combination treatment; in three, tachyzoites were isolated, although only one was PCR-positive, showing changes in the cerebral sonogram, borderline IgA, and the Sabin tetrad. One fetus died, and one non-reactive IgM pregnant woman showed ocular recurrence. The municipality of residence, contact with cats during adulthood, and ingestion of unpasteurized milk were shown to be important risk factors. Congenital toxoplasmosis was observed in a pregnancy referred late for treatment. Follow-up of children born to mothers with diagnosed or suspected acute toxoplasmosis is crucial in the management of the changes that toxoplasmosis may cause.