Prospective evalution of pregnant women with suspected acute toxoplasmosis treated in a reference prenatal care clinic at a university teaching hospital in Southern Brazil.

Infection by the protozoan Toxoplasma gondii during pregnancy demands greater attention from the health authorities due to the risk of placental transmission, which can have devastating consequences to the foetus and newborn. This study was conducted in a high-risk prenatal care outpatient clinic of a university teaching hospital. Pregnant women screened for specific IgM and IgG anti -T. gondii, attended from January 2009 to August 2018 were included. From 530 suspected patients, 218 were followed up and they presented positive IgM and IgG anti- T. gondii. From these patients, 83 (38.0%) had low IgG avidity, 39 (18%) seroconverted in the second or third trimester of pregnancy, 19 (8.7%) had no avidity test, 69 (31.6%) had high IgG avidity after 16 weeks of gestation, five had recurrent chorioretinitis (2.2%) and three (1.3%) were seropositive to HIV. Complementary diagnoses were made in 30/48 (62.5%) of the patients revealing the presence of specific IgA antibodies raised to T. gondii; 3/63 (4.8%) peripheral blood samples and 1/57 (1.8%) amniotic fluid sample. There were eight foetal deaths, one case of neonatal hepatomegaly and one case of T. gondii DNA detected in a peripheral blood sample. Of the 139 newborn deliveries at the teaching hospital, there was a 38% loss of follow-up. The prevalence of congenital toxoplasmosis was 1.2 cases/1,000 live births in this study area, according to the retrospective survey of cases. Prenatal treatment may have helped to reduce the risk of vertical transmission.

Analysis of cytokines IFN-γ, TNF-α, TGF-ß and nitric oxide in amniotic fluid and serum of pregnant women with toxoplasmosis in southern Brazil.

This study detected and compared the levels of IFN-γ, TNF-α, TGF-ß and nitric oxide (NO) in amniotic fluid (AF) and serum of pregnancies with acute toxoplasmosis, Southern Brazil. It also was compared the levels of the same mediators in the serum of pregnancies in acute and chronic toxoplasmosis with non-infected. Serological investigation, anti-T gondii IgM and IgG, of the 67 pregnancies was determined by Elisa MEIA. Forty two were uninfected, eight in chronic phase and 17 in acute phase. Among the acute phase, seven agreed to amniocentesis. The cytokines, in serum and in AF, were assessed by sandwich ELISA, and NO was estimated from the nitrite measurement with Griess reagent. The IFN-γ and TGF-ß levels in the AF and blood were similar, while TNF-α levels was lower in the AF. On the other hand, NO was higher in the AF. Chronically infected pregnant women have showed lower levels of INF-γ than those in acute and uninfected pregnancies. The serological levels of TNF-α were lower in pregnancies with toxoplasmosis, when compared with non-infected. TGF-ß levels were higher in pregnancies in acute phase when compared with uninfected or chronically infected. NO in the serum of the infected had lower levels than those non-infected. In summary, higher concentrations of NO and lower levels of TNF-α were observed in the AF than in the serum of acute pregnancies, while TGF-ß e INF-γ levels were similar in both biological material. In the serum of infected pregnancies was observed decrease in inflammatory mediators and increase of TGF-ß.

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)

An alternative method to recover Toxoplasma gondii from greenery and fruits.

Toxoplasma gondii oocysts are an important form of contamination with a high dispersion in the environment, but their detection is still a challenge. This study evaluated the recovery of oocysts from strawberries and crisphead lettuce. Samples (250 g of strawberries or one head of lettuce) were experimentally inoculated with 10, 10(2), 10(3) and 10(4) T. gondii oocysts, by two separate processes, spot dripping and immersion. Then, 50 g of each sample was washed, filtered through a cellulose ester membrane, and concentrated by centrifugation. Three aliquots were taken for DNA extraction in a direct way, after freeze-thaw (FT) cycles or ultrasound (US), followed by PCR (B22-B23 and Tox4-Tox5 primers). The T. gondii DNA was amplified with the primers B22-B23 in all samples contaminated by dripping and when DNA extraction was carried out after FT or US. These techniques may be useful in epidemiological surveillance in the control of this zoonosis.

Predominance of Giardia duodenalis Assemblage AII in Fresh Leafy Vegetables from a Market in Southern Brazil.

We investigated the presence of Giardia duodenalis cysts and its genotypes in raw leafy vegetables sold in a Brazilian market. These products are different from those sold in most street markets because the producers themselves display and sell their products and rely on specialized technical and sanitary assistance. Vegetable and water samples were collected from 14 (80%) producers who cultivated vegetables that are typically consumed raw for sale at the market, obtained at the market and farms, respectively. A total of 128 samples of leafy greens (chives, parsley, cabbage, arugula, watercress, and chicory) and 14 water samples were analyzed by direct immunofluorescence and PCR techniques. The positive samples were genotyped (GHD gene) using PCR and restriction fragment length polymorphism. The analyses indicated that 16 (12.5%) of 128 samples were positive by PCR, while 1 (0.8%) of 128 samples were positive by immunofluorescence. Giardia cysts were not detected in the water samples obtained at the farms. The molecular technique revealed a genotype with zoonotic potential, which underscores the challenge in the control of giardiasis dissemination via the consumption of raw vegetables.

Aborto espontâneo e toxoplasmose ocular em um casal infectado com Toxoplasma gondii / Spontaneous abortion and ocular toxoplasmosis in a couple infected with Toxoplasma gondii

OBJETIVOS: Relatar os casos de um casal, em que a esposa apresentou toxoplasmose na gestação e o esposo, após 15 anos, foi diagnosticado com toxoplasmose ocular. RELATO DOS CASOS: Gestante, grávida de gêmeos, residente de um estado na região Sul do Brasil. No primeiro mês de gestação apresentou sorologia não reagente para IgG e IgM anti-Toxoplasma gondii. Na sétima semana de gestação houve soroconversão (IgM e IgG anti-T.gondii reagentes) e aborto natural. O esposo, após 15 anos desde o episódio da esposa, queixou-se de visão embaçada/irritada. O exame de fundoscopia revelou lesões típicas de coriorretinite recidivante por toxoplasmose no olho direito. Os exames sorológicos foram IgG anti-T.gondii reagente e IgM anti-T.gondii não reagente. CONCLUSÕES: Este relato, de um casal com desfechos clínicos importantes de toxoplasmose, em diferentes formas, enfatiza a relevância do problema da toxoplasmose, que nas suas diversas manifestações, pode trazer graves consequências para a vida de uma família.

AIMS: To report the cases of wife and husband with toxoplasmosis. The woman acquired the infection during pregnancy while her husband was diagnosed with ocular toxoplasmosis 15 years later. CASES REPORT: A woman with twin pregnancy, living in southern Brazil, was seronegative for Toxoplasma gondii IgG and IgM antibodies in the first month of gestation. Seroconversion (positive T. gondii IgM and IgG antibodies) occurred in the seventh week of gestation, resulting in spontaneous abortion. Fifteen years later, her husband presented with eye irritation and blurred vision. The funduscopic examination revealed typical lesions of recurrent chorioretinitis in the right eye. The serological tests were positive for T. gondii IgG and negative for IgM. CONCLUSIONS: This report of a couple with important clinical outcomes of two different types of toxoplasmosis underscores the importance of this disease which, in its various manifestations, may have serious consequences for a family's life.

Association of cytokines in individuals sensitive and insensitive to dust mites in a Brazilian population.

INTRODUCTION: Allergic reaction to dust mites is a relatively common condition among children, triggering cutaneous and respiratory responses that have a great impact on the health of this population. Anaphylactic hypersensitivity is characterized by an exacerbated response involving the production of regulatory cytokines responsible for stimulating the production of IgE antibodies. OBJECTIVE: To investigate an association of variants in cytokine genes (IL1A-889, IL1B-511, +3962, IL1R1970, IL1RA11100, IL4RA+1902, IL12-1188, IFNG+874, TGFB1 codon 10, codon 25, TNFA-308, -238, IL2-330, +166, IL4-1098, -590, -33, IL6-174, nt565, and IL10-1082, -819, -592) between patients sensitive to dust mites and a control group. METHODS: A total of 254 patients were grouped as atopic and non-atopic according to sensitivity as evaluated by the Prick Test and to cytokine genotyping by the polymerase chain reaction-sequence specific primers (PCR-SSP) method using the Cytokine Genotyping Kit. RESULTS: A comparison between individuals allergic to Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Blomia tropicalis and a non-atopic control group showed significant differences between allele and genotype frequencies in the regulatory regions of cytokine genes, with important evidence for IL4-590 in T/C (10.2% vs. 43.1%, odd ratio [OR] = 0.15, p = 5.2 10-8, pc = 0.0000011, and 95% confidence interval [95%CI] = 0.07-0.32) and T/T genotypes (42.9% vs. 13.8%, OR = 4.69, p = 2.5 10-6, pc = 0.000055, and 95%CI = 2.42-9.09). Other associations were observed in the pro-inflammatory cytokines IL1A-889 (T/T, C, and T) and IL2-330 (G/T and T/T) and the anti-inflammatory cytokines IL4RA+1902 (A and G), IL4-590 (T/C, T/T, C, and T), and IL10-592 (A/A, C/A, A, and C). CONCLUSION: Our results suggest a possible association between single nucleotide polymorphisms (SNPs) in cytokine genes and hypersensitivity to dust mites.

Toxoplasmosis: an examination of knowledge among health professionals and pregnant women in a municipality of the State of Paraná.

INTRODUCTION: The aim of this study was to investigate the knowledge of toxoplasmosis among professionals and pregnant women in the public health services in Paraná, Brazil. METHODS: A cross-sectional observational and transversal study of 80 health professionals (44 nurses and 36 physicians) and 330 pregnant women [111 immunoglobulin M (IgM)- and IgG-non-reactive and 219 IgG-reactive] was conducted in 2010. An epidemiological data questionnaire was administered to the professionals and to the pregnant women, and a questionnaire about the clinical aspects and laboratory diagnosis of toxoplasmosis was administered to the professionals. RESULTS: The participants frequently provided correct responses about prophylactic measures. Regarding the clinical and laboratory aspects, the physicians provided more correct responses and discussed toxoplasmosis with the pregnant women. The professionals had difficulty interpreting the avidity test results, and the physicians stated that they referred pregnant women with high-risk pregnancies to a county reference center. Of the professionals, 53 (91.4%) reported that they instructed women during prenatal care, but only 54 (48.6%) at-risk pregnant women and 99 (45.2%) women who were not at risk reported receiving information about preventive measures. The physicians provided verbal instructions to 120 (78.4%) women, although instructional materials were available in the county. The pregnant women generally lacked knowledge about preventive measures for congenital toxoplasmosis, but the at-risk pregnant women tended to respond correctly. CONCLUSIONS: This study provides data to direct public health policies regarding the importance of updating the knowledge of primary care professionals. Mechanisms should be developed to increase public knowledge because prophylactic strategies are important for preventing congenital toxoplasmosis.

Toxoplasmosis: an examination of knowledge among health professionals and pregnant women in a municipality of the State of Paraná

Introduction The aim of this study was to investigate the knowledge of toxoplasmosis among professionals and pregnant women in the public health services in Paraná, Brazil. Methods A cross-sectional observational and transversal study of 80 health professionals (44 nurses and 36 physicians) and 330 pregnant women [111 immunoglobulin M (IgM)- and IgG-non-reactive and 219 IgG-reactive] was conducted in 2010. An epidemiological data questionnaire was administered to the professionals and to the pregnant women, and a questionnaire about the clinical aspects and laboratory diagnosis of toxoplasmosis was administered to the professionals. Results The participants frequently provided correct responses about prophylactic measures. Regarding the clinical and laboratory aspects, the physicians provided more correct responses and discussed toxoplasmosis with the pregnant women. The professionals had difficulty interpreting the avidity test results, and the physicians stated that they referred pregnant women with high-risk pregnancies to a county reference center. Of the professionals, 53 (91.4%) reported that they instructed women during prenatal care, but only 54 (48.6%) at-risk pregnant women and 99 (45.2%) women who were not at risk reported receiving information about preventive measures. The physicians provided verbal instructions to 120 (78.4%) women, although instructional materials were available in the county. The pregnant women generally lacked knowledge about preventive measures for congenital toxoplasmosis, but the at-risk pregnant women tended to respond correctly. Conclusions This study provides data to direct public health policies regarding the importance of updating the knowledge of primary care professionals. Mechanisms should be developed to increase public knowledge because prophylactic strategies are important for preventing congenital toxoplasmosis. .

Avaliação eosinofílica e soropositividade para anticorpos IgG anti-toxocara em crianças atendidas pelo sistema único de saúde / Eosinophilic count and seropositivity for IgG antibodies to toxocara spp. in children assisted at the public health service / Evaluación eosinófila y suero-positividad para anticuerpos igG anti-toxocara en niños atendidos por el sistema único de salud

OBJETIVO: Verificar a associação entre a presença de eosinofilia e a soropositividade para anticorpos IgG anti-Toxocara spp. em crianças atendidas pelo Sistema Único de Saúde no Noroeste do Paraná, Brasil. MÉTODOS: Estudo retrospectivo com crianças de sete meses a 12 anos, atendidas pelo Sistema Único de Saúde do Noroeste do Paraná, com teste ELISA para a pesquisa de anticorpos IgG anti-Toxocara spp. e contagem de eosinófilos (eosinofilia >600 células/mm³). RESULTADOS: Entre as 1.199 crianças, 386 (32,2 por cento) apresentaram anticorpos IgG anti-Toxocara spp. A soroprevalência e a eosinofilia foram mais frequentes em crianças de sete meses a cinco anos. A eosinofilia foi observada em 7,8 por cento dos pacientes soro-reagentes ao Toxocara spp.. CONCLUSÕES: Foi observada elevada prevalência de anticorpos anti-Toxocara spp., principalmente nos menores de cinco anos. Com exceção de algumas crianças que apresentaram sintomas respiratórios e presença de eosinofilia, a maioria foi assintomática e não mostrava eosinofilia. A pesquisa de eosinófilos é ferramenta secundária para o diagnóstico de toxocaríase.

OBJECTIVE: To study the association between the presence of eosinophilia and IgG antibodies to Toxocara spp. in children assisted by the public health service, in the northwestern region of Parana State, in southern Brazil. METHODS: A retrospective study of children aged seven months to 12 years old assisted by the Public Health Service in northwest state of Paraná, Brazil. ELISA test was performed in all children in order to detect IgG antibodies to Toxocara spp. and eosinophil amounts (eosinophilia > 600 cells/mm3). RESULTS: Among 1,199 screened children, 386 (32.2 percent) had IgG antibodies to Toxocara spp. The seroprevalence of Toxocara spp. and the eosinophilia were more common among children of seven months to five years old. Eosinophilia was observed in 7.8 percent of seropositive patients to Toxocara spp. CONCLUSIONS: There was a high prevalence of anti-Toxocara spp., mainly in children under five years old. With the exception of some children who had respiratory symptoms and eosinophilia, most of them were asymptomatic and did not present eosinophilia. Eosinophilic count is a secondary laboratory finding in the diagnosis of toxocariasis.

OBJETIVO: Verificar la asociación entre la presencia de eosinofilia y una suero-positividad para anticuerpos IgG anti-Toxocara spp. en niños atendidos por el Sistema Único de Salud en el noroeste de Paraná, Brasil. MÉTODOS: Estudio retrospectivo en niños de siete meses a 12 años de edad, atendidos por el Sistema Único de Salud en el noroeste de Paraná, con prueba de ELISA para la investigación de anticuerpos IgG anti-Toxocara spp. y recuento de eosinófilos (eosinofilia > 600 células/mm³). RESULTADOS: Entre los 1.199 niños, 386 (32,2 por ciento) presentaron anticuerpos IgG anti-Toxocara spp. La suero-prevalencia y la eosinofilia fueron más frecuentes en niños de siete meses a cinco años. La eosinofilia fue observada en 7,8 por ciento de los pacientes suero-reactivos al Toxocara spp. CONCLUSIÓN: Se observó elevada prevalencia de anticuerpos anti-Toxocara spp., principalmente en niños menores de cinco años. Excepto por algunos niños que presentaron síntomas respiratorios y presencia de eosinofilia, la mayoría de ellas fue asintomática y mostraban eosinofilia. La investigación de eosinófilos es herramienta adicional a los casos con indicios clínicos de toxocariase.