Clinical heterogeneity in patients with myoclonus associated to COVID-19.

OBJECTIVE: This study aims to report the clinical heterogeneity of myoclonus in 6 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: Patient data were obtained from medical records from the University Hospital Dr. Josep Trueta, Girona, Spain. RESULTS: Six patients (5 men and 1 woman, aged 60-76 years) presented with different myoclonus phenotypes. All of them had a medical history of hypertension and overweight. The latency of myoclonus appearance ranged from 1 to 129 days. The phenotype most observed was generalized myoclonus. Special phenotypes such as painful legs and moving toes syndrome with jerking feet, Lazarus sign-like, action myoclonus/ataxia syndrome, and segmental myoclonus secondary to myelitis have been described too. Levetiracetam and clonazepam were medications most used successfully. Two patients died for complications not related to myoclonus. CONCLUSIONS: Our 6 cases highlight the heterogeneity of the clinical spectrum of myoclonus associated to COVID-19 (MYaCO). MYaCO pathogenesis is suspected to be due to an immune-mediated para- or post-infectious phenomenon; nevertheless, further research is needed to elucidate this hypothesis.

Consenso Argentino de toxoplasmosis congénita 2020 / Argentine Consensus of congenital toxoplasmosis

Resumen La transmisión vertical de la infección por Toxoplasma gondii ocurre cuando la madre se infecta por primera vez en el transcurso del embarazo. El diagnóstico de la infección materna y la del re cién nacido se logra con el conjunto de pruebas serológicas, hallazgos clínicos y ecográficos. El reconocimiento temprano de la infección materna permite un tratamiento que reduce la tasa de transmisión y el riesgo de daño en el producto de la concepción. El objetivo de este consenso de expertos fue revisar la literatura científica para actualizar las recomendaciones de práctica clínica respecto de la prevención, el diagnóstico y el tratamiento de la toxoplasmosis congénita en nuestro país.

Abstract Mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. Diag nosis of maternal infection and the newborn is achieved by a combination of serological tests, clinical features and ultrasound images. An early diagnosis of maternal infection allows treatment that offers a reduction both in transmission rate and risk of congenital damage. The aim of this expert consensus was to review the scientific literature which would enable an update of the clinical practice guideline of prevention, diagnosis and treatment of congenital toxoplasmosis in our country.

[Argentine consensus of congenital toxoplasmosis]. / Consenso argentino de toxoplasmosis congénita 2020.

Mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. Diagnosis of maternal infection and the newborn is achieved by a combination of serological tests, clinical features and ultrasound images. An early diagnosis of maternal infection allows treatment that offers a reduction both in transmission rate and risk of congenital damage. The aim of this expert consensus was to review the scientific literature which would enable an update of the clinical practice guideline of prevention, diagnosis and treatment of congenital toxoplasmosis in our country.

La transmisión vertical de la infección por Toxoplasma gondii ocurre cuando la madre se infecta por primera vez en el transcurso del embarazo. El diagnóstico de la infección materna y la del recién nacido se logra con el conjunto de pruebas serológicas, hallazgos clínicos y ecográficos. El reconocimiento temprano de la infección materna permite un tratamiento que reduce la tasa de transmisión y el riesgo de daño en el producto de la concepción. El objetivo de este consenso de expertos fue revisar la literatura científica para actualizar las recomendaciones de práctica clínica respecto de la prevención, el diagnóstico y el tratamiento de la toxoplasmosis congénita en nuestro país.

[Prevalence of anti-Toxoplasma gondii antibodies in pregnant women in seven hospitals in Buenos Aires area. Comparison 2006 vs. 2017]. / Prevalencia de anticuerpos anti-Toxoplasma gondii en embarazadas en siete hospitales de Buenos Aires. Comparación entre 2006 y 2017.

We analyzed the presence of IgG and IgM anti-Toxoplasma gondii, as a measure of infection, in pregnant women attending seven hospitals in the Metropolitan Area of Buenos Aires during 2006 and 2017. T. gondii seroprevalence in 2006 vs. 2017, was: Hospital Alemán: 22 and 17% (p = 0.004), Hospital Fiorito: 44 and 33% (p < 0.001), Hospital Gandulfo: 30 and 34% (p 0.025), Hospital Grierson 60 and 44% (p < 0.001), Hospital Rivadavia: 59 and 51% (p = 0.003), Hospital Sardá: 47 and 39% (p < 0.001), and Hospital Thompson: 61 and 51% (p < 0.001). The comparison showed a significant decrease in seroprevalence in six hospitals. We also observed a significant decrease in the reactivity for IgM in 2017 compared to 2006 and in the seroprevalence for T. gondii in the overall population of pregnant women in the study. This means that a greater number of women are susceptible to develop acute infection during pregnancy.

Se analizó de forma retrospectiva la presencia de anticuerpos séricos IgG e IgM anti-Toxoplasma gondii en las embarazadas que concurrieron a siete hospitales del área Metropolitana de Buenos Aires durante 2006 y 2017. La prevalencia de infección, medida como presencia de anticuerpos, en 2006 vs. 2017, fue: Hospital Alemán: 22 y 17% (p = 0.004), Hospital Fiorito: 44 y 33% (p < 0.001), Hospital Gandulfo: 30 y 34% (p 0.025), Hospital Grierson: 60 y 44% (p < 0.001), Hospital Rivadavia: 59 y 51% (p=0.003), Maternidad Sardá 47 y 39% (p < 0.001) y Hospital Thompson: 61 y 51% (p < 0.001). La comparación demostró una disminución estadísticamente significativa de la seroprevalencia en seis hos pitales. También disminuyeron significativamente la reactividad para IgM en 2017 respecto de 2006 y la seroprevalencia para T. gondii en el total de la población de embarazadas estudiadas, lo que significa un mayor número de mujeres susceptible de desarrollar infección aguda durante el embarazo.

Prevalencia de anticuerpos anti-Toxoplasma gondii en embarazadas en siete hospitales de Buenos Aires: Comparación entre 2006 y 2017 / Prevalence of anti-Toxoplasma gondii antibodies in pregnant women in seven hospitals in Buenos Aires area. Comparison 2006 vs. 2017

Se analizó; de forma retrospectiva la presencia de anticuerpos só;©ricos IgG e IgM anti-Toxoplasma gondii en las embarazadas que concurrieron a siete hospitales del ó;rea Metropolitana de Buenos Aires durante 2006 y 2017. La prevalencia de infecció;n, medida como presencia de anticuerpos, en 2006 vs. 2017, fue: Hospital Alemán: 22 y 17% (p = 0.004), Hospital Fiorito: 44 y 33% (p < 0.001), Hospital Gandulfo: 30 y 34% (p 0.025), Hospital Grierson: 60 y 44% (p < 0.001), Hospital Rivadavia: 59 y 51% (p=0.003), Maternidad Sardá 47 y 39% (p < 0.001) y Hospital Thompson: 61 y 51% (p < 0.001). La comparació;n demostró; una disminució;n estadísticamente significativa de la seroprevalencia en seis hos pitales. Tambín disminuyeron significativamente la reactividad para IgM en 2017 respecto de 2006 y la seroprevalencia para T. gondii en el total de la població;n de embarazadas estudiadas, lo que significa un mayor nó;ºmero de mujeres susceptible de desarrollar infecció;n aguda durante el embarazo.

We analyzed the presence of IgG and IgM anti- Toxoplasma gondii, as a measure of infection, in pregnant women attending seven hospitals in the Metropolitan Area of Buenos Aires during 2006 and 2017. T. gondii seroprevalence in 2006 vs. 2017, was: Hospital Alemán: 22 and 17% (p = 0.004), Hospital Fiorito: 44 and 33% (p < 0.001), Hospital Gandulfo: 30 and 34% (p 0.025), Hospital Grierson 60 and 44% (p < 0.001), Hospital Rivadavia: 59 and 51% (p = 0.003), Hospital Sardá: 47 and 39% (p < 0. 001), and Hospital Thompson: 61 and 51% (p < 0.001). The comparison showed a significant decrease in seroprevalence in six hospitals. We also observed a significant decrease in the reactivity for IgM in 2017 compared to 2006 and in the seroprevalence for T. gondii in the overall population of pregnant women in the study. This means that a greater number of women are susceptible to develop acute infection during pregnancy.

HTLV-1 cosmopolitan and HTLV-2 subtype b among pregnant women of non-endemic areas of Argentina.

OBJECTIVES: The objective of this study was to estimate the prevalence of human T cell lymphotropic virus (HTLV)-1/2, HIV-1, hepatitis B virus (HBV), Trypanosoma cruzi, Treponema pallidum and Toxoplasma gondii infections and to identify the subtypes/subgroups of HTLV-1/2 among pregnant women (PW) from non-endemic provinces of Argentina. METHODS: Methods A total of 2403 samples were screened for HTLV-1/2 and confirmed by western blot and PCR. The long terminal repeat (LTR) of HTLV-1 and HTLV-2 were amplified. Phylogenetic analysis was performed by Neighbour Joining by using molecular evolutionary genetics analysis (MEGA) 4.0. RESULTS: Among a total of 2403 PW studied, 6 (0.25%) tested positive for HTLV-1/2 (3 HTLV-1 (0.12%) and 3 HTLV-2 (0.12%)). The total prevalence when distributed by province was 0.3% (3/804) for Buenos Aires (BA), 0.4% (1/241) for BA surroundings, 0.1% (1/707) for Neuquen and 1.0% (1/95) for Ushuaia. In San Juan, no PW were HTLV-1/2 positive. The prevalence was similar when compared with rates among blood donors of the same areas and years. The phylogenetic analysis classified one sequence as HTLV-1 aA and one as HTLV-2b. The prevalence of HIV-1, HBV, T cruzi, T pallidum and T gondii was 0.6%, 0.2%, 1.4%, 1.2% and 20.9%, respectively. One case of HTLV-1/HIV-1 and one of HTLV-2/HIV-1 co-infection were detected. CONCLUSIONS: HTLV-1/2, which have been associated with different diseases, are circulating among PW of Argentina, even in non-endemic areas. Therefore, testing should be recommended in women who have risk factors for these infections given that the majority of HTLV-1/2 mother to child transmission can be prevented by the avoidance of breast feeding.

Estudio multicéntrico para la prevención de la toxoplasmosis prenatal en Buenos Aires / Multicenter study on the prevention of congenital toxoplasmosis in Buenos Aires

La toxoplasmosis es una infección causada por Toxoplasma gondii, parásito intracelular de distribución universal cuya tasa de seroprevalencia varía según la región. En el feto o recién nacido la infección causa morbilidad y mortalidad. El presente trabajo es una evaluación práctica de las propuestas del Consenso Argentino de Prevención de la Toxoplasmosis Prenatal. Participaron 9 hospitales de Buenos Aires y Conurbano donde se atendieron 19825 partos entre el 1º de mayo del 2006 y el 30 de abril del 2007. Se realizaron pruebas de tamizaje serológico en 13632 embarazadas con determinaciones de IgG e IgM por método de ELISA. La prevalencia de anticuerpos IgG específicos anti Toxoplasma gondii fue del 49%. Los sueros clasificados con criterio de infección reciente se remitieron al laboratorio del Hospital Alemán para ampliar el estudio. A los recién nacidos de estas madres se les efectuó control clínico y serológico. El análisis de los resultados de las 351 muestras enviadas confirmó que 121 (32%) pacientes podrían haberse infectado durante el embarazo, en 176 (46%) se descartó la infección reciente, en 37 embarazadas (10%) la serología no fue concluyente y en 47 (12%) faltó la fecha de gestación para su interpretación. Se efectuó control clínico y serológico a 94 recién nacidos de madres con infección durante el embarazo y se detectaron 5 toxoplasmosis congénitas con daño fetal, una microcefalia y cuatro coriorretinitis. El estudio permitió validar las guías y recomendaciones del Consenso Argentino de Toxoplasmosis Congénita.

Toxoplasmosis is an infection caused by Toxoplasma gondii, an intracellular parasite of universal distribution, with a variable prevalence depending on the region. This infection causes both morbidity and mortality in the fetus and newborn. The present study is an evaluation of the Argentine Consensus Guidelines regarding prenatal prevention of toxoplasmosis. Screening tests in pregnant women were done in nine different hospitals within the city of Buenos Aires and surroundings, where 19825 births between May 1st 2006 and April 30th 2007 were registered. Screening tests were done in 13632 pregnant women, using IgG and IgM determinations by ELISA. If acute infection was suspected, the patient‘s serum was sent to the reference laboratory to fulfill the pending tests: Sabin Feldman, ISAGA M, ISAGA A, ISAGA E and avidity. Clinical and serologic evaluation was done to all newborn of these mothers. Three hundred and fifty one specimens were sent and analyzed. Conclusions from the analysis were as follows: 121 (32%) patients probably acquired the infection during pregnancy, in 176 (46%) patients, acute infection was excluded, in 37 women (10%) serologic results were inconclusive, and in 47 (12%) the interpretation of results was impossible due to lack of information on the exact gestational age. Clinical and serologic control was performed in 94 newborns of mothers infected during pregnancy, and 5 congenital toxoplasmosis were detected, with fetal damage, four corioretinitis and one case of microcephaly. This study allowed us to validate the Argentine Consensus of Congenital Toxoplasmosis Guidelines.

[Argentine Consensus of Congenital Toxoplasmosis]. / Consenso Argentino de Toxoplasmosis Congénita.

The mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. The prenatal and early postnatal diagnosis can only be achieved by serological testing. Serologic tests have different sensitivities, specificities and complexities, so that different tests in more than one blood sample are necessary for the diagnosis. Serological follow-up of the infants should be conducted during the first year of life or until the diagnosis of congenital toxoplasmosis can be ruled out. Treatment recommendations try to reduce the transmission rate and the risk of congenital damage. Congenital toxoplasmosis incidence rate is approximately 5 per 1000 births, but can be reduced to 0.5 per 1000 with an active screening program. The aim of this consensus group was to review the scientific literature on congenital toxoplasmosis and prepare a statement on prevention, diagnosis and treatment that should be implemented in our country.

Consenso argentino de toxoplasmosis congénita / Argentine Consensus of Congenital Toxoplasmosis

La transmisión de la infección por Toxoplasma gondii de la madre al hijo ocurre cuando la madre se infecta por primera vez en el transcurso del embarazo. Tanto el diagnóstico prenatal, como el del primer año de vida se basa en pruebas serológicas; y la mayoría de las veces es necesario realizar más de una de estas pruebas ya que tienen distintos porcentajes de sensibilidad y/o especificidad así como distintos niveles de complejidad. El recién nacido requiere seguimiento serológico en el primer año de vida o hasta que se descarte el diagnóstico de toxoplasmosis congénita. El diagnóstico temprano de la infección, en la mujer embarazada, permite un tratamiento oportuno y se indica con el propósito de reducir la tasa de transmisión y el daño congénito. Es posible que con un programa activo, de prevención y tratamiento temprano, se pueda reducir la tasa de incidencia de la toxoplasmosis congénita de alrededor del 5 por mil nacimientos a 0.5 por mil. El objetivo de este consenso fue revisar la literatura científica para la prevención, el diagnóstico y el tratamiento de la toxoplasmosis congénita, para que se pueda implementar en nuestro país.

The mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. The prenatal and early postnatal diagnosis can only be achieved by serological testing. Serologic tests have different sensitivities, specificities and complexities, so that different tests in more than one blood sample are necessary for the diagnosis. Serological follow-up of the infants should be conducted during the first year of life or until the diagnosis of congenital toxoplasmosis can be ruled out. Treatment recommendations try to reduce the transmission rate and the risk of congenital damage. Congenital toxoplasmosis incidence rate is approximately 5 per 1000 births, but can be reduced to 0.5 per 1000 with an active screening program. The aim of this consensus group was to review the scientific literature on congenital toxoplasmosis and prepare a statement on prevention, diagnosis and treatment that should be implemented in our country.

[Multicenter study on the prevention of congenital toxoplasmosis in Buenos Aires]. / Estudio multicéntrico para la prevención de la toxoplasmosis prenatal en Buenos Aires.

Toxoplasmosis is an infection caused by Toxoplasma gondii, an intracellular parasite of universal distribution, with a variable prevalence depending on the region. This infection causes both morbidity and mortality in the fetus and newborn. The present study is an evaluation of the Argentine Consensus Guidelines regarding prenatal prevention of toxoplasmosis. Screening tests in pregnant women were done in nine different hospitals within the city of Buenos Aires and surroundings, where 19825 births between May 1st 2006 and April 30th 2007 were registered. Screening tests were done in 13632 pregnant women, using IgG and IgM determinations by ELISA. If acute infection was suspected, the patient's serum was sent to the reference laboratory to fulfill the pending tests: Sabin Feldman, ISAGA M, ISAGA A, ISAGA E and avidity. Clinical and serologic evaluation was done to all newborn of these mothers. Three hundred and fifty one specimens were sent and analyzed. Conclusions from the analysis were as follows: 121 (32%) patients probably acquired the infection during pregnancy, in 176 (46%) patients, acute infection was excluded, in 37 women (10%) serologic results were inconclusive, and in 47 (12%) the interpretation of results was impossible due to lack of information on the exact gestational age. Clinical and serologic control was performed in 94 newborns of mothers infected during pregnancy, and 5 congenital toxoplasmosis were detected, with fetal damage, four corioretinitis and one case of microcephaly. This study allowed us to validate the Argentine Consensus of Congenital Toxoplasmosis Guidelines.