Long-term Ocular Outcomes in Congenital Toxoplasmosis Treated Perinatally.

BACKGROUND: Congenital toxoplasmosis (CT) can be accompanied by serious organ manifestations, particularly retinochoroiditis, and may occur throughout life. We aimed to monitor long-term ocular prognosis in a large French cohort of patients with CT and its changes over time in the context of mandatory prenatal screening (since 1992) and incidence decrease since 2008. METHODS: Patients with CT diagnosed between 1987 and 2021 were prospectively included and followed for up to 35 years. The effect of the period of conception on the risk of first retinochoroiditis has been tested using a flexible extension of the Cox model. Incidence rates of retinochoroiditis were estimated. RESULTS: A total of 646 infected live born children were followed for a median of 12 years (range, 0.5-35); 187 patients (29%) had at least 1 ocular lesion (first at a median age of 5 years; range, 0-26 years) with peaks at 7 and 12 years. Early maternal infection and the presence of nonocular signs at birth were associated with a higher risk of retinochoroiditis, whereas delayed diagnosis of CT (after birth versus before or at birth) was associated with a lower risk (13% decrease for each additional month after birth; P = .01). A period effect for the risk of developing retinochoroiditis in patients born after 2008 was not detected. CONCLUSIONS: Despite prenatal screening and prolonged perinatal treatment, retinochoroiditis is not a rare event in French patients with CT and can occur well into adulthood, with peak incidences at 7 and 12 years of age. It rarely causes severe damage but warrants regular follow-up into adulthood.

Gestational toxoplasmosis treatment changes the child's prognosis: A cohort study in southern Brazil.

BACKGROUND: We evaluate the drug treatment for pregnant women with acute toxoplasmosis to reduce the risk of congenital infection, side effects (prenatal and postnatal treatment in children) and the hazard of discontinuing the infant's medication. METHODS: We conducted a prospective cohort study to assess the risks of congenital toxoplasmosis among children born to acutely infected women with and without treatment. We examined the relationship between "exposed" and "infected children", "number of infant neutrophils", "prenatal" and "postnatal treatment". Factor analysis of mixed data (FAMD) was used to analyze the data. All children started treatment at the hospital. FINDINGS: Between 2017 and 2021, 233 pregnant women were evaluated at the University Hospital of Maringá; ninety-four met criteria for acute gestational toxoplasmosis. We followed up 61 children; eleven (18%) had the infection confirmed and 50 (82%) were free of toxoplasmosis (exposed). Children born to untreated mothers have 6.5-times higher risk of being infected; the transmission rate among untreated mothers was 50% versus 8.3% among treated ones. Three decreasing values of immunoglobulin G were a security parameter for stopping the child's medication in the exposed group (50/61). Neutropenia was the leading side effect among children and the infected had a 2.7 times higher risk. There was no correlation between maternal use of pyrimethamine and children's neutropenia. INTERPRETATION: The follow-up of women with acute T. gondii infection and their children, through a multidisciplinary team, availability of anti-T. gondii serology and pre- and post-natal treatments reduced the risk of toxoplasmosis transmission.

Congenital toxoplasmosis among hospitalized infants in Poland in the years 2007-2021: study based on the national hospital registry.

Congenital toxoplasmosis (CT) is a rare entity and it may pose a life-threatening risk for the newborns. The aim of the study was to evaluate the incidence and other selected factors of CT in Poland. Our study is a population-based study on CT patients in 2007-2021. The study was based on 1504 hospitalization records of first-time diagnosis of CT in newborns. In the study group, we observed 763 males (50.7%) and 741 females (49.3%). The mean and median age was 31 days and 10 days, respectively. Based on the hospital registry, the mean annual CT incidence was estimated to be 2.6 per 10,000 live births (95% CI 2.0-3.2 per 10,000 live births). The incidence of CT cases fluctuated over the years 2007-2021, with the highest incidence in 2010 and the lowest one in 2014. There were no statistically significant differences between the incidence of CT in relation to sex or place of residence. The periodic fluctuations in the number of cases of congenital toxoplasmosis indicates the need to develop effective prevention programs to effectively counteract the disease and its consequences.

Temporal trend, spatial analysis and spatiotemporal clusters of infant mortality associated with congenital toxoplasmosis in Brazil: Time series from 2000 to 2020.

OBJECTIVE: To analyse the spatial, temporal and spatial-temporal patterns of infant mortality associated with congenital toxoplasmosis in Brazil between the years 2000 and 2020. METHODS: Ecological study of time series, with spatial analysis and spatiotemporal scan of infant mortality associated with congenital toxoplasmosis from the records of deaths of the Mortality Information System of the Brazilian Ministry of Health. The rates were smoothed by the Local Empirical Bayesian model. The Global Moran Index, Global Geary's Contiguity and Getis-Ord General statistics were calculated for spatial autocorrelation assessment. The trends were evaluated by the Joinpoint method. RESULTS: We identified 1183 infant deaths associated with congenital toxoplasmosis in Brazil between 2000 and 2020. The predominant characteristics were male sex (52.1%), post-neonatal age group (51.9%), white race/colour (45.7%), and Southeast region of residence (40.0%). The infant mortality rate associated with congenital toxoplasmosis showed an increasing trend in the country in the years analysed. The spatial analysis showed heterogeneous distribution of mortality in the Brazilian territory and found no evidence of spatial autocorrelation; but spatial-temporal analysis identified three risk clusters involving 703 municipalities. CONCLUSION: Infant mortality associated with congenital toxoplasmosis is a persistent public health problem in Brazil. The risk factors male sex, indigenous race/colour, early neonatal age, North and Northeast regions and risk clusters mapped in this study should be observed for future analysis and planning of health care policies in the control of infant deaths associated with congenital toxoplasmosis. Health surveillance strategies and public health policies need to be strengthened.

Maternal and congenital toxoplasmosis in Mayotte: Prevalence, incidence and management.

BACKGROUND: Toxoplasmosis is an infection caused by an intracellular protozoan, Toxoplasma gondii. It is usually asymptomatic, but toxoplasmosis acquired during pregnancy can cause congenital toxoplasmosis, potentially resulting in fetal damage. Epidemiological information is lacking for toxoplasmosis in Mayotte (a French overseas territory). We evaluated (1) the prevalence of maternal toxoplasmosis, (2) the incidence of maternal and congenital toxoplasmosis, and (3) the management of congenital toxoplasmosis in Mayotte. METHODOLOGY / PRINCIPAL FINDINGS: We collected all the available data for toxoplasmosis serological screening during pregnancy and maternal and congenital cases of toxoplasmosis obtained between January 2017 and August 2019 at the central public laboratory of Mayotte (Mamoudzou). Using toxoplasmosis serological data from samples collected from 16,952 pregnant women we estimated the prevalence of toxoplasmosis in Mayotte at 67.19%. Minimum maternal toxoplasmosis incidence was estimated at 0.29% (49/16,952, 95% CI (0.0022-0.0038)), based on confirmed cases of maternal primary infection only. The estimated incidence of congenital toxoplasmosis was 0.09% (16/16,952, 95% CI (0.0005-0.0015). Missing data made it difficult to evaluate management, but follow-up was better for mothers with confirmed primary infection and their infants. CONCLUSIONS / SIGNIFICANCE: The seroprevalence of toxoplasmosis among pregnant women and the incidence of toxoplasmosis are higher in Mayotte than in mainland France. There is a need to improve the antenatal toxoplasmosis screening and prevention programme, providing better information to physicians and the population, to improve management and epidemiological monitoring.

Identification and multilocus genotyping of Toxoplasma gondii isolates from congenital infection in north of Iran.

Congenital toxoplasmosis can cause severe consequences in the fetus, such as spontaneous abortion which is affected by parasite strain. Also, recent studies revealed the high genetic diversity of Toxoplasma gondii. This study aims to investigate the serological status of T. gondii in pregnant women, multilocus genotyping in aborted fetuses' tissue, and archived formalin-fixed paraffin-embedded placenta. This study was performed on 100 pregnant women with spontaneous abortion and their aborted fetuses, and 250 of the archived placentae in Iran. The blood and tissue were examined for seroprevalence and genotype determination of T. gondii using ELISA and multilocus nested-PCR-RFLP, respectively. Anti-T. gondii IgG and IgM were detected in 68 samples (68%) and 1 (1%) out of 100 serums. Toxoplasma DNA was identified in 1 (1%) aborted fetuses' tissue and 32 (12.8%) placenta samples. Overall, ten positive DNA samples were successfully genotyped, and five genotypes were recognized (ToxoDB#1, #2, #10, #27, and #48). The obtained results indicated congenital toxoplasmosis is a severe risk in this region. As type I is highly pathogen and can lead to severe complications, the prevention of the infection should be considered in seronegative pregnant women.

Is the incidence of congenital toxoplasmosis declining?

Prenatal infection with the protozoan parasite Toxoplasma gondii can cause congenital toxoplasmosis (CT), an often fatal or lifelong-disabling condition. Several studies of human populations have reported temporal decreases in seroprevalence, suggesting declining CT incidence. However, the consistency of this trend among diverse populations remains unclear, as does its implication for prenatal screening programmes, the major intervention against CT. Using temporally resolved data on the seroprevalence of T. gondii in various countries, we discuss how the parasite's changing epidemiology may affect trends in CT incidence in varying and counterintuitive ways. We argue that parasite stage-specific serology could be helpful for understanding underlying causes of secular changes in seroprevalence. Furthermore, we highlight the importance of updating cost-effectiveness estimates of screening programmes, accounting for neuropsychiatric sequelae.

Boletim epidemiológico: perfil de morbimortalidade do Hospital Estadual e Maternidade Nossa Senhora de Lourdes de julho a setembro de 2023 / Epidemiological bulletin: morbidity and mortality profile of the Nossa Senhora de Lourdes State Hospital and Maternity Hospital from July to September 2023

Boletim epidemiológico que tem como objetivo descrever os dados dos agravos e doenças de notificações compulsórias, perfil de natalidade e perfil de morbimortalidade do Hospital Estadual e Maternidade Nossa Senhora de Lourdes. Trata-se de um estudo descritivo, elaborado através dos dados obtidos pelas notificações de doenças e agravos notificados, das declarações de nascidos vivos e dados dos óbitos onde foram emitidas as declarações de óbitos e realizado a investigação de óbitos. Os dados foram coletados através do sistema MV PEP, Sistema SINAN Net, SINAN Online, Comissão de Verificação de Óbitos e planilhas do NHE

Epidemiological bulletin that aims to describe data on conditions and diseases subject to compulsory notification, birth rate profile and morbidity and mortality profile of the Hospital Estadual e Maternidade Nossa Senhora de Lourdes. This is a descriptive study, prepared using data obtained from notifications of notified diseases and conditions, declarations of live births and data on deaths where death certificates were issued and death investigations were carried out. Data were collected through the MV PEP system, SINAN Net System, SINAN Online, Death Verification Commission and NHE spreadsheets

Profile of pregnant women and children accompanied due to T. gondii exposure at a referred healthcare center: What has changed in 10 years? / Perfil de gestantes e crianças acompanhadas por exposição ao Toxoplasma gondii num centro de referência: O que mudou 10 anos depois?

Abstract Objectives: to characterize the profile of pregnant women and newborns accompanied at a reference center for infectious-parasitic diseases, after the exposure of T. gondii, establishing comparisons with a previous study, in the same location, ten years ago. Methods: this is a retrospective cohort study, with a follow-up of four years (2016 to 2019), using the previous study carried out from 2002 to 2010 as a comparative for the variables assessed. Mothers who presented tests suggestive of seroconversion for the disease during prenatal care and their respective concepts, followed up over a year, were included. The chi-square test was used, assuming a significance level of 5% for the comparison of the groups in the two periods. Results: during the period from 2016 to 2019, 79 binomials were studied, whereas 58 binomials were accompanied in the previous period. Comparing both periods, the findings showed lower proportions of adolescents (p<0.001), with low schooling (p<0.001), with low serological testing (p<0.001) and with late or postnatal diagnosis (p<0.001). As to the children, the findings showed fewer changes in fundoscopy (p<0.001), strabismus (p=0.002), hepatomegaly (p=0.026) and any sequelae (p<0.001). Conclusion: a positive advance was observed regarding the care provided for the mother-child binomial affected by T. gondii, with a reduction in negative outcomes for the child. However, there are still challenges concerning the diagnosis and proper management of the disease.

Resumo Objetivos: caracterizar o perfil de gestantes e neonatos acompanhadas em um centro de referência em doenças infecto-parasitárias, após exposição ao Toxoplasma gondii, estabelecendo comparações em relação a estudo prévio, no mesmo local, há dez anos. Métodos: trata-se de estudo de coorte retrospectivo, com seguimento de quatro anos (2016 a 2019), servindo o estudo prévio realizado de 2002 a 2010 como comparativo para as variáveis estudadas. Foram incluídas mães que apresentaram durante o pré-natal exames sugestivos soroconversão para a doença e seus respectivos conceptos, acompanhados ao longo de um ano. Utilizou-se o teste qui-quadrado, assumindo-se nível de significância de 5% para a comparação dos grupos nos dois períodos. Resultados: durante o período de 2016 a 2019, foram estudados 79 binômios, enquanto no período anterior foram acompanhados 58 binômios. Comparando-se os dois períodos, em relação às mães, registraram-se menores proporções de adolescentes (p<0,001), de baixa escolaridade (p<0,001), baixa realização de testes sorológicos (p<0,001) e com diagnóstico tardio ou pós-natal (p<0,001). Em relação às crianças, verificaram-se menores proporções de alterações de fundoscopia (p<0,001), estrabismo (p=0,002), hepatomegalia (p=0,026) e qualquer sequela (p<0,001). Conclusão: observou-se um avanço em relação aos cuidados para o binômio mãe-filho acometido pelo T. gondii, com redução de desfechos negativos sobre a criança. Todavia, ainda existem desafios para o diagnóstico e adequado manejo da doença.

Congenital toxoplasmosis with severe neurological disease in a referral hospital in Peru. / Toxoplasmosis congénita con enfermedad neurológica severa en un hospital de referencia del Perú.

The aim of this study was to describe the epidemiological, clinical, and therapeutic characteristics of patients diagnosed with congenital toxoplasmosis (CT) with severe neurological disease. We reviewed the medical records of patients under 1 year of age with positive IgM test for Toxoplasma gondii and brain, eye, and/or hearing involvement. This study was carried out at the Instituto Nacional de Salud del Niño San Borja (INSNSB), Lima, Peru. Twenty-one patients diagnosed with CT were evaluated; 57.1% were female, and the median age at diagnosis was 3.1 months (IQR: 1.7-7.3). The main central nervous system manifestations were hydrocephalus (76.2%), intracranial calcifications (52.4%), microcephaly (42.9%), and convulsions (25.6%); the most frequent ocular manifestation was chorioretinitis (38.1%). In conclusion, 64% of CT cases had one or more manifestations of severe neurological disease.

El propósito del presente estudio fue describir las características epidemiológicas, clínicas, y terapéuticas de pacientes con diagnóstico de toxoplasmosis congénita (TC) con enfermedad neurológica severa. Se revisaron las historias clínicas de los pacientes menores de 1 año con serología IgM positiva para Toxoplasma gondii y compromiso encefálico, ocular y/o auditivo. El estudio se realizó en el Instituto Nacional de Salud del Niño San Borja (INSN-SB) en Lima, Perú. Se evaluaron a 21 pacientes con diagnóstico de TC, el 57,1% fueron del sexo femenino y la mediana de edad al momento del diagnóstico fue 3,1 meses (RIC: 1,7-7,3). Las principales manifestaciones del sistema nervioso central fueron hidrocefalia (76,2%), calcificaciones intracraneales (52,4%), microcefalia (42,9%), y convulsiones (25,6%); la manifestación ocular más frecuente fue la coriorretinitis (38,1%). En conclusión, 64% de los casos de TC tuvieron una o más manifestaciones de enfermedad neurológica severa.

A Systematic Review to Evaluate a Possible Association Between Congenital Toxoplasmosis and Preterm Labor.

BACKGROUND: Congenital toxoplasmosis (CT) is a widespread infection in several countries, and it is defined as an infection of a fetus, newborn, or infant under 1 year of age. Moreover, it represents a thread to pregnant women globally. The objective of our study is to evaluate a potential association between prematurity and CT and whether intrauterine transmission impacts gestational length during pregnancy. METHODS: PubMed, Cochrane Library and Google Scholar databases were searched from 1950 to 2019. Case-control studies, retrospective, and prospective cohort studies were eligible. Seven studies were included from a total of 314. The Newcastle-Ottawa scale was used to establish the quality of the articles included. RESULTS: Based on our review, an association between CT and preterm labor was not established, which may reflect heterogeneity in screening, treatments administered, and differing reported incidences of CT across continents over 69 years. A multicenter prospective cohort study powered to investigate a potential association is indicated. CONCLUSION: Further studies are needed including multicenter prospective cohort studies powered to investigate key clinical associations such as vertical transmission and preterm birth.

[Ocular toxoplasmosis in infants 0 to 12 months of age with congenital toxoplasmosis]. / Toxoplasmosis ocular en lactantes de 0 a 12 meses de edad con toxoplasmosis congénita.

BACKGROUND: Ocular toxoplasmosis (OT) is a retinochoroiditis that evolves with several episodes of inflammation and can occur both in the congenital or acquired form of the disease, Aim: To describe the frequency and clinical characteristics of OT in infants aged 0 to 12 months, children of mothers with positive serology for toxoplasmosis in the perinatal period. METHODS: Cross-sectional descriptive, ambispective study. RESULTS: Infants from 0 to 12 months of age, whose mothers had positive serology for toxoplasmosis in the perinatal period, referred to the pediatric ophthalmology service for evaluation, were admitted. Demographic variables, maternal and infant serology and the results of the ophthalmological examination were collected. Data were analyzed in SPSS v21 Results: 46.4% of 125 infants had OT, of them 67.2% were female, (p = 0.04) the median age was 6 months, 41% had IgG and IgM positive. The lesions were bilateral in 82.8%, central in 86.2%, and inactive in 81%. Retinochoroiditis was accompanied by strabismus in 41%. CONCLUSIONS: The frequency of OT in this population of infants with congenital toxoplasmosis was high. more than 80% of the eye lesions were inactive, centrally located and bilaterally involved.

Isolation and characterization of Toxoplasma gondii isolates from human congenital toxoplasmosis cases reveal a new virulent genotype in São Paulo, Brazil.

Toxoplasma gondii causes severe disease in congenitally infected fetuses. The severity of fetal infection is related to the gestational stage at the time of maternal infection, parasite burden, and genotypic characteristics. South America has a high incidence of congenital toxoplasmosis and has the highest genotypic diversity of the parasite. In Brazil, clinical toxoplasmosis in children is notorious, however there are very limited data regarding the strains recovered from congenital infections. In this study, T. gondii strains from two cases of severe congenital toxoplasmosis from the São Paulo metropolitan area were isolated (TgHumIMTBr2 and TgHumIMTBr3) and biologically and molecularly characterized using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and microsatellite analysis, revealing a new non-archetypal virulent genotype designated as #318. The other isolate, genotype #175, has already been described in domestic and wild animals in Brazil, but is now associated with acute toxoplasmosis in humans. These data reinforce the role of non-archetypal T. gondii genotypes in the severity of human congenital toxoplasmosis, highlighting the importance of studies focused on parasite isolation and genotyping for a better understanding of the virulence of isolates from human toxoplasmosis and contributing to the knowledge of the diversity of T. gondii in Brazil.

Toxoplasmosis ocular en lactantes de 0 a 12 meses de edad con toxoplasmosis congénita / Ocular toxoplasmosis in infants 0 to 12 months of age with congenital toxoplasmosis

INTRODUCCIÓN: La toxoplasmosis ocular (TO) es una retinocoroiditis que evoluciona con varios episodios de inflamación y puede presentarse, tanto en la forma congénita o adquirida de la enfermedad, OBJETIVO: Describir la frecuencia y características clínicas de la TO en lactantes de 0 a 12 meses, hijos de madres con serología positiva para toxoplasmosis en el periodo perinatal. METODOLOGÍA: Estudio descriptivo transversal, ambispectivo. Ingresaron lactantes de 0 a 12 meses de edad, cuyas madres tenían serología positiva para toxoplasmosis en el periodo perinatal, remitidos al servicio de oftalmología pediátrica para evaluación. Se recogieron variables demográficas, serología materna y de los lactantes, y los resultados del examen oftalmológico. Los datos fueron analizados en SPSS-v21. RESULTADOS: El 46,4% de 125 lactantes tenían TO, de ellos, 67,2% era de sexo femenino (p = 0,04), la mediana de edad fue de 6 meses, el 41% tenía IgG e IgM positiva. Las lesiones fueron bilaterales en 82,8%, central en 86,2%, e inactivas en 81%. La retinocoroiditis se acompañó de estrabismo en 41%. CONCLUSIONES: La frecuencia de TO en esta población de lactantes con toxoplasmosis congénita, fue elevada. Más de 80% de las lesiones oculares eran inactivas, de localización central y compromiso bilateral.

BACKGROUND: Ocular toxoplasmosis (OT) is a retinochoroiditis that evolves with several episodes of inflammation and can occur both in the congenital or acquired form of the disease, AIM: To describe the frequency and clinical characteristics of OT in infants aged 0 to 12 months, children of mothers with positive serology for toxoplasmosis in the perinatal period. METHODS: Cross-sectional descriptive, ambispective study. RESULTS: Infants from 0 to 12 months of age, whose mothers had positive serology for toxoplasmosis in the perinatal period, referred to the pediatric ophthalmology service for evaluation, were admitted. Demographic variables, maternal and infant serology and the results of the ophthalmological examination were collected. Data were analyzed in SPSS v21 RESULTS: 46.4% of 125 infants had OT, of them 67.2% were female, (p = 0.04) the median age was 6 months, 41% had IgG and IgM positive. The lesions were bilateral in 82.8%, central in 86.2%, and inactive in 81%. Retinochoroiditis was accompanied by strabismus in 41%. CONCLUSIONS: The frequency of OT in this population of infants with congenital toxoplasmosis was high. more than 80% of the eye lesions were inactive, centrally located and bilaterally involved.

Toxoplasma gondii Prevalence in Pregnant Women in Jataí - GO: a 10-year profile / Prevalência do Toxoplasma gondii em Gestantes no Município de Jataí ­ GO: um recorte de 10 anos / Prevalencia de Toxoplasma gondii en mujeres embarazadas de la Ciudad de Jataí - GO: un período de 10 años

Background and Objectives: Toxoplasmosis is a cosmopolitan zoonosis caused by the Toxoplasma gondii protozoan, transmitted mainly through contaminated water or food, beyond vertical transmission. In the State of Goiás, there is a lack of data on the prevalence of the disease, hence the relevance of this cross-sectional study to determine the prevalence of toxoplasmosis in pregnant women in the municipality of Jataí. Methods: Data were collected from pregnant women attended by the public health network in the municipality from January 2005 to December 2015. Results: During the analyzed period, 11,350 pregnant women were attended; 75% with IgG antibodies and 0,60% IgM antibodies reactive for T. gondii, with a reduction in the number of cases since 2010. Conclusion: The high seroprevalence found shows that pregnant women are in close contact with factors that trigger the infection and a reduction in the number of cases indicates the efficacy of epidemiological surveillance actions developed for this population group.(AU)

Justificativa e Objetivos: Toxoplasmose é uma zoonose cosmopolita causada pelo protozoário Toxoplasma gondii, transmitido principalmente através de água e alimentos contaminados e pela transmissão vertical. No estado de Goiás existe uma escassez de dados referentes à prevalência da toxoplasmose. Diante dessa realidade, tornou-se relevante esse estudo transversal que determinasse a prevalência da toxoplasmose nas gestantes no município de Jataí. Métodos: Foram coletados dados de grávidas atendidas pela rede pública de saúde no município no período de janeiro de 2005 a dezembro de 2015. Resultados: No período analisado, foram atendidas 11.350 gestantes, sendo 75% delas com anticorpos IgG e 0,60% anticorpos IgM reagentes para T. gondii, com redução no número de casos a partir de 2010. Conclusão: A alta soroprevalência encontrada demonstra que as grávidas estão em íntimo contato com os fatores que desencadeiam a infecção. É necessário investigar os fatores que contribuem para a elevada taxa de infecção.(AU)

Justificacíon y Objetivos: La toxoplasmosis es uma zoonosis cosmopolita causada por el protozoo Toxoplasma gondii, que se transmite principalmente através del agua o alimentos contaminados, además de la transmisión vertical. Em el estado de Goiás, se carece de dados sobre la prevalência de la enfermedad y ante esta realidade, es relevante este estudio transversal para determinar la prevalência de toxoplasmosis em gestantes del município de Jataí. Métodos: Se recolectaron dados de gestantes atendidas por la red de salud pública del município de Enero de 2005 a Diciembre de 2015. Resultados: Entre el período analizado se trató a 11.350 gestantes, 75% de ellas com anticuerpos IgG y 0,60% anticuerpos IgM reactivos para T. gondii, com uma reducción em el número de casos a partir de 2010. Conclusión: La alta soroprevalência encontrada muestra que las mujeres embarazadas están em estrecho contacto com los fatores desencadenantes de la infección y uma reducción em el número de casos apunta a uma eficácia em las acciones de vigilância epidemiológica desarrolladas para este grupo de problación.(AU)

Antenatal factors related to congenital toxoplasmosis in Rio De Janeiro, Brazil.

BACKGROUND: Toxoplasmosis is one of the main preventable congenital infections in Brazil. This manuscript aims to describe antenatal factors possibly associated with congenital toxoplasmosis (CT). METHODS: This is a case-control study, with data collected from medical records, from infants admitted under one year of age at the Infectious Diseases Clinic of Instituto de Puericultura e Pediatria Martagão Gesteira, reference center from Rio de Janeiro, exposed to toxoplasmosis during their antenatal period. Patients diagnosed with CT were classified as cases and those exposed without infection as controls. RESULTS: A total of 289 patients were followed up in 10 years. CT was confirmed in 43 (14.9%) of which six (14%) were asymptomatic, five (12%) had the classic triad (retinochoroiditis, hydrocephalus and intracranial calcifications), 27/42 (64.3%) had reactive IgM. Even after adjusted for prematurity, cases were born with lower weight (OR 0.49 - IC95% 0.33-0.73). There was a 13% increase in chance of CT per gestational week of the maternal diagnosis. Maternal fever, consumption of poorly washed vegetables during pregnancy, and diagnosis in the third trimester were associated with CT (OR: 6.43, 6.55, and 2.16, respectively). CONCLUSION: Fever during pregnancy, consumption of poorly washed vegetables and diagnosis in the third trimester were associated with CT. Infants with diagnosis of CT were born with lower weight than the controls.

Evaluation of implementation of the primary, secondary and tertiary prevention measures of the Surveillance Program of Gestational and Congenital Toxoplasmosis in the city of Londrina-PR.

Toxoplasmosis acquired during pregnancy is one that can lead to death or malformations of the foetus, and it is a complex disease to diagnose. The objective of the study was to evaluate the Surveillance Program of Gestational and Congenital Toxoplasmosis. To assess primary prevention, 424 pregnant women were interviewed regarding their knowledge of prevention measures in 2019. Secondary prevention measures were assessed, and the results of anti-Toxoplasma gondii serological tests were collected from pregnant women, from 2015 to 2018. In tertiary prevention measures, babies of mothers with a recent suspicion of T. gondii infection were screened to verify forwarding to the reference service. As a result, 45.5% (192/424) reported that they had received guidance from health professionals; 35.4% (68/192) changed their risk habits. The variables of schooling and age, having received prior guidance from health professionals and feline possession, proved to be significant when associated with the notions of preventive measures. 90.2% (17,423/19,319) of pregnant women had undergone serological tests to detect anti-T. gondii antibodies, but there was an excess in requests for tests and medication and only 40.6% (26/64) of the children were referred to the reference hospital. The Program presents positive results about the performance of serological screening in prenatal care; however, the dissemination of knowledge as for the prevention of toxoplasmosis and the request for tests need to be improved.

Psychometric properties of CVFQ7-BR-toxo to evaluate vision-related quality of life in children with congenital toxoplasmosis in Brazil.

PURPOSE: The high prevalence and severity of congenital toxoplasmosis in Brazil, with several affected individuals progressing to low vision, emphasize the importance of evaluating their quality of life. In this study, the Children's Visual Function Questionnaire (CVFQ) was adapted to the sociocultural context of Brazilian children, and its psychometric properties were investigated for evaluating the vision-related quality of life of these individuals. METHODS: This was a nested cross-sectional epidemiological study that prospectively monitored a cohort of 142 preschool children at a single referral university hospital in Belo Horizonte, Brazil. All children underwent complete ophthalmological examination, including visual acuity testing and binocular indirect ophthalmoscopy. Questionnaires were applied to their parents and caregivers to evaluate quality of life perception, as well as socioeconomic status of their families. Psychometric properties of the quality of life scale were evalua-ted by multivariate statistical analyses. RESULTS: Adaptation to the Brazilian version of CVFQ-7 resulted in CVFQ-BR-toxo, a questionnaire for evaluating the perception of parents/caregivers about the vision-related quality of life of preschool children with congenital toxoplasmosis. The following six subscales were identified based on description, variability structure, and interpretation/grouping of items: general health, visual acuity, visual performance/functional vision, personal and social behavior, impact on family, and treatment. Children with low vision related to congenital toxoplasmosis had significantly lower scores for the following subscales: visual acuity (p=0.004), visual performance/functional vision (p=0.008), impact on family (p=0.001), and overall health (p=0.001). CONCLUSION: Psychometric properties were appropriate concerning the validity of the quality of life construct. CVFQ-BR-toxo could demonstrate the impact of vision impairment on families of children with congenital toxoplasmosis.

The Term Newborn: Congenital Infections.

Maternal pathogens can be transmitted to the fetus resulting in congenital infection with sequelae ranging from asymptomatic infection to severe debilitating disease and still birth. The TORCH pneumonic (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) is used widely, but it provides a limited description of the expanding list of pathogens associated with congenital infection. This article focuses on the evaluation and management of infants with common congenital infections such as cytomegalovirus, and infections that warrant early diagnosis and treatment to prevent serious complications, such as toxoplasmosis, human immunodeficiency virus, and syphilis. Zika virus and Chagas disease remain uncommon.

Toxoplasma gondii in South America: a differentiated pattern of spread, population structure and clinical manifestations.

Toxoplasma gondii is an obligate intracellular parasite belonging to the phylum Apicomplexa. It has a worldwide distribution and can infect a wide variety of intermediate hosts, including humans. In South America, toxoplasmosis shows high health impacts, and the incidence of the disease is frequently reported and more severe than in other regions, such as Europe. Although most T. gondii infections are asymptomatic, severe manifestations can occur in cases of congenital toxoplasmosis and immunocompromised individuals. In South America, the ocular disease in immunocompetent individuals is also frequently reported. Treatment for any clinical manifestation of toxoplasmosis consists of the combination of sulfadiazine (SDZ) and pyrimethamine (PYR). However, failures in the treatment of toxoplasmosis have been reported, especially in South America, suggesting the acquisition of resistance against SDZ and PYR. Another paradigm present in the literature is that once infected with T. gondii, the host is immunologically protected from further reinfections. However, some studies indicate cases of congenital transmission of T. gondii from immunocompetent pregnant women with chronic infection, suggesting the possibility of reinfection in humans. Thus, in this review, we will cover several aspects of South American T. gondii isolates, such as genetic characterization, disease manifestation, host reinfection and drug resistance.