Fatores associados a enteroparasitoses em escolares da rede municipal de ensino de Cambé / Factors associated with intestinal parasites in schoolchildren of municipal schools in Cambé

O objetivo deste trabalho foi determinar os fatores associados à prevalência das parasitoses intestinais em escolares da rede municipal de Cambé, Paraná. Foram analisadas 1996 amostras de fezes, coletadas entre 2006 e 2009, pelos métodos de Hoffmann, Pons e Janer (1934), de Faust e colaboradores e de Kato-Katz. A prevalência encontrada foi de 23,2%. Os parasitas encontrados foram Entamoebacoli (10,4%); Endolimax nana (9,6%), Giardia lamblia (6,4%), Enterobius vermicularis (1,5%), Entamoeba histolytica/dispar (0,3%), Trichuris trichiura (0,4%), Iodamoeba butschlii, Hymenolepisnana e Ancilostomídeos (0,2%) e Ascaris lumbricoides e Schistosoma mansoni (0,1%). Não houve diferença estatisticamente significativa com relação ao sexo. A faixa etária, a renda familiar, o grau de instrução da mãe, o consumo de água não tratada, a ausência de esgoto e o hábito da criança frequentar córregos apresentaram associação com a presença de enteroparasitas. Apesar da maior prevalência ser de protozoários comensais este dado é preocupante, pois indica que a transmissão fecal-oral está presente nesta população podendo ocorrer aumento na transmissão das formas patogênicas, já que estas possuem as mesmas vias de transmissão. Foram identificados casos de esquistossomose que não eram autóctones, porém o diagnóstico precoce desta infecção foi importante para se evitar a contaminação do meio ambiente.

The aim of this work was to determine factors associated with the prevalence of intestinal parasites in school children in the municipality of Cambé, Paraná. A total of 1996 stool samples were collected between 2006 and 2009, using the methods of Hoffman, Pons and Janer, Faust and collaborators and the Kato-Katz. The prevalence was 23.2%. The parasites found were Entamoeba coli (10.4%); Endolimax nana (9.6%), Giardia lamblia (6.4%), Enterobius vermicularis (1.5%), Entamoeba histolytica/dispar(0.3%), Trichuris trichiura (0.4%), Iodamoeba butschlii, Hymenolepis nana and hookworm infection(0.2%) and Ascaris lumbricoides and Schistosoma mansoni (0.1%). We found no statistically significant gender differences. The age, family income, mother’s education level, consumption of untreated water, absence of sewage collection and contact with freshwater streams were associated with the presenceof intestinal parasites. Although the highest prevalence of protozoa is commensal this is worrying as it indicates that the fecal-oral transmission is present in this population and may increase the transmission of pathogenic forms, since they share the same transmission routes. The identified cases of schistosomiasiswere not autochthonous, but early diagnosis of this infection was important to avoid contamination of the environment.

First record of Borrelia burgdorferi B31 strain in Dermacentor nitens ticks in the northern region of Parana (Brazil)

The aim of this study was to investigate the presence of DNA of Borrelia burgdorferi sensu lato (s.l.) in ticks that feed on horses used for animal traction in rural Jataizinho, Parana, Brazil. Between February and June 2008, a total of 224 ticks was collected of which 75% were identified as Dermacentor nitens and 25% as Amblyomma cajenense. To amplify B. burgdorferi s.l. DNA, the intergenic space region (ISR) between the 5S (rrf) 23S (rrl) rRNA genes was used as targets for nested-PCR. Two ticks of the D. nitens species were positive for B. burgdorferi s.l. Both species showed a fragment of 184 bp, but the sequencing revealed 99.9% homology with the B. burgdorferi sensu stricto (s.s.) strain B31. These results showed, for the first time, the presence of spirochete DNA infecting ticks that parasitize horses used for animal traction, in the rural municipality mentioned. In conclusion, this study opens up promising prospects for determining the infection rate of B. burgdorferi s.s. genospecies or other species in the equine population, as well as the impact of the infection rate on Lyme disease in the state of Parana.

Gestational toxoplasmosis in Paraná State, Brazil: prevalence of IgG antibodies and associated risk factors

The aim of the present study was to verify the association between seropositivity for IgG anti-Toxoplasma gondii antibodies and social, economic and environmental variables of pregnant women attending the public health centers of Paraná, Brazil. From January 2007 to July 2010, 2226 pregnant women were interviewed and detection of anti-T. gondii specific IgG and IgM antibodies was performed by chemiluminescence test. Seropositivity for anti-T. gondii IgG was observed in 1151 (51.7%) pregnant women, 29 of which (1.3%) presented IgM reagent with IgG of high avidity. The variables associated with the presence of IgG were residency in the rural area, more than one pregnancy, less than or equal to eight years schooling, low per capita income, age group, raw or poorly cooked meat ingestion, and contact with the soil. There was neither association with raw fruit and vegetable ingestion nor with the presence of cats in the residencies.

Toxoplasmosis, leptospirosis and brucellosis in stray dogs housed at the shelter in Umuarama municipality, Paraná, Brazil

Background : Leptospirosis, toxoplasmosis and brucellosis are diseases with worldwide distribution. Among stray dogs, these zoonoses are facilitated by direct contact with other animal species, by the habit of scavenging garbage and hunting in search of food, drinking standing water, smelling other animals' urine, licking female genitalia and the sexual act itself. The objective of this study was to detect antibodies anti-Toxoplasma gondii, anti-Leptospira spp., anti-Brucella canis and anti-Brucella abortus in stray dogs housed in shelters at Umuarama city, Paraná, Brazil. In order to detect toxoplasmosis, indirect immunofluorescence assay (IFA) was performed, agglutination microscopic (MAT) test for leptospirosis and agar gel immunodiffusion (AGID) and buffered acidified antigen (BAA) tests for brucellosis. Results : Of the 175 serum samples analyzed, 70.85% were considered positive for toxoplasmosis by IFA, 20% by MAT for leptospirosis and 2.85% by AGID for Brucella canis. Conclusions : The serological results of this study showed that stray dogs housed at the private shelter are potential carriers of these three different zoonoses and contribute to the spread and maintenance of these etiologic agents in the urban area of Umuarama (PR), Brazil.(AU)

Toxoplasmosis, leptospirosis and brucellosis in stray dogs housed at the shelter in Umuarama municipality, Paraná, Brazil

Background : Leptospirosis, toxoplasmosis and brucellosis are diseases with worldwide distribution. Among stray dogs, these zoonoses are facilitated by direct contact with other animal species, by the habit of scavenging garbage and hunting in search of food, drinking standing water, smelling other animals' urine, licking female genitalia and the sexual act itself. The objective of this study was to detect antibodies anti-Toxoplasma gondii, anti-Leptospira spp., anti-Brucella canis and anti-Brucella abortus in stray dogs housed in shelters at Umuarama city, Paraná, Brazil. In order to detect toxoplasmosis, indirect immunofluorescence assay (IFA) was performed, agglutination microscopic (MAT) test for leptospirosis and agar gel immunodiffusion (AGID) and buffered acidified antigen (BAA) tests for brucellosis. Results : Of the 175 serum samples analyzed, 70.85% were considered positive for toxoplasmosis by IFA, 20% by MAT for leptospirosis and 2.85% by AGID for Brucella canis. Conclusions : The serological results of this study showed that stray dogs housed at the private shelter are potential carriers of these three different zoonoses and contribute to the spread and maintenance of these etiologic agents in the urban area of Umuarama (PR), Brazil.

Zoonoses in humans from small rural properties in Jataizinho, Parana, Brazil

The aim of this study was to conduct a serological survey for Lyme diseases, brucellosis, leptospirosis and toxoplasmosis and identify the risk variables related to these zoonoses in humans living in the rural area of Jataizinho, state of Parana, Brazil. A total of 63 rural properties were surveyed. Additionally, 207 serum samples collected from these rural area inhabitants were tested for indirect immunofluorescence (IFI) and western blots (WB) were performed to detect Borrelia burgdorferi (sensu lato); a tamponated acidified antigen test (AAT) and 2-mercaptoethanol (2-ME) were used to detect antibodies of Brucella abortus; the microscopic agglutination test (MAT) was carried out to detect antibodies anti-Leptospira spp. and IFI was used to find antibodies of Toxoplasma gondii. Two of the samples (0.96%) were reactive for Lyme borreliosis, three (1.4%) for brucellosis, 25 (12.1%) for leptospirosis and 143 (69.1%) for toxoplasmosis. Although the town of Jataizinho has a human development index (IDH) that was considered to be average (0.733) in the state of Parana, the low social, economic and cultural conditions of the population from small rural properties have resulted in lack of basic information on animal health and direct or indirect contact with the various species of domestic animals, wildlife and ticks have probably contributed to the prevalence levels found. These results show the need for additional regional studies in order to determine the epidemiological characteristics of these diseases as well as their respective vectors and reservoirs so that effective prophylaxis can be administered in the human population.

Leishmaniose tegumentar americana em cão errante da região noroeste do estado do Paraná - relato de caso / Cutaneous leishmaniasis in a stray dog in the northwestern region of the state of Paraná - a case report / Leishmaniose tegumentaria americana en perros callejeros de la región noroeste del estado de Paraná - relato de caso

A Leishmaniose Tegumentar (LT) é uma doença parasitária cosmopolita provocada por um protozoário pertencente à Ordem Kinetoplastida, família Trypanossomatidea e Gênero Leishmania e é transmitida por insetos dípteros hematófagos pertencentes à subfamília Phlebotominae. Nos cães a forma tegumentar se manifesta com lesões mucocutâneas, formação de úlceras de fundo granulomatoso e bordas salientes de difícil cicatrização. O objetivo deste trabalho foi relatar a presença de anticorpos anti-Leishmania spp. em um cão errante com sintomatologia clínica sugestiva para LTA na região noroeste do estado do Paraná. O resultado positivo no exame sorológico encontrado no presente trabalho sugere que houve a circulação do agente etiológico e, consequentemente, a exposição deste animal ao parasito, porém novos estudos com cães errantes e domiciliados com ou sem sintomatologia característica para LTA devem ser realizados para esclarecer melhor a participação do cão na epidemiologia da LTA no município local.

Cutaneous Leishmaniasis (CL) is a cosmopolitan parasitic disease caused by a protozoan belonging to the Kinetoplastida order, Trypanossomatidea family and Leishmania genus, and is transmitted by blood-sucking flies belonging to the Phlebotominae subfamily. In dogs, the cutaneous form manifests with mucocutaneous lesions, granulomatous bottom ulcers and difficult to heal flanges. This study aimed to report the presence of anti-Leishmania spp. in a stray dog with clinical symptoms suggesting LTA in the northwestern region of the state of Paraná. The positive serology found in the present study suggests that there was a movement of the etiological agent and, therefore, this animal’s exposure to the parasite, but further studies with stray and and domestic dogs with or without characteristic symptoms of LTA should be done to understand the role of a dog in the leishmaniasis epidemiology in the local municipality.

La Leishmaniosis Tegumentaria (LT) es una enfermedad parasitaria cosmopolita provocada por un protozoario perteneciente al Orden Kinetoplastida, familia Trypanosomatidae, Género Leishmania y es transmitida por insectos dípteros hematófagos pertenecientes a la subfamilia Phlebotominae. En perros, la forma tegumentaria se manifiesta con lesiones mucocutáneas, formación de úlceras de fondo granulo matoso y bordas salientes de difícil cicatrización. El objetivo de esta investigación fue relatar la presencia de anticuerpos anti-Leishmania spp. en un perro callejero con sintomatología clínica sugestiva para LTA en la región noroeste del estado de Paraná. El resultado positivo encontrado en el examen serológico, en la investigación, sugiere que hubo circulación del agente etiológico y, consecuentemente, la exposición de este animal al parasito, pero nuevos estudios con perros callejeros y domiciliados con o sin sintomatología característica para LTA deben ser realizados, para aclarar mejor la participación del perro en la epidemiología de LTA en el municipio local.

Soroepidemiologia da toxoplasmose em gestantes a partir da implantação do Programa de Vigilância da Toxoplasmose Adquirida e Congênita em municípios da região oeste do Paraná / Seroepidemiology of toxoplasmosis in pregnant women since the implementation of the Surveillance Program of Toxoplasmosis Acquired in Pregnancy and Congenital in the western region of Paraná, Brazil

OBJETIVO: Avaliar a suscetibilidade das gestantes à toxoplasmose em serviço público de saúde de dois municípios da região oeste do Paraná. MÉTODOS: Foram avaliadas 422 gestantes por meio da pesquisa sorológica de anticorpos IgG e IgM anti-Toxoplasma gondii (ELISA e MEIA). As soronegativas repetiram a sorologia no segundo e terceiro trimestre de gestação. Em um dos municípios, também foi realizada a triagem neonatal em 27 recém-nascidos para detecção de IgM anti-Toxoplasma gondii pelo teste de fluorometria. Todas as gestantes responderam a um questionário epidemiológico, para análise dos fatores associados ao risco da infecção pelo Toxoplasma gondii. Para análise estatística, foram consideradas a variável dependente da presença de IgG anti-Toxoplasma gondii e as variáveis independentes contidas no questionário epidemiológico. RESULTADOS: A prevalência de anticorpos IgG anti-Toxoplasma gondii nas gestantes foi de 59,8 e 60,6 por cento. Em um dos municípios, as variáveis associadas à presença de anticorpos IgG foram baixo nível de escolaridade e mais de uma gestação. Não houve associação com os outros fatores investigados, como a ingestão de carnes cruas ou mal cozidas, vegetais crus, salames coloniais, manipulação de terra ou areia, horta em casa e gatos em casa. No outro município, não foi observada associação estatística com nenhuma das variáveis estudadas. Não foi confirmado nenhum caso de infecção aguda nem de soroconversão em ambos os municípios. Nenhuns dos recém-nascidos avaliados apresentou positividade para toxoplasmose. CONCLUSÃO: A toxoplasmose é comum nas gestantes atendidas pelo serviço público de saúde da região estudada e há 40 por cento delas suscetíveis à infecção. Esse dado reforça a necessidade de manter o programa implantado nesses municípios.

PURPOSE: To evaluate the susceptibility to toxoplasmosis in pregnant women in the public health service from two cities in the western region of Paraná, Brazil. METHODS: Four thousand twenty-two pregnant women were evaluated for anti-Toxoplasma gondii IgG and IgM by ELISA and MEIA. Seronegative pregnant women repeated the serology in the second and third trimester of pregnancy. Neonatal screening of 27 newborns was also performed in one of the cities to detect IgM anti- Toxoplasma gondii by fluorometry. All pregnant women answered an epidemiological questionnaire to analyze the factors associated with the risk of infection by Toxoplasma gondii. For statistical analysis, the presence of IgG anti-Toxoplasma gondii was considered as the dependent variable and the variables contained in the epidemiological questionnaire as the independent ones. RESULTS: The prevalence of anti-Toxoplasma gondii IgG in pregnant women was 59.8 and 60.6 percent. In one of the cities, the variables associated with the presence of IgG antibodies were low educational level and more than one pregnancy. There was no association with other factors studied such as consumption of raw or undercooked meat, consumption of raw vegetables, consumption of colonial salami, handling soil or sand, the presence of a home vegetable garden and cats in the household. In the other city there was no statistical association with the variables studied. No case of acute infection and no seroconversion were confirmed in either city. None of the infants evaluated were positive for toxoplasmosis. CONCLUSION: Toxoplasmosis is common in pregnant women attended by the public health service in the region studied and 40 percent of them are susceptible to the infection. These data reinforce the need to keep the screening program in these cities.

Programas de controle da toxoplasmose congênita / Programs for control of congenital toxoplasmosis

A toxoplasmose congênita pode causar aborto e danos neurológicos e/ou oculares ao feto. Desde que a Áustria e a França estabeleceram a triagem pré-natal, a prevalência da toxoplasmose caiu de 50 por cento para 35 por cento e de 84 por cento para 44 por cento, respectivamente. Outros países, como o Reino Unido, adotam práticas educativas para reduzir o risco de infecção em gestantes soronegativas. No Brasil, a triagem pré-natal é realizada nos estados do Mato Grosso do Sul e Minas Gerais e nas cidades de Curitiba e Porto Alegre. Em Londrina, Paraná, foi implantado o "Programa de Vigilância da Toxoplasmose Adquirida na Gestação e Congênita", que se baseia na triagem sorológica, com orientação sobre as medidas de prevenção e monitoramento sorológico trimestral nas gestantes inicialmente soronegativas, além do acompanhamento das gestantes e crianças com infecção aguda e notificação dos casos. Nos primeiros quatro anos da implantação, a avaliação do programa demonstrou uma redução de 63 por cento no número de gestantes e de 42 por cento no número de crianças encaminhadas aos serviços de referência, resultando na liberação de vagas para o atendimento de pacientes com outras doenças. Quanto aos medicamentos, houve redução de 62 por cento no consumo de ácido folínico e de 67 por cento de sulfadiazina. Além disso, a definição dos protocolos resultou na padronização do atendimento e segurança para a tomada de decisões por parte dos médicos. Portanto, como existem diversos protocolos individualizados nos diversos serviços e regiões, o estabelecimento de uma conduta ideal e consensual, com respaldo técnico, implicará na adoção de medidas que, certamente, ocasionarão economia aos cofres públicos, com a diminuição da toxoplasmose congênita.

Congenital toxoplasmosis can cause miscarriage and neurological and/or eye damage to the fetus. Since Austria and France established the prenatal screening, the prevalence of toxoplasmosis has declined from 50 percent to 35 percent and 84 percent to 44 percent, respectively. Other countries, such as the United Kingdom, have educational practices to reduce the risk of infection in seronegative pregnant women. In Brazil, prenatal screening is carried out in the states of Mato Grosso do Sul and Minas Gerais and the cities of Curitiba and Porto Alegre. In Londrina, state of Parana, the "Health Surveillance Program for Toxoplasmosis Acquired during Pregnancy and Congenital Toxoplasmosis" was established, which is based on serological screening, advising on prevention measures and quarterly serological monitoring in pregnant women that are initially seronegative, in addition to the monitoring of pregnant women and children with acute infection and case notification. In the first four years of implementation, the program evaluation showed a 63 percent reduction in the number of pregnant women and 42 percent in the number of children referred to reference services, resulting in the opening of vacancies for the care of patients with other diseases. As for medications, there was a 62 percent reduction in consumption of folic acid and 67 percent of sulfadiazine. Moreover, the definition of the protocols resulted in the standardization of care and safety for the decision-making by physicians. Therefore, as there are several protocols individualized in various departments and regions, the establishment of an ideal, consensual conduct with technical support, will result in implementing measures that will certainly save public resources, with the decrease in congenital toxoplasmosis.

Soroprevalência da Leishmaniose Tegumentar Americana (LTA) canina e fauna de Flebotomíneos (Diptera: Psychodidae) em Bela Vista do Paraíso, Paraná / Seroprevalence of Cutaneous Leishmaniasis (LC) in dogs and identification of vectors (Diptera: Psychodidae) in Bela Vista do Paraíso, Parana state

O trabalho teve como objetivo determinar a soroprevalência da Leishmaniose Tegumentar Americana (LTA) canina no município de Bela Vista do Paraíso, Paraná, comparar as técnicas de imunofluorescência indireta (IFI) e ensaio imunoenzimático (ELISA) e identificar as espécies de flebotomíneos presentes, possivelmente envolvidas no ciclo do parasito. Amostras de sangue de 489 cães foram submetidas à pesquisa de anticorpos anti-Leishmania sp. pela IFI e ELISA. Foram consideradas positivas as amostras que apresentaram título ≥ 40 na IFI e densidade ótica ≥ 0.174 no ELISA. Entre as amostras analisadas, 222 (45,4%) foram reagentes pela IFI e 189 (38,7%) pelo ELISA. Comparando-se os testes foram encontradas 176 amostras positivas (36,0%) e 254 negativas (51,9%) para ambas as técnicas. A sensibilidade do ELISA foi de 79,3% e a especificidade foi de 95,1%. O coeficiente global do teste foi de 87,0% com coeficiente Kappa de 0,75. A análise das variáveis para cães com sorologia positiva pela IFI demonstrou diferença significativa em relação à ausência de matas e ausência de convívio com outras espécies animais. Em cães sororeagentes pelo ELISA as variáveis que apresentaram diferença significativa foram o tipo de mata ciliar existente no ambiente, a ausência de lixo, o esgoto a céu aberto e lançado diretamente em rios ou córregos e do lixo lançado em terreno baldio, queimado ou enterrado. O resultado obtido com a captura dos flebotomíneos foi a predominância do Lutzomyia whitmani com 79,9% das espécies coletadas. Os resultados demonstraram que a LTA está amplamente disseminada na população canina do município de Bela Vista do Paraíso, e que tanto a IFI como o ELISA podem ser utilizados para o diagnóstico. Deste modo o cão apresenta-se como um elo entre o ciclo silvestre e o peridomiciliar da LTA, podendo tornar-se um sinalizador do agente no ecossistema da doença nesse ecossistema.

The aim of this study was to determine the seroprevalence of Cutaneous Leishmaniasis (CL) in dogs of Bela Vista do Paraiso, Parana state, compare the IFA and ELISA techniques and identify the vectors possibly involved in the cycle of the parasite. Were collected blood samples from 489 dogs that were subjected to detection of anti-Leishmania sp. by IFA and by ELISA. Were considered positive samples ≥40 titers in IFA and for ELISA ≥ 0.174 optical density. Among the samples analyzed, 222 (45.4%) were positive by IFA and 189 (38.7%) by ELISA. Comparing the tests were found 176 positive samples (36.0%) and 254 negative (51.9%) for both techniques. The sensitivity of ELISA was 79.3% and specificity was 95.1%. The global coefficient of the test was 87.0% with kappa coefficient of 0.75. Analysis of variables for dogs with positive serology by IFA showed significant differences regarding the absence of forests and lack of contact with other animal species. Positive sera by ELISA in dogs variables that showed significant differences were the type of riparian vegetation existing in the environment, the lack of garbage, open sewers and released directly into rivers or streams and garbage thrown on wasteland, burned or buried. The result obtained with the capture of sandflies was the predominance of Lutzomyia whitmani with 79.9% of the species collected. The result obtained with the capture of sandflies was the predominance of Lutzomyia whitmani with 79.9% of the species collected. The results showed that the LTA is widespread in the canine population of Bela Vista do Paraiso, and both the IFI and ELISA can be used for diagnosis. So the dog appears as a link between wild and peridomestic cycle of CL may become an amplifier of disease in this ecosystem.

Factors associated to infection by Toxoplasma gondii in pregnant women attended in Basic Health Units in the city of Rolândia, Paraná, Brazil / Fatores associados à infecção por Toxoplasma gondii em gestantes atendidas nas Unidades Básicas de Saúde do município de Rolândia, Paraná, Brasil

The aim of the present work was to determine the prevalence of IgG and IgM anti-Toxoplasma gondii antibodies and the factors associated to the infection in pregnant women attended in Basic Health Units in Rolândia, Paraná, Brazil. The sample was divided in two groups: group I (320 pregnant women who were analyzed from July 2007 to February 2008) and group II (287 pregnant women who were analyzed from March to October 2008). In group I, it was found 53.1 percent of pregnant women with IgG reactive and IgM non-reactive, 1.9 percent with IgG and IgM reactive, 0.3 percent with IgG non-reactive and IgM reactive and 44.7 percent with IgG and IgM non-reactive. In group II, it was found 55.1 percent with IgG reactive and IgM non-reactive and 44.9 percent with IgG and IgM non-reactive. The variables associated to the presence of IgG antibodies were: residence in rural areas, pregnant women between 35-40 years old, low educational level, low family income, more than one pregnancy, drinking water which does not originate from the public water supply system and the habit of handling soil or sand. Guidance on primary prevention measures and the quarterly serological monitoring of the pregnant women in the risk group are important measures to prevent congenital toxoplasmosis.

O objetivo deste trabalho foi determinar a prevalência de anticorpos IgG e IgM anti-Toxoplasma gondii e os fatores associados à infecção em gestantes atendidas nas Unidades Básicas de Saúde de Rolândia, Paraná, Brasil. A amostra foi dividida em dois grupos: grupo I (320 gestantes, analisadas entre julho de 2007 e fevereiro de 2008) e grupo II (287 gestantes, analisadas de março a outubro de 2008). No grupo I, foram encontrados 53,1 por cento de gestantes IgG reagente e IgM não reagente, 1,9 por cento de IgG e IgM reagentes, 0,3 por cento de IgG não reagente e IgM reagente e 44,7 por cento de IgG e IgM não reagentes. No grupo II foram 55,1 por cento de IgG reagente e IgM não reagente e 44,9 por cento de IgG e IgM não reagentes. As variáveis associadas à infecção foram: residência em área rural, gestantes entre 35-40 anos de idade, baixa escolaridade, baixa renda familiar, mais de uma gravidez, consumo de água não proveniente do sistema de abastecimento público de água e hábito de manipular terra ou areia. As orientações sobre medidas de prevenção primária e o acompanhamento sorológico trimestral das gestantes no grupo de risco são medidas importantes para prevenir a toxoplasmose congênita.