Seroprevalencia de Toxoplasma gondii y su relación con trastornos mentales en adultos / Seroprevalence of Toxoplasma gondii and its Relationship with Mental Disorders in the Adult Population

El Toxoplasma gondii es un parásito que se encuentra, aproximadamente, en el 30 % de la población humana. Durante los últimos años se ha evidenciado que la infección latente puede ser un factor de riesgo para el desarrollo de trastornos mentales; particularmente para la esquizofrenia, ansiedad, trastornos bipolares y trastornos de conducta. La asociación con los trastornos neuropsiquiátricos pueden explicarse por la influencia que tiene el parásito sobre la expresión de múltiples neurotransmisores; entre ellos la dopamina. Se realizó una búsqueda en las bases de datos PubMed y SciELO de 2015 a 2023, se seleccionaron artículos originales y de revisión de revistas científicas internacionales, en idiomas inglés y español con el objetivo de describir la relación entre la seroprevalencia de T. gondii y el desarrollo de trastornos mentales en población adulta. Existe relación entre los trastornos mentales en la población adulta con la infección por Toxoplasma gondii y este aumenta la posibilidad de desarrollar esquizofrenia y depresión en individuos sin historial previo, y que podría exacerbar cuadros psiquiátricos previos con dificultad en el tratamiento. Sin embargo, no todos los datos estadísticos establecen una relación directa, algunos estudios demuestran una asociación, ciertos datos son discordantes, lo que abre una puerta para futuras investigaciones.

Toxoplasma gondii is a parasite that is found in approximately 30 % of the human population. In recent years, it has been shown that latent infection can be a risk factor for the development of mental disorders; particularly schizophrenia, anxiety, bipolar disorders, and conduct disorders. The association with neuropsychiatric disorders can be explained by the influence of the parasite on the expression of multiple neurotransmitters; among them, dopamine has received the most attention. A narrative bibliographic review article was done with the search of original and review articles in international scientific journals, in English and Spanish listing the relationship between the seroprevalence of T. gondii and the development of mental disorders in the adult population. The relationship between mental disorders in the adult population with Toxoplasma gondii infection is present and increases the possibility of developing schizophrenia and depression in individuals with no previous history, including the ability to worsen previous psychiatric conditions, making it difficult for standard management. Not all statistical data establish a direct relationship, some studies show an association and certain data are discordant, which opens a door for future research.

Perceptions and feelings of pregnant women undergoing outpatient follow-up for toxoplasmosis

Introduction: Toxoplasmosis persists as a neglected disease and poses a challenge to public health, especially due to the risk of vertical transmission, which can lead to countless biological complications for the newborn and to psychological and emotional repercussions for the mother. Objective: To understand the perceptions and feelings of pregnant women affected by toxoplasmosis undergoing outpatient follow-up. Materials and Methods: A qualitative and exploratory study developed with 12 women with gestational toxoplasmosis undergoing specialized outpatient follow-up in a municipality from the state of Paraná, Brazil. The data were collected through semi-structured individual interviews and subjected to content analysis, supported by descending hierarchical classification. Results: The pregnant women experienced situations ranging from diagnosis and treatment to preventing the disease in the child and family. These experiences generated fear, distress and uncertainty about the disease, which were not adequately addressed during prenatal assistance in primary care. However, the pregnant women emphasized the importance of the multiprofessional team at the secondary level in monitoring and health education. Discussion: Although the pregnant women felt confident about the treatment and its implications for the child's health, discovering the diagnosis impacted their everyday lives and those of their families, especially due to lack of reliable information about toxoplasmosis and to the absence of emotional support at the primary level. Conclusions: There was a temporary scenario of disinformation among these women, who were not properly guided and supported. However, the guidelines offered in secondary health care were essential for improving knowledge and practices in health.

Catarata congênita nas infecções intrauterinas mais comuns (STORCH): revisão de literatura / Congenital cataract in the most common intrauterine infections (STORCH): a review of the literature

RESUMO Objetivo: O objetivo deste estudo foi revisar os aspectos clínicos e patológicos da catarata congênita secundária às infecções por sífilis, toxoplasmose, rubéola, citomegalovírus e herpes simples. Métodos: Trata-se de uma revisão de literatura, na qual foram incluídos artigos de periódicos indexados às bases de dados PubMed®, Cochrane, Lilacs, Embase e SciELO de 2010 a 2023. Resultados: Foram encontrados 45 artigos, e, após seleção, restaram 9 artigos. Além disso, foram adicionados artigos para enriquecer a discussão. A infecção por sífilis está relacionada a alterações corneanas. O citomegalovírus e a toxoplasmose estão relacionados com a coriorretinite e/ou microftalmia. A rubéola é responsável por causar catarata, glaucoma, microftalmia e retinite em sal e pimenta. Conclusão: Foram abordadas as principais etiologias infecciosas e seu quadro clínico na CC. O melhor tratamento para CC é cirúrgico associado a acompanhamento clínico, mas a prevenção é a maneira mais eficaz de combater a CC de etiologia infecciosa. O diagnóstico precoce e o tratamento efetivo previnem alterações e sequelas visuais irreversíveis. Nesse contexto, mostram-se importantes as ações de políticas públicas para o melhor desfecho clínico e melhor qualidade de vida.

ABSTRACT Objective: To review the clinical and pathological aspects of CC secondary to infections by syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes simplex. Methods: This is a literature review. Articles from journals indexed to PubMed, COCHRANE, LILACS, EMBASE and SCIELO from 2010 to 2023 were included. Results: A total of 45 articles were found, which, after selection, remained in 9 articles. Some articles were included to enrich the discussion in this topic. The infection caused by syphilis is related to corneal changes. Cytomegalovirus and Toxoplasmosis due to chorioretinitis and/or microphthalmia. Rubella is responsible for causing cataracts, glaucoma, microphthalmia, and salt and pepper retinitis. Conclusion: The main infectious etiologies and their clinical status in CC were addressed. The best treatment for CC is surgery associated with clinical follow-up, but prevention is the most effective way to combat CC of infectious etiology. Early diagnosis and effective treatment prevent irreversible visual changes and sequelae. In this context, public policy actions are important for the best clinical outcome and better quality of life.

Calcified cerebral toxoplasmosis associated with recurrent perilesional edema causing neurological manifestations in an HIV-infected individual: case report with a decade-long follow-up

ABSTRACT Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.

Toxoplasmosis outbreak in São Paulo, Brazil: Epidemiology and visual outcome

ABSTRACT Purpose: To describe a 2019 acute toxoplasmosis outbreak in the city of São Paulo, Brazil, and to evaluate the laboratory serological profile for toxoplasmosis for three consecutive years. The ophthalmological manifestations of the patients involved in the outbreak were also studied. Methods: A cross-sectional descriptive study of a toxoplasmosis outbreak in São Paulo, Brazil, between February and May 2019. Epidemiological data were described, as were the observed ocular manifestations. As part of this study the number of patients with positive IgM toxoplasmosis serology was obtained from a large laboratory network (DASA) for three consecutive years, including the year of the outbreak (2018, 2019, 2020). Results: Eighty-three individuals were identified in the outbreak and two clusters were studied. The clinical picture of at least 77% of the patients, the epidemiological analysis, and the short incubation period (5-8 days) suggested contamination by oocysts. Serological laboratory data analysis revealed an increase of positive toxoplasmosis IgM in 2019 of 73% compared to the previous year. Ophthalmological examination revealed that at least 4.8% of the patients developed toxoplasmic retinochoroiditis, none of whom had been treated during the acute systemic disease. Conclusion: Our findings indicate vegetable contamination as the possible source of this outbreak, a high prevalence of toxoplasmosis in São Paulo during the outbreak period, and a drop in the number of tests during the COVID-19 pandemic. Retinochoroiditis was observed in at least 4.8% of the cases. We confirm the need to implement effective means for the prevention, diagnosis, and treatment of the disease. This may involve raising awareness among the population of the importance of vegetable hygiene, and improved quality control of food and water.

Prevalencia de baja avidez de Inmunoglobulina G anti Toxoplasma gondii y comportamiento de riesgo para toxoplasmosis en embarazada / Prevalence of low avidity of anti-Toxoplasma gondii immunoglobulin G and risk behavior for toxoplasmosis in pregnant women

Introducción: la toxoplasmosis es una infección zoonótica producida por Toxoplasma gondii, protozoo intracelular que puede afectar al hijo de la mujer embarazada y causar severas secuelas por lo que el monitoreo serológico debe ser realizado. Objetivo: determinar la prevalencia de baja avidez IgG anti Toxoplasma gondii y el comportamiento de riesgo para la enfermedad de toxoplasmosis en mujeres que estuvieron embarazadas durante el período 2017-2019 que acudieron al Instituto de Investigaciones en Ciencias de la Salud de la Universidad Nacional de Asunción-Paraguay. Metodología: fueron analizadas 371 fichas de pacientes con serología IgG positiva para toxoplasmosis cuyas muestras fueron procesadas en el Departamento de Producción del Instituto de Investigaciones en Ciencias de la Salud entre los años 2017-2019. Posteriormente, en el año 2020, se realizó 149/371 encuestas digitales de en estas mismas mujeres sobre conocimiento y comportamiento de riesgos para Toxoplasmosis. Resultados: se observó una prevalencia de 18 % de baja avidez para toxoplasmosis. A partir de la encuesta se encontró el 98 % conoce la enfermedad, el 73 % adquirió información durante el embarazo y el 50,3 % recibió orientación de prevención, además, el 65 % refirió como formas de transmisión comer carnes mal cocidas y verduras crudas. En cuanto al comportamiento de riesgo 46 % consume de aguatería, 20 % consume carne a punto medio y 78 % vegetales crudos. El 54 % realiza actividad de cultivo, tienen mascotas como gatos 4,3 %, perros 82 %, además el 9 % refirió dormir con sus mascotas. Conclusión: la prevalencia de baja Avidez en la población estudiada fue del 18 %. Se evidenció algunos comportamientos de riesgo para la toxoplasmosis en las mujeres encuestadas, por lo que se demuestra la necesidad de aplicar programas de prevención primaria en nuestro país.

Introduction: toxoplasmosis is a zoonotic infection caused by Toxoplasma gondii, an intracellular protozoan that can affect children of pregnant women and cause severe sequelae; therefore, serological monitoring should be performed. Objective: to determine the prevalence of low avidity IgG anti-Toxoplasma gondii and the risk behavior for toxoplasmosis disease in pregnant women during the 2017-2019 time period, who attended the Health Sciences Research Institute of the Universidad Nacional de Asuncion - Paraguay. Methodology: a total of 371 patient records with positive IgG serology for toxoplasmosis, whose samples were processed in the Production Department of the Instituto de Investigaciones en Ciencias de la Salud between the years 2017-2019 were analyzed. Subsequently, in 2020, 149/371 digital surveys of the same women were conducted on their knowledge and risk behavior for toxoplasmosis. Results: a low avidity prevalence of 18 % for toxoplasmosis was observed. 98 % knew about the disease, 73 % acquired information during pregnancy, and 50.3 % received preventive orientation. 65 % reported that eating undercooked meat and raw vegetables is a form of disease transmission. Regarding risk behavior, 46 % of the participants consumed poultry, 20 % consumed medium-rare-cooked meat, and 78 % consumed raw vegetables. Fifty-four percent of the patients performed farming activities, 44.3 % had cats as pets, 82 % had dogs, and 9 % slept with their pets. Conclusion: some risk behaviors for toxoplasmosis were evident in the women surveyed, demonstrating the need to implement primary prevention programs in our country.

Prevalencia de baja avidez de Inmunoglobulina G anti Toxoplasma gondii y comportamiento de riesgo para toxoplasmosis en embarazada

Introducción: la toxoplasmosis es una infección zoonótica producida por Toxoplasma gondii, protozoo intracelular que puede afectar al hijo de la mujer embarazada y causar severas secuelas por lo que el monitoreo serológico debe ser realizado. Objetivo: determinar la prevalencia de baja avidez IgG anti Toxoplasma gondii y el comportamiento de riesgo para la enfermedad de toxoplasmosis en mujeres que estuvieron embarazadas durante el período 2017-2019 que acudieron al Instituto de Investigaciones en Ciencias de la Salud de la Universidad Nacional de Asunción-Paraguay. Metodología: fueron analizadas 371 fichas de pacientes con serología IgG positiva para toxoplasmosis cuyas muestras fueron procesadas en el Departamento de Producción del Instituto de Investigaciones en Ciencias de la Salud entre los años 2017-2019. Posteriormente, en el año 2020, se realizó 149/371 encuestas digitales de en estas mismas mujeres sobre conocimiento y comportamiento de riesgos para Toxoplasmosis. Resultados: se observó una prevalencia de 18 % de baja avidez para toxoplasmosis. A partir de la encuesta se encontró el 98 % conoce la enfermedad, el 73 % adquirió información durante el embarazo y el 50,3 % recibió orientación de prevención, además, el 65 % refirió como formas de transmisión comer carnes mal cocidas y verduras crudas. En cuanto al comportamiento de riesgo 46 % consume de aguatería, 20 % consume carne a punto medio y 78 % vegetales crudos. El 54 % realiza actividad de cultivo, tienen mascotas como gatos 4,3 %, perros 82 %, además el 9 % refirió dormir con sus mascotas. Conclusión: la prevalencia de baja Avidez en la población estudiada fue del 18 %. Se evidenció algunos comportamientos de riesgo para la toxoplasmosis en las mujeres encuestadas, por lo que se demuestra la necesidad de aplicar programas de prevención primaria en nuestro país.

Introduction: toxoplasmosis is a zoonotic infection caused by Toxoplasma gondii, an intracellular protozoan that can affect children of pregnant women and cause severe sequelae; therefore, serological monitoring should be performed. Objective: to determine the prevalence of low avidity IgG anti-Toxoplasma gondii and the risk behavior for toxoplasmosis disease in pregnant women during the 2017-2019 time period, who attended the Health Sciences Research Institute of the Universidad Nacional de Asuncion - Paraguay. Methodology: a total of 371 patient records with positive IgG serology for toxoplasmosis, whose samples were processed in the Production Department of the Instituto de Investigaciones en Ciencias de la Salud between the years 2017-2019 were analyzed. Subsequently, in 2020, 149/371 digital surveys of the same women were conducted on their knowledge and risk behavior for toxoplasmosis. Results: a low avidity prevalence of 18 % for toxoplasmosis was observed. 98 % knew about the disease, 73 % acquired information during pregnancy, and 50.3 % received preventive orientation. 65 % reported that eating undercooked meat and raw vegetables is a form of disease transmission. Regarding risk behavior, 46 % of the participants consumed poultry, 20 % consumed medium-rare-cooked meat, and 78 % consumed raw vegetables. Fifty-four percent of the patients performed farming activities, 44.3 % had cats as pets, 82 % had dogs, and 9 % slept with their pets. Conclusion: some risk behaviors for toxoplasmosis were evident in the women surveyed, demonstrating the need to implement primary prevention programs in our country.

Prevalencia de toxoplasmosis en niños de entre uno y seis años de edad

Fundamento: la toxoplasmosis adquirida en niños durante los primeros años de vida es la consecuencia de la transmisión por vía oral de esta parasitosis. Objetivo: determinar la prevalencia de infección por Toxoplasma gondii en niños en los primeros años de vida y relacionarlos con variables epidemiológicas de infestación. Métodos: estudio descriptivo y transversal para examinar la presencia de anticuerpos IgG anti-Toxoplasma gondii en niños de uno a seis años de edad en el área rural del municipio Cueto durante el periodo 2020-2021. Se utilizó un muestreo probabilístico por cuotas y se recopilaron variables demográficas y epidemiológicas. Se obtuvo una muestra de 200 niños, a los que se les tomó suero a través de venopunción. Se utilizó la técnica de IFI para determinar la presencia de anticuerpos IgG anti-Toxoplasma gondii y se aplicó la prueba no paramétrica Chi-Cuadrado de Pearson para comprobar hipótesis de investigación. Resultados: la seropositividad a T. gondii fue de un 58 % en la muestra estudiada; se encontró relación entre la infestación y la convivencia con gatos domésticos y con la procedencia del agua. No se encontraron diferencias significativas en la prevalencia de T. gondii en relación con la edad, el sexo, nivel social, cultural y la higiene ambiental, consumo de carnes, frutas y hortalizas, convivencias con animales de corral. Conclusiones: se evidencia seroprevalencia a T. gondii en la población infantil de uno a seis años de edad y su relación con la procedencia del agua y la convivencia con gatos.

Foundation: acquired toxoplasmosis in children during the first years of life is the consequence of the oral transmission of this parasitosis. Objective: to determine the prevalence of Toxoplasma gondii infection in children in the first years of life and relate them to epidemiological variables of infestation. Methods: descriptive and cross-sectional study to examine the presence of IgG anti-Toxoplasma gondii antibodies in children from one to six years of age in the rural area of ​​the Cueto municipality during the period 2020-2021. Quota probabilistic sampling was used and demographic and epidemiological variables were collected. A sample of 200 children was obtained, from whom serum was taken through venipuncture. The IFI technique was used to determine the presence of IgG anti-Toxoplasma gondii antibodies and the Pearson Chi-Square non-parametric test was applied to verify research hypotheses. Results: seropositivity to T. gondii was 58% in the studied sample; A relationship was found between the infestation and the coexistence with domestic cats and with the origin of the water. No significant differences were found in the prevalence of T. gondii in relation to age, sex, social and cultural level, and environmental hygiene, consumption of meat, fruit, and vegetables, and living with farm animals. Conclusions: T. gondii seroprevalence is evidenced in the child population from one to six years of age and its relationship with the source of water and living with cats.

Insulinoma: reporte de un caso con resección quirúrgica exitosa

El insulinoma es un tumor endocrino del páncreas, el cual produce hiperinsulinismo y provoca disminución severa de la glucemia, con síntomas crónicos como desvanecimiento. Es más frecuente en varones y puede presentarse a cualquier edad, ya sea como neoplasias solitarias o múltiples, estas últimas conocidas por formar parte del grupo de neoplasias endocrinas múltiples tipo 1 (MEN 1). Los insulinomas son de rara presentación y requieren tratamiento quirúrgico resectivo; la resolución de los síntomas es el marcador de curación. En la presente publicación, se describe un caso de insulinoma en una mujer de 51 años, de presentación típica desde el punto de vista clínico, con síntomas y signos de hiperinsulinismo. Los exámenes de laboratorio indican un aumento de la secreción de insulina, mientras que las imágenes por resonancia magnética muestran características del insulinoma, donde se puede apreciar la tumoración pancreática. Este caso se trató mediante resección quirúrgica por medio de laparotomía exploratoria, utilizando la técnica de enucleación del tumor pancreático, la cual se describe al detalle en la publicación; no se presentaron complicaciones intraoperatorias ni posoperatorias, es decir, desde el punto de vista curativo, el resultado fue exitoso. Esta es la técnica quirúrgica que se emplea en el Hospital Nacional Arzobispo Loayza en Lima, Perú, ante casos como el descrito. Este tipo de neoplasia es muy poco común, por lo que se le debe considerar de alta sospecha y, en este caso, las imágenes fueron fundamentales para optar por la resección quirúrgica. En el hospital Arzobispo Loayza se han tratado otros casos de insulinoma mediante cirugía; asimismo, se ha presentado, al menos, un caso de nesidioblastosis, en donde no se pudo administrar un tratamiento adecuado al paciente.

Insulinoma is a pancreatic neuroendocrine tumor that produces hyperinsulinism and causes a severe lowering of blood glucose levels with chronic symptoms such as fainting. It is more common in males and can occur at any age, either as solitary or multiple neoplasms, the latter known to be part of the multiple endocrine neoplasia, type 1 (MEN 1) group. Insulinomas are rare and require resective surgery, with symptoms resolution being the marker of recovery. This article describes a case of insulinoma in a 51-year-old woman with a clinically typical presentation and signs and symptoms of hyperinsulinism. Laboratory tests revealed increased insulin secretion, while magnetic resonance imaging showed features of insulinoma, where the pancreatic tumor could be seen. This case was treated by surgical resection of the pancreatic tumor during an exploratory laparotomy, using the enucleation technique, which is described in detail herein. There were no intraoperative or postoperative complications, i.e., the result was successful in terms of health recovery. This surgical technique is used at Hospital Nacional Arzobispo Loayza in Lima, Peru, when facing cases such as the one described. This type of neoplasm is very uncommon, so it should be considered highly suspicious and, in this case, the images were essential for choosing the surgical resection. Other cases of insulinoma have been treated surgically at the Hospital; moreover at least one case of nesidioblastosis could not receive an adequate treatment.

Síndrome alterno mesencefálico: síndrome de Weber en dos pacientes varones VIH positivos con toxoplasmosis cerebral

En este reporte se describen dos casos de pacientes varones con VIH diagnosticados por serología, que no estaban recibiendo tratamiento. Ambos pacientes desarrollaron el síndrome alterno mesencefálico y la lesión estructural, causada por la infección del sistema nervioso central por toxoplasmosis cerebral, confirmada mediante una resonancia magnética cerebral. Esta condición se constató por serología en líquido cefalorraquídeo. El síndrome de Weber es un tipo de síndrome alterno mesencefálico poco frecuente y existe poca información de su clínica y evolución. Fue descrito por sir Herman David Weber en 1863, y se caracteriza por la lesión ipsilateral del fascículo del III par craneal, con presencia de hemiparesia contralateral debida a la lesión de la vía corticoespinal y corticobulbar del pedúnculo cerebral. Las causas que lo originan incluyen tanto procesos isquémicos o hemorrágicos, que lesionan el fascículo del III par craneal y pedúnculo cerebral, como neoplasias intraencefálicas, aneurismas, hematomas extradurales y procesos infecciosos que se comportan como procesos expansivos. Los pacientes evaluados presentaron clínica de ptosis palpebral, visión doble vertical, dificultad para bipedestación, hemiparesia, hiporreflexia, sensibilidad superficial y profunda disminuidas, equilibrio y coordinación alterados, III par parético, habla incoherente, desorientación en tiempo, espacio y persona de manera intermitente y asimetría facial. Para la toxoplasmosis se aplicó un tratamiento específico con trimetropim-sulfametoxasol, clindamicina y prednisona por vía oral, lo cual permitió una mejoría del cuadro clínico. En el presente caso clínico se presenta la secuencia de los hechos, manejo y breve revisión de la literatura para su consideración como diagnóstico y su relevancia en el paciente con VIH-toxoplasmosis del sistema nervioso central.

This report describes the case of two male HIV-positive patients who were not receiving treatment and whose diagnosis was confirmed by serology testing. Both patients developed midbrain stroke syndrome and the structural injury, which was caused by a central nervous system infection due to cerebral toxoplasmosis, was verified by brain magnetic resonance imaging. This condition was confirmed by cerebrospinal fluid serology testing. Weber's syndrome is a very rare type of midbrain stroke syndrome with little information available on its symptoms and evolution. It was first described by Sir Herman David Weber in 1863 and is characterized by ipsilateral injury of the third cranial nerve fascicle with contralateral hemiparesis due to injury of the corticospinal and corticobulbar tracts of the cerebral peduncle. Its causes range from ischemic or hemorrhagic processes, which damage the third cranial nerve fascicle and cerebral peduncle, to brain tumors, aneurysms, extradural hematomas and infectious diseases that behave like spreading processes. The assessed patients showed clinical signs and symptoms such as ptosis; vertical double vision; difficulty standing up; hemiparesis; hyporeflexia; decreased superficial and deep sensation; poor balance and coordination; third cranial nerve palsy; slurred speech; intermittent disorientation in time, place and person; and facial asymmetry. Oral trimethoprim-sulfamethoxazole, clindamycin and prednisone were administered as specific treatment for toxoplasmosis, which enabled the improvement of the clinical picture. This case report presents the sequence of events, treatment and a brief review of the literature to be considered in the diagnosis and determine its importance in patients with HIV-toxoplasmosis of the central nervous system.

Toxoplasmosis en el embarazo: Características epidemiológicas, clínicas y laboratoriales en un centro de referencia

La toxoplasmosis es una zoonosis causada por el protozoarioToxoplasma gondii (T. gondii), de gran impacto en la salud fetal cuando se adquiere durante el embarazo, debido al riesgo de transmisión vertical. Puede producir manifestaciones clínicas en los recién nacidos: coriorretinitis, hidrocefalia, calcificaciones y retardo psicomotor. La detección precoz y la instauración de una terapéutica adecuada son claves para evitar complicaciones asociadas a la transmisión materno fetal. Objetivo: Describir las características clínicas de gestantes con diagnóstico de toxoplasmosis y de los recién nacidos de éstas, durante los años 2018 al 2021 que acudieron al Servicio de Infectología del Instituto de Previsión Social (IPS). Materiales y métodos: Estudio observacional, descriptivo, de corte trasversal, utilizando un registro de datos de pacientes gestantes que acudieron al IPS durante los años 2018 al 2021. Resultados: Se incluyeron 62 gestantes; mediana de edad de 30 años, (21-44 años); 4 (6%) gestantes, realizaron su primera consulta en el primer trimestre, 39 (63%) en el segundo y 19 (31%) en el tercer trimestre. 9 (15%) pacientes fueron clasificadas como seroconversión, y 53 (85%) con sospecha de infección aguda. 55 pacientes fueron sometidas a amniocentesis; 26 (47%) tuvieron resultado de PCR detectable para Toxoplasma gondii en liquido amniótico, y 29 (53%) no detectable. Sólo 19 recién nacidos contaban con serologías para diagnóstico de toxoplasmosis congénita. Entre las complicaciones fetales se encontraron macrocefalia, e ictericia del RN.

Toxoplasmosis is a zoonosis caused by the protozoan Toxoplasma gondii (T. gondii), with a great impact on fetal health when acquired during pregnancy, due to the risk of vertical transmission. It can produce clinical manifestations in newborns: chorioretinitis, hydrocephalus, calcifications and psychomotor retardation. Early detection and the establishment of adequate therapy are key to avoiding complications associated with fetal-maternal transmission. Objective: To describe the clinical characteristics of pregnant women diagnosed with toxoplasmosis and their newborns, during the years 2018 to 2021 who attended the Infectious Diseases Service of the Social Welfare Institute (IPS). Materials and methods: Observational, descriptive, cross-sectional study, using a data registry of pregnant patients who attended the IPS during the years 2018 to 2021. Results: 62 pregnant women were included; median age 30 years, (21-44 years); 4 (6%) pregnant women had their first consultation in the first trimester, 39 (63%) in the second and 19 (31%) in the third trimester. 9 (15%) patients were classified as having seroconversion, and 53 (85%) with suspected acute infection. 55 patients underwent amniocentesis; 26 (47%) had detectable PCR results for Toxoplasma gondii in amniotic fluid, and 29 (53%) undetectable. Only 19 newborns had serology tests for the diagnosis of congenital toxoplasmosis. Among the fetal complications were macrocephaly, and newborn jaundice.

Características de las lesiones retinianas en pacientes con diagnóstico de Toxoplasmosis ocular que acuden a un centro de referencia en oftalmología en Paraguay

Introducción: La toxoplasmosis es una enfermedad parasitaria, en América Latina la prevalencia es relativamente alta, se sabe que la enfermedad no solo es la causa más frecuente de uveítis posterior, sino también la causa principal de la uveítis en sí misma. En Paraguay no se dispone de datos epidemiológicos publicados sobre la misma. Objetivo: Determinar las características de las lesiones retinianas en pacientes con diagnóstico de Toxoplasmosis ocular. Metodología: El presente estudio es observacional, descriptivo, de corte transversal, temporalmente retrospectivo, con muestreo no probabilístico de casos consecutivos. Se enfocó en pacientes con diagnóstico de Toxoplasmosis que acudieron al servicio de Oftalmología del Hospital de Clínicas, durante el periodo de junio de 2020 a febrero 2022. Resultados: Se observó un 54,3 % de mujeres, una media de 30,62 +/- 12,96 años y un 62,8 % de procedencia urbana. El 88,3 % de los casos fueron unilaterales, la mitad de episodios primarios, el 93,6 % casos agudos, y el 97,9 % tuvo un mecanismo de trasmisión adquirido. La mayoría se presentó como Panuveítis, las localizaciones más frecuentes de las lesiones retinocoroideas fueron el Polo posterior (extramacular) y la periferia. El principal abordaje terapéutico fue el tratamiento con Trimetoprim Sulfametoxazol y corticoides sistémicos, la duración del tratamiento fue de 6,51 +/- 1,52 semanas, y las principales complicaciones fueron la Vitritis residual y la Hipertensión ocular. Discusión: La toxoplasmosis ocular es una causa importante de morbilidad visual. Se hace fundamental la prevención de la infección por este parásito mediante medidas higiénico-sanitarias, así como el diagnóstico y tratamiento precoz de los pacientes infectados, de tal manera a disminuir las complicaciones asociadas a esta patología.

Introduction: Toxoplasmosis is a parasitic disease, in Latin America the prevalence is relatively high, it is known that the disease is not only the most frequent cause of posterior uveitis, but also the main cause of uveitis itself. In Paraguay there are no published epidemiological data on it. Objective: To determine the characteristics of retinal lesions in patients diagnosed with ocular Toxoplasmosis. Methods: This study is observational, descriptive, cross-sectional, temporally retrospective, with non-probabilistic sampling of consecutive cases. It focused on patients diagnosed with Toxoplasmosis who attended the Ophthalmology service of the Hospital de Clínicas, during the period from June 2020 to February 2022. Results: 54.3% of women were observed, an average of 30.62 +/ - 12.96 years old and 62.8% of urban origin. 88.3% of the cases were unilateral, half were primary episodes, 93.6% acute cases, and 97.9% had an acquired transmission mechanism. Most presented as panuveitis, the most frequent locations of retinochoroidal lesions were the posterior pole (extramacular) and the periphery. The main therapeutic approach was treatment with trimethoprim sulfamethoxazole and systemic corticosteroids, the duration of treatment was 6.51 +/- 1.52 weeks, and the main complications were residual vitritis and ocular hypertension. Discussion: Ocular toxoplasmosis is an important cause of visual morbidity. It is essential to prevent infection by this parasite through hygienic-sanitary measures, as well as early diagnosis and treatment of infected patients, in order to reduce the complications associated with this pathology.

Seroprevalence of Toxoplasmosis in Puerperal Women Treated at a Tertiary Referral Hospital / Soroprevalência de toxoplasmose em puérperas atendidas em um hospital terciário de referência

Abstract Objective To evaluate the seroprevalence of toxoplasmosis among puerperal women cared for at a tertiary university hospital and the level of understanding of these puerperal women about toxoplasmosis, vertical transmission, and its prophylaxis. Methods For this cross-sectional study, we evaluated 225 patients using presential interviews, prenatal documentation, and electronic medical records. Data were stored using Research Electronic Data Capture (REDCap) software. Prevalence rates were estimated by the presence of reactive IgG antibodies against Toxoplasma gondii. Data analysis was performed using the chi-square test and calculation of the odds ratio (OR). Seroreactivity to T. gondii and exposure variables (age, educational level, and parity) were analyzed using a confidence interval (95%CI) and a significance level of 5% (p < 0.05). Results The seropositivity rate for T. gondii was 40%. There was no association between seroprevalence and age. Primiparity was a protective factor against seropositivity and low education was a risk factor. Conclusion Knowledge of T. gondii infection and its transmission forms was significantly limited, presenting a risk for acute maternal toxoplasmosis and vertical transmission of this protozoan. Increasing the education level regarding the risk of toxoplasmosis during pregnancy could reduce the rates of infection and vertical transmission of this parasite.

Resumo Objetivo Avaliar a soroprevalência de toxoplasmose entre puérperas atendidas em um hospital universitário terciário e o nível de compreensão dessas puérperas sobre toxoplasmose, transmissão vertical e sua profilaxia. Métodos Para esse estudo transversal, foram avaliadas 225 pacientes utilizando entrevistas presenciais, documentação de pré-natal e prontuário eletrônico. Os dados foram armazenados usando o software Research Electronic Data Capture (REDCap). As taxas de prevalência foram estimadas pela presença de anticorpos IgG reativos contra o Toxoplasma gondii. A análise dos dados foi realizada por meio do teste do qui-quadrado e cálculo do odds ratio (OR). A sororreatividade ao T. gondii e as variáveis de exposição (idade, escolaridade e paridade) foram analisadas, utilizando-se intervalo de confiança (IC95%) e nível de significância de 5% (p < 0,05). Resultados A taxa de soropositividade para T. gondii foi de 40%. Não houve associação entre soroprevalência e idade. A primiparidade foi fator de proteção contra a soropositividade e a baixa escolaridade foi fator de risco. Conclusão O conhecimento da infecção por T. gondii e suas formas de transmissão foi significativamente limitado, apresentando risco para toxoplasmose materna aguda e transmissão vertical desse protozoário. Aumentar o nível de escolaridade quanto ao risco de toxoplasmose durante a gravidez pode reduzir as taxas de infecção e transmissão vertical desse parasita.

Cerebral toxoplasmosis with neurological co-infection in people living with AIDS/HIV: results of a prospective cohort in São Paulo, Brazil / Toxoplasmose cerebral com coinfecção neurológica em pessoas que vivem com HIV/AIDS: resultados de uma coorte prospectiva em São Paulo, Brasil

Abstract Background Concomitant neurological diseases in people living with HIV/AIDS (PLWHA) is a challenging subject that has been insufficiently evaluated by prospective clinical studies. The goal of the present study was to identify the clinical characteristics and outcomes of PLWHA with cerebral toxoplasmosis and neurological co-infections. Methods We conducted a prospective observational cohort study at a tertiary teaching center in São Paulo, Brazil, from January to July 2017. Hospitalized PLWHA aged ≥ 18 years with cerebral toxoplasmosis were consecutively enrolled. A standardized neurological examination was performed at admission and weekly until discharge or death. Diagnosis and treatment followed institutional routines; neuroradiology, molecular diagnosis, neurosurgery, and the intensive care unit (ICU) were available. The main outcomes were neurological coinfections and in-hospital death. Results We included 44 (4.3%) cases among 1,032 hospitalized patients. The median age was 44 (interquartile range [IQR]: 35-50) years, and 50% (n = 22) of the patients were male. The median CD4+ T lymphocyte count was of 50 (IQR: 15-94) cells/mm3. Multiple lesions on computed tomography were present in 59% of the cases. Neurological coinfections were diagnosed in 20% (n = 9) of the cases, and cytomegalovirus was the most common etiology (encephalitis: n = 3; polyradiculopathy: n = 2). Longer hospital stays (30 versus 62 days; p= 0.021) and a higher rate of ICU admissions (14% versus 44%; p= 0.045) were observed among PLWHA with neurological coinfections in comparison to those without them. The rate of in-hospital mortality was of 13.6% (n = 6) (coinfection group: 33%; no coinfection group: 8.6%; p= 0.054). Conclusion Neurological c-infections were common among PLWHA with cerebral toxoplasmosis, and cytomegalovirus was the main copathogen. The group of PLWHA with neurological co-infections underwent longer hospital stays and more frequent intensive care unit admissions. Additionally, this group of patients tended to have higher in-hospital mortality rate.

Resumo Antecedentes Coinfecções neurológicas em pessoas que vivem com HIV/AIDS (PVHA) é um tema que não foi suficientemente avaliado em estudos clínicos prospectivos. Nosso objetivo foi identificar as características clínicas e os desfechos de PVHA com toxoplasmose cerebral e coinfecções neurológicas. Métodos Estudo prospectivo de coorte observacional conduzido em um centro de ensino terciário de São Paulo, Brasil, entre janeiro e julho de 2017. Foram incluídos consecutivamente PVHA internadas com ≥ 18 anos e toxoplasmose cerebral. Realizou-se exame neurológico padronizado na admissão e semanalmente até a alta/óbito. Tanto o diagnóstico quanto o tratamento seguiram a rotina institucional; neurorradiologia, diagnóstico molecular, neurocirurgia e Unidade de Terapia Intensiva (UTI) estavam disponíveis. Os principais desfechos foram coinfecções neurológicas e óbitos hospitalares. Resultados Incluímos 44 (4,3%) casos entre 1.032 pacientes internados. A idade mediana foi de 44 (intervalo interquartil [IIQ]: : 35-50) anos, e 50% (n = 22) dos pacientes eram do sexo masculino. A contagem mediana de linfócitos T CD4+ foi de 50 (IIQ:15-94) células/mm3. Múltiplas lesões na tomografia computadorizada foram observadas em 59% dos casos. Coinfecções neurológicas foram diagnosticadas em 20% (n = 9) dos casos, sendo o citomegalovírus a etiologia mais comum (encefalite: n = 3; polirradiculopatia: n = 2). Observou-se maior tempo de internação (26 versus 62 dias; p= 0,021) e uma taxa mais alta de admissão à UTI (14% versus 44%; p= 0,045) em PVHA com coinfecções neurológicas em comparação àquelas sem coinfecção. A mortalidade intra-hospitalar foi de 13,6% (n = 6) (grupo com coinfecções: 33% versus grupo sem coinfecção: 8,6%; p= 0,054). Conclusão Coinfecções neurológicas foram comuns em PVHA com toxoplasmose cerebral, sendo o citomegalovírus o principal copatógeno. O grupo de PVHA com coinfecções neurológicas apresentou maior tempo de internação, maior taxa de internações na UTI, e tendência a maior taxa de mortalidade intra-hospitalar.

Neospora caninum e toxoplasma gondii: revisão de literatura / Neospora caninum and toxoplasma gondii: review of literature / Neospora caninum y toxoplasma gondii: revisión de literatura

A Neospora caninum e a Toxoplasma gondii são os agentes etiológicos que causam a Neosporose e a Toxoplasmose, respectivamente. Estas duas doenças são consideradas de grande importância econômica e de distribuição mundial, que acometem tanto animais de produção quanto animais domésticos. Apresentam sinais clínicos inespecíficos, sendo a Neosporose frequentemente associada ao abortamento em fêmeas. Ambas enfermidades costumavam ser confundidas, dificultando o diagnóstico. São causadas por protozoários cosmopolitas de ciclos biológicos heteróxenos. O Toxoplasma gondii é responsável por doença clínica em cães e gatos, enquanto o Neospora caninum acomete somente cães. Além disso, não há, até o momento, relatos de Neosporose em humanos, diferente da Toxoplasmose. Ocasionalmente esta pode ocorrer em coiotes, suínos, ovinos, caprinos, equinos, cervídeos e bubalinos. Anticorpos contra Neospora tem sido descrito em raposas, camelos e felídeos. O objetivo da presente revisão, é elucidar a forma de transmissão, sinais clínicos, diagnóstico, tratamento e controle de ambas as doenças, mostrando suas semelhanças, afim de que se possa diagnosticá-las corretamente.(AU)

Neospora caninum and toxoplasma gondii are agents of great economic importance and worldwide distribution that affect production and domestic animals. They present nonspecific clinical signs, and neosporosis is a disease that frequently causes abortion in females, which is considered current, because both used to be confused, making diagnosis difficult. They are protozoan, cosmopolitan, of heterogeneous biological cycles. Toxoplasma gondii is responsible for clinical disease in dogs and cats, while Neospora caninum affects only dogs. Furthermore, there are no reports to date of neosporosis in humans, other than toxoplasmosis. Occasionally it may occur in coyotes, pigs, sheep, goats, horses, deer, and bubaline. Antibodies to Neospora have been described in foxes, camels, and felids. This review aims to elucidate the transmission, clinical signs, diagnosis, treatment, and control of both diseases, showing their similarities, so that they can be correctly diagnosed.(AU)

Neospora caninum y Toxoplasma gondii son los agentes etiológicos que causan Neosporosis y Toxoplasmosis, respectivamente. Estas dos enfermedades se consideran de gran importancia económica y de distribución mundial, afectando tanto al ganado como a los animales domésticos. Presentan signos clínicos inespecíficos y la neosporosis se asocia con frecuencia al aborto en mujeres. Ambas dolencias solían ser erróneas, lo que hacía difícil el diagnóstico. Son causados por protozoos cosmopolitas de ciclos biológicos heterogéneos. Toxoplasma gondii es responsable de enfermedades clínicas en perros y gatos, mientras que Neospora caninum sólo ataca a perros. Además, no se han notificado casos de Neosporosis en humanos hasta el momento, diferente de Toxoplasmosis. Ocasionalmente esto puede ocurrir en coyotes, cerdos, ovejas, cabras, caballos, ciervos y bubalinos. Se han notificado anticuerpos contra la Neospora en zorros, camellos y felinos. El propósito de esta revisión es dilucidar la forma de transmisión, los signos clínicos, el diagnóstico, el tratamiento y el control de ambas enfermedades, mostrando sus similitudes, de manera que puedan ser diagnosticadas correctamente.(AU)

Toxoplasma gondii SAG2, SAG3 and GRA6 alleles and single nucleotide polymorphism in congenital infections with known parasite load and clinical outcome

ABSTRACT Amniotic fluid DNA samples were genotyped by multilocus-nested-PCR-RFLP, but only three of 11 markers amplified 113 of 122 (92.6%) samples, resulting in 12 untyped and 101 partial non-archetypal genotypes. The 101 typed samples were subdivided into four groups: G1 with 73 samples (5'and 3' SAG2 allele I + SAG3 allele III + GRA6 allele III), 53 had parasite load ≤ 102 parasites/mL (43 asymptomatic, 10 mild infections), 17 had load > 102 and ≤ 103 (one mild, 13 moderate and three severe), and three had load > 103 parasites/mL (three severe); G2 with 22 samples (5'and 3' SAG2 allele I + SAG3 allele III), all parasite load levels ≤ 102 parasites/mL (18 asymptomatic and four mild); G3 with five samples (5' and 3' SAG2 allele I + SAG3 allele II), parasite load ≤ 102 parasites/mL (three asymptomatic and two mild); G4 with one sample (5' and 3' SAG2 allele II + SAG3 allele II + GRA6 allele I), a parasite load < 102 parasites/mL in an asymptomatic infant. After DNA sequencing, restriction sites confirmed SAG2, SAG3 and GRA6 alleles in 98.7%, 100% and 100% of the cases, respectively, while single nucleotide polymorphisms confirmed 90% of 5'-SAG2 allele I; 98.7% of 3'-SAG2 allele I; 98% of SAG-3 allele III, but only 40% of GRA6 allele III results. For the moment, partial non-archetypal genotypes of parasites did not show any relationship with either parasite load in amniotic fluid samples or clinical outcome of infants at the age of 12 months.

Atenção primária à saúde como coordenadora do cuidado no atendimento pré-natal de alto risco para toxoplasmose gestacional: relato de caso / Primary health care as care coordinator in high-risk prenatal care for gestational toxoplasmosis: case report / La atención primaria de salud como coordinadora asistencial en la atención prenatal de alto riesgo de toxoplasmosis gestacional: caso clínico

Introdução: a toxoplasmose é considerada uma enfermidade com grande impacto no contexto da saúde pública, especialmente quanto à infecção primária durante a gestação e o risco de transmissão congênita. A Atenção Primária à Saúde (APS) é considerada a porta de entrada aos serviços de saúde e também a coordenadora do cuidado. Objetivo: este trabalho visa relatar um caso de toxoplasmose gestacional e a importância da APS como coordenadora do cuidado no pré-natal de alto risco. Relato do caso: trata-se de uma quartigesta, 27 anos de idade, de cor parda, atualmente desempregada e residente em área de vulnerabilidade sociodemográfica. Iniciou seu pré- natal tardiamente, sendo realizado seu primeiro atendimento com idade gestacional de 17 semanas e 5 dias. Esse caso foi observado e acompanhado durante o período do internato médico em APS I que ocorre no nono e décimo período do curso de medicina de uma universidade federal localizada em município de médio porte. Resultados: esta experiência possibilitou o aprendizado sobre o tratamento e protocolo da toxoplasmose gestacional na APS, a articulação com a atenção especializada e funcionamento da rede. Considerações finais: a toxoplasmose gestacional e consequente transmissão transplacentária, permanece no cenário epidemiológico como uma das doenças que impactam na saúde fetal e neonatal com graves consequências para o indivíduo na vida adulta, e a APS desempenha papel primordial quanto a elaboração de medidas preventivas, no planejamento reprodutivo, na captação precoce da gestante para o início do pré-natal e como a principal coordenadora do cuidado nos casos diagnosticados de toxoplasmose gestacional.

Introduction: toxoplasmosis is considered a disease with a great impact in the context of public health, especially regarding primary infection during pregnancy and the risk of congenital transmission. Primary Health Care (PHC) is considered the gateway to health services and also the care coordinator. Objective: this paper aims to report a case of gestational toxoplasmosis and the importance of PHC as a coordinator of high-risk prenatal care. Case report: this paper presents a quartigest, 27 years old, brown, currently unemployed and residing in an area of sociodemographic vulnerability. She started her prenatal care late, with her first appointment at 17 weeks and 5 days of gestation. This case was observed and followed up during the medical internship in APS I, which occurs in the ninth and tenth period of the medicine course at a federal university located in a medium-sized municipality. Results: this experience made it possible to learn about the treatment and protocol of gestational toxoplasmosis in PHC, the articulation with specialized care and the functioning of the network. Final considerations: gestational toxoplasmosis and consequent transplacental transmission, remains in the epidemiological scenario as one of the diseases that impact fetal and neonatal health with serious consequences for the individual in adult life, also PHC plays a key role in the development of preventive measures, reproductive planning, early detection of pregnant women for the start of prenatal care and as the main coordinator of care in diagnosed cases of gestational toxoplasmosis.

Introducción: la toxoplasmosis es considerada una enfermedad de gran impacto en el contexto de la salud pública, especialmente en lo que se refiere a la infección primaria durante el embarazo y al riesgo de transmisión congénita. La Atención Primaria de Salud (APS) es considerada la puerta de entrada a los servicios de salud y también la coordinadora de los cuidados. Objetivo: este trabajo tiene como objetivo relatar un caso de toxoplasmosis gestacional y la importancia de la APS como coordinadora de los cuidados prenatales de alto riesgo. Relato del caso: se presenta el caso de una cuarentona, de 27 años, morena, actualmente desempleada y residente en una zona de vulnerabilidad sociodemográfica. Inició su control prenatal tardíamente, con su primera consulta a las 17 semanas y 5 días de gestación. Este caso fue observado y seguido durante la pasantía médica en APS I, que ocurre en el noveno y décimo período del curso de medicina en una universidad federal localizada en un municipio de tamaño medio. Resultados: esta experiencia permitió conocer el tratamiento y protocolo de la toxoplasmosis gestacional en APS, la articulación con la atención especializada y el funcionamiento de la red. Consideraciones finales: la toxoplasmosis gestacional y la consecuente transmisión transplacentaria, se mantiene en el escenario epidemiológico como una de las enfermedades que impactan en la salud fetal y neonatal con graves consecuencias para el individuo en la vida adulta, asimismo la APS cumple un rol fundamental en el desarrollo de medidas preventivas, planificación reproductiva, detección precoz de la embarazada para el inicio del control prenatal y como principal coordinadora de la atención en los casos diagnosticados de toxoplasmosis gestacional.

Clinical outcomes of intravitreal treatment for ocular toxoplasmosis: systematic review and meta-analysis

ABSTRACT Background: Ocular toxoplasmosis is the leading cause of infectious posterior uveitis worldwide, accounting for 30-50% of all cases in immunocompetent patients. Conventional treatment is associated with adverse effects and does not prevent recurrence. Intravitreal drug administration can improve disease outcomes and reduce side effects. Herein, we conducted a systematic review and meta-analysis on the efficacy of intravitreal injections for treating ocular toxoplasmosis. Methods: The systematic search was conducted using PubMed, SciELO, and Google Scholar with the descriptors "ocular toxoplasmosis" AND "intravitreal". We analyzed studies that met the inclusion criteria, i.e., experimental cases in patients treated intravitreally for ocular toxoplasmosis. Considering the systematic review, we focused on the number of intravitreal injections, the therapeutic drug class, and the presence of preexisting conditions. To assess the efficacy of intravitreal injections, a meta-analysis was performed using visual acuity, side effects, disease recurrence, and inflammatory responses as variables. Results: Intravitreal injection-induced side effects were rarely observed (0.49% [0.00, 1.51%] ). The use of antiparasitic and anti-inflammatory drugs afforded improved visual acuity (99.81% [98.60, 100.00%]) and marked effectiveness in treating ocular toxoplasmosis. Conclusions: Intravitreal injections may facilitate the successful treatment of ocular toxoplasmosis. However, clinicians should carefully evaluate the presence of preexisting conditions for ocular toxoplasmosis or previous diseases, as these can impact the decision to administer intravitreal injections.

Toxoplasma gondii exposure in felines: an alarming factor to public health from mineiros, Goiás / Exposição ao toxoplasma gondii em felinos: um fator alarmante para a saúde pública de Mineiros, Goiás / Exposición a toxoplasma gondii en felinos: un factor alarmante para la salud pública de Mineiros, Goiás

Toxoplasmosis is a cosmopolitan disease caused by Toxoplasma gondii, an obligate protozoan that affects endothermic animals, including man. Being a zoonosis that can cause abortions, fetal malformations and blindness. Cats are the definitive hosts, acting as a source of dissemination. In order to collect epidemiological data on the distribution of T. gondii in Mineiros, Goiás, samples of domestic cats were analyzed to verify the circulation of the protozoan and reinforce preventive measures. Ninety-four samples of domestic cats, regardless of gender, age and breed, were randomly processed in the neighborhoods of Mineiros, Goiás. They were submitted to the indirect fluorescent antibody test for antibodies against T. gondii, using tachyzoites as antigens and anti-cat IgG conjugate (1:16 were positive). Of the 94 samples analyzed, 35 (37.2%) were reagents, of which four had a titration of 1:16, ten of 1:32, eleven of 1:64, eight of 1:128 and two of 1:256. All cats were semi-domiciled, but lifestyle and diet were not assessed. T. gondii infection is rarely symptomatic and the severity depends on the pathophysiological state. Brazil has high prevalence rates and requires effective care in the management of cats. In Mineiros, 29 reports of infected pregnant women were identified. Although infection in humans occurs primarily through consumption of undercooked meat, ingestion of oocysts in feces of cats is a possibility. Therefore, state public health institutions and veterinarians should promote health education, highlighting food hygiene. Since, when symptomatic, the disease presents severe clinical conditions and, in some cases, irreversible.

A toxoplasmose é uma doença cosmopolita causada pelo Toxoplasma gondii, um protozoário obrigatório que afeta animais endotérmicos, incluindo o homem. Sendo uma zoonose que pode causar abortos, malformações fetais e cegueira. Os gatos são os hospedeiros definitivos, atuando como fonte de disseminação. Para coletar dados epidemiológicos sobre a distribuição do T. gondii em Mineiros, Goiás, amostras de gatos domésticos foram analisadas para verificar a circulação do protozoário e reforçar as medidas preventivas. Noventa e quatro amostras de gatos domésticos, independente de sexo, idade e raça, foram processadas aleatoriamente nos bairros de Mineiros, Goiás. Foram submetidos ao teste de anticorpo fluorescente indireto para pesquisa de anticorpos contra T. gondii, utilizando como antígenos taquizoítos e conjugado anti-cat IgG (1:16 foram positivos). Das 94 amostras analisadas, 35 (37,2%) eram reagentes, das quais quatro tiveram titulação de 1:16, dez de 1:32, onze de 1:64, oito de 1:128 e duas de 1:256. Todos os gatos eram semi-domiciliados, mas o estilo de vida e a dieta não foram avaliados. A infecção por T. gondii raramente é sintomática e a gravidade depende do estado fisiopatológico. O Brasil possui altas taxas de prevalência e requer cuidados efetivos no manejo dos gatos. Em Mineiros, foram identificadas 29 notificações de gestantes infectadas. Embora a infecção em humanos ocorra principalmente pelo consumo de carne mal cozida, a ingestão de oocistos nas fezes de gatos é uma possibilidade. Portanto, as instituições estaduais de saúde pública e os médicos veterinários devem promover a educação em saúde, destacando a higiene alimentar. Já que, quando sintomática, a doença apresenta quadros clínicos graves e, em alguns casos, irreversíveis.

La toxoplasmosis es una enfermedad cosmopolita causada por Toxoplasma gondii, un protozoario obligado que afecta a animales endotérmicos, incluido el hombre. Ser una zoonosis que puede provocar abortos, malformaciones fetales y ceguera. Los gatos son los huéspedes definitivos, actuando como fuente de diseminación. Con el fin de recolectar datos epidemiológicos sobre la distribución de T. gondii en Mineiros, Goiás, se analizaron muestras de gatos domésticos para verificar la circulación del protozoario y reforzar las medidas preventivas. Noventa y cuatro muestras de gatos domésticos, independientemente de género, edad y raza, fueron procesadas al azar en los barrios de Mineiros, Goiás. Se sometieron a la prueba de anticuerpos fluorescentes indirectos contra T. gondii, utilizando como antígenos taquizoítos e IgG anti-cat conjugada (1:16 fueron positivos). De las 94 muestras analizadas, 35 (37,2%) fueron reactivos, de los cuales cuatro tuvieron una titulación de 1:16, diez de 1:32, once de 1:64, ocho de 1:128 y dos de 1:256. Todos los gatos tenían domicilio parcial, pero no se evaluó el estilo de vida ni la dieta. La infección por T. gondii rara vez es sintomática y la gravedad depende del estado fisiopatológico. Brasil tiene altas tasas de prevalencia y requiere una atención eficaz en el manejo de los gatos. En Mineiros se identificaron 29 casos de mujeres embarazadas infectadas. Aunque la infección en los seres humanos se produce principalmente a través del consumo de carne poco cocida, la ingestión de ovoquistes en las heces de los gatos es una posibilidad. Por lo tanto, las instituciones estatales de salud pública y los veterinarios deben promover la educación sanitaria, destacando la higiene alimentaria. Dado que, cuando sintomática, la enfermedad presenta cuadros clínicos severos y, en algunos casos, irreversibles.

Stability of sulfadiazine sugar-free oral suspensions for the treatment of congenital toxoplasmosis

Abstract This study aimed to develop and evaluate the stability of sulfadiazine sugar-free extemporaneous oral suspensions, focusing on treating congenital toxoplasmosis. The excipients were carefully chosen to obtain safe products for the pediatric population. Sulfadiazine suspensions (100 mg/ mL) were prepared from the raw material or tablets, stored in amber glass bottles at 5±3ºC, and evaluated at 0, 14, and 30 days. An ultra-performance liquid chromatographic method was developed and validated to assay the drug. The particle size ranged from 29.3 to 50.6 µm, with some variation over the study; pH values around 7.0 and non-Newtonian behavior were observed without modification in the period. Formulations showed a fast dissolution rate (>80% in 15 minutes) without variation over the study. The drug assay was about 100% of the label claimed throughout the study, demonstrating the chemical stability and the preparations' dose homogeneity. The microbiological investigation indicated that both preparations met the requirements for the microbial count and absence of pathogens. In conclusion, the developed formulations can be used for 30 days when stored under refrigeration. The oral suspensions produced are easy to prepare and contain safe components, providing an alternative for congenital toxoplasmosis treatment in children.