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.

Infección por Toxoplasma gondii y accidentes de tránsito. Evidencias epidemiológicas de una asociación poco conocida

Recientes pesquisas en las que se utilizó la detección de anticuerpos anti-Toxoplasma gondii como herramienta diagnóstica de toxoplasmosis latente, demostraron asociación entre la infección crónica por el parásito y la disminución de funciones cognitivas, las enfermedades psiquiátricas (esquizofrenia, bipolar, trastornos obsesivo-compulsivos), las enfermedades degenerativas (enfermedad de Alzheimer, múltiples esclerosis, enfermedad de Huntington), y cambios de comportamiento (mayor frecuencia de conductas suicidas y, sobre todo, de accidentes de tránsito). En la literatura revisada, varios estudios demostraron seroprevalencias de anticuerpos anti-T. gondii significativamente mayores en grupos de personas involucradas en accidentes de tránsito que las de sus correspondientes grupos control. La no disponibilidad de fármacos adecuados contra los bradizoítos de T. gondii y de vacunas efectivas contra el parásito, además de no posibilitarse la demostración de una posible relación causal, se obstaculizaba la que podría resultar una vía complementaria para el control de los accidentes de tránsito, un problema de la cotidianidad universal de muy adversas consecuencias humanas y sociales. En perspectivas, la superación de estas limitaciones debe recibir una adecuada atención, tanto de las autoridades sanitarias como de la Academia. En esa dirección, el propósito de este documento es contribuir a ganar conciencia sobre la existencia de esa asociación.

Recent investigations, in which the detection of anti-Toxoplasma gondii antibodies has been used as a diagnostic tool for latent toxoplasmosis, have shown an association between chronic infection by the parasite and decreased cognitive functions, psychiatric illnesses (schizophrenia, bipolar disorder, obsessive - compulsive disorders), degenerative diseases (Alzheimer's disease, multiple sclerosis, Huntington's disease) and behavioral changes (greater frequency of suicidal behaviors and, above all, traffic accidents). In the reviewed literature, several studies demonstrated significantly higher seroprevalence of anti-T. gondii in groups of people involved in traffic accidents than in their corresponding control groups. The unavailability of adequate drugs against T. gondii bradyzoites and effective vaccines against the parasite, in addition to not allowing the demonstration of a possible causal relationship, hinders what could be a complementary way to control traffic accidents, a problem of universal daily life with very adverse human and social consequences. In perspective, overcoming these limitations should receive adequate attention, both from the health authorities and from academia. In this direction, the purpose of this document is to contribute to raising awareness of the existence of this association.

Occurrence of anti-Toxoplasma gondii antibodies in meat and dairy goat herds in Rio Grande do Norte, Brazil / Ocorrência de anticorpos anti-Toxoplasma gondii em rebanhos caprinos de corte e leiteiros do Rio Grande do Norte, Brasil

Toxoplasmosis is caused by Toxoplasma gondii, which is the main causative agent of abortion in small ruminants. Goats are among the animals that are most susceptible to this protozoon, and the disease that it causes leads to significant economic losses and has implications for public health, since presence of the parasite in products of goat origin is one of the main sources of human infection. Because of the significant economic impact, there is an urgent need to study the prevalence of T. gondii infection among goats in Sertão do Cabugi, which is the largest goat-producing region in Rio Grande do Norte. In the present study, the ELISA assay was used to test 244 serum samples from nine farms, located in four different municipalities in the Sertão do Cabugi region, which is an important goat-rearing region. The results showed that the prevalence of anti-T. gondii antibodies was 47.1% and that there was a significant association between positivity and the variables of age (≥ 34 months), location (Lajes, Angicos and Afonso Bezerra) and farm (all the farms). The avidity test was applied to all the 115 ELISA-positive samples to distinguish between acute and chronic infection. One hundred and three samples (89.6%) displayed high-avidity antibodies, thus indicating that most of the animals presented chronic infection, with a consequent great impact on the development of the goat production system and a risk to human health.

A toxoplasmose é causada pelo Toxoplasma gondii, principal agente causador de aborto em pequenos ruminantes. Os caprinos são uns dos animais mais suscetíveis a esse protozoário, levando a perdas econômicas significativas e implicações para a saúde pública, uma vez que a presença do parasito em produtos de origem caprina é uma das principais fontes de infecção humana. Devido ao impacto econômico significativo torna-se urgente estudar a prevalência da infecção, pelo T. gondii, entre caprinos do Sertão do Cabugi, a maior região produtora de caprinos no Rio Grande do Norte. O presente estudo utilizou o ELISA para testar 244 amostras de soro de 9 fazendas, situadas em 4 diferentes cidades na região do Sertão do Cabugi; uma importante região de criação de cabras. Os resultados mostraram uma prevalência de 47,1% para anticorpos anti- T. gondii e uma significativa associação entre a positividade e as variáveis idade (≥ 34 meses), localização (Lajes, Angicos e Afonso Bezerra e propriedade (todas as fazendas). O teste de avidez foi aplicado a todas as 115 amostras positivas pelo ELISA para discriminar entre infecção aguda e crônica. Cento e três amostras (89,6%) apresentaram anticorpos de alta avidez; indicando que a maioria dos animais estavam em infecção crônica, gerando um grande impacto sobre o desenvolvimento do sistema de produção em cabras e um risco para a saúde humana.

Prevalência e fatores de risco associados à infecção por Toxoplasma gondii em granjas suinícolas tecnificadas no Estado de Alagoas / Prevalence and risk factors associated with infection by Toxoplasma gondii on commercial swine farms in the state of Alagoas, Brazil

Objetivou-se com este estudo calcular a prevalência e identificar os fatores de risco associados à infecção por Toxoplasma gondii em suínos criados em granjas tecnificadas no Estado de Alagoas, Brasil. Para compor a amostra do estudo de prevalência foram utilizados 342 suínos, sendo 312 matrizes e 30 varrões, oriundos de sete granjas de ciclo completo e distribuídas em cinco municípios do Estado de Alagoas. O exame sorológico para a pesquisa de anticorpos anti-Toxoplasma gondii foi realizado através da técnica de Imunofluorescência Indireta (RIFI), utilizando-se anticorpos anti-IgG-suíno conjugado ao isotiocianato de fluoresceína. A análise dos fatores de risco foi realizada por meio da aplicação de questionários constituídos por perguntas objetivas referentes ao criador, às características gerais da propriedade, ao manejo produtivo, reprodutivo e sanitário. Determinou-se uma prevalência de 26,9 por cento (92/342) de suínos soropositivos. O fator associado à infecção foi a introdução de reprodutores nas granjas nos últimos cinco anos (p=0,014; OR=1,83; IC=1,13-2,96). Concluiu-se que a infecção por Toxoplasma gondii encontra-se disseminada em suínos criados em granjas tecnificadas no Estado de Alagoas, Brasil. Recomenda-se o controle da população de gatos, a realização de práticas de limpeza e higienização das instalações e realização de testes laboratoriais para diagnóstico da infecção por T. gondii nos animais a serem introduzidos no plantel como medidas de redução dos índices de infecção na região estudada.

This study was aimed to determine the prevalence and to identify risk factors associated with infection by Toxoplasma gondii in pigs from commercial swine farms in the state of Alagoas, Brazil. To compose the sample size of prevalence 342 pigs were used, with 312 sows and 30 boars, from of seven swine farms and distributed in five districts of the state of Alagoas. The serological examination for the detection of anti-Toxoplasma gondii antibodies was achieved by Indirect Immunofluorescence (IFAT), using anti-pig IgG-conjugated to fluorescein isothiocyanate. The analysis of risk factors were performed by the application of questionnaires consisting of objective questions relating to the designer, the general characteristics of the property, the production, reproductive and health management. The prevalence was of 26,9 percent (92/342) of seropositive pigs. The associated factor was the boars introduction on farms in the last five years (p=0,014; OR=1,83; CI=1,13-2,96). It is concluded that infection with Toxoplasma gondii is widespread in commercial pig farms in the state of Alagoas, Brazil. The results suggest the control of cat population, the performance of cleaning and sanitation practices and laboratory testing to detect of infection by T. gondii in animals to be placed on the farms as measures to reduce the infection rates on region studied.

Preliminary analysis of cerebral proteins of mice with acute Toxoplasma gondii infection by 2D electrophoresis / 中国血吸虫病防治杂志

Objective To explore the impact of acute Toxoplasma gondii infection on cerebral proteins and nerve growth in mice by 2D electrophoresis. Methods The cerebral proteins from C57BL/6J mice infected with Toxoplasma gondii and normal paired mice were extracted. The discrepant proteins were checked by 2D electrophoresis. Isoelectric focusing was determined as the first direction (immobilized pH gradient gel 3-10) ,SDS-PAGE as the second direction to execute 2D electrophoresis, and PDQuest 1.0 software was used to analyze 2D electrophoretogram. Results The protein spots in Toxoplasma gondii infected mice and normal paired mice were (132 ±10) and (170 ± 13) , respectively. After the analysis by PDQuest 1. 0 software, only 19 protein spots were found to express in infected mice and only 37 protein spots were found to express in normal paired mice. Additionally, the obvious quantitative changes in a part of proteins of the cerebrum in the both group occurred. Conclusion There are obvious changes in cerebral proteins from mice with acute Toxoplasma gondii infection, which provids useful clues for studying the cerebral proteins injury in acute Toxoplasma gondii infected mice and the new cure drug.

Experimental and clinical study on affection of Toxoplasma gondii infection on male reproduction / 中国血吸虫病防治杂志

Objective To study the male reproductive ability of male rats with Toxoplasma gondii ( Tg) infection and investigate the variation of Toxoplasma infection in seminal plasma of infertile patients and explore its mechanism. Methods Thirty SD rats were randomly divided into 3 groups. The rats in the Toxoplasma infection group were administrated intraperitoneally with tachyzoites of Tg. in a dosage of 2 × 10~ 5/ml(2ml) , the rats in the treated group were administered with the same dosage of the tachyzoites and from the second day after the infection they were treated with 200 mg/kg azithromycin for 7 days, and the normal group was given physiological saline. Nine weeks after the infection, the serum sex hormone level, number,vitality, activity and quantity of spermatozoa and activities of enzymes in testa's of the testicular tissues were determined in the male rats. The female rats infected with Tg were matched with normal female rats at a ratio of 1: 2 for one week, and on the 21st day of pregnancy, the number of corpora luteum, sex ratio and the weight, body length and tail length of fetus were measured. The ELISA method was used todetermine the seminal plasma's anti-Tg IgG antibody of the 169 patients with infertility and 35 males with normal fertility. Meanwhile the NO levels in their semina were determined by means of nitric acid reducase. Results The number, activity .vitality, serum level of sex hormones were all lower in the infected rats than those in the normal and treated groups. The number of fetus in the pregnant rats matched with the infected male rats was significantly fewer, but the average body weight, body length, tail length of the fetuses and sex proportion showed no significant difference in comparison with those of the control group. The anti-Toxoplasma gondii antibody positive rate in the masculine infertility patients was 18.35% , being significantly higher than 2. 86% in the normal fertility group(P < 0.05 ). The mean NO level in the semina from the infertility group was (146.68 ± 38. 87) μnol/L , which was significantly higher than (84.92 ± 26.72) μnol/L( P < 0.01) in the fertility group. Conclusion Toxoplasma gondii infection can cause certain influences on the male reproductive ability.

Effect of Toxoplasma gondii infection upon the expressions of brain-derived neurotrophic factor and N-methyl-D-aspirate receptor in rat hippocampus / 中国人兽共患病学报

To investigate the effect of Toxoplasma gondii infection upon the expression of brain-derived neurotrophic factor (BDNF) mRNA and N-methyl-D-aspirate receptor (NMDA) subunits NR2A and NR2B,Wistar rats of 4 weeks old were randomly divided into 3 groups with 10 rats in each group in which 2 mL suspensions of T.gondii tachyzoits in the concentrations of 2×10~7/mL and 2×10~5/mL were injected intra-peritoneally to rats in group A and group B respectively, serving as the experimental groups, while 2 mL of sterile physiologic saline was injected intra-peritoneally in group C serving as the control group. Four weeks after injection, the expressions of BDNF mRNA and BDNF protein in the brain tissues were detected by in situ hybridization and immunohistochemical assay and the expressions of NR2A and NR2B immune activity in the hippocampal CA1,CA3 and DG were investigated by using computer-assisted image analysis system. Compared with the control group, the expression of BDNF protein in the hippocampus of the experimental groups was significantly enhanced [(64.27±23.18), (50.39±19.34) vs (44.68±22.74)/mm~2,P＜0.05]. In addition, the increased expressions of BDNF mRNA in the hippocampus of the experimental groups were also demonstrated [(0.13±0.02), (0.12±0.02) vs (0.09±0.01); P＜0.05]. In the expression of the NR2A protein, their expressions in group A and B of rats were significantly lower than that of group C in CA3 (P＜0.05),but there was no significant change in CA1 and DG. In the expression of NR2B protein, the expressions in group A and B were also lower than that of group C in CA1 and CA3, and had no significant change in DG. It is evident that the expressions of BDNF mRNA and BDNF protein in hippocampal tissues were significantly increased following chronic infection with T.gondii, supporting the hypothesis that BDNF may be involved in the intrinsic neuro-protective mechanism.

Analysis of levels of tumor necrosis factor-? in sera of abortion patients caused by Toxoplasma gondii infection / 中国血吸虫病防治杂志

Objective To explore the relationship between tumor necrosis factor-?(TNF-?)level in the serum of maternal women with intrauterine infection of Toxoplasma gondii and absortion.Methods An examination was carried out on TNF-? in maternal sera and DNA of Toxoplasma gondii in the cervical secretions,and the aborted tissues of the abortion group,and the cervical secretions of the control group by ELISA and PCR,respectively.Results The TNF-? levels increased in the sera of women with intrauterine infection of Toxoplasma before abortion as compared with those of the control group and those of themselves after abortions.There were high TNF-? levels in the sera of prognostication abortion women with Toxoplasma infection before the anti-Toxoplasma treatment as compared with those of the control group and those of themselves after the treatment with azithromycin.Conclusion The results suggest that Toxoplasma gondii infection is an important factor to increase the TNF-? level in maternal serum.