Elaboration and analysis of psychometric properties of a questionnaire to assess pregnant women's knowledge about toxoplasmosis / Elaboração e análise de propriedades psicométricas de um questionário para avaliar o conhecimento de gestantes sobre toxoplasmose

Abstract Objectives: to elaborate and analyze the psychometric properties of a questionnaire to assess among pregnant women's knowledge about toxoplasmosis. Methods: methodological study elaborating an instrument conducted in the north of Minas Gerais in 2019. The steps followed were: 1. Elaboration of the questionnaire items based on medical literature available in indexed databases. 2. Content validation. 3. Apparent validation. 4. Construct validation with hypothesis testing after the application of the questionnaire and comparison of the mean scores using the Mann-Whitney U test. 5. Reliability analysis with internal consistency analysis and test-retest. Results: the final instrument consisted of 26 items. Content validation reached 90% agreement among experts. The hypothesis test found a significant diference among the scores of the groups evaluated (p<0.001). Cronbach's alpha found a value of 0.84 and the test-retest showed an intra-class correlation index of 0.78 (p<0.001). Conclusions: the instrument elaborated proved to be valid and reliable and could be used to assess among pregnant women's knowledge about toxoplasmosis and, therefore, guiding to the educational and preventive measures.

Resumo Objetivos: elaborar e analisar as propriedades psicométricasde um questionáriopara avaliação do conhecimento sobre toxoplasmose entre gestantes. Métodos: estudo metodológico de elaboração de instrumento, realizado no norte de Minas Gerais, em 2019. O estudo seguiu os seguintes passos: 1. Elaboração dos itens a do questionário, com base na literatura médica disponível em bases indexadas. 2. Validação de conteúdo. 3. Validação aparente. 4. Validação de constructo, com teste de hipóteses, após aplicação do questionário e comparação de médias dos escores por meio do teste U de Mann-Whitney. 5. Análise de confabilidade, com análise da consistência interna e teste-reteste. Resultados: o instrumento final foi composto por 26 itens. Na validação de conteúdo alcançou 90% de concordância entre os experts. O teste de hipótese registrou diferença significativa entre os escores dos grupos avaliados (p<0,001). O alfa de Cronbach apresentou valor de 0,84 e o teste-reteste apresentou índice de correlação intra-classe de 0,78 (p<0,001). Conclusão: o instrumento elaborado apresentou-se válido e confável e poderá ser utilizado para avaliação de conhecimento sobre toxoplasmose entre gestantes, norteando medidas educativas e preventivas.

Avaliação do nível de conhecimento sobre Toxoplasmose por pais e/ou responsáveis de crianças em Centros Municipais de Educação Infantil em Foz do Iguaçu-Pr / Brasil / Knowledge level of toxoplasmosis by parents and/or legal guardians in child education Municipal Centers in Foz do Iguaçu, Paraná, Brazil

O objetivo deste estudo foi avaliar o nível de conhecimento prévio e a assimilação de informações novas sobre toxoplasmose pelos pais e/ou responsáveis de crianças matriculadas em Centros Municipais de Educação Infantil (CMEI) do município de Foz do Iguaçu, PR, Brasil. Trata-se de um estudo comparativo, descritivo e de abordagem quantitativa com 163 pais e/ou responsáveis por crianças em CMEI. Aplicou-se questionário contendo 12 questões objetivas sobre a toxoplasmose, aplicado em dois momentos sequenciais da pesquisa M1 (pré-intervenção educativa) e M2 (pós-intervenção educativa). Inicialmente, o questionário foi aplicado para a avaliação do conhecimento prévio sobre a toxoplasmose, seguindo de palestra referente ao tema e, ao término, reaplicado o mesmo questionário para verificação da assimilação das informações. Os dados foram analisados pelo programa BioEstat 5.0®, considerando-se um nível de significância de 5%. Foi identificado um desconhecimento de 62,6% dos pais e/ou responsáveis pelas crianças na avaliação no M1 para as variáveis investigadas (p<0,05). No M2, o percentual de respostas satisfatórias elevou-se consideravelmente (p<0,05). Este estudo evidenciou a necessidade de ampliação de conhecimento de pais e/ou responsáveis por crianças e a eficácia das orientações sobre toxoplasmose.

The purpose of this study was to evaluate the level of prior knowledge and assimilation of new information about toxoplasmosis by parents and/or legal guardians of children enrolled in Child Education Municipal Centers (CMEI) in the city of Foz do Iguaçu, Paraná, Brazil. This is a comparative study using a descriptive and quantitative approach with 163 parents and/or legal guardians of children in CMEIs. A questionnaire containing 12 objective questions about toxoplasmosis, applied in two sequential moments - M1 (pre-educational intervention) and M2 (post-educational intervention) was used. Initially, the questionnaire was applied for the evaluation of prior knowledge about toxoplasmosis, followed by a lecture on the topic and, at the end, the same questionnaire was reapplied to verify the assimilation of the information. The data were analyzed using the BioEstat 5.0® program, considering a 5% level of significance. The results identified a deficit of knowledge in 62.6% of parents and/or legal guardians in the M1 evaluation for the investigated variables (p<0.05). In M2, the percentage of satisfactory responses increased considerably (p<0.05). This study evidenced the need to increase the knowledge of parents and/or legal guardians of children and the effectiveness of orientation about toxoplasmosis.

Measles, rubella, mumps and Toxoplasma gondii antibodies in saliva of vaccinated students of schools and universities in São Paulo City, Brazil

ABSTRACT Introduction: Vaccines are well-established public health interventions with major impacton the prevalence of infectious diseases, but outbreaks are occurring frequently due to pri-mary and secondary failures, despite high coverage. Surveillance of efficacy and duration ofinduced immunity is a difficult task as it requires invasive blood sampling in children andteenagers. Saliva can be an acceptable alternative source of IgG to assess vaccine efficacyand toxoplasmosis incidence. We investigated IgG response for measles, mumps, rubella,and T. gondii in saliva samples of vaccinated young people. Methods: Saliva was collected from 249 public schools students from São Paulo, Brazil, aged7 to 13 years old, during an interactive exhibition on hygiene. We used S. aureus proteinA solid phase capture assay for IgG reactive to biotinylated purified proteins. Paired salivaand serum (47) were tested from young adults with serum evidence of T. gondii infectionand from negative children less than 12 month old for standardization. Reproducibility wasgreater than 98% and sensitivity and specificity of the saliva assays were greater than 95%,as well as the concordance of paired saliva and serum samples. Results: Saliva from high school students showed a prevalence of 8.5% (95% CI: 5.0-11.9%)for anti T. gondii IgG; 96.8% (94.6-99%) of anti-measles IgG; 59.1% (53-65%) of anti-rubella IgG,and 57.5% (51.3-63.6%) of anti-mumps IgG. Discussion: The prevalence of antibodies against mumps and rubella after 6-8 years of vaccination was lower than against measles among students. The findings of this study demonstrate the feasibility of saliva sampling for follow-up of vaccine immune status in teenagers. This useful approach allows for IgG detection for vaccine control or epidemio- logical studies.

Conhecimento dos profissionais de saúde e acadêmicos de medicina e enfermagem sobre toxoplasmose / Knowledge of healthcare professionals and academic medicine and nursing on toxoplasmosis / Conocimiento de profesionales de la salud y medicina académica y enfermería en toxoplasmosis

Introdução: a toxoplasmose é uma doença de transcurso benigno que, quando ocorre na gestação, pode levar a sérias repercussões ao feto. Objetivo: identificar o conhecimento dos profissionais de saúde e acadêmicos de enfermagem e medicina sobre toxoplasmose. Método: estudo de revisão integrativa da literatura realizada com artigos publicados nas bases Medline, Lilacs e Bdenf, entre 2008 e 2017, em português, inglês e espanhol. Resultados: encontraram-se oito artigos que contemplaram os critérios de inclusão, predominantemente na língua inglesa (75%) e publicados entre 2014 a 2017 (62,5%), nos quais constatouse déficit no conhecimento a respeito da prevenção, ciclo biológico, diagnóstico e tratamento da toxoplasmose. Conclusão: os profissionais envolvidos na assistência pré-natal e os estudantes de enfermagem e medicina apresentam conhecimento deficiente sobre a toxoplasmose na gestação, o que compromete a qualidade do pré-natal e evidencia a necessidade de serem implementadas estratégias ensino-aprendizagem mais eficazes na formação acadêmica e educação continuada em saúde.(AU)

Introduction: Toxoplasmosis is a benign disease that, when it occurs during pregnancy, can lead to serious fetus repercussions. Objective: to identify the knowledge of health professionals and nursing and medical students about toxoplasmosis. Method: integrative literature review study, conducted with articles published in the Medline, Lilacs and Bdenf databases, between 2008 and 2017, in Portuguese, English and Spanish. Results: eight articles were found that included the inclusion criteria, predominantly in English (75%) and published between 2014 and 2017 (62.5%), in which there was a lack of knowledge regarding prevention, biological cycle, diagnosis and treatment of toxoplasmosis. Conclusion: Nursing and medical professionals and students involved in prenatal care present poor knowledge about toxoplasmosis during pregnancy, which compromises the quality of prenatal care and highlights the real need for implementation of more effective teaching-learning in academic and continuing health education.(AU)

Introducción: la toxoplasmosis es una enfermedad benigna que, cuando ocurre durante el embarazo, puede tener serias repercusiones para el feto. Objetivo: identificar el conocimiento de los profesionales de salud y académicos de enfermería y medicina sobre toxoplasmosis. Método: estudio de revisión integrativa de la literatura, realizada con artículos publicados en las bases de datos Medline, Lilacs y Bdenf, entre 2008 y 2017, en portugués, inglés y español. Resultados: se encontraron ocho artículos que contemplaron los criterios de inclusión, predominantemente en el idioma inglés (75%) y publicado entre 2014 y 2017 (62.5%), en los cuales se constató déficit en el conocimiento acerca de la prevención, ciclo biológico, diagnóstico y tratamiento de la toxoplasmosis. Conclusión: los profesionales y los estudiantes de enfermería y medicina involucrados en la asistencia prenatal presentan un conocimiento deficiente sobre la toxoplasmosis en la gestación, lo que compromete la calidad de la atención prenatal y resalta la necesidad real de implementar estrategias de enseñanza-aprendizaje más efectivas en la formación académica y educación continua.(AU)

Conhecimento e comportamento preventivo de gestantes sobre Toxoplasmose no município de Imperatriz, Maranhão, Brasil / Toxoplasmosis knowledge and preventive behavior among pregnant women in the city of Imperatriz, Maranhão, Brazil

Resumo O objetivo desse estudo foi avaliar o conhecimento e o comportamento preventivo sobre a toxoplasmose e relacionar com as condições socioeconômicas, do pré-natal e ambientais entre as gestantes da Estratégia Saúde da Família (ESF), do município de Imperatriz, Maranhão, Brasil. Neste estudo transversal foi aplicado um questionário estruturado e pré-testado, com amostra de 239 gestantes. Somente 23,4% das gestantes apresentaram bom conhecimento sobre a doença, com ênfase no domínio prevenção; 58,9% adotaram adequadamente os comportamentos preventivos. Os resultados obtidos chamam a atenção pela associação significativa a vários fatores de risco para a toxoplasmose, como: consumo de água sem tratamento (OR = 2,1245; IC95% = 1,20-3,73; p = 0,0128), contato com gatos (OR = 7,6875; IC95% = 4,22-13,97; p < 0,0001), limpeza das fezes do gato (OR = 6,8738; IC95% = 3,02-15,60; p < 0,0001), consumo de carne crua (OR = 5,7405; IC95% = 3,21-10,24; p < 0,0001) e mexer com areia (OR = 10,7376; IC95% = 4,64-24,85; p < 0,0001), gerando a necessidade de uma educação continuada sobre a toxoplasmose para as gestantes atendidas na ESF de Imperatriz, e o estabelecimento de medidas preventivas mais integrais, com políticas públicas de saúde e educação que levem em consideração questões econômicas, sociais, ambientais e culturais.

Abstract The aim of this study was to assess toxoplasmosis knowledge and preventive behavior, and relate these to socioeconomic, pre-natal and environmental issues among pregnant women served by the Family Health Strategy in the municipality of Imperatriz, Maranhão, Brazil. This is a cross-sectional study performed by applying a structured and pre-tested questionnaire to a sample of 239 pregnant women. Only 23.4% of the pregnant women had good knowledge of the disease, primarily in the area of prevention, and 58.9% adopted suitable preventive behaviors. The results obtained show a significant association of various toxoplasmosis risk factors, such as drinking untreated water (OR = 2.1245; IC95% = 1.20-3.73; p = 0.0128), contact with cats (OR = 7.6875; IC95% = 4.22-13.97; p < 0,0001), cleaning cat feces (OR = 6.8738; IC95% = 3.02-15.60; p < 0.0001), eating raw meat (OR = 5.7405; IC95% = 3.21-10.24 and handling sand/cat litter OR = 10.7376; IC95% = 4.64-24.85; p < 0.0001). This shows a need for continued education on toxoplasmosis for the pregnant women seen by the Imperatriz FHS, and for more comprehensive preventive measures, with public health and education policies that take into consideration economic, social, environmental and cultural issues.

Prevalencia de toxoplasmosis en estudiantes de la Universidad Nacional de Chimborazo en Ecuador / Prevalence of toxoplasmosis in students of the National University of Chimborazo in Ecuador

Introducción: La infección por Toxoplasma gondii durante la edad fértil de la mujer, es un problema de salud no bien entendido en la población, círculos médicos y decisores dentro de los sistemas de salud; al no considerar importante las formas de adquirirla y el riesgo que implica infectarse durante el embarazo. En Ecuador no existen datos consistentes de la circulación y endemicidad de esta parasitosis, siendo esta la situación problémica el motivo de este trabajo. Objetivo: Conocer la seroprevalencia de Toxoplasma gondii en mujeres jóvenes en edad fértil y su relación con el nivel de conocimiento sobre la enfermedad. Métodos: Se evaluó el comportamiento serológico de T. gondii en 105 muestras de sueros de alumnas de la Universidad Nacional de Chimborazo de la Carrera de Laboratorio Clínico e Histopatológico, mediante la determinación de IgG anti T. gondii utilizando la Técnica de Quimioluminiscencia. Resultados: 38 alumnas (36,0 por ciento) resultaron ser positivas para anticuerpos contra T. gondii, lo que indica el contacto con el parásito en algún momento de su vida. La falta de conocimiento sobre las principales vías de contagio puede ser la causa de la seropositividad demostrada, lo que representa un riesgo para las seronegativas durante el embarazo. Conclusiones: Se demuestra seroprevalencia de la infección por T. gondii en la población estudiada y la endemicidad del parásito(AU)

Introduction : Toxoplasma gondii is the infection that occurs during the fertile age of women and is a health problem not well understood by the people, doctors and leaders of the health systems of some countries; as it does not consider important the ways of acquiring it and the risk involved in becoming infected during pregnancy. In Ecuador there aren´t consistent data on the circulation and endemicity of this parasitosis, being this problematic situation the reason for this work. Objective : The purpose of the present study was to determine the seroprevalence of Toxoplasma gondii in young women of childbearing age and their relation with the level of knowledge about the disease. Methods: The serological behavior of T. gondii was evaluated in 105 samples of sera from the National University of Chimborazo of the Clinical and Histopathological Laboratory, by the determination of IgG anti T. gondii using the Chemiluminescence Technique. Results: Of the study population, 38 students (36.0 percent) were found to be positive for antibodies to T. gondii, indicating contact with the parasite at some point in their life. The demonstrated seropositivity may be due to the lack of knowledge about the main routes of infection, the risk of being seronegative during pregnancy and the high endemicity of the parasite. Conclusions : The seroprevalence of T. gondii infection in the studied population were demonstrated(AU)

Toxoplasmosis diseminada en un paciente con trasplante de corazón a pesar de la profilaxis con trimetoprim-sulfametoxazol / Disseminated toxoplasmosis in a heart transplant patient despite cotrimoxazole prophylaxis: A case report

Resumen Se reporta el caso de un paciente de sexo masculino, de 61 años de edad, quien ocho meses después de someterse a un trasplante de corazón presentó una enfermedad sistémica con compromiso del sistema nervioso central y del sistema inmunológico, así como de pulmón, riñón, colon y piel, y a quien finalmente se le diagnosticó toxoplasmosis diseminada, a pesar de haber recibido profilaxis con trimetoprim-sulfametoxazol, debido a que el órgano provenía de un donante positivo para toxoplasmosis siendo él un receptor negativo. Se discuten las opciones de profilaxis en nuestro medio.

Abstract We report the case of a 61 year-old male who underwent heart transplantation eight months before developing a systemic condition with central nervous system, lung, kidney, colonic, cutaneous, and hematologic involvement, found to be secondary to a systemic toxoplasmosis despite co-trimoxazole prophylaxis in a previous-to-transplant seronegative patient receiving a heart from a seropositive donor. A review of prophylactic options in our environment is discussed.

Efecto del tratamiento prenatal con espiramicina en la frecuencia de retinocoroiditis por toxoplasmosis congénita en una cohorte colombiana / Effect of antenatal spiramycin treatment on the frequency of retinochoroiditis due to congenital toxoplasmosis in a Colombian cohort

Resumen Introducción. La toxoplasmosis de la gestación es frecuente y grave. Hasta ahora no hay consenso sobre la utilidad del tratamiento para prevenir complicaciones oculares en el neonato. En la actualidad, uno de los medicamentos utilizados en las madres diagnosticadas es la espiramicina oral. Infortunadamente, en algunas mujeres gestantes no se hace el diagnóstico prenatal y, por esta u otras razones, no reciben el tratamiento. Objetivo. Describir la relación entre el tratamiento con espiramicina durante el embarazo en madres con toxoplasmosis de la gestación y la presentación de toxoplasmosis ocular en los recién nacidos. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo de serie de casos. Se evaluó una serie prospectiva de pacientes con toxoplasmosis de la gestación durante tres años de seguimiento en el Servicio de Retinología de la Clínica Universitaria Bolivariana de Medellín. Resultados. Se registraron 23 madres con diagnóstico de toxoplasmosis de la gestación. Quince de ellas (65 %) recibieron durante la gestación tratamiento con espiramicina en dosis de 3 g al día; uno de los neonatos (6,6 %) presentó toxoplasmosis ocular. De las ocho (35 %) pacientes que no recibieron tratamiento, cinco (62,5 %) tuvieron hijos con compromiso ocular por toxoplasma. La razón de momios (odds ratio, OR) del efecto protector contra dicho compromiso en los pacientes cuyas madres recibieron tratamiento fue de 0,04 (IC95% 0,00-0,67), con valor de p menor de 0,01 en la prueba exacta de Fisher. Solo se evidenció compromiso del sistema nervioso central por toxoplasmosis mediante las imágenes de tomografía o ecografía cerebral en dos (14 %) pacientes de las 14 en quienes se hicieron estos estudios. Los dos pacientes presentaron, además, compromiso ocular; ambos fueron diagnosticados en el momento del nacimiento y sus madres no habían recibido tratamiento prenatal. Conclusiones. Estos resultados evidencian que el tratamiento con espiramicina durante el embarazo en la toxoplasmosis de la gestación redujo en 96 % (IC95% 33-100 %) el riesgo relativo de presentar la enfermedad en el recién nacido.

Abstrat Introduction: Gestational toxoplasmosis is frequent and severe. There is still debate about the benefits of treatment against ocular manifestations in the newborn. Spiramycin treatment is used for this purpose, unfortunately prenatal diagnosis is sometimes delayed and pregnant women are not treated. Objective: To describe the relationship between treatment with spiramycin during pregnancy in mothers with gestational toxoplasmosis and development of ocular toxoplasmosis in newborns. Materials and methods: We conducted a descriptive study of a case series. We evaluated a prospective cohort of patients diagnosed with gestational toxoplasmosis during three years at the Retinology Service at the Clínica Universitaria Bolivariana in Medellín. Results: Gestational toxoplasmosis was found in 23 mothers; 15 (65%) were treated during pregnancy with 3 g per day of spiramycin, eight (35%) patients were untreated. In the treated group just one newborn developed ocular toxoplasmosis (6.6%), in contrast with five (62.5%) of the eight patients who did not receive treatment. These results suggest that pregnancy treatment reduces the relative risk of ocular toxoplasmosis in the newborn by 96% (95% CI: 33 - 100%). Only two (14%) of the patients who were evaluated, had nervous system involvement related to toxoplasmosis in CT scan or cerebral ultrasound. These two patients also developed ocular pathology and were diagnosed at the time of birth, so they did not received antenatal treatment. Conclusions: A protective effect was found against the ocular involvement in patients whose mother received treatment with spiramycin (OR=0.04;95% CI: 0.00-0.67), p<0.01 (Fisher's Exact Test).

Toxoplasmose gestacional: uma revisão / Gestational toxoplasmosis: a review

A toxoplasmose é uma das infecções parasitárias mais comuns em humanos e possui ampla distribuição geográfica. Segundo estudos realizados no Brasil, a soroprevalência de toxoplasmose na população adulta em geral varia aproximadamente entre 40% e 80%, sendo que, no Rio Grande do Sul, cerca de 82% da população adulta apresenta sorologia positiva para o Toxoplasma gondii. A soroprevalência varia conforme as regiões de estudo, sobretudo quando relacionadas a condições sanitárias e índices socioeconômicos. O objetivo deste estudo foi realizar uma revisão bibliográfica sobre a toxoplasmose adquirida durante a gestação. A transmissão vertical apresenta relevância pelos danos causados ao neonato, como doença severa ou discreta. Entretanto, a toxoplasmose congênita ou suas sequelas podem ser evitadas. Definir os fatores de risco em cada população é de fundamental importância para determinar as estratégias de promoção à saúde. Estratégias essas que devem ser baseadas no conhecimento dos fatores que afetam o comportamento das gestantes. Oportunizar palestras de prevenção por meio de medidas profiláticas e acompanhamento pré-natal, seguidas de monitoramento trimestral, certamente ajudarão a reduzir os danos causados pela infecção congênita, evitando sequelas ao neonato

Prevalencia de la infección toxoplásmica en mujeres en edad fertil de Córdoba-Argentina / Prevalence of Toxoplasma infection in women of childbearing age Córdoba-Argentina

Toxoplasmosis es la infección parasitaria más difundida en el planeta. Como enfermedad tiene poca morbilidad y mortalidad y no debería plantearse como un problema en salud pública a no ser por dos situaciones: A) - las mujeres fértiles serológicamente negativas por la posibilidad de infectarse en el curso del embarazo y B) - los pacientes inmunosuprimidos. Por ser el hospital Rawson de Córdoba, el centro de mayor demanda respecto a esta parasitosis, se inició este estudio desde el año 1994 y se continuó hasta el 2010 inclusive, planteándose los siguientes objetivos: 1- Evaluar la población en riesgo de hacer toxoplasmosis en el curso del embarazo. 2- Identificar los factores de riesgo que pudieran determinar la seroconversión de la población expuesta. Se encuestaron por medio de una ficha clínico-epidemiológica en que se identifican 1200 mujeres. El único criterio de inclusión fue la edad de 15 a 35 años. Se las distribuyó en 3 grupos de 400 pacientes cada uno. En la ficha clínico-epidemiológica se indagó sobre datos demográficos, estado gestacional, hábitos alimentarios, contacto con felinos.Se observó una elevada prevalencia de toxoplasmosis, ya que 1018 (85%) encuestadas estaban previamente infectadas y 182 (15%) resultaron serológicamente negativas.

SUMMARY: Toxoplasmosis is the most widely spread parasitic infection in our planet. As a disease it shows little morbility and mortality and should not be properly viewed as a public health issue except in two cases: A) in serologically negative fertile women since they are likely to infected during their pregnancy period. B) in immunosuppressed patients. Since the Rawson Hospital of Córdoba, Argentina is the medical center with the highest demand of this parasitosis, a research study was launched in the year 1994 all through 2010 and it had two aims: 1. To evaluate the population at risk of toxoplasmosis during pregnancy. 2. To identify the risk factors that could determine seroconversion of the exposed population. 1200 women were interviewed and identified by means of a clinicalepidemiologic record. Only patients between 15 and 35 years of age were admitted to this study. The cohort was divided into 3 groups of 400 patients each group. The questionnaire of the record included information about demographic data, gestational condition, food habits and contact with felines. A high prevalence of toxoplasmosis was observed due to the fact that 1018 interviewed women (85%) had been previously infected and 182 (15%) turned out to be serologically negative. The most relevant risk factor detected was carnivorism present in 100% of all women studied. On the contrary, environmental factors (weather, geographical location) environmental hygiene and contact with home felines were not deemed to be alarming factors.

Toxoplasma seroepidemiology in women who intend to marry in Jahrom, Islamic Republic of Iran

Infection with Toxoplasma gondii during pregnancy can lead to severe fetal sequelae. This cross-sectional study aimed to determine T. gondii seropositivity among a sample of young women in Jahrom, Islamic Republic of Iran. Four hundred and three young women with a mean age of 20.3 years who presented for pre-marriage laboratory testing were entered in the study. T. gondii antibodies [IgG and IgM] were measured using ELISA. Of the 403 women, 15% were seropositive for T. gondii antibodies [13% for IgG and 2% for IgM].Seropositivity for T. gondii IgG differed according to age groups but there was no significant difference [P = 0.83]. IgM seropositivity showed the highest rate among women aged < 20 years. Many young women in Jahrom Province are susceptible to primary toxoplasmosis during pregnancy, therefore, appropriate educational programmes to improve knowledge in this population should be implemented to prevent toxoplasmosis-related congenital malformations

Profilaxis de toxoplasmosis en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos / Prophylaxis against Toxoplasma gondii disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation

Toxoplasmosis is a widely distributed zoonosis produced by the parasite T. gondii. In Chile the seroprevalence has been estimated between 20-37% in general population. Defined risk groups acquire or reactivate the infection by T. gondii in patients undergoing SOT and HSCT are: heart transplant or heart-lung with D (+) and R (-), allogeneic HSCT with R (+), HSCT with cord cells, GVHD, history of previous clinical toxoplasmosis and use of corticosteroids for prolonged periods or in high doses. Hand washing, hygiene in food handling and weekly post-transplant surveillance since day 15 post transplant for six months, are universally recommended. All patients with SOT and HSCT, regardless of risk, should receive prophylaxis with cotrimoxazole and require no another specific prophylaxis against T. gondii (A2). It is particularly important in high-risk patients who cannot receive cotrimoxazole prophylaxis establish specific alternative against T. gondii (B3).

Toxoplasmosis es una zoonosis ampliamente distribuida, producida por el parásito T. gondii. En Chile la seroprevalencia se ha estimado entre 20-37% en la población general. Se han deinido grupos de riesgo de adquirir o reactivar la infección por T. gondii en pacientes sometidos a TOS y a TPH: trasplante cardíaco o de corazón-pulmón con D (+) y R (-); TPH alogénico con R (+); TPH con células de cordón; EICH activa; antecedentes de toxoplasmosis clínica previa y uso de corticoesteroides por tiempo prolongado o en altas dosis. De manera universal son importantes el lavado de manos e higiene en manipulación de alimentos y el seguimiento periódico post-trasplante con RPC desde los 15 días, una vez por semana, durante seis meses. Todos los pacientes con TOS y TPH, independiente de su riesgo, deben recibir proilaxis universal con cotrimoxazol y no requieren otra proilaxis especíica contra T. gondii ( A2 ). Es particularmente importante que en los pacientes de alto riesgo que no puedan recibir cotrimoxazol, se establezca proilaxis alternativa especíica contra T. gondii (B3).

Seroprevalencia de toxoplasmosis en mujeres no embarazadas / Seroprevalence of Toxoplasma gondii infection in non pregnant women

El diagnóstico de toxoplasmosis en mujeres no embarazadas permite iniciar medidas preventivas y de vigilancia, para reducir la manifestación de la enfermedad y la transmisión congénita. El estudio serológico debe extenderse a embarazadas y completarse con datos epidemiológicos para establecer los principales factores de riesgo

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.

Carta de Búzios: proposta para o controle da toxoplasmose no Brasil / Letter of búzios: proposition for the control of toxoplasmosis in Brazil

Nos dias 20 e 21 de setembro de 2008, em Armação dos Búzios, Rio de Janeiro, por ocasião do Congresso Centenário do Toxoplasma, foi realizado o Primeiro Simpósio Nacional de Toxoplasmose, que reuniu profissionais que se dedicam ao estudo da toxoplasmose. Foi criada a Rede Brasileira de Toxoplasmose, com finalidade de incrementar a parceria em pesquisa e a troca de experiências assistenciais, de forma a encontrar soluções mais abrangentes, que possam beneficiar o maior número possível de brasileiros. Este documento sintetiza as preocupações desse grupo de especialistas e propõe a inclusão dos itens descritos abaixo na pauta dos órgãos oficiais.

In September 20-21, 2008, in the city of Armação dos Búzios, Rio de Janeiro, Brazil, during the Toxoplasma Centennial Congress, the First National Symposium of Toxoplasmosis was held, which congregated professionals who are dedicated to the study of toxoplasmosis. The Brazilian Network of Toxoplasmosis was created, with the aims of developing research partnership and exchanging clinical experiences, which may lead to comprehensive solutions with benefits for the largest possible number of Brazilians. This document summarizes the concerns of this group of experts, and recommends the inclusion of the items described below in the agenda of the official organizations.

Toxoplasmose e gestação: resultados perinatais e associação do teste de avidez de IgG com infecção congênita em gestantes com IgM anti-Toxoplasma gondii reagente / Toxoplasmosis and pregnancy: perinatal results and association of the IgG avidity test with congenital infection in pregnant women with positive anti-Toxoplasma gondii IgM

Objetivos: verificar os desfechos perinatais em gestantes com toxoplasmose aguda e se houve associação entre os resultados dos testes de avidez para anticorpos IgG anti-Toxoplasma gondii e a presença ou ausência de infecção fetal/neonatal. Métodos: um estudo transversal incluiu gestantes com diagnóstico sorológico de toxoplasmose apresentando IgM específica reagente, atendidas no Ambulatório de Gestação de Alto Risco da Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, no período de novembro de 2002 a novembro de 2007. Resultados do teste de avidez de IgG demonstrando índices superiores a 30% foram considerados alta avidez, enquanto valores inferiores a 30% foram considerados baixa avidez. Definiram-se como sendo de infecção fetal e/ou neonatal os casos com resultado positivo para a reação em cadeia da polimerase no líquido amniótico ou com IgM específica para toxoplasmose reagente no sangue do recém-nascido. Resultados: considerando-se todas as gestantes referidas para o ambulatório de gestação de alto risco no período estudado, a frequência de gestantes com IgM anti-Toxoplasma gondii reagente foi de 10,8% (176/1.634). A taxa de infecção congênita nessas pacientes foi de 4% (7/176). O teste de avidez de IgG foi realizado em 162 gestantes (92%), encontrando-se avidez alta em 144 (88,9%). Houve associação (p=0,003) entre avidez alta e ausência de toxoplasmose fetal/neonatal na amostra estudada, com razão de prevalência de 13,4 (intervalo de confiança [IC] 95% 2,2-86,6). O Valor preditivo positivo do teste de avidez (probabilidade de infecção congênita com avidez baixa) foi de 22% (IC 95% 6%-47%), enquanto o valor preditivo negativo (probabilidade de ausência da infecção congênita com avidez alta) foi de 98% (IC 95% 94%-99%).

Aims: To verify the perinatal outcomes in pregnant women with acute toxoplasmosis, and to determine if there was association between the results of Toxoplasma gondii-specific IgG avidity test and the presence or absence of fetal/neonatal infection. Methods: A cross-sectional study included pregnant women with serological diagnosis of acute toxoplasmosis (presenting a positive Toxoplasma gondii-specific IgM test) attended at the outpatient unit for high-risk pregnancy of the Faculty of Medicine, Federal University of Mato Grosso do Sul, Brazil, in the period from November 2002 to November 2007. Test results demonstrating IgG avidity index above 30% were considered high avidity, while values below 30% were considered low avidity. Fetal and/or neonatal infection was defined by positive result for the polymerase chain reaction in amniotic fluid, or by a positive Toxoplasma gondii-specific IgM test in the newborn?s serum. Results: Considering all pregnant women referred to the outpatient unit for high-risk pregnancy in the period of study, frequency of pregnant women with positive Toxoplasma gondii-specific IgM was 10.8% (176/1.634). The rate of congenital infection in these patients was 4% (7/176). The IgG avidity test was performed in 162 patients (92% of the 176 pregnant women with positive IgM), and the avidity was high in 144 (88.9%). There was an association (p=0.003) between high avidity and no fetal/neonatal toxoplasmosis in our sample, with a prevalence ratio of 13.4 (confidence interval [CI] 95% 2.2-86.6). The positive predictive value of the avidity test (probability of congenital infection with a low avidity) was 22% (95% 6%-47%), while the negative predictive value (probability of absence of congenital infection with a high avidity) was 98% (95% CI 94% -99%).

Avaliação de um folheto educativo abordamento o conhecimento sobre toxoplasmose / Evaluation of an educational handout on knowledge about toxoplasmosis

Aims: The study sought to determine the factors associated with prior knowledge about toxoplasmosis, and to assess what participants learned after reading an educational handout. Methods: Participants were recruited at two sites in California: a public meeting about water quality in Morro Bay; and at the Women Infants and Children?s Nutrition Program office or La Leche League meetings in Yolo County. Demographic differences between sites were compared using Fisher?s exact test, and change in knowledge before and after reading the handout using Mantel-Haenszel methodology. Results: Non-Hispanic white participants were more likely than those of Hispanic ethnicity (62% vs. 20%, respectively) to have prior knowledge about toxoplasmosis. The most common source of information was newspapers (36%). Only 16% had obtained information from medical professionals. After reading the handout, 85% of participants identified Toxoplasma gondii as a parasite and 98% identified cats as the source of oocysts. Ninety-eight percent of participants who read the handout were aware they could acquire infection from cat faeces, 94% from meat, 78% from soil or in utero, and 69% from unwashed vegetables. Fewer (59%) recognized all sources. Conclusions: Knowledge about Toxoplasma gondii increased in all areas evaluated, but gaps remained, particularly with regard to environmental sources of Toxoplasma gondii infection and clinical manifestations of disease. In addition to care in handling cat faeces/litter and avoidance of undercooked meat, healthcare providers counseling pregnant women should emphasize the importance of wearing gloves when gardening, hand washing after handling soil or meat, and rinsing fresh vegetables thoroughly before consumption.

Soroepidemiologia da toxoplasmose em estudantes de nível secundário naárea metropolitana de Guadalajara, Jalisco, México / Seroepidemiology of toxoplasmosis in high-school students in the metropolitan area of Guadalajara, Jalisco, Mexico

Aims: To determine the prevalence of specific antibodies and the associated risk factors for toxoplasmosis in students attending high-shool in Zapopan, Jalisco, Mexico. Methods: Toxoplasma gondii-specific IgG and IgM antibodies were detected by using a home-made indirect immunofluorescence antibodies test. Socio-demographic variables and risk factors were recorded. The correlation was measured by Odds Ratio (95% CI), using Chi-square or Fischer test for statistical significance. Results: Blood samples from 174 volunteer students were collected. The age range was 14 to 25 years old, and 109 (63%) were female. Prevalence of Toxoplasma gondii-specific IgG and IgM antibodies were 17.8% and 4.6%, respectively. We did not find statistically significant differences due to age or gender. From the risk factors studied, the only significant association was found between T.gondii-specific IgG antibodies and the consumption of undercooked meat. Seven out of 11 (63.6%) students who consumed undercooked meat were IgG positive, compared with 22/159 (13.8%) who did not have this habit (OR 10.8, 95%CI 2.9-40.4). Other variables were not statistically significant. Conclusions: Prevalence of Toxoplasma gondii specific IgG and IgM antibodies were 17.8% and 4.6%, respectively. Students who had consumed undercooked meat had a 10.8 times greater risk of acquiring Toxoplasma gondii infection.

Objetivos: Determinar la prevalencia de anticuerpos anti-Toxoplasma y factores de riesgo asociados para toxoplasmosis en estudiantes de bachillerato en Zapopan, Jalisco, México. Métodos: Los anticuerpos IgG e IgM anti-Toxoplasma gondii fueron determinados usando el método de inmunofluorescencia indirecta realizado en nuestro laboratorio y previamente estandarizado. Variables socio-demográficas y factores de riesgo para toxoplasmosis fueron analizados y correlacionados con la presencia de anticuerpos. La correlación fue realizada mediante razón de momios con un intervalo de confianza del 95%. Fueron utilizados Chi cuadrada ó significancia estadística de Fischer. Resultados: Fueron determinados los anticuerpos en 174 estudiantes. El rango de edad fue de 14 a 25 años y 109 (63%) correspondió al género femenino. La prevalencia de anticuerpos anti-Toxoplasma fue de 17,8% para IgG y 4,6% para IgM. No se encontraron diferencias estadísticamente significativas con relación a edad y genero. De los factores de riesgo estudiados, la asociación entre anticuerpos anti-Toxoplasma clase IgG y el consumo de carne poco cocida fue la única significativa. Siete de cada 11 (63,6%) los estudiantes que consumieron carne mal cocida IgG-positivos, en comparación con 22/159 (13,8%) que no tenían este hábito (odds ratio: 10,8, intervalo de confianza del 95%: 2,9-40,4). Otras variables no fueron estadísticamente significativas. Conclusiones: La prevalencia de anticuerpos anti-Toxoplasma clase IgG fue de 17,8% y 4,6% a IgM. Los estudiantes que consumían carne mal cocida tuvieron 10,8 veces mayor riesgo para adquirir la infección por Toxoplasma gondii.

Toxoplasmose como assunto de saúde pública na Sérvia: [revisão] / Toxoplasmosis as a public health issue in Serbia: [review]

Aims: To review the significance of toxoplasmosis as a public health issue in Serbia, and analyze the current strategies to alleviate the burden of the disease. Source of data: Relevant clinical and epidemiological reports from Serbia published since 1975. Summary of findings: Despite 50 years of continuous work on Toxoplasma gondii and toxoplasmosis in Serbia, exact data on the frequency of acute clinical disease, acute infections in pregnancy and congenital infection in the offspring are still lacking, due to the vague legal provision that toxoplasmosis is subject to reporting ?in case of epidemiological indications?. What, however, is clear is that the major Toxoplasma-induced public health issue in Serbia, like elsewhere in Europe, is congenital toxoplasmosis. Continuous monitoring of particular patient groups showed a dramatic decrease in the prevalence of infection over the past two decades, and a consequently increased proportion of women susceptible to infection in pregnancy, suggesting a potential increase in the incidence of congenital toxoplasmosis. Studies of risk factors for infection transmission have provided data to guide national health education campaigns. Conclusions: It is expected that the recent appointment of the National Reference Laboratory for Toxoplasmosis as the focal point for the collection of data from the primary level, will provide the means for accurate assessment of the measure of the problem, which is a prerequisite of an evidence-based nation-wide prevention program. In the mean time, health education of all pregnant women, focused at risk factors of major local significance, is advocated as a sound and financially sustainable option to reduce congenital toxoplasmosis.