Prevalência de toxoplasmose em gestantes atendidas em dois centros de referência em uma cidade do Nordeste, Brasil / Prevalence of toxoplasmosis in pregnant women in two reference centers in a city in Northeast Brazil

OBJETIVO: Determinar a prevalência de toxoplasmose e identificar os principais fatores associados à sororeatividade em gestantes atendidas em dois centros de referência em uma cidade do Nordeste do Brasil. MÉTODOS: Foi realizado um estudo transversal com 561 gestantes atendidas em dois centros de referência para pré-natal de alto risco em uma cidade do Nordeste do Brasil. Todas foram entrevistadas por meio de um questionário epidemiológico e foram coletadas amostras de sangue em que foram realizadas sorologia anti-Toxoplasma gondii para IgG e IgM (ELISA), teste de avidez da IgG e reação em cadeia da polimerase (PCR). A análise estatística foi realizada com o programa SPSS version 18.0 Windows, usando odds ratio e intervalo de confiança de 95%, considerando-se o nível de significância de 5%. RESULTADOS: Constatou-se sororeatividade para toxoplasmose em 437 (77,0%), susceptibilidade em 124 (22,1%) e 5 (0,9%) gestantes com infecção ativa. Não encontramos associação significativa entre sororeatividade para toxoplasmose e idade, procedência, renda, escolaridade, situação da rede de esgotos, número de gestações e idade gestacional. As variáveis com associação significativa (p≤0,05) para sororeatividade foram: multigestas (p=0,03) e convívio com cães soltos na rua (p=0,001). CONCLUSÕES: O estudo permitiu identificar uma alta sororeatividade para toxoplasmose entre as pacientes atendidas no pré-natal, assim como os fatores associados à sororeatividade, devendo ser reforçadas orientações apropriadas sobre medidas de prevenção primária e monitoramento sorológico trimestral das gestantes nesse município e outras regiões do Nordeste do Brasil. .

PURPOSE: To determine the prevalence of toxoplasmosis and to identify the main factors associated with seroreactivity in pregnant women cared for at two reference centers in a city in Northeast Brazil. METHODS: A cross-sectional study was conducted on 561 pregnant women at two high-risk prenatal reference centers in a city in Northeast Brazil. All women were interviewed using an epidemiological questionnaire and had their blood samples collected for the following serological tests: anti-Toxoplasma gondii IgG and IgM (ELISA), IgG avidity test, and polymerase chain reaction (PCR). Statistical analysis was carried out using SPSS version 18.0 for Windows, calculating odds ratio, confidence interval of 95% and with the level of significance set at 5%. RESULTS: Seroreactivity for toxoplasmosis was detected in 437 women (77.0%), susceptibility in 124 (22.1%) and active infection in 5 (0.9%). There was no significant association between seroreactivity for toxoplasmosis and age, location, income, education, availability of sewage, number of pregnancies or gestational age. The variables significantly associated (p≤0.05) with seroreactivity were multiparity (p=0.03) and living with stray dogs (p=0.01). CONCLUSIONS: This study identified high seroreactivity for toxoplasmosis among patients seen during prenatal care, as well as factors associated with seroreactivity. Appropriate guidelines about primary preventive measures should be emphasized and quarterly serological monitoring is recommended for pregnant women in this city and elsewhere in the Northeast of Brazil. .

Seroprevalence of Toxoplasma gondii IgG antibody in HIV/AIDS-infected individuals in Maputo, Mozambique / Seroprevalencia de IgG anti- Toxoplasma gondii en personas infectadas por el VIH/SIDA Maputo, Mozambique / Soroprevalência de IgG anti- Toxoplasma gondii em pessoas infectadas pelo HIV/Aids em Maputo, Moçambique

OBJECTIVE To analyze the prevalence of IgG antibodies to Toxoplasma gondii in patients infected with HIV/AIDS and the association of demographic and social variables. METHODS Descriptive cross-sectional study that included the analysis of sociodemographic data and laboratory findings of 200 patients infected with HIV/AIDS treated in a laboratory unit in Maputo, Mozambique, in 2010. Individual data for all participants were collected with a self-administered questionnaire. Plasma samples were tested for IgG testing of anti- T. gondii using hemagglutination for the analysis of antibodies. RESULTS The seroprevalence of IgG anti- T. gondii was 46.0% (95%CI 39.2;52.9), 39.3% (95%CI 29.5;50.0) in men and 50.9% (95%CI 41.9;59.8) in women, with no difference between sex (OR 1.30; 95%CI 0.95;1.77; p = 0.12). Ages ranged from 10 to 60 years, with a higher prevalence of infection in older age groups, but with no significant difference between them. Regularly consuming cattle meat (OR 1.74; 95%CI 1.04;2.89, p = 0.05), breeding cats/dogs (OR 6.18; 95%CI 3.60;10.62, p < 0.000) and having regular contact with soil (OR 3.38; 95%CI 2.19;5.21; p < 0.000) were significantly associated with risk of latent infection. CONCLUSIONS Toxoplasmosis is an infection with high prevalence in Mozambique. Cultural and behavioral aspects increase the risk. Toxoplasmosis can be responsible in our environment by the great burden of morbidity and mortality associated with meningoencephalic injuries in patients with HIV/AIDS. .

OBJETIVO Evaluar la prevalencia de anticuerpos IgG anti- Toxoplasma gondii en personas infectadas por VIH/SIDA y la asociación de variables demográficas y sociales. MÉTODOS Estudio transversal que incluyó el análisis de datos sociodemográficos y de laboratorio de 200 personas infectadas por VIH/SIDA, atendidas en unidad de laboratorio en 2010 en la Provincia de Maputo, Mozambique. Los datos fueron colectados por medio de cuestionario auto llenado por todos los participantes. Para el análisis de anticuerpos, las muestras de plasma colectadas fueron confirmadas para evaluación anti- T. gondii por hemaglutinación. RESULTADOS La seroprevalencia de IgG anti- T. gondii fue de 46% (IC95% 39,2;52,9), 39,3% (IC95% 29,5;50,0) en hombres y de 50,9% (41,9-59,8%) en mujeres, sin diferencia entre sexo (OR 1.30; IC95% 0.95;1.77; p = 0.12). La edad varió de 10 a 60 años, con mayor prevalencia de infección en grupos etarios más ancianos, pero sin haber diferencia significativa entre ellos. Consumir carne de ganado bovino regularmente (OR 1,74; IC95% 1,04;2,89, p = 0,05), poseer cria de gatos/perros (OR 6,18; IC95% 3,60;10,62, p < 0,000) y tener contacto regular con la tierra (OR 3,38; IC95% 2,19;5,21, p < 0,000) estuvieron significativamente asociados al riesgo de infección latente. CONCLUSIONES La infección por toxoplasmosis presenta alta prevalencia en la población de Mozambique, cuyo riesgo se amplía por los aspectos culturales y de comportamiento. La toxoplasmosis puede ser responsable por la gran carga de morbi-mortalidad asociada a lesiones meningoencefálicas en personas con VIH/SIDA en el país. .

OBJETIVO Avaliar a prevalência de anticorpos IgG anti- Toxoplasma gondii em pessoas infectadas pelo HIV/Aids e a associação de variáveis demográficas e sociais. MÉTODOS Estudo transversal que incluiu a análise de dados sociodemográficos e laboratoriais de 200 pessoas infectadas por HIV/Aids, atendidas em unidade laboratorial em 2010 na Província de Maputo, Moçambique. Os dados foram coletados por meio de questionário autopreenchido por todos os participantes. Para a análise de anticorpos, amostras de plasma coletadas foram confirmadas para testagem de IgG anti- T. gondii por hemaglutinação. RESULTADOS A soroprevalência de IgG anti- T. gondii foi de 46,0% (IC95% 39,2;52,9), 39,3% (IC95% 29,5;50,0) em homens e de 50,9% (IC95% 41,9;59,8) em mulheres, sem diferença entre sexo (OR 1.30; IC95% 0.95;1.77; p = 0.12). A idade variou de 10 a 60 anos, com maior prevalência de infecção em grupos etários mais idosos, mas sem haver diferença significativa entre eles. Ter consumo regular de carne de gado bovino (OR 1,74; IC95% 1,04;2,89, p = 0,05), possuir criação de gatos/cães (OR 6,18; IC95% 3,60;10,62, p < 0,000) e ter contato regular com a terra (OR 3,38; IC95% 2,19;5,21, p < 0,000) estiveram significativamente associados ao risco de infecção latente. CONCLUSÕES A infecção por toxoplasmose apresenta alta prevalência na população de Moçambique, cujo risco amplia-se pelos aspectos culturais e comportamentais. A toxoplasmose pode ser responsável pela grande carga de morbimortalidade associada a lesões meningoencefálicas em pessoas com HIV/Aids no país. .

Avaliação comparativa entre o desempenho dos reagentes paratoxoplasmose AxSYM, VIDAS e VIDIA em um país latinoamericano com alta soroprevalência / Comparative evaluation of AxSYM, VIDAS and VIDIA toxoplasmosis reagent performance in a high seroprevalence Latin American country

Aims: The purpose of this study was to compare the performance of three automated immunoassays for the detection of IgM and IgG Toxoplasma gondii antibodies using sera of pregnant women living in Colombia, a Latin American country with a high seroprevalence. Methods: A total of 905 sera were tested for IgM antibodies and 914 for IgG antibodies with AxSYM, VIDAS and VIDIA immunoassays. Discrepancies were resolved by using the dye test for IgG antibodies, and the ISAGA test for IgM. Results: The overall agreement between AxSYM, VIDAS and VIDIA assays was excellent for detection of IgG and IgM antibodies, and discrepancies were relatively rare (3.6% and 5.5% of sera for IgG and IgM antibodies, respectively). The performance of the three immunoassays was similar for the detection of IgG antibodies with high sensitivity (100.00% for VIDIA, 99.59% for VIDAS, 99.38% for AxSYM) and specificity (99.04% for VIDIA, 98.82% for AxSYM, 98.57% for VIDAS). The specificity for IgM antibodies was excellent for the three immunassays (99.88% for VIDIA, 99.76% for AxSYM and VIDAS). The sensitivity of the detection of IgM antibodies was higher with VIDIA (95.12%) than with VIDAS (76.74%) and AxSYM (61.90%) assays. The correlation between IgG titers was limited between AxSYM and VIDAS assays and between AxSYM and VIDIA assays, but was excellent between VIDIA and VIDAS assays. Conclusions: Our study performed with Latin American sera confirmed the excellent specificity of AxSYM, VIDAS and VIDIA assays for the detection of IgG and IgM antibodies already reported in other countries. The sensitivity of the detection of IgG antibodies was slightly higher with VIDIA than with VIDAS and AxSYM assays. The sensitivity of the detection of IgM antibodies was higher with VIDIA than with VIDAS and AxSYM assays.

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%).

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.

Inquérito soroepidemiológico para toxoplasmose e avaliação dos condicionantes para sua transmissão em universitários de Campo Grande, Mato Grosso do Sul / Seroepidemiological survey of toxoplasmosis and evaluation of theconditioning factors for its transmission in undergraduate students fromCampo Grande, Mato Grosso do Sul State, Brazil

Objetivos: avaliar, por meio de inquérito soroepidemiológico, a ocorrência da infecção pelo Toxoplasma gondii em universitários dos cursos de Enfermagem e Ciências Biológicas da Universidade Anhanguera ? UNIDERP, Campo Grande, Mato Grosso do Sul. Métodos: as amostras de soro foram submetidas ao teste de ELISA de fase sólida para determinação dos anticorpos específicos IgM e IgG contra Toxoplasma gondii. Os dados foram correlacionados a fatores sociodemográficos e hábitos que poderiam ter influenciado na transmissão da infecção. Resultados: entre os 100 universitários estudados, 39% (39/100) apresentaram-se IgG reagentes para toxoplasmose (intervalo de confiança [IC] 95%: 29,4%-48,6%) e nenhum IgM reagente. Observou-se associação estatisticamente significativa entre a presença de gatos em domicílio e a positividade para toxoplasmose. Entre os acadêmicos soro reagentes, 72,97%(IC 95%: 58,7%-87,3%) declararam possuir ou ter possuído gatos em domicílio, enquanto que entre os soronegativos para toxoplasmose, 50% (IC 95%: 36,9%-63,1%) relatavam possuir ou ter possuído gatos. Com relação aos fatores de risco alimentares (ingestão de carne crua/mal cozida, legumes crus, leite cru e ovo cru), não foi detectada associação com a infecção por Toxoplasma gondii. A frequência de indivíduos soro reagentes foi significativamente maior na faixa etária acima dos 25 anos (p=0,01). Conclusões: a ocorrência de anticorpos anti-Toxoplasma gondii foi relativamente baixa em relação à prevalência média encontrada em diferentes amostras populacionais do Brasil. O fator de risco identificado como provável responsável pela infecção foi a presença de gatos no domicílio. A prevalência de soropositividade para toxoplasmose foi maior na faixa etária acima dos 25 anos.

Aims: To evaluate, by means of a seroepidemiological survey, the occurrence of Toxoplasma gondii infection in undergraduate students of Nursing and Biological Sciences from the Anhanguera ? UNIDERP University, in Campo Grande, Mato Grosso do Sul State. Methods: Serum samples were tested with solid phase ELISA for determination of specific IgM and IgG antibodies against Toxoplasma gondii. The data were correlated to sociodemographic factors and habits that might have influenced the transmission of infection. Results: Among the 100 students studied, 39% (39/100) were IgG reagent for toxoplasmosis (confidence interval [CI) 95%: 29.4%-48.6%) and none were IgM reagent. A statistically significant association between the presence of cats at home and positivity for toxoplasmosis was found. Among serum reagent academics, 72.97% (95% CI: 58.7%-87.3%) reported owning or having owned cats in the home, while among the seronegative for toxoplasmosis, 50% (CI 95%: 36.9%-63.1%) reported owning or having owned cats. With respect to alimentary risk factors (eating of raw/undercooked meat, raw vegetables, raw milk and raw egg), no association was found with Toxoplasma gondii infection. The frequency of serum reactive individuals was significantly higher in the age group above 25 years (p=0.01). Conclusions: The occurrence of anti-Toxoplasma gondii specific antibodies was relatively low when compared to the average prevalence found in different population samples from Brazil. Presence of cats at home was the risk factor identified as likely responsible for the infection. The prevalence of seropositivity for toxoplasmosis was higher in the age group above 25 years.

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.