Prevenção primária da toxoplasmose: conhecimento e atitudes de profissionais de saúde e gestantes do serviço público de Maringá, estado do Paraná / Primary prevention of toxoplasmosis: knowledge and attitudes of health professionals and pregnant women of public service of Maringa, Parana state, Brazil

Objetivos: Avaliar conhecimento e atitudes de profissionais e gestantes do serviço público de saúde sobre a toxoplasmose.Métodos: Um estudo transversal, realizado de janeiro de 2009 a janeiro de 2010 nas unidades básicas de saúde da cidade de Maringá, no Paraná, incluiu profissionais de saúde e gestantes. Dados sobre conhecimento e atitudes em relação à toxoplasmose foram coletados com questionários específicos. A estatística foi realizada pelo programa Bioestat 5.0.Resultados: O estudo incluiu 212 profissionais de saúde e 499 gestantes. Dentre os profissionais de saúde, 88,7%, apresentaram dúvidas quanto às formas evolutivas do Toxoplasma gondii que infectam o homem. Entre os médicos, 69,7%, não souberam qual a conduta a ser adotada diante de uma gestante com IgM e IgG anti-Toxoplasma gondii reagentes; 39,4% não souberam responder em qual período gestacional pode-se adquirir a toxoplasmose; e 15,1% não sabiam que orientações profiláticas devem ser dadas à gestante. Entre as gestantes, 42,08% afirmaram consumir carne crua, 13,63% afirmaram consumir leite in natura e 20,84% relataram não lavar utensílios ao trocar de alimento. Apenas 16,23% relataram ter recebido informações sobre prevenção da toxoplasmose durante a gestação.Conclusões: É urgente melhorar a capacitação de profissionais de saúde envolvidos no atendimento de gestantes em prevenção primária de toxoplasmose.

Aims: To assess knowledge and attitudes of pregnant women and professionals of public health service about toxoplasmosis.Methods: A cross-sectional study conducted from January 2009 to January 2010 in basic health units in the city of Maringa, Parana, included health professionals and pregnant women. Data on knowledge and attitudes regarding toxoplasmosis were collected using specific questionnaires. Statistical analysis was performed by the BioStat 5.0.Results: The study included 212 health professionals and 499 pregnant women. Among health professionals, 88.7% had doubts about the evolving forms of Toxoplasma gondii that infect humans. Among physicians, 69.7% did not know how to approach a pregnant woman with reactive Toxoplasma gondii-immunoglobulins M and G; 39.4% could not answer at what gestational age toxoplasmosis can be acquired, and 15.1% did not know which prevention guidelines should be given for pregnant women. Among pregnant women, 42.08% reported consuming raw meat, 13.63% reported consuming raw milk and 20.84% reported not washing utensils when switching food. Only 16.23% reported having received information about preventing toxoplasmosis during pregnancy.Conclusions: It is urgent to improve training of health professionals involved in caring for pregnant women on primary prevention of toxoplasmosis.

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.