Revisión sistemática de la exactitud diagnóstica de la gota gruesa en comparación con la reacción en cadena de la polimerasa para malaria asociada al embarazo, 2010-2022 / Systematic review of the diagnostic accuracy of thick smear compared to polymerase chain reaction for pregnancy-associated malaria, 2010-2022

RESUMEN Objetivos. Evaluar la exactitud de gota gruesa (GG) frente a la reacción en cadena de la polimerasa (PCR) cuantitativa para la malaria asociada al embarazo (MAE). Materiales y métodos. Se realizó una revisión sistemática de pruebas diagnósticas en nueve bases de datos. Se evaluó la calidad metodológica con QUADAS. Se estimó sensibilidad, especificidad, cociente de probabilidad positivo (CPP) y negativo (CPN), razón de odds diagnóstica (ORD) y área bajo la curva ROC. Se determinó la heterogeneidad con el estadístico Q de Der Simonian-Laird y la incertidumbre con el porcentaje de peso de cada estudio sobre el resultado global. Resultados. Se incluyeron diez estudios con 5691 gestantes, 1415 placentas y 84 neonatos. En los estudios con nPCR (PCR anidada) y qPCR (PCR cuantitativa) como estándar, los resultados de exactitud diagnóstica fueron estadísticamente similares, con sensibilidad muy baja (50 y 54%, respectivamente), alta especificidad (99% en ambos casos), alto CPP y deficiente CPN. Usando nPCR la OR diagnóstica fue 162 (IC95%=66-401) y el área bajo la curva ROC fue 95%, mientras que con qPCR fueron 231 (IC95%=27-1951) y 78%, respectivamente. Conclusiones. Mediante un protocolo exhaustivo se demostró el bajo desarrollo de investigaciones sobre la exactitud diagnóstica de la GG en MAE. Se demostró que la microscopía tiene un desempeño deficiente para el diagnóstico de infecciones asintomáticas o de baja parasitemia, lo que afianza la importancia de implementar otro tipo de técnicas en el seguimiento y control de las infecciones por malaria en las gestantes, con el fin de lograr el control y posible eliminación de la MAE.

ABSTRACT Objective. To evaluate the accuracy of thick smear (TS) versus quantitative polymerase chain reaction (PCR) for pregnancy-associated malaria (PAM). Materials and methods. We carried out a systematic review of diagnostic tests in nine databases. Methodological quality was evaluated with QUADAS. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the ROC curve were estimated. Heterogeneity was determined with the Der Simonian-Laird Q method and uncertainty with the weighted percentage of each study on the overall result. Results. We included 10 studies with 5691 pregnant women, 1415 placentas and 84 neonates. In the studies with nested PCR (nPCR) and quantitative PCR (qPCR) as the standard, the diagnostic accuracy results were statistically similar, with very low sensitivity (50 and 54%, respectively), high specificity (99% in both cases), high PLR and poor NLR. When nPCR was used, the DOR was 162 (95%CI=66-401) and the area under the ROC curve was 95%, while with qPCR it was 231 (95%CI=27-1951) and 78%, respectively. Conclusions. We demonstrated that research on the diagnostic accuracy of TS in PAM is limited. Microscopy showed poor performance in the diagnosis of asymptomatic or low parasitemia infections, which reinforces the importance of implementing other types of techniques for the follow-up and control of malaria infections in pregnant women, in order to achieve the control and possible elimination of PAM.

Toxoplasmosis in pregnancy: a clinical, diagnostic, and epidemiological study in a referral hospital in Rio de Janeiro, Brazil

ABSTRACT Toxoplasmosis in pregnant women can cause significant morbidity and mortality in the fetus, which may be mitigated by early diagnosis and treatment. Social factors have also been related to the risk of developing the congenital form of toxoplasmosis, since some of these factors interfere directly in the quality of prenatal care. This study aimed to describe the clinical, laboratory, and epidemiological data of pregnant women diagnosed with toxoplasmosis and their newborns followed up at a referral hospital in Rio de Janeiro, Brazil. This was descriptive cohort study of 334 pregnant women with toxoplasmosis followed from May 2014 to December 2017. We conducted interviews to assess knowledge about the disease and its preventive measures, analyzed clinical and laboratory data during antenatal visits, and collected data from the newborns' medical charts. Results: This was a predominantly low-income women cohort study, with little schooling, mainly referred from public health services late in pregnancy (178; 53.3%), in the second and third trimesters (286; 85.6%). Diagnosis of acute toxoplasmosis had not been confirmed in 171 cases (51.2%). Out of 183 (54.9%) women who had initiated treatment at the original health services, 45 (24.6%) received an incorrect prescription. Seventy-two amniocenteses were performed, with positive real-time polymerase chain reaction (qPCR) in the amniotic fluid in two cases (2.8%). Congenital toxoplasmosis at birth was identified in eight newborns (5.4%). Conclusion: Late referral to specialized medical services, inadequate toxoplasmosis management at the original prenatal care services, and social vulnerabilities are contributing factors to the persistent occurrence of congenital toxoplasmosis cases.

Malaria congénita por Plasmodium falciparum / Congenital malaria by Plasmodium falciparum

INTRODUCCIÓN: La malaria congénita (MC) es la infección por Plasmodium spp adquirida in útero o durante el parto y sus manifestaciones clínicas son inespecíficas. Puede causar enfermedad grave en la embaraza da y en el recién nacido. OBJETIVO: describir dos casos de MC causados por Plasmodium falciparum, diagnóstico diferencial de sepsis en recién nacidos de gestantes que hayan visitado o residan en áreas endémicas para malaria. CASOS CLÍNICOS: Neonatos de sexo femenino, nacidos en área no endémica para malaria, diagnosticados con sepsis neonatal y tratados con antibióticos sin respuesta clínica. Después de la primera semana de vida la gota gruesa identificó trofozoítos de Plasmodium falciparum y los neonatos recibieron tratamiento con quinina intravenosa con mejoría. Las madres de las recién nacidas tuvieron malaria en el embarazo, una de ellas recibió tratamiento y estaba asintomática y otra tenía malaria complicada al momento del parto. CONCLUSIONES: La MC puede causar enfermedad neonatal grave con manifestaciones clínicas inespecíficas y similares a la sepsis, el tratamiento oportuno disminuye el riesgo de malaria complicada. Es un diagnóstico diferencial en recién nacidos de mujeres con malaria durante el embarazo o gestantes que visiten o residan en áreas endémicas.

INTRODUCTION: Congenital malaria (CM) is a Plasmodium spp infection acquired in utero or during delivery with nonspecific clinical manifestations. Plasmodium falciparum can cause severe illness in pregnant wo men and newborns. OBJECTIVE: to describe two cases of CM caused by Plasmodium falciparum, di fferential diagnosis of sepsis in newborns of pregnant women who live in or have visited endemic malaria zones. CLINICAL CASES: Female neonates born in a non-endemic malaria area, diagnosed with neonatal sepsis and treated with antibiotics without clinical response. After the first week of life, the peripheral blood smear identified trophozoites of Plasmodium falciparum thus the newborns were treated with intravenous quinine, improving their condition. The mothers of the two newborns who had malaria in pregnancy, one of them received treatment and she was asymptomatic, and the other one had severe malaria at the time of delivery. CONCLUSIONS: CM can cause severe neonatal disease with non-specific, sepsis-like clinical manifestations in which early treatment decreases the risk of complicated malaria. It is a differential diagnosis in newborns of women with a history of malaria during pregnancy or pregnant women visiting or living in endemic malaria areas.

Seroprevalence of toxoplasmosis in pregnant women and its associated factors among hospital and community populations in Lambayeque, Peru

Abstract INTRODUCTION Toxoplasmosis is a zoonosis caused by Toxoplasma gondii. This study investigated the prevalence and factors associated with toxoplasmosis among pregnant women. METHODS We followed an analytical observational study. From July 2016 to June 2017, 218 pregnant women were selected. The infection was detected through serological dosage of anti-T.gondii Immunoglobulin(Ig) M and IgG antibodies. RESULTS The seroprevalence was 35.8%; the factors associated with infection were consumption of non-drinking water, residence in an urban area, and threatened abortion during the current pregnancy. CONCLUSIONS The seroprevalence of toxoplasmosis among pregnant women is high. The risk factors are dependent on environmental determinants.

Visceral leishmaniasis in pregnant women from Rio Grande do Norte, Brazil: A case report and literature review

Abstract Visceral leishmaniasis (VL) in pregnant is considered rare. We present the case of a woman with 24 gestational weeks presenting fever, hepatosplenomegaly, pancytopenia, and inversion of albumin/globulin ratio. Anti-rK39 was positive and amastigotes were visualized on myelogram. Treatment with LAmB showed disease improvement. The newborn was born healthy at term, with delivery performed without complications. As VL in pregnancy can progress to death and complications for the mother-fetus binomial, inclusion of VL in the differential diagnosis of patients from endemic areas with compatible clinical picture is mandatory. Treatment with LAmB demonstrates safety and high cure rates in pregnancy.

Frequency and factors associated with Toxoplasma gondii infection in pregnant women and their pets in Ilhéus, Bahia, Brazil

Abstract INTRODUCTION: Toxoplasmosis is an asymptomatic disease that can lead to systemic disease in the fetus of pregnant women with primary infection. This study aimed to determine the prevalence of toxoplasmosis, associated factors, and correlation between the serology of pregnant women and their pets, in the municipality of Ilhéus, Bahia, Brazil. METHODS: This cross-sectional study was conducted in 196 pregnant women and their cats or dogs (n=89). Semi-structured interviews were conducted and serum samples from the pregnant women were tested to detect IgM and IgG antibodies against Toxoplasma gondii, and avidity tests were performed for IgM-positive samples. The serum collected from pets were tested for IgG antibodies, and IgM antibodies in cats. A non-conditional logistic regression analysis was performed to identify infection-associated factors. RESULTS: IgG and IgM antibodies were detected in 67.9% (133/196) and 1.5% (3/196) samples, respectively, for women with an avidity of over 60%. Age ≥ 25 and the presence of cats in the vicinity were found to be associated with infection, while the level of education and previous orientation toward prevention of toxoplasmosis were protective factors in pregnant women. IgG antibodies were detected in 46.1% (41/89) of the animals, and cats were found to be negative for IgM. For the animals, age ≥ 1 year was a factor associated with infection. There was no correlation between serology of the pregnant women and the animals (p=0.15). CONCLUSIONS: An elevated prevalence of toxoplasmosis was detected in the region. Therefore, the adoption of preventive measures by public healthcare bodies is recommended.

Epidemiological factors associated with Toxoplasma gondii infection in postpartum women treated in the public healthcare system of Goiânia, State of Goiás, Brazil

Abstract INTRODUCTION: Knowledge of the epidemiological profile and risk factors for Toxoplasma gondii infection among postpartum women is a relevant issue, because this protozoan can be vertically transmitted to the developing fetus, which can cause severe and debilitating disease. The aim of this study was to assess the risk factors associated with T. gondii infection in postpartum women in Goiânia, GO, Brazil. METHODS: This cross-sectional study comprised 229 postpartum women, among whom 204 were chronically infected (IgG+/IgM-), and 25 were seronegative (IgG-/IgM-; control group). All the patients were asked to complete a form to provide sociodemographic, clinical, dietary, and cultural information. The data were analyzed to compare seropositivity and risk factors based on the odds ratio (OR) thereof. RESULTS: The sociodemographic characteristics associated with the risk for toxoplasmosis were: education ≤ 8 years [OR: 2.521, confidence interval (CI): 1.01-6.301, p=0.049], and age ≥ 30 years (OR: 4.090; CI: 1.180-14.112, p=0.023). Clinical and behavioral characteristics related to eating raw and undercooked meat, were not found to be risk factors associated with a positive test for toxoplasmosis. CONCLUSIONS: Our findings concur with the results of other studies conducted in Brazil and abroad, where variables such as low levels of schooling, and advanced age (≥ 30 years) are major risk factors for pregnant women to become infected with T. gondii.

Toxoplasmosis congénita: Diagnóstico serológico, RPC, aislamiento y caracterización molecular de Toxoplasma gondii / Congenital toxoplasmosis: Serology, PCR, parasite isolation and molecular characterization of Toxoplasma gondii

Resumen Introducción El diagnóstico de toxoplasmosis congénita (TC) en el recién nacido es muy importante porque debe recibir tratamiento siempre, sintomático o no, para evitar o aminorar las secuelas de la enfermedad. Objetivo Evaluación comparativa de los métodos disponibles en la institución para el diagnóstico de TC. Materiales y Métodos Se evaluaron métodos diagnósticos en 67 niños cuyas madres cursaron toxoplasmosis aguda durante el embarazo. Se utilizó la técnica de Sabin Feldman para IgG al nacimiento y durante el seguimiento serológico hasta el año de vida. Para determinar IgM, IgA e IgE se utilizó la técnica immunosorbent agglutination assay (ISAGA). El diagnóstico directo se realizó por reacción de polimerasa en cadena (RPC), aislamiento y caracterización molecular del parásito. Resultados La sensibilidad (S) de ISAGA IgM fue 87%, ISAGA IgA 91% y la especificidad (E) fue 100% para ambas; cuando se realizaron en conjunto, la S aumentó a 98%. La detección de IgE contribuyó al diagnóstico cuando se la detectó sólo en la sangre del neonato y no en sangre materna. Se aisló el parásito en cuatro casos de TC, uno fue genotipo II y los otros tres, genotipos "atípicos". La S del aislamiento fue 80% y la E 100%. Conclusión Los métodos serológicos utilizados mostraron una buena eficacia diagnóstica. Un caso fue detectado sólo por el aislamiento y la caracterización molecular tiene gran valor epidemiológico.

Background. Congenital toxoplasmosis diagnosis in the newborn is a very important issue due to the need for early treatment to prevent future sequels. Aim To compare available methods at the institution for the diagnosis of congenital toxoplasmosis. Material and Methods In this study we have evaluated the different diagnostic tests used in 67 congenital exposed newborns, including serological tests, PCR, parasite isolation and molecular characterization. Results The ISAGA IgM and IgA tests showed sensitivity (Se) of 87 and 91%, respectively, and specificity (Sp) of 100%. When ISAGA IgM and IgA were performed simultaneously, the Se increased to 98% and the Sp was 100%. The presence of IgE contributed to the diagnosis when it was detected in the child's serum but not in maternal blood. In four congenital infected children the parasite was isolated and genotyped: one was genotype II and the other three were "atypical" genotypes. No parasite was isolated in children without congenital toxoplasmosis. Discussion Overall, serological tests showed a good diagnostic performance although in one case they were all negative and isolation was the only tool to identify the infection. We conclude that it is essential to use all diagnostic tests in every single exposed child, including if possible, molecular characterization due to its epidemiological implication.

Appraisal of prenatal anti-Toxoplasma gondii [IGG+IGM]-IHA/IGM-Elisa screening in single samples VIA IGG Avidity test

Congenital toxoplasmosis is associated with important morbidity and mortality. Since vertical transmission of Toxoplasma gondii can occur in acute cases, antenatal screening for recent infections is vital. Accurate determination of acute toxoplasmosis requires a combination of immunoassays, usually not routinely applied for screening purposes. This study evaluated the anti-T. gondii [IgG+IgM]/IgM prenatal screening procedure by IgG avidity assay

The routine prenatal screening for [IgG+IgM] anti-T. gondii by indirect hemagglutination [IHA] in serum samples was done of 2247 pregnant women who attended two hospitals between 2011 and 2013 revealed 487 [21.7%] positive samples. Examination of IHA-positive sera by IgM and IgG/IgG-avidity concurrent ELISA tests revealed 7 positive and 3 border-line IgM-ELISA titers during the initial check-up of 10 women, who were then followed up at 3-4 week-intervals. Among these, 4 [40%] showed simultaneous high avidity IgG antibodies, indicating distant infection by the parasite, and no anti-T. gondii specific IgG could be detected in follow-up sera of two cases [20%], indicating false IgM initial positive results. Only 4 [40%] women showed simultaneous IgM and low avidity IgG antibodies indicating active infections. Avoidance of an overdiagnosis of acute toxoplasmosis Anti-T. gondii [IgG+IgM]/IgM prenatal screening must be supplemented by a discriminative test like IgG avidity ELISA

Evaluation of a recombinant rhoptry protein 2 enzyme-linked immunoassay for the diagnosis of toxoplasmosis acquired during pregnancy

The aim of this study was to evaluate an enzyme-linked immunoassay with recombinant rhoptry protein 2 (ELISA-rROP2) for its ability to detectToxoplasma gondii ROP2-specific IgG in samples from pregnant women. The study included 236 samples that were divided into groups according to serological screening profiles for toxoplasmosis: unexposed (n = 65), probable acute infection (n = 48), possible acute infection (n = 58) and exposed to the parasite (n = 65). When an indirect immunofluorescence assay forT. gondii-specific IgG was considered as a reference test, the ELISA-rROP2 had a sensitivity of 61.8%, specificity of 62.8%, predictive positive value of 76.6% and predictive negative value of 45.4% (p = 0.0002). The ELISA-rROP2 reacted with 62.5% of the samples from pregnant women with probable acute infection and 40% of the samples from pregnant women with previous exposure (p = 0.0180). Seropositivity was observed in 50/57 (87.7%) pregnant women with possible infection. The results underscored that T. gondii rROP2 is recognised by specific IgG antibodies in both the acute and chronic phases of toxoplasmosis acquired during pregnancy. However, the sensitivity of the ELISA-rROP2 was higher in the pregnant women with probable and possible acute infections and IgM reactivity.

Malaria in pregnant women living in areas of low transmission on the southeast Brazilian Coast: molecular diagnosis and humoural immunity profile

Studies on autochthonous malaria in low-transmission areas in Brazil have acquired epidemiological relevance because they suggest continued transmission in what remains of the Atlantic Forest. In the southeastern portion of the state of São Paulo, outbreaks in the municipality of Juquitiba have been the focus of studies on the prevalence of Plasmodium, including asymptomatic cases. Data on the occurrence of the disease or the presence of antiplasmodial antibodies in pregnant women from this region have not previously been described. Although Plasmodium falciparum in pregnant women has been widely addressed in the literature, the interaction of Plasmodium vivax and Plasmodium malariae with this cohort has been poorly explored to date. We monitored the circulation of Plasmodium in pregnant women in health facilities located in Juquitiba using thick blood film and molecular protocols, as well as immunological assays, to evaluate humoural immune parameters. Through real-time and nested polymerase chain reaction, P. vivax and P. malariae were detected for the first time in pregnant women, with a positivity of 5.6%. Immunoassays revealed the presence of IgG antibodies: 44% for ELISA-Pv, 38.4% for SD-Bioline-Pv and 18.4% for indirect immunofluorescence assay-Pm. The high prevalence of antibodies showed significant exposure of this population to Plasmodium. In regions with similar profiles, testing for a malaria diagnosis might be indicated in prenatal care.

Toxoplasmosis-rllated knowledge among pregnant nd postpartum women attended inn public health units in niterói, rio de janeiro, Braill / Conhecimento sobre toxoplasmose entre gestantes e puérperas atendidas na rede pública de saúde do município de Niterói, Rio de Janeiro, Brasil

The present study conducted a toxoplasmosis-related knowledge level survey with 400 pregnant and puerperal women attended in public health units in the municipality of Niterói, Rio de Janeiro. Only 111 (27.8%) women claimed to know about the disease. Most of them (n = 289; 72.2%) had never heard about toxoplasmosis nor knew how to prevent the infection by Toxoplasma gondii. A significant difference (p = 0.013) regarding the presence of anti-T. gondii IgG was observed between women who claimed to know about the disease and those who had never heard about it. These results highlight the importance of a systematic serological screening process for toxoplasmosis, as well as the importance of primary prevention by accurate information during prenatal care, an important Public Health action to be implemented.

Este estudo teve por objetivo realizar um levantamento do conhecimento de 400 gestantes e puérperas atendidas na rede pública de saúde do município de Niterói, Estado do Rio de Janeiro sobre a toxoplasmose. Apenas 111 (27,8%) participantes relataram conhecer a doença. A maioria 289 (72,2%) nunca ouviu falar sobre a toxoplasmose, principalmente sobre as formas de prevenção da infecção pelo Toxoplasma gondii. Foi encontrada diferença significativa entre as pacientes que disseram conhecer a toxoplasmose e aquelas que relataram desconhecer a doença com relação à presença de anticorpos IgG anti- T.gondii (p = 0,013). Estes resultados permitem ressaltar a importância do rastreamento sorológico sistemático na infecção toxoplásmica, bem como a prevenção primária por meio de informações corretas durante o pré-natal, sendo esta uma importante medida de saúde pública a ser implementada.

Epidemiological factors associated with seropositivity for toxoplasmosis in pregnant women from Gurupi, State of Tocantins, Brazil

Introduction Knowledge of the prevalence and risk factors for Toxoplasma gondii dissemination among pregnant women is relevant because the parasite can be spread from mother to infant. The objective of this study was to assess the epidemiology and risk factors of toxoplasmosis in pregnant women from Gurupi, State of Tocantins, Brazil, from February 2012 to June 2013. Methods The study population included 487 pregnant women. Sociodemographic, dietary and cultural data were collected using a standardized and validated form. Peripheral blood was collected for serologic testing using the ELISA test (IgM/IgG antibodies). The data were analyzed by comparing seropositivity with risk factors using crude and adjusted odds ratios. Results The prevalence rate for IgG and IgM antibodies was 68.7% and 5.7%, respectively. Sociodemographic characteristics associated with toxoplasmosis risk included the following: education level ≤ 8 years (OR: 6.612; CI: 1.450-30.144), age ≥ 30 years (OR: 5.273; CI: 1.166-23.844), working outside the home (OR: 1.604; CI: 1.015-2.536), and family income of two minimum wages or lower (OR: 2.700; CI: 1.891-8.182). Regarding dietary habits, there was a significant association of seropositivity with meat intake (OR: 1.78; CI: 1.149-4.080), cutting vegetables without washing the cutting board beforehand (OR: 2.051; CI: 1.165-3.614), frequent intake of vegetables (OR: 2.051; CI: 1.368-3.006) and in natura milk intake (OR: 2.422; CI: 1.014-5.785). Conclusions The high prevalence rates of toxoplasmosis in Gurupi are related to age, raw meat and in natura milk intake, as well as education level, working outside the home, and poor hygienic habits during meal preparation. .

Comparison of two assays in the diagnosis of toxoplasmosis: immunological and molecular

Serological tests for Toxoplasma gondii are inadequate because antibody production either fails or is significantly delayed. This study in eastern Iraq investigated the IgG-avidity ELISA test for detecting recent T. gondii infections among pregnant women and compared immunological methods and PCR as molecular assays in the diagnosis of T. gondii. Serums samples were taken from 130 pregnant women at risk of toxoplasmosis and a control group of 25 women with normal pregnancy. Of 50 IgM- and/or IgG-positive samples, only 15 showed low IgG-avidity antibodies. PCR was performed on 25 selected samples. Toxoplasma DNA was detected in 15/15 IgM-positive with low IgG-avidity and 1/3 IgM-positive with high IgG-avidity. None of the IgM-negative with high IgG-avidity showed any Toxoplasma DNA. ELISA IgG-avidity when used in combination with ELISA IgG/IgM is a valuable assay for the exclusion of ongoing or recently acquired T. gondii infection in pregnant women

Gestational toxoplasmosis in Paraná State, Brazil: prevalence of IgG antibodies and associated risk factors

The aim of the present study was to verify the association between seropositivity for IgG anti-Toxoplasma gondii antibodies and social, economic and environmental variables of pregnant women attending the public health centers of Paraná, Brazil. From January 2007 to July 2010, 2226 pregnant women were interviewed and detection of anti-T. gondii specific IgG and IgM antibodies was performed by chemiluminescence test. Seropositivity for anti-T. gondii IgG was observed in 1151 (51.7%) pregnant women, 29 of which (1.3%) presented IgM reagent with IgG of high avidity. The variables associated with the presence of IgG were residency in the rural area, more than one pregnancy, less than or equal to eight years schooling, low per capita income, age group, raw or poorly cooked meat ingestion, and contact with the soil. There was neither association with raw fruit and vegetable ingestion nor with the presence of cats in the residencies.

Prevención de la toxoplasmosis congénita en un hospital de Buenos Aires / Prevention of congenital toxoplasmosis in a Buenos Aires hospital

La prevención de la toxoplasmosis congénita se basa en la información de la mujer con medidas de prevención primaria, el diagnóstico serológico y el tratamiento de la embarazada y del niño. Se presentan los resultados de 12 años de implementación de un programa de prevención de la toxoplasmosis congénita, la tasa de madres infectadas, de transmisión vertical, de niños infectados y la gravedad de la afección causada. Se realizó un estudio observacional prospectivo sobre 12 035 gestantes atendidas en la maternidad del Hospital Alemán de Buenos Aires entre enero de 2000 y diciembre de 2011. Se observó una prevalencia de anticuerpos anti Toxoplasma gondii de 18.33% (2 206/12 035). Treinta y siete mujeres de 9 792 susceptibles tuvieron infección aguda, la tasa de incidencia de infección materna fue de 3.78 por 1 000 nacimientos. La tasa de transmisión transplacentaria de la infección fue 5.4% (2/37). Dos recién nacidos tuvieron toxoplasmosis congénita, uno no tuvo signos clínicos y el otro presentó coriorretinitis y estrabismo. Recibieron tratamiento 35 madres y los 2 niños con toxoplasmosis congénita. En conclusión: Las cifras de transmisión obtenida permiten considerar a este programa de prevención como un recurso válido para minimizar el impacto de la toxoplasmosis congénita.

The prevention of congenital toxoplasmosis is based on providing information to women, serologic diagnosis and treatment of the infected mother and child. In this article we present the results of 12 years of implementation of a congenital toxoplasmosis prevention program in which we measured the mother´s infection incidence rate, the transmission rate and the number and severity of infection in newborns. The study was performed on 12 035 pregnant women in the period 2000-2011. The prevalence rate of antibodies against Toxoplasma gondii was 18.33% (2 206/12 035). Thirty-seven out of 9 792 susceptible women presented acute infection and the mother's infection incidence rate was 3.78 per 1000 births. The transplacental transmission rate was 5.4% (2/37). Two newborns presented congenital toxoplasmosis infection, one had no clinical signs while the other presented strabismus and chorioretinitis. Thirty-five infected mothers and the two children with congenital infection were treated. The transmission rates obtained allow consider this prevention program as a valid resource to minimize the impact of congenital toxoplasmosis.

Epidemiological profile of Trypanosoma cruzi-infected mothers and live birth conditions in the state of Minas Gerais, Brazil

INTRODUCTION: The aim of this study was to assess the epidemiological characteristics of Trypanosoma cruzi-infected mothers and the live birth conditions of neonates. METHODS: A serological survey with IgG-specific tests was conducted using dried blood samples from newborn infants in the State of Minas Gerais. T. cruzi infection was confirmed in mothers through positive serology in two different tests, and infected mothers were required to have their infants serologically tested after the age of 6 months. The birth conditions of the neonates were obtained from the System of Information on Live Births database. RESULTS: The study included 407 children born to T. cruzi-infected mothers and 407 children born to uninfected mothers. The average age of seropositive mothers was 32 years (CI95% 31.3-32.6), which was greater than the average age of seronegative mothers - 25 years (CI95% 24.8-25.2). The mothers' level of education was higher among uninfected mothers (41% had 8 or more years of education, versus 22% between the infected mothers). Vaginal delivery was more frequent among infected mothers. There was no evidence of inter-group differences with respect to the child's sex, gestational age, birth weight or Appearance, pulse, grimace, activity and respiration (APGAR) scores at 1 and 5 minutes. Conclusions: The level of education and the greater number of previous pregnancies and cases of vaginal delivery reflect the lower socioeconomical conditions of the infected mothers. In the absence of vertical transmission, neonates had similar health status irrespective of the infection status of their mothers. .

Prevalence and risk factors for Toxoplasma gondii infection among pregnant and postpartum women attended at public healthcare facilities in the City of Niterói, State of Rio de Janeiro, Brazil

Introduction To determine the prevalence of immunoglobulin G (IgG) and immunoglobulin M (IgM) anti-Toxoplasma gondii antibodies among pregnant and postpartum women attended within the public healthcare system in Niterói, State of Rio de Janeiro, and to detect possible exposure factors associated with T. gondii infection in this population. Methods IgM and IgG anti-T. gondii antibodies were investigated in 276 pregnant and 124 postpartum women by using the indirect immunofluorescence (IFAT) and immunoenzymatic assay (ELISA) techniques. The participants were selected by convenience sampling. All these 400 patients filled out a free and informed consent statement, answered an epidemiological questionnaire and were informed about the disease. Results Among the 400 samples analyzed, 234 (58.5%) were reactive to IgG anti-T. gondii antibodies, according to the IFAT and/or ELISA assay. One pregnant woman was found to be reactive to IgM anti-T. gondii antibodies, with an intermediate IgG avidity test. Risk factor analysis showed that seropositivity was significantly associated (p<0.05) with age, contact with cats and presence of rodents at home. Through a logistic regression model, these associations were confirmed for age and contact with cats, while education at least of the high school level was found to be a protective factor. Conclusions The prevalence rate of IgG anti-T. gondii antibodies in the City of Niterói was high and the risk factors for infection detected after multivariate analysis were: age over 30 years, contact with cats and education levels lower than university graduate level. .

Perfil epidemiológico de toxoplasmose em gestantes / Epidemiological profile of toxoplasmosis in pregnant women

JUSTIFICATIVA E OBJETIVOS: A toxoplasmose apresenta importância pela sua alta prevalência, ampla distribuição, apresentação em imunocomprometidos e gravidade dos casos congênitos, sendo considerada um problema de saúde pública. Considerando a importância na gestação e a escassez de publicações nacionais, é de grande relevância esse estudo que pode auxiliar o planejamento de ações preventivas. Assim, objetivou-se verificar o perfil epidemiológico de toxoplasmose em gestantes em Chapecó nos últimos cinco anos. MÉTODO: Estudo observacional transversal descritivo. Foram pesquisadas todas as gestantes com diagnóstico definitivo, provável e possível de toxoplasmose atendida na rede pública, que foram encaminhadas para o centro de referência em gestação de alto risco, no período de agosto de 2005 a dezembro de 2009. RESULTADOS: A prevalência de infecção aguda encontrada no município foi de 0,57 para cada 1.000 gestantes, sendo observada prevalência de 12,7 gestantes com toxoplasmose aguda para cada 1.000 gestantes de alto risco. 1,3% das gestações de alto risco foram por toxoplasmose. A idade das pacientes variou de14 a 38 anos, com média de idade de 24,1 ± 6,9 anos. 67% das gestantes foram diagnosticadas no 1º trimestre. Em relação às unidades básicas de saúde de origem, houve uma distribuição geográfica periférica; entretanto, sem diferença significativa entre elas. O consumo de salame foi o único fator de risco pesquisado que apresentou relevância neste grupo de pacientes. CONCLUSÃO: Observou-se prevalência de gestantes com toxoplasmose aguda menor do que em outros estudos. Muitas gestantes foram encaminhadas sem ter diagnóstico definitivo ou provável da infecção. Ratificou-se a importância de um pré-natal precoce e efetivo.

BACKGROUND AND OBJECTIVES: Toxoplasmosis is important due to its high prevalence, wide distribution, presentation in immunocompromised patients and severity of congenital cases, being considered a public health problem. Considering the importance in pregnancy and the low number of Brazilian publications, this study is very relevant since it could assist the planning of preventive actions. Thus, we aimed at verifying the epidemiology profile of toxoplasmosis in pregnant women in the city of Chapecó in the last five years. METHOD: A cross-sectional observational study. All pregnant women diagnosed with definite, probable, and possible toxoplasmosis, seen in public health system units, who were referred to the high risk pregnancy center from August/2005 to December/2009 were surveyed. RESULTS: The prevalence of acute infection found in the city was 0.57 per 1.000 pregnant women, with a prevalence of 12.7 pregnant women with acute toxoplasmosis for every 1.000 high risk pregnant women being observed. 1.3% of high risk pregnancies were due to toxoplasmosis. The patients' age ranged from 14 to 38 years, with an average of 24.1 ± 6.9 years. Sixty seven percent of pregnant women were diagnosed in the first trimester. When regarding the basic healthcare units, there was a peripheral geographical distribution; however, no significant difference between them was observed. The consumption of salami was the only risk factor studied that had relevance in this group of patients. CONCLUSION: A prevalence of pregnant women with acute toxoplasmosis lower than in other studies was observed. Many pregnant women were referred without definitive or probable diagnosis of infection. This study reiterated the importance of early and effective prenatal care.

Epidemiologic aspects of toxoplasmosis and evaluation of its seroprevalence in pregnant women / Aspectos epidemiológicos da toxoplasmose e avaliação de sua soroprevalência em gestantes

INTRODUCTION: The aim of the present study was to analyze the exposure to risk factors for toxoplasmosis disease and the level of knowledge in pregnant women who were treated by the Public Health Care System (SUS) from October 2007 to September 2008 in Divinópolis City, Brazil. METHODS: We analyzed 2,136 prenatal exams of pregnant women that were treated from October 2007 to September 2008. RESULTS: Out of the 2,136 pregnant women evaluated, 200 answered a quantitative questionnaire; 49.5% were seropositive for immunoglobulin (Ig) G and 3.6% for IgM. Comparative analysis of congenital toxoplasmosis cases were evaluated in 11 regions and showed an irregular distribution (p < 0.01). This difference was also observed among the pregnant women observed in each location. The results from the questionnaire show that 93% of the pregnant women had no knowledge about toxoplasmosis, and 24% presented with positive serology, but no clinical manifestation. Analysis for pregnant IgG-positive women and the presence of pets showed a statistically significant correlation (p < 0.05), suggesting that the transmission of this disease might occur in the domestic environment. CONCLUSIONS: We suggest the implementation of a triage program for pregnant women and health education to encourage their use of SUS services.

INTRODUÇÃO: O objetivo deste trabalho foi estudar os fatores de riscos da toxoplasmose e investigar o nível de conhecimento das gestantes atendidas pelo Sistema Único de Saúde (SUS), no município de Divinópolis, Brasil. MÉTODOS: Para isso, foram analisados os exames pré-natais de 2.136 gestantes durante o período de outubro de 2007 a setembro de 2008. RESULTADOS: Das 2.136 gestantes avaliadas, 200 foram entrevistadas; destas, 49,5% foram soropositivas para IgG e 3,6% para IgM. A análise comparativa dos casos de toxoplasmose congênita, entre as 11 regiões que compõem o município, demonstrou uma distribuição irregular da enfermidade entre as localidades (p<0,01). As respostas dos questionários demonstraram que 93% das gestantes conhecem quase nada sobre toxoplasmose sendo que 24% apresentaram sorologia positiva sem manifestações clínicas. A análise de correlação entre gestantes IgG positivas e presença de animais de estimação foi estatisticamente significativa (p<0,05), reforçando a possibilidade da transmissão da enfermidade ocorrer no ambiente doméstico. CONCLUSÕES: É sugerida a implementação de um programa de triagem das gestantes, Educação em Saúde, que amplie e estimule a utilização dos serviços prestados pelo SUS.