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.

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. .

Prevalence of congenital toxoplasmosis among a series of Turkish women / Prevalencia de toxoplasmosis congénita en una serie de mujeres en Turquía

Background: Toxoplasma gondii infection during pregnancy causes congenital malformations. Pregnant women should be screened for this infection since it is preventable and treatable. Aim: To study the sero prevalence of Toxoplasma gondii infection among pregnant women living in lzmir, Turkey. Material and Methods: A blood sample was obtained from 4651 women aged between 15 and 45years, during their first trimester of pregnancy. IgM and IgG antibodies against Toxoplasma gondii were measured using an ELISA assay. Among women with both IgG and IgM antibodies positive, an IgG avidity test was performed, using a VIDAS kit. Results: IgG antibodies were positive in 1871 (39.9%) participants. Of these, 48 (2.5%) also had positive IgM antibodies. In 41 ofthese 48 women, the IgG avidity test was performed and only one woman had a low avidity. This woman was treated with Spiramycin. Her offspring had an intrauterine growth retardation and oligohydramnios. A chorioretinitis was diagnosed in the offspring of other woman with both antibodies positive. Conclusions: In this series, the prevalence of congenital toxoplasmosis was low. However, women with positive antibodies against Toxoplasma Gondii should be further studied and followed during their pregnancy.

Antecedentes: La infección por Toxoplasma gondii durante el embarazo causa malformaciones congénitas. Se debe efectuar serologíapara esta infección en mujeres embarazadas ya que es prevenible y tratable. Objetivo: Estudiar la seroprevalencia de infección por Toxoplasma gondii en mujeres embarazadas que viven en Esmirna, Turquía. Material y Métodos: Se obtuvo una muestra de sangre en 4.651 mujeres cuyas edades fluctuaban entre 15 y 45, años, durante su primer trimestre de embarazo. Los anticuerpos IgM e IgG en contra de Toxoplasma gondii se midieron por ELISA. En mujeres que tenían anticuerpos IgG e IgM positivos, un ensayo de avidez de IgG se efectuó utilizando el kit VIDAS. Resultados: Los anticuerpos IgG fueron positivos en 1.871 participantes (39,9%). De estas, 48 (2,5%) también tenían anticuerpos IgM positivos. En 41 de estas 48 mujeres, se efectuó el test de avidez y sólo una tenía una baja avidez. Esta mujer se trató con espiramicina y su producto de concepción tuvo un retardo de crecimiento intrauterino y un oligohidroamnios. Una corioretinitis se diagnosticó en el producto de concepción de otra mujer con ambos anticuerpos positivos. Conclusiones: La seroprevalencia de toxoplasmosis congénita en esta serie de pacientes fue baja, sin embargo, las mujeres con anticuerpos positivos deben ser tratadas y seguidas.

IgG Western Blot for Confirmatory Diagnosis of Equivocal Cases of Toxoplasmosis by EIA-IgG and Fluorescent Antibody Test

The performance values of available techniques used in serodiagnosis of toxoplasmosis are satisfactory but they raise problems of equivocal and discordant results for very low IgG titers. Recently marketed, LDBio-Toxo II IgG Western blot (IB) showed an excellent correlation with the dye test. We estimated the proportion of equivocal and discordant results between the enzyme immunoassay Platelia Toxo IgG (EIA-IgG) and fluorescent antibody test (FAT) and assessed the usefulness of the IB as a confirmatory test. Out of 2,136 sera collected from pregnant women, 1,644 (77.0%) tested unequivocally positive and 407 (19.0%) were negative in both EIA-IgG and FAT. The remaining 85 (4%) sera showed equivocal or discordant results. Among them, 73 (85.9%) were positive and 12 (14.1%) were negative in IB. Forty-one (89.1%) equivocal sera in EIA-IgG and 46 (86.8%) equivocal sera in FAT were positive in IB. Reducing the cut-off values of both screening techniques improved significantly their sensitivity in detecting very low IgG titers at the expense of their specificity. In conclusion, equivocal results in routine-used techniques and their discordance in determination of the immune status in pregnancy women were not uncommon. IB test appeard to be highly useful in these situations as a confirmatory technique.

Soroepidemiologia da toxoplasmose em gestantes a partir da implantação do Programa de Vigilância da Toxoplasmose Adquirida e Congênita em municípios da região oeste do Paraná / Seroepidemiology of toxoplasmosis in pregnant women since the implementation of the Surveillance Program of Toxoplasmosis Acquired in Pregnancy and Congenital in the western region of Paraná, Brazil

OBJETIVO: Avaliar a suscetibilidade das gestantes à toxoplasmose em serviço público de saúde de dois municípios da região oeste do Paraná. MÉTODOS: Foram avaliadas 422 gestantes por meio da pesquisa sorológica de anticorpos IgG e IgM anti-Toxoplasma gondii (ELISA e MEIA). As soronegativas repetiram a sorologia no segundo e terceiro trimestre de gestação. Em um dos municípios, também foi realizada a triagem neonatal em 27 recém-nascidos para detecção de IgM anti-Toxoplasma gondii pelo teste de fluorometria. Todas as gestantes responderam a um questionário epidemiológico, para análise dos fatores associados ao risco da infecção pelo Toxoplasma gondii. Para análise estatística, foram consideradas a variável dependente da presença de IgG anti-Toxoplasma gondii e as variáveis independentes contidas no questionário epidemiológico. RESULTADOS: A prevalência de anticorpos IgG anti-Toxoplasma gondii nas gestantes foi de 59,8 e 60,6 por cento. Em um dos municípios, as variáveis associadas à presença de anticorpos IgG foram baixo nível de escolaridade e mais de uma gestação. Não houve associação com os outros fatores investigados, como a ingestão de carnes cruas ou mal cozidas, vegetais crus, salames coloniais, manipulação de terra ou areia, horta em casa e gatos em casa. No outro município, não foi observada associação estatística com nenhuma das variáveis estudadas. Não foi confirmado nenhum caso de infecção aguda nem de soroconversão em ambos os municípios. Nenhuns dos recém-nascidos avaliados apresentou positividade para toxoplasmose. CONCLUSÃO: A toxoplasmose é comum nas gestantes atendidas pelo serviço público de saúde da região estudada e há 40 por cento delas suscetíveis à infecção. Esse dado reforça a necessidade de manter o programa implantado nesses municípios.

PURPOSE: To evaluate the susceptibility to toxoplasmosis in pregnant women in the public health service from two cities in the western region of Paraná, Brazil. METHODS: Four thousand twenty-two pregnant women were evaluated for anti-Toxoplasma gondii IgG and IgM by ELISA and MEIA. Seronegative pregnant women repeated the serology in the second and third trimester of pregnancy. Neonatal screening of 27 newborns was also performed in one of the cities to detect IgM anti- Toxoplasma gondii by fluorometry. All pregnant women answered an epidemiological questionnaire to analyze the factors associated with the risk of infection by Toxoplasma gondii. For statistical analysis, the presence of IgG anti-Toxoplasma gondii was considered as the dependent variable and the variables contained in the epidemiological questionnaire as the independent ones. RESULTS: The prevalence of anti-Toxoplasma gondii IgG in pregnant women was 59.8 and 60.6 percent. In one of the cities, the variables associated with the presence of IgG antibodies were low educational level and more than one pregnancy. There was no association with other factors studied such as consumption of raw or undercooked meat, consumption of raw vegetables, consumption of colonial salami, handling soil or sand, the presence of a home vegetable garden and cats in the household. In the other city there was no statistical association with the variables studied. No case of acute infection and no seroconversion were confirmed in either city. None of the infants evaluated were positive for toxoplasmosis. CONCLUSION: Toxoplasmosis is common in pregnant women attended by the public health service in the region studied and 40 percent of them are susceptible to the infection. These data reinforce the need to keep the screening program in these cities.

Pregnancy malaria: cryptic disease, apparent solution

Malaria during pregnancy can be severe in non-immune women, but in areas of stable transmission, where women are semi-immune and often asymptomatic during infection, malaria is an insidious cause of disease and death for mothers and their offspring. Sequelae, such as severe anaemia and hypertension in the mother and low birth weight and infant mortality in the offspring, are often not recognised as consequences of infection. Pregnancy malaria, caused by Plasmodium falciparum, is mediated by infected erythrocytes (IEs) that bind to chondroitin sulphate A and are sequestered in the placenta. These parasites have a unique adhesion phenotype and distinct antigenicity, which indicates that novel targets may be required for development of an effective vaccine. Women become resistant to malaria as they acquire antibodies against placental IE, which leads to higher haemoglobin levels and heavier babies. Proteins exported from the placental parasites have been identified, including both variant and conserved antigens, and some of these are in preclinical development for vaccines. A vaccine that prevents P. falciparum malaria in pregnant mothers is feasible and would potentially save hundreds of thousands of lives each year.

Antibody dynamics during gestation in cows naturally infected with Neospora caninum from four dairy herds in Brazil / Dinâmica de anticorpos durante a gestação em vacas naturalmente infectadas com Neospora caninum de quatro rebanhos leiteiros no Brasil

Neospora caninum has been described as an important cause of abortion in bovine worldwide. The objective of the present study was to characterize patterns of antibody dynamics during gestation in dairy cows naturally infected with N. caninum. Twelve N. caninum naturally infected cows were selected from four dairy herds from Brazil and blood samples were monthly collected during pregnancy. Serum were tested for antibodies against N. caninum by Indirect Fluorescent Antibody Test (IFAT). During this period, all cows remained clinically normal and gave birth to healthy calves. The cows remained seropositives during the study and N. caninum IFAT titers ranged from 100 to 12,800; only animal 234 presented one negative result in the first month of pregnancy. Significant differences of N. caninum IFAT titers were found between months from 1 to 9 of pregnancy bythe Friedman Test (P<0.001). The statistical analysis showed an increase of N. caninum antibody titers from second and third trimester of pregnancy in relation to first trimester. High titers were observed in few cows after month fifth of pregnancy. This study showed a variation of specific antibody levels in seropositive cows during different gestational periods. The highest values were observed during the second and third trimester. The antibody increase after the fifth month of gestation was not associated to abortion.

Neospora caninum é descrito como uma importante causa de abortamento em bovinos por todo o mundo. O objetivo do presente estudo foi caracterizar o padrão da dinâmica de anticorpos durante a gestação em vacas leiteiras infectadas naturalmente por N. caninum. Doze vacas gestantes infectadas naturalmente com N.caninum foram selecionadas de quatro rebanhos leiteiros do Brasil e amostras de sangue foram mensalmente colhidas da concepção até o parto das vacas. Soros foram testados para anticorpos contra N. caninum pela reação de imunofluorescência indireta (RIFI). Durante a gestação, todas as vacas permaneceram clinicamente normais e geraram bezerros saudáveis. As vacas permaneceram soropositivas durante o estudo e títulos de anticorpos anti-N.caninum variaram de 100 a 12.800; somente o animal 234 apresentou um resultado negativo no primeiro mês de gestação. Diferenças significativas dos títulos da RIFI para N. caninum foram encontradas entre os meses de 1 a 9 de gestação pelo Teste de Friedman (P<0,001). As análises estatísticas mostraram um aumento dos títulos de anticorpos anti-N. caninum no segundo e terceiro trimestre de gestação em relação ao primeiro trimestre. Altos títulos de anticorpos foram observados em algumas vacas após o mês cinco de gestação. Este estudo mostrou variação dos níveis de anticorpos em vacas soropositivas durante diferentes períodos gestacionais. Altos títulos foram observados durante o segundo e terceiro trimestre e o aumento dos títulos de anticorpos após o quinto mês de gestação não foi associado a abortamentos.

Perfil sorológico para toxoplasmose em gestantes atendidas em maternidade / Serologic profile of toxoplasmosis in pregnant women attended at a teaching-hospital in Recife

OBJETIVOS: Determinar o perfil sorológico para toxoplasmose e identificar os principais fatores associados à susceptibilidade (pacientes com imunoglobulinas IgG e IgM ausentes) em gestantes atendidas em uma maternidade-escola do Recife. MÉTODOS: Realizou-se um estudo de corte transversal, incluindo 503 gestantes submetidas à sorologia para toxoplasmose no IMIP (Recife), no período de outubro de 2004 a abril de 2005. Realizou-se imunofluorescência indireta para pesquisa de IgG e IgM e um breve questionário foi aplicado às pacientes, descrevendo-se identificação, características demográficas e obstétricas, antecedentes mórbidos relevantes, hábitos de vida e tipo de moradia. Para análise estatística, utilizaram-se os testes Qui quadrado de associação e exato de Fisher, com um nível de significância de 5 por cento. RESULTADOS: Constatou-se imunidade para toxoplasmose em 74,7 por cento, susceptibilidade em 22,5 por cento e "possível" infecção ativa em 2,8 por cento das gestantes. Não se encontrou associação estatisticamente significativa entre susceptibilidade para toxoplasmose e idade, procedência, condições mórbidas, hábitos, condições de habitação, rede de esgotos, criação de animais domésticos, número de gestações e idade gestacional. Verificou-se uma associação significativa entre susceptibilidade para toxoplasmose e escolaridade, com uma maior freqüência de susceptibilidade entre mulheres com oito ou mais anos de estudo. CONCLUSÃO: A freqüência de susceptibilidade para toxoplasmose é relativamente baixa entre pacientes atendidas no pré-natal em nosso meio e nenhum outro fator preditivo além da escolaridade foi identificado.

OBJECTIVES: To determine the serologic profile of toxoplasmosis and the main factors associated with susceptibility (patients without IgM and IgG antibodies) in pregnant women attended at a teaching-hospital in Recife, Brasil. METHODS: A cross-sectional study was carried out, enrolling 503 pregnant women submitted to serology for toxoplasmosis at IMIP (Recife) from October 2004 to April 2005. Anti-Toxoplasma IgG and IgM antibodies were studied by IFA. A short questionnaire was administered to patients to provide identification, demographic and obstetrical characteristics, past history of morbidity, habits and dwelling conditions. The chi-square and Fisher-exact tests were used at a 5 percent level of significance. RESULTS: Immunity for toxoplasmosis was present in 74.7 percent, susceptibility in 22.5 percent and "possible" active infection in 2.8 percent of patients. No significant associations were observed between toxoplasmosis susceptibility and age, location, conditions of morbidity, habits, dwelling conditions and sewage system, living with animals, pregnancy and gestational age. A significant association between toxoplasmosis susceptibility and schooling was found, with a higher frequency of susceptibility among women with eight or more years of schooling. CONCLUSION: Susceptibility for toxoplasmosis was relatively low in these prenatal patients and schooling was the only identifiable predictive factor.

Nutritional factors associated with anaemia in pregnant women in northern Nigeria.

This study was conducted to assess the relative contribution of iron, folate, and B 12 deficiency to anaemia in pregnant women in sub-Saharan Africa. In total, 146 pregnant women, who attended two antenatal clinics in Gombe, Nigeria, were recruited into the study. The majority (54%) of the women were in the third trimester. Blood samples were obtained for determination of haematocrit and for measurement of serum iron, total iron-binding capacity, ferritin, folate, vitamin B12, and homocysteine. Malaria was present in 15 (9.4%) women. Based on a haemoglobin value of<105 g/L, 44 (30%) women were classified as anaemic. The major contributing factor to anaemia was iron deficiency based on the serum concentration of ferritin (<10 ng/mL). The mean homocysteine concentration for all subjects was 14.1 pmol/L, and homocysteine concentrations were inversely correlated with concentrations of folate and vitamin B 12. The serum homocysteine increased markedly at serum vitamin B12 levels below 250 pmol/L. The most common cause of anaemia in the pregnant women in northern Nigeria was iron deficiency, and the elevated concentrations of homocysteine were most likely due to both their marginal folate and vitamin B12 status.

Cytoadhesion of Plasmodium falciparum-infected erythrocytes and the infected placenta: a two-way pathway

Malaria is undoubtedly the world's most devastating parasitic disease, affecting 300 to 500 million people every year. Some cases of Plasmodium falciparum infection progress to the deadly forms of the disease responsible for 1 to 3 million deaths annually. P. falciparum-infected erythrocytes adhere to host receptors in the deep microvasculature of several organs. The cytoadhesion of infected erythrocytes to placental syncytiotrophoblast receptors leads to pregnancy-associated malaria (PAM). This specific maternal-fetal syndrome causes maternal anemia, low birth weight and the death of 62,000 to 363,000 infants per year in sub-Saharan Africa, and thus has a poor outcome for both mother and fetus. However, PAM and non-PAM parasites have been shown to differ antigenically and genetically. After multiple pregnancies, women from different geographical areas develop adhesion-blocking antibodies that protect against placental parasitemia and clinical symptoms of PAM. The recent description of a new parasite ligand encoded by the var2CSA gene as the only gene up-regulated in PAM parasites renders the development of an anti-PAM vaccine more feasible. The search for a vaccine to prevent P. falciparum sequestration in the placenta by eliciting adhesion-blocking antibodies and a cellular immune response, and the development of new methods for evaluating such antibodies should be key priorities in mother-child health programs in areas of endemic malaria. This review summarizes the main molecular, immunological and physiopathological aspects of PAM, including findings related to new targets in the P. falciparum var gene family. Finally, we focus on a new methodology for mimicking cytoadhesion under blood flow conditions in human placental tissue.

Importância do rastreamento pré-concepcional e pré-natal da infecção por T. gondii; prevalência sorológica em um hospital público / The importance of screening preconception and antenatal T. gondii infection serological prevalence in a public hospital

A infecção aguda pelo Toxoplasma gondii quando acomete a mulher durante a gestação pode trazer graves conseqüências para o recém-nascido, devido à possibilidade de transmissão placentária. A pesquisa de anticorpos IgG específicos para T.gondii em 553 mulheres atendidas em diferentes setores do Hospital Universitário ( UFSM) permitiu determinar a prevalência da infecção nesta população, que foi de 64 (355/553). A pesquisa de anticorpos IgM foi solicitada em 160 destas pacientes, onde 6,25 (10/160) apresentaram resultados reagentes com níveis deste anticorpo entre 2,8- 0,6 UI/ml, o que tanto pode sugerir presença de infecção aguda como anticorpos IgM residuais, resultantes de infecção passada recente.A taxa de 36 de mulheres suscetíveis, sujeitas a adquirir a infecção durante a gravidez, alerta para a importância do rastreamento desta infecção. O acompanhamento sorológico durante a rotina pré-natal permitirá a detecção precoce dos casos de infecção aguda, através da soroconversão, permitindo intervenção rápida, com instituição de medicação adequada. A pesquisa destes anticorpos, como rotina pré-concepcional, permitirá instituição de medidas preventivas através de informações higieno-dietéticas profiláticas, minimizando o risco de adquirir esta infecção durante o futuro da gravidez.

Comparison of semi-automatized assays for anti-T. gondii IgG detection in low-reactivity serum samples: importance of the results in patient counseling

Toxoplasmosis is a disease which can cause severe congenital infection and is normally diagnosed by the detection of T. gondii specific antibodies in the serum of infected patients. Several different tests allow to distinguish recent from past infections and to quantify anti-T. gondii specific IgG, and the results can be used as markers for immunity. In the present study, we compare the performance of two different methodologies, the Elfa (bioMérieux S.A) and the Meia (Abbott Laboratories) in detecting T. gondii specific IgG in low-reactivity sera. Of 76 analyzed samples, three presented discrepant results, being positive in the Abbott AxSYM Toxo IgG assay, and negative in the bioMérieux Vidas Toxo IgG II assay. By using other tests, the three sera were confirmed to be negative. The results are discussed in the context of their importance for patient management, especially during pregnancy

Influence of placental malaria infection on foetal outcome in the Gambia: twenty years after Ian Mcgregor.

Malaria infection in pregnancy has serious health consequences among mothers and offspring. The influence of placental malaria infection on foetal outcome was studied in a Gambian rural setting where few pregnant women take antimalarial chemoprophylaxis. During July-December 1997, three hundred thirteen mother-newborn pairs (singletons only) were consecutively recruited into a study of the effects of placental malaria infection on the outcome of pregnancy. Placental blood and tissue were collected at delivery. Babies were clinically assessed until discharge. The overall prevalence of placental malaria infection was 51.1% by placental histology and 37.1% by blood smear. The primigravid women were more susceptible to placental malaria than the multigravidae (65.3% vs 44.7%, p=0.01). Placental malaria was significantly associated with pre-term deliveryand intrauterine growth retardation (p<0.01), and there was a four-fold risk of delivering low-birth-weight babies if mothers had parasitized placentae [OR=4.42, 95% confidence interval (CI) 2.10-9.27]. A reduction of mean birth-weight of babies by 320 g was associated with placental malaria infection (p<0.001). Similarly, a two-fold risk of stillbirth delivery (OR=2.22, 95% CI 1.04-4.72) was observed among the infected mothers. The findings showed that there was still an overall poor foetal outcome associated with placental malaria infection. The findings of this study confirm the findings of an earlier study by McGregor in the Gambia that the low birth-weight rate is significantly higher if the placenta is parasitized. In addition, this study observed that the high stillbirth and prematurity rates were associated with placental malaria infection. The findings of the present study suggest undertaking of effective malaria-control strategies during pregnancy, such as use of insecticide-impregnated bednets, intermittent and early treatment for malaria, and antimalarial chemoprophylaxis, in the Gambia.

A study of anemia in pregnant women with Plasmodium falciparum at district hospitals in Vientiane, Lao PDR.

A descriptive cross-sectional study was carried out among pregnant women attending antenatal care at the district hospital, with suspected clinical manifestation of malaria in order to determine the prevalence of anemia and malaria among pregnant women and to determine any correlation between degree of anemia and degree of malaria parasitemia in pregnancy with malaria infection. This is a quantitative research method using face-to-face questionnaire. This study was undertaken at the district hospitals of Vientiane Prefecture and Vientiane Province. Sixty-eight pregnant women with suspected malarial clinical manifestations attending the antenatal care at these hospitals were recruited during June - October, 1998. The subjects were asked about their sociodemographic, socio-economic characteristics, gravida and parity, gestational age, last pregnancy and past history of hematology diseases. Blood samples (dry smear for thick and thin blood films) were examined at the same time for Plasmodium falciparum. The study showed that the prevalence of anemia (Hb < 11 g/dl) and severe anemia (Hb 4-6.9 g/dl) in the total sample population was 48.5% and 8.8% respectively. However, the prevalence of anemia among pregnant women with malaria was 68.75% compared to those without malaria infection (42.31%), but the difference was not statistically significant (p=0.117). A plausible explanation could be small sample size. The prevalence of severe anemia in pregnancy with malaria parasitemia was 18.8% compared to those without parasitemia (5.8%). The difference was not statistically significant (p=0.102). The difference of the mean hemoglobin level in falciparum positive cases and falciparum negative cases was clinically and statistically significant (RR = 1.63 and p=0.00679). There was some evidence of a negative correlation between the degree of anemia and parasitemia count (r= -0.19 and r2= -0.04). In conclusion this population had high prevalence of anemia in pregnant women and P. falciparum may be the main factor associated with anemia. There is a need to investigate other causes of anemia among pregnant women. Our results suggest that frequent and regular antenatal monitoring is necessary for the pregnant women. They should be encouraged to attend antenatal clinics through health education, increased health personnel awareness of proper management for the pregnant women with fevers from malarial endemic areas. There is a need for further research in this area in order to obtain adequate sample size.

Difference of Toxoplasma gondii antibodies between Thai and Austrian pregnant women.

Toxoplasma gondii IgG and IgM antibodies of Thai and Austrian pregnant women were studied, in the same laboratory unit, by using the Sabin-Feldman dye test and ISAGA-IgM. In Thai pregnant women, IgG antibody was found in 21.7%, mostly the IgG titers were low and all were negative for IgM antibody. Conversely in Austrian pregnant women, IgG antibody was found in 30.0% with high titer, and there were 19 (6.3%) cases positive for IgM antibody. The seropositivity of T. gondii IgG antibody in Austrian pregnant women was significantly higher than in Thai (p = 0.02) and the titers were much higher. Two possibilities are postulated to explain the data: it may be because Thai women were infected at a younger age than Austrian women, so they were in the chronic infection stage corresponding with their negativity of IgM antibody or it may be due to the difference of strain virulence of T. gondii from the different parts of the world.

Importance of blood glucose level at the time of admission in severe and complicated malaria.

A prospective study of blood glucose level at the time of admission was done on 532 cases of severe and complicated malaria admitted in classified malaria ward at PBM Hospital, Bikaner. Eleven patients had blood glucose level < 40 mg% (< 2.2 mmol/L) and all were unconscious with diagnosis of cerebral malaria. Four patients became conscious with i.v. infusion of 25% dextrose only without receiving any specific antimalarial treatment. Recognition of these patients of "falciparum malaria with hypoglycaemia" by blood glucose estimation at the time of admission can significantly affect the ultimate outcome. The mortality trend was more in patients having blood glucose level < 40 mg% (< 2.2 mmol/L) in comparison to group of patients having blood glucose level between 41 to 60 mg% (2.2 to 3.3 mmol/L) and was least in those having blood glucose level > 60 mg% (> 3.3 mmol/L).

Alkaline phosphatase activity in plasma of pregnant chagasic patients

The Kinetic properties of plasma placental alkaline phosphatase patients with Chagas' disease were studied. When Cl2 Mg was used as activator the same increase of activity (17-20 per cent) was found in the chagasic and non chagasic groups. The enzyme was not inhibited by F-ion in any of the groups. No significant differences were detected between the two groups (chagasic and non chagasic) when the enzyme was treated with inhibitors such as EDTA and L-phenylamine. However, when the CN- ion was used, the enzyme of the normal pregnant women followed a Michaelian curve, whereas in the chagasic group a sigmoideal plot was observed. Thus, the Hill coefficient was 1.1 for the normal group and over 1.5 for the chagasic.

Avaliaçäo da parasitemia em mulheres portadoras de infecçäo pelo Trypanosoma cruzi durante e após a gestaçäo / Evaluation of parasitaemia in women who are carriers of Trypanosoma cruzi infection during and after pregnancy

Avaliou-se o perfil parasitêmico de 119 chagásicos crônicos, através de 828 xenodiagnósticos, realizados durante (465 xenos) e após a gravidez (363 xenos) visando rastrear uma possível variaçäo da parasitemia nesses períodos. A freqüência de xenos positivos foi maior durante a gestaçäo. Por outro lado, a freqüência de triatomíneos infectados foi, também maior durante a gravidez, indicando níveis parasitêmicos mais elevados neste período. Apenas 17 por cento das mäes estudadas tiveram dois ou mais xenos positivos durante a gravidez. Nestas mulheres, a diferença entre a freqüência de xenos positivos durante e após a gravidez foi elevada, sugerindo ter havido exacerbaçäo da infecçäo chagásica, pelo menos em algumas delas