Boletim epidemiológico: perfil de morbimortalidade do Hospital Estadual e Maternidade Nossa Senhora de Lourdes de julho a setembro de 2023 / Epidemiological bulletin: morbidity and mortality profile of the Nossa Senhora de Lourdes State Hospital and Maternity Hospital from July to September 2023

Boletim epidemiológico que tem como objetivo descrever os dados dos agravos e doenças de notificações compulsórias, perfil de natalidade e perfil de morbimortalidade do Hospital Estadual e Maternidade Nossa Senhora de Lourdes. Trata-se de um estudo descritivo, elaborado através dos dados obtidos pelas notificações de doenças e agravos notificados, das declarações de nascidos vivos e dados dos óbitos onde foram emitidas as declarações de óbitos e realizado a investigação de óbitos. Os dados foram coletados através do sistema MV PEP, Sistema SINAN Net, SINAN Online, Comissão de Verificação de Óbitos e planilhas do NHE

Epidemiological bulletin that aims to describe data on conditions and diseases subject to compulsory notification, birth rate profile and morbidity and mortality profile of the Hospital Estadual e Maternidade Nossa Senhora de Lourdes. This is a descriptive study, prepared using data obtained from notifications of notified diseases and conditions, declarations of live births and data on deaths where death certificates were issued and death investigations were carried out. Data were collected through the MV PEP system, SINAN Net System, SINAN Online, Death Verification Commission and NHE spreadsheets

Profile of pregnant women and children accompanied due to T. gondii exposure at a referred healthcare center: What has changed in 10 years? / Perfil de gestantes e crianças acompanhadas por exposição ao Toxoplasma gondii num centro de referência: O que mudou 10 anos depois?

Abstract Objectives: to characterize the profile of pregnant women and newborns accompanied at a reference center for infectious-parasitic diseases, after the exposure of T. gondii, establishing comparisons with a previous study, in the same location, ten years ago. Methods: this is a retrospective cohort study, with a follow-up of four years (2016 to 2019), using the previous study carried out from 2002 to 2010 as a comparative for the variables assessed. Mothers who presented tests suggestive of seroconversion for the disease during prenatal care and their respective concepts, followed up over a year, were included. The chi-square test was used, assuming a significance level of 5% for the comparison of the groups in the two periods. Results: during the period from 2016 to 2019, 79 binomials were studied, whereas 58 binomials were accompanied in the previous period. Comparing both periods, the findings showed lower proportions of adolescents (p<0.001), with low schooling (p<0.001), with low serological testing (p<0.001) and with late or postnatal diagnosis (p<0.001). As to the children, the findings showed fewer changes in fundoscopy (p<0.001), strabismus (p=0.002), hepatomegaly (p=0.026) and any sequelae (p<0.001). Conclusion: a positive advance was observed regarding the care provided for the mother-child binomial affected by T. gondii, with a reduction in negative outcomes for the child. However, there are still challenges concerning the diagnosis and proper management of the disease.

Resumo Objetivos: caracterizar o perfil de gestantes e neonatos acompanhadas em um centro de referência em doenças infecto-parasitárias, após exposição ao Toxoplasma gondii, estabelecendo comparações em relação a estudo prévio, no mesmo local, há dez anos. Métodos: trata-se de estudo de coorte retrospectivo, com seguimento de quatro anos (2016 a 2019), servindo o estudo prévio realizado de 2002 a 2010 como comparativo para as variáveis estudadas. Foram incluídas mães que apresentaram durante o pré-natal exames sugestivos soroconversão para a doença e seus respectivos conceptos, acompanhados ao longo de um ano. Utilizou-se o teste qui-quadrado, assumindo-se nível de significância de 5% para a comparação dos grupos nos dois períodos. Resultados: durante o período de 2016 a 2019, foram estudados 79 binômios, enquanto no período anterior foram acompanhados 58 binômios. Comparando-se os dois períodos, em relação às mães, registraram-se menores proporções de adolescentes (p<0,001), de baixa escolaridade (p<0,001), baixa realização de testes sorológicos (p<0,001) e com diagnóstico tardio ou pós-natal (p<0,001). Em relação às crianças, verificaram-se menores proporções de alterações de fundoscopia (p<0,001), estrabismo (p=0,002), hepatomegalia (p=0,026) e qualquer sequela (p<0,001). Conclusão: observou-se um avanço em relação aos cuidados para o binômio mãe-filho acometido pelo T. gondii, com redução de desfechos negativos sobre a criança. Todavia, ainda existem desafios para o diagnóstico e adequado manejo da doença.

Toxoplasmosis ocular en lactantes de 0 a 12 meses de edad con toxoplasmosis congénita / Ocular toxoplasmosis in infants 0 to 12 months of age with congenital toxoplasmosis

INTRODUCCIÓN: La toxoplasmosis ocular (TO) es una retinocoroiditis que evoluciona con varios episodios de inflamación y puede presentarse, tanto en la forma congénita o adquirida de la enfermedad, OBJETIVO: Describir la frecuencia y características clínicas de la TO en lactantes de 0 a 12 meses, hijos de madres con serología positiva para toxoplasmosis en el periodo perinatal. METODOLOGÍA: Estudio descriptivo transversal, ambispectivo. Ingresaron lactantes de 0 a 12 meses de edad, cuyas madres tenían serología positiva para toxoplasmosis en el periodo perinatal, remitidos al servicio de oftalmología pediátrica para evaluación. Se recogieron variables demográficas, serología materna y de los lactantes, y los resultados del examen oftalmológico. Los datos fueron analizados en SPSS-v21. RESULTADOS: El 46,4% de 125 lactantes tenían TO, de ellos, 67,2% era de sexo femenino (p = 0,04), la mediana de edad fue de 6 meses, el 41% tenía IgG e IgM positiva. Las lesiones fueron bilaterales en 82,8%, central en 86,2%, e inactivas en 81%. La retinocoroiditis se acompañó de estrabismo en 41%. CONCLUSIONES: La frecuencia de TO en esta población de lactantes con toxoplasmosis congénita, fue elevada. Más de 80% de las lesiones oculares eran inactivas, de localización central y compromiso bilateral.

BACKGROUND: Ocular toxoplasmosis (OT) is a retinochoroiditis that evolves with several episodes of inflammation and can occur both in the congenital or acquired form of the disease, AIM: To describe the frequency and clinical characteristics of OT in infants aged 0 to 12 months, children of mothers with positive serology for toxoplasmosis in the perinatal period. METHODS: Cross-sectional descriptive, ambispective study. RESULTS: Infants from 0 to 12 months of age, whose mothers had positive serology for toxoplasmosis in the perinatal period, referred to the pediatric ophthalmology service for evaluation, were admitted. Demographic variables, maternal and infant serology and the results of the ophthalmological examination were collected. Data were analyzed in SPSS v21 RESULTS: 46.4% of 125 infants had OT, of them 67.2% were female, (p = 0.04) the median age was 6 months, 41% had IgG and IgM positive. The lesions were bilateral in 82.8%, central in 86.2%, and inactive in 81%. Retinochoroiditis was accompanied by strabismus in 41%. CONCLUSIONS: The frequency of OT in this population of infants with congenital toxoplasmosis was high. more than 80% of the eye lesions were inactive, centrally located and bilaterally involved.

Toxoplasma gondii Prevalence in Pregnant Women in Jataí - GO: a 10-year profile / Prevalência do Toxoplasma gondii em Gestantes no Município de Jataí ­ GO: um recorte de 10 anos / Prevalencia de Toxoplasma gondii en mujeres embarazadas de la Ciudad de Jataí - GO: un período de 10 años

Background and Objectives: Toxoplasmosis is a cosmopolitan zoonosis caused by the Toxoplasma gondii protozoan, transmitted mainly through contaminated water or food, beyond vertical transmission. In the State of Goiás, there is a lack of data on the prevalence of the disease, hence the relevance of this cross-sectional study to determine the prevalence of toxoplasmosis in pregnant women in the municipality of Jataí. Methods: Data were collected from pregnant women attended by the public health network in the municipality from January 2005 to December 2015. Results: During the analyzed period, 11,350 pregnant women were attended; 75% with IgG antibodies and 0,60% IgM antibodies reactive for T. gondii, with a reduction in the number of cases since 2010. Conclusion: The high seroprevalence found shows that pregnant women are in close contact with factors that trigger the infection and a reduction in the number of cases indicates the efficacy of epidemiological surveillance actions developed for this population group.(AU)

Justificativa e Objetivos: Toxoplasmose é uma zoonose cosmopolita causada pelo protozoário Toxoplasma gondii, transmitido principalmente através de água e alimentos contaminados e pela transmissão vertical. No estado de Goiás existe uma escassez de dados referentes à prevalência da toxoplasmose. Diante dessa realidade, tornou-se relevante esse estudo transversal que determinasse a prevalência da toxoplasmose nas gestantes no município de Jataí. Métodos: Foram coletados dados de grávidas atendidas pela rede pública de saúde no município no período de janeiro de 2005 a dezembro de 2015. Resultados: No período analisado, foram atendidas 11.350 gestantes, sendo 75% delas com anticorpos IgG e 0,60% anticorpos IgM reagentes para T. gondii, com redução no número de casos a partir de 2010. Conclusão: A alta soroprevalência encontrada demonstra que as grávidas estão em íntimo contato com os fatores que desencadeiam a infecção. É necessário investigar os fatores que contribuem para a elevada taxa de infecção.(AU)

Justificacíon y Objetivos: La toxoplasmosis es uma zoonosis cosmopolita causada por el protozoo Toxoplasma gondii, que se transmite principalmente através del agua o alimentos contaminados, además de la transmisión vertical. Em el estado de Goiás, se carece de dados sobre la prevalência de la enfermedad y ante esta realidade, es relevante este estudio transversal para determinar la prevalência de toxoplasmosis em gestantes del município de Jataí. Métodos: Se recolectaron dados de gestantes atendidas por la red de salud pública del município de Enero de 2005 a Diciembre de 2015. Resultados: Entre el período analizado se trató a 11.350 gestantes, 75% de ellas com anticuerpos IgG y 0,60% anticuerpos IgM reactivos para T. gondii, com uma reducción em el número de casos a partir de 2010. Conclusión: La alta soroprevalência encontrada muestra que las mujeres embarazadas están em estrecho contacto com los fatores desencadenantes de la infección y uma reducción em el número de casos apunta a uma eficácia em las acciones de vigilância epidemiológica desarrolladas para este grupo de problación.(AU)

Comparison between Enzyme Immunoassays Performed on Samples of Dried Blood and Serum for Toxoplasmosis Prenatal Screening: Population-based Study / Comparação entre ensaios imunoenzimáticos realizados em amostras de sangue seco e soro para triagem prénatal da toxoplasmose: Estudo populacional

Abstract Objective Most prenatal screening programs for toxoplasmosis use immunoassays in serum samples of pregnant women. Few studies assess the accuracy of screening tests in dried blood spots, which are of easy collection, storage, and transportation. The goals of the present study are to determine the performance and evaluate the agreement between an immunoassay of dried blood spots and a reference test in the serum of pregnant women from a population-based prenatal screening program for toxoplasmosis in Brazil. Methods A cross-sectional study was performed to compare the immunoassays Imunoscreen Toxoplasmose IgM and Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil)in dried blood spots with the enzymelinked fluorescent assay (ELFA, BioMérieux S.A., Lyon, France) reference standard in the serum of pregnant women from Minas Gerais Congenital Toxoplasmosis Control Program. Results The dried blood spot test was able to discriminate positive and negative results of pregnant women when comparedwith the reference test, with an accuracy of 98.2% for immunoglobulin G (IgG), and of 95.8% for immunoglobulin M (IgM). Conclusion Dried blood samples are easy to collect, store, and transport, and they have a good performance,making this a promisingmethod for prenatal toxoplasmosis screening programs in countries with continental dimensions, limited resources, and a high prevalence of toxoplasmosis, as is the case of Brazil.

Resumo Objetivo A maioria dos programas de triagem pré-natal para toxoplasmose utiliza imunoensaios em amostras de soro de gestantes. Poucos estudos avaliam a acurácia dos testes de triagem em amostras de sangue seco, que são de fácil coleta, armazenamento e transporte. Este estudo teve como objetivo determinar o desempenho e avaliar a concordância entre um imunoensaio em sangue seco e um teste de referência em soro de gestantes de um programa de rastreamento pré-natal de base populacional para toxoplasmose no Brasil. Métodos Realizou-se um estudo transversal para comparar os imunoensaios Imunoscreen Toxoplasmose IgM e Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil) em sangue seco com o padrão de referência ensaio fluorescente ligado a enzimas (enzyme-linked fluorescent assay, ELFA, BioMérieux S.A., Lion, França) no soro de gestantes do Programa de Controle de Toxoplasmose Congênita de Minas Gerais. Resultados O exame em sangue seco foi capaz de discriminar os resultados positivos e negativos das gestantes quando comparado ao teste de referência, com acurácia de 98,2% para imunoglobulina G (IgG), e de 95,8% para imunoglobulina M (IgM). Conclusão O sangue seco apresenta bom desempenho e é uma amostra de fácil coleta, armazenamento e transporte, o que o torna um método promissor para programas de triagem pré-natal de toxoplasmose em países com dimensões continentais, recursos limitados, e alta prevalência de toxoplasmose, como é o caso do Brasil.

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.

Characterization of prenatal healthcare for implementation of congenital toxoplasmosis surveillance program: cross-sectional study

ABSTRACT BACKGROUND: Prenatal toxoplasmosis remains a neglected disease worldwide and few government programs focusing on its prevention are available. Success in these programs has been extensively reported in the literature, yet the strategies used for their implementation, as a model for such actions in different communities, have not been described. OBJECTIVE: To describe the aspects of prenatal care strategies in 13 municipalities within the regional healthcare unit of Araçatuba, in the northwestern region of the state of São Paulo in 2017, focusing on congenital toxoplasmosis. DESIGN AND SETTING: Descriptive study on prenatal healthcare within the Brazilian National Health System, in 13 participating municipalities. METHODS: Data on serological tests, referral clinics, notifications, healthcare strategies, health education and drugs for infected children were requested through a questionnaire that was sent via e-mail to people responsible for healthcare services in these municipalities. RESULTS: Major differences relating to diagnoses, reference outpatient clinics, notifications, health education and healthcare and drugs for infected children were reported among the prenatal strategies of these 13 municipal healthcare services. CONCLUSION: The lack of standardized prenatal strategy in the study area may compromise the prevention of infection. However, our identification of each aspect of prenatal care corroborates the need to implement a healthcare surveillance program relating to congenital toxoplasmosis.

Follow-up of toxoplasmosis during pregnancy: ten-year experience in a University hospital in southern Brazil / Acompanhamento da toxoplasmose durante a gravidez: uma década de experiência em um hospital universitário no Sul do Brasil

Abstract Objective To describe a population of pregnant women diagnosed with toxoplasmosis and their respective newborns, describing the hospital protocol for treatment and follow-up. Methods Retrospective cohort of pregnant women with acute toxoplasmosis infection and risk of transplacental transmission who were sent to the Fetal Medicine Group of Hospital de Clínicas de Porto Alegre (HCPA) between - January 1, 2006 and December 31, 2016. All patients with confirmed disease were included. The diagnostic protocol and treatment were applied; a polymerase chain reaction (PCR) analysis of the amniotic fluid was used to diagnose toxoplasmosis and determine the treatment. The newborns were followed up at the pediatric outpatient clinic specializing in congenital infection. The patients who were not followed up or were not born in the HCPA were excluded. Results A total of 65 patients were confirmed to have gestational toxoplasmosis; 40 performed amniocentesis, and 6 (15%) were identified as having positive PCR in the amniotic fluid. In five of those cases, this result associated with the gestational age defined the triple therapy during pregnancy, and in one case, it defined the monotherapy (advanced gestational age). A total of 4 of these newborns were treated from birth with triple therapy for 10months, 1 was not treated (due to maternal refusal), and 1 progressed to death within the first 54 hours of life due to complications of congenital toxoplasmosis. Of the 34 remaining cases with a negative PCR, 33 were treated with monotherapy and 1 was treated with triple therapy (ultrasound findings); of these children, 9 (26.5%) presented negative immunoglobulin G (IgG), 24 (70.6%) presented positive IgG (but none presented positive immunoglobulin M [IgM]), and 1 (2,9%) presented alterations compatible with congenital disease and started treatment with the triple therapy soon after birth. Out of the total sample of 60 patients, among the 25 who did not perform amniotic fluid PCR, 5 were treated with triple therapy (ultrasound findings/prior treatment) and 20 patients were submitted to monotherapy; only two newborns underwent treatment for congenital toxoplasmosis. Among the 65 cases of gestational toxoplasmosis, 6 (9,2%) children had a diagnosis of congenital toxoplasmosis, and 2 patients with triple therapy felt severe adverse effects of the medications. Conclusions The present study suggests that research on PCR screening of the amniotic fluid may be useful to identify patients with a higher potential for fetal complications, who may benefit from the poly-antimicrobial treatment. Patients with negative PCR results must continue to prevent fetal infection with monotherapy, without risk of fetal or maternal impairment.

Resumo Objetivo Descrever uma população de pacientes diagnosticadas com toxoplasmose na gestação e seus respectivos recém-nascidos, relatando o protocolo do hospital durante o tratamento e seguimento. Métodos Coorte retrospectiva de gestantes com infecção aguda por toxoplasmose e risco de transmissão transplacentária, encaminhadas para acompanhamento pelo Grupo deMedicina Fetal doHospital de Clínicas de Porto Alegre (HCPA) entre 1o de janeiro de 2006 e 31 de dezembro de 2016. Todas as pacientes comdoença confirmada foram incluídas. O protocolo de diagnóstico e tratamento foi aplicado; uma análise da reação em cadeia da polimerase (RCP) no líquido amniótico foi utilizada para diagnosticar a toxoplasmose e determinar o tratamento. Os recém-nascidos foram acompanhados no ambulatório de pediatria especializadoeminfecções congênitas. Pacientes que não foramseguidas ou cujo parto não foi feito no hospital foram excluídas. Resultados A toxoplasmose gestacional foi confirmada em 65 pacientes; 40 realizaram amniocentese, e 6 (15%) foram identificadas com RCP positiva no líquido amniótico. Este resultado associado à idade gestacional definiu a terapia tríplice durante a gestação em 5 casos, e a monoterapia em 1 caso (por idade gestacional avançada). Quatro destas crianças foram tratadas desde o nascimento com terapia tríplice por 12 meses, 1 não foi tratada (por recusa materna), e 1 evoluiu com óbito dentro das primeiras 54 horas de vida devido a complicações da toxoplasmose congênita. Dos 34 casos remanescentes com RCP negativa, 33 foram tratados com monoterapia, e 1 foi tratado com terapia tríplice (por achados ultrassonográficos); destes recém-nascidos, 9 (26,5%) tiveram imunoglobulina G (IgG) negativa, 24 (70,6%) tiveram IgG positiva, mas nenhum apresentou imunoglobulina M (IgM) positiva, e 1 (2,9%) apresentou alterações compatíveis comdoença congênita e iniciou a terapia tríplice logo após o nascimento. Entre as 25 pacientes que não fizeram RCP no líquido amniótico, 5 foram tratadas com terapia tríplice (por achados ultrassonográficos/ tratamento prévio) e 20 receberam monoterapia; somente 2 recém-nascidos receberam tratamento para toxoplasmose congênita. Entre os 65 casos de toxoplasmose gestacional, 6 (9,2%) recém-nascidos tiveram o diagnóstico de toxoplasmose congênita. Um total de 2 pacientes submetidas à terapia tríplice apresentaram efeitos adversos severos das medicações utilizadas. Conclusão Este estudo sugere que a triagem da RCP para toxoplasmose do líquido amniótico pode ser útil no rastreamento de pacientes com maior potencial para complicações fetais, que podem se beneficiar do tratamento poli antimicrobiano. Pacientes com RCP negativa devem continuar a prevenir a infecção fetal com monoterapia, sem risco de comprometimento fetal ou materno.

No todo es Zika: toxoplasmosis congénita, ¿aún prevalente en Colombia? / Not everything is Zika: congenital toxoplasmosis, still prevalent in Colombia?

RESUMEN La toxoplasmosis congénita continúa siendo un problema de salud pública. Aun existiendo guías plenamente divulgadas y conocidas, se observa poca implementación de las mismas y falta de adecuada interpretación de pruebas serológicas en gestantes Esto puede generar falta de captación y tratamiento en embarazadas con primoinfección por Toxoplasma gondii. Reportamos una serie de casos, con compromiso neurológico y sistémico (dificultad respiratoria, hepatoesplenomegalia, enterocolitis, calcificaciones cerebrales, trombocitopenia, corioretinis, ascitis, choque). Si bien el virus de Zika causó epidemia en 2015-2016 en Brasil, Colombia y otros países, toxoplasmosis es un diagnóstico diferencial aún prevalente en estos países, con secuelas graves, discapacidad neurológica y riesgo de daño ocular, incluso tardío. Adicionalmente, existen algunas variedades de cepas de T. gondii con comportamiento más agresivo en Latinoamérica, lo cual empeora la presentación de los casos, incluyendo además mayor riesgo de muerte.

ABSTRACT Congenital toxoplasmosis continues to be a public health threat. Even existing guidelines, publicly known, its implementation and lack of appropriate interpretation of serological tests in pregnancy is often observed. This leds to failure in opportunities for positive and known interventions to decrease the fetal risk due to Toxoplasma gondii infection. We reported herein a case series, with variable neurological and systemic compromise (respiratory distress, hepatosplenomegaly, enterocolitis, brain calcifications, thrombocytopenia, ascites, shock), even fatal, calling for awareness about the fact that despite the Zika epidemics in 2015-2016 in Brazil, Colombia and other countries, precisely toxoplasmosis, is a differential diagnosis still prevalent in these territories, that can leds to severe consequences, with neurological disability and risk of ocular damage, even lately. Additionally, with varieties of T. gondii with more aggressive patterns in Latin America, which make worse those cases, including also a higher risk of death.

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

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

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

Seroprevalence of Toxoplasma gondii among pregnant women in Almadinah Almunawwarah KSA

Objectives: Given its detrimental obstetric and congential sequelae, the detection of primary toxoplasmosis is most critical during pregnancy. This study aims to detect the seroprevalence of Toxoplasma gondii [Toxoplasma gondii] among pregnant women who either have histories suggestive of toxoplasmosis or may be at risk

Methods: Serum samples of 150 pregnant women aged 18 -45 years were tested by the rapid Toxoplasma test [TOXO IgM/IgG test, InTec]. The results were further confirmed by the enzyme-linked immunosorbent assay [ELISA] technique for IgM and IgG

Results: Serological results of toxoplasmosis seropositivity were statistically analyzed in light of the available epidemiological data. Thirty-two cases [21.3%] were IgG positive, and none was IgM positive, as shown by both tests

Conclusion: Significant relations were observed between seropositivity, maternal age and history of abortion, and probability of delivering a child with a congenital anomaly. Despite the lack of evidence of recent infection in this study, the high rates of T. gondii seropositivity among pregnant women signaled a threat of primary exposure during pregnancy

Seguimiento clínico y serológico de recién nacidos con IgM materna reactiva para toxoplasmosis. Policlínica de Infectología pediátrica. Hospital Escuela del Litoral, Paysandú. Años 2008-2013 / Clinical and serologic follow-up of newborns with maternal Igm toxoplasmosis positive. Pediatrics Infectious Diseases Polyclinic

Introducción: la infección por Toxoplasma gondii durante el embarazo puede resultar en graves complicaciones para el feto y dejar importantes secuelas en el recién nacido (RN). El objetivo del estudio fue realizar un seguimiento clínico y serológico de los recién nacidos cuyas madres tenían IgM reactiva para toxoplasmosis en el embarazo y analizar las características clínicas y serológicas de los que presentaron toxoplasmosis congénita (TC). Material y método: estudio descriptivo, prospectivo y longitudinal de RN cuyas madres tuvieron serología IgM reactiva en el embarazo y que fueron derivados para su seguimiento a la Policlínica de Infectología Pediátrica del Hospital de Paysandú en el período junio de 2008 a junio de 2013. Resultados: de los 51 RN evaluados, 50 fueron de término con una media de peso al nacer de 3.120 g y 5 fueron pequeños para la edad gestacional (PEG). Dos presentaron microcefalia y dos estuvieron expuestos a otras infecciones durante el embarazo (sífilis y virus de la inmunodeficiencia humana). De los 42 (82,3%) que completaron su seguimiento, en siete se diagnosticó TC (13,7%) y se descartó la infección en 35 (68,5%). En éstos la media de desaparición de la IgG fue de 6,2 meses. Tres de los infectados fueron sintomáticos y tenían IgM reactiva al nacer. Cuatro presentaron secuelas en la evolución. De ocho RN a los que se les indicó tratamiento, tres lo completaron. En 6 (85,7%) de los infectados se confirmó la seroconversión materna durante el embarazo. Conclusiones: si bien la TC no es muy frecuente en nuestro país, la morbilidad es muy importante. La presencia de seroconversión materna obliga a estudiar y tratar al RN hasta que se descarte la infección. La serología en el RN demuestra, en nuestro medio, una escasa sensibilidad y a falta de otras técnicas obliga a realizar el seguimiento clínico y serológico con IgG durante el primer año de vida.

Introduction: Toxoplasma gondii infection during pregnancy can result in serious complications for the fetus and causes serious sequelae in the newborn. The study aimed to conduct a clinical and serological follow-up of newborns whose mothers were toxoplasma IgM positive during pregnancy and to analyze the clinical and serological evolution of those with congenital toxoplasmosis (CT) features. Method: descriptive, prospective, longitudinal study of newborns whose mothers were toxoplasma IgM positive during pregnancy and who were referred for follow-up to the Pediatrics Infectious Diseases Polyclinic. Escuela del Litoral Hospital, Paysandú, from June, 2008 through June, 2013. Results: out of 51 newborns assessed, 50 were term newborns with a mean birth weight of 3,120 g and 5 were small for gestational age (SGA). Two had microcephaly and 2 were exposed to other infections during pregnancy (syphilis and human immunodeficiency virus). Seven (13.7%) of the 42 (82.3%) newborns who completed follow-up CT were diagnosed with toxoplasmosis, and infection was ruled out in 35 (68.5%) newborns. In the latter half of the disappearance of IgG was 6.2 months. Three (43%) were infected symptomatic and had reactive IgM at birth. Four (57%) evidenced sequelae in evolution. Eight newborns were prescribed treatment, 3 of them completed it. In six (85.7%) of them infected maternal seroconversion during pregnancy was confirmed. Conclusions: although CT is not very common in our country, the disease is very important. The presence of maternal seroconversion forced to study and treat the newborns until infection is ruled out. Serology in the newborns demonstrates, in our environment, poor sensitivity and lack of other techniques necessary to undertake clinical and serological follow-up of IgM during the first year of life.

Incidence of congenital toxoplasmosis among infants born to HIV-coinfected mothers: case series and literature review

Introduction: There is a paucity of data on the occurrence of congenital toxoplasmosis in children born to mothers dually infected with HIV and Toxoplasma gondii. Objective: To evaluate aspects of the mother–infant pairs associated with vertical transmission of toxoplasmosis in women co-infected with HIV in a referral center for perinatally acquired infections in Belo Horizonte, Brazil. Methods: Descriptive study of HIV vertically exposed children, with congenital toxoplasmosis, followed at a referral center (cohort/Belo Horizonte). Prenatal and post-natal variables for the mother–infant pairs were evaluated. A literature review with no filtering for time and language was performed to identify reports of congenital toxoplasmosis in HIV vertically exposed children. Results: Among 2007 HIV vertically exposed children evaluated in the period from 1998 to 2011, 10 cases of congenital toxoplasmosis were identified (incidence: 0.5%, 95% confidence interval: 0.24–0.91). In searching the literature 22 additional cases in 17 reports were found. Combining the findings of our cohort with other reported cases, 50% (16/32) of congenital toxoplasmosis in HIV vertically exposed children were from Brazil. The cases of congenital toxoplasmosis in HIV vertically exposed children identified in Brazil occurred mainly in the post-Highly Active Antiretroviral Therapy era (p = 0.002) and presented a lower death rate (p = 0.003) than those from other countries. In the cohort/Belo Horizonte, HIV infection was identified mainly during gestation; T. gondii vertical transmission was observed in pregnant women with CD4+>500 cells/mm3 and latent toxoplasmosis. High rates of ocular lesions (87.5%) and central nervous system involvement (70%) were detected. Conclusions: The risk of vertical transmission of T. gondii in HIV-infected women is low and has been usually associated with maternal immunosuppression and elevated viral load. However, ...

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.

Incidence of congenital toxoplasmosis in the city of Belém, state of Pará, northern Brazil, determined by a neonatal screening program: preliminary results / Incidência de toxoplasmose congênita na cidade de Belém, estado do Pará, norte do Brasil, através de um programa de triagem neonatal: resultados preliminares

INTRODUCTION: The aim of this study was to determinate the incidence of congenital toxoplasmosis among a group of newborns (NBs) from Belém using neonatal screening. METHODS: Among the 6,000 newborns referred for investigation of genetic and metabolic diseases, 1,000 were selected for screening for congenital toxoplasmosis by determining the amount of IgM in the eluates of blood collected on filter paper. Positive tests were confirmed using paired serology of the NB and his mother. RESULTS: Out of the 1,000 NBs assessed, one had a positive screening result that was confirmed by paired serology. CONCLUSIONS: The incidence of congenital toxoplasmosis in Belém was 10/10,000 live NBs.

INTRODUÇÃO: O objetivo do estudo foi determinar a incidência da toxoplasmose congênita em um grupo de recém-nascidos (RNs) de Belém, pela triagem neonatal. MÉTODOS: Entre 6.000 RNs, encaminhados para investigação de doenças genéticas e metabólicas, foram selecionados 1.000 para triagem de toxoplasmose congênita, através da pesquisa de anticorpos IgM em eluatos de sangue colhido em papel de filtro. Os testes positivos foram confirmados, através da sorologia pareada do RN e respectiva genitora. RESULTADOS: Dos 1.000 RNs investigados, um apresentou triagem positiva confirmada pela sorologia pareada. CONCLUSÕES: A incidência de toxoplasmose congênita em Belém foi de 10/10.000 RNs vivos.

Programas de controle da toxoplasmose congênita / Programs for control of congenital toxoplasmosis

A toxoplasmose congênita pode causar aborto e danos neurológicos e/ou oculares ao feto. Desde que a Áustria e a França estabeleceram a triagem pré-natal, a prevalência da toxoplasmose caiu de 50 por cento para 35 por cento e de 84 por cento para 44 por cento, respectivamente. Outros países, como o Reino Unido, adotam práticas educativas para reduzir o risco de infecção em gestantes soronegativas. No Brasil, a triagem pré-natal é realizada nos estados do Mato Grosso do Sul e Minas Gerais e nas cidades de Curitiba e Porto Alegre. Em Londrina, Paraná, foi implantado o "Programa de Vigilância da Toxoplasmose Adquirida na Gestação e Congênita", que se baseia na triagem sorológica, com orientação sobre as medidas de prevenção e monitoramento sorológico trimestral nas gestantes inicialmente soronegativas, além do acompanhamento das gestantes e crianças com infecção aguda e notificação dos casos. Nos primeiros quatro anos da implantação, a avaliação do programa demonstrou uma redução de 63 por cento no número de gestantes e de 42 por cento no número de crianças encaminhadas aos serviços de referência, resultando na liberação de vagas para o atendimento de pacientes com outras doenças. Quanto aos medicamentos, houve redução de 62 por cento no consumo de ácido folínico e de 67 por cento de sulfadiazina. Além disso, a definição dos protocolos resultou na padronização do atendimento e segurança para a tomada de decisões por parte dos médicos. Portanto, como existem diversos protocolos individualizados nos diversos serviços e regiões, o estabelecimento de uma conduta ideal e consensual, com respaldo técnico, implicará na adoção de medidas que, certamente, ocasionarão economia aos cofres públicos, com a diminuição da toxoplasmose congênita.

Congenital toxoplasmosis can cause miscarriage and neurological and/or eye damage to the fetus. Since Austria and France established the prenatal screening, the prevalence of toxoplasmosis has declined from 50 percent to 35 percent and 84 percent to 44 percent, respectively. Other countries, such as the United Kingdom, have educational practices to reduce the risk of infection in seronegative pregnant women. In Brazil, prenatal screening is carried out in the states of Mato Grosso do Sul and Minas Gerais and the cities of Curitiba and Porto Alegre. In Londrina, state of Parana, the "Health Surveillance Program for Toxoplasmosis Acquired during Pregnancy and Congenital Toxoplasmosis" was established, which is based on serological screening, advising on prevention measures and quarterly serological monitoring in pregnant women that are initially seronegative, in addition to the monitoring of pregnant women and children with acute infection and case notification. In the first four years of implementation, the program evaluation showed a 63 percent reduction in the number of pregnant women and 42 percent in the number of children referred to reference services, resulting in the opening of vacancies for the care of patients with other diseases. As for medications, there was a 62 percent reduction in consumption of folic acid and 67 percent of sulfadiazine. Moreover, the definition of the protocols resulted in the standardization of care and safety for the decision-making by physicians. Therefore, as there are several protocols individualized in various departments and regions, the establishment of an ideal, consensual conduct with technical support, will result in implementing measures that will certainly save public resources, with the decrease in congenital toxoplasmosis.

Modelo para la dinámica de transmisión de la toxoplasmosis congénita / A model of congenital toxoplasmosis transmission dynamics

La toxoplasmosis es una zoonosis parasitaria de amplia distribución mundial, que infecta una gran proporción de poblaciones humanas y animales, producida por el parásito Toxoplasma gondii, siendo de gran importancia el contagio de mujeres gestantes, puesto que ésta zoonosis causa enfermedades en los fetos a través de infección transplacentaria; tradicionalmente se ha utilizado una tasa de infección madre-feto constante; sin embargo, hay evidencias de una fuerte relación con la semana de gestación de la madre en el momento de contagiar al feto. Este trabajo describe la dinámica de transmisión de la toxoplasmosis congénita a través de un modelo estructurado en la edad que tiene en cuenta la semana de gestación de la madre; el modelo está acoplado con un modelo espacio-temporal que describe la dispersión de T. gondii a través de gatos, el cual proporciona la cantidad de parásitos en el ambiente, de la cual depende que una mujer gestante se infecte. Se hacen simulaciones variando la cantidad de parásitos y la distancia a la que se encuentra la gestante del lugar del inóculo; además, se varían algunos parámetros equivalentes a posibles medidas de control. Se encuentran cambios importantes al comparar el comportamiento de las poblaciones de gestantes infectadas, cuando se usa tasa de infección madrefeto constante y cuando se usa tasa dependiente de la semana de gestación, lo que permite concluir que la semana de gestación en la que se encuentra la población de gestantes infectadas es fundamental en la transmisión de la infección al feto.

Toxoplasmosis is a parasitic zoonosis having worldwide distribution; it infects many human and animal populations and is produced by the parasite Toxoplasma gondii, this being of great importance in contagion of pregnant women since this zoonosis causes illness in the fetus through transplacental infection. A constant mother-foetus infection rate has traditionally been used. Nevertheless, there is evidence of a strong relationship between a mother's gestation week and the moment when a foetus becomes infected. This work describes congenital toxoplasmosis transmission dynamics by using an age-structured model taking a mother's gestational week into account. The model was adapted to a space-time model describing T. gondii dispersion through cats; this provided the amount of parasites in the environment depending on which a pregnant woman would become infected. Simulations were done, varying the amount of parasites and the pregnant mother-inoculum distance. Some parameters related to possible control measures were also varied. Important changes were found when comparing infected pregnant female population patterns, when a constant mother-fetus infection rate was used and when a dependent pregnancy week rate was used. This led to concluding that the gestation week in which the mothers became infected is fundamental in infection being transmitted to their fetuses.

Estimativa da distribuição regional da toxoplasmose congênita no Brasil a partir dos resultados de triagem neonatal / Estimation of the regional distribution of congenital toxoplasmosisin Brazil from the results of neonatal screening

Aims: To determine the prevalence of congenital toxoplasmosis in Brazil from samples of dried blood on filter paper from neonates attended by a private program of neonatal screening. Methods: Blood samples collected from neonates by puncturing the heel and dried on filter paper, received from all Brazilian states from September 1995 to July 2009, were tested for Toxoplasma gondii-specific IgM antibodies. For each positive screening test, confirmatory tests were performed in sera of mothers and newborns, obtained by venipuncture. The infants were monitored and classified as infected according to one of the following criteria: presence of Toxoplasma gondii-specific IgM and IgG in the newborn and the mother; Toxoplasma gondii-specific IgM and IgG in the newborn only; Toxoplasma gondii-specific IgM and IgG in the mother only; or increasing amount of Toxoplasma gondii-specific IgG in the infant. Results: A total of 800,164 blood samples were tested. The overall prevalence of congenital toxoplasmosis was found to be 1/1,613 (6/10,000) in the country, ranging from 1/5,447 to 1/495 (2/10,000 to 20/10,000) in different states. Conclusions: Neonatal screening on a large scale is an important tool for determining the prevalence of congenital toxoplasmosis. The high prevalence of the infection in Brazil and the wide variability of its epidemiology among the states support the need to develop policies on health and education to prevent and control congenital toxoplasmosis across the country, respecting the peculiarities of each state.

Objetivo: estimar a prevalência da toxoplasmose congênita Brasil por meio de amostras de sangue seco em papel filtro, obtidas de neonatos atendidos por um programa privado de triagem neonatal. Métodos: amostras de sangue coletadas de neonatos por punção de calcâneo e absorvidas em papel filtro, recebidas de todos os estados brasileiros entre setembro de 1995 e julho de 2009, foram testadas para anticorpos IgM anti-Toxoplasma gondii. Para cada teste positivo na triagem, foram realizados exames confirmatórios em soros das mães e dos neonatos, obtidos por punção venosa periférica. Os casos foram considerados confirmados de acordo com um dos seguintes critérios: presença de IgM e IgG anti-Toxoplasma gondii no neonato e na mãe; IgM e IgG anti-Toxoplasma gondii somente no neonato; IgM e IgG anti-Toxoplasma gondii somente na mãe; ou aumento progressivo dos anticorpos IgG anti-Toxoplasma gondii no lactente. Resultados: foram testadas 800.164 amostras. Observou-se uma prevalência geral de toxoplasmose congênita no país de 1/1.613, variando de 1/1.547 a 1/495 (2/10.000 to 20/10.000) em diferentes estados. Conclusões: a triagem neonatal em larga escala é uma ferramenta importante para a determinação da prevalência da toxoplasmose congênita. A alta prevalência dessa infecção no Brasil e a ampla variabilidade de sua epidemiologia entre os estados confirmam a necessidade de políticas de saúde e educação voltadas à prevenção e ao controle da toxoplasmose congênita em todo o país, respeitando as peculiaridades de cada estado.

Toxoplasmose congênita em crianças sul-americanas: [revisão] / Congenital toxoplasmosis in south American children: [review]

Aims: To review the present knowledge about congenital toxoplasmosis in South America and to advance some hypothesis for future research. Source of data: Medline and Scielo database search for papers reporting clinical characteristics of cohorts of children in South America and comparative studies between South America and other continents. Summary of findings: Systematic analysis of primary data obtained during screening programs showed that the risk of ocular lesions in congenital toxoplasmosis was much higher in the South American cohorts (47%; 18/38) than in Europe (14%, 79/550). The crude risk of intracranial lesions was much higher in the cohorts from South America (53%, 20/38) than those from Europe (9%, 49/550). In a Colombian cohort it was found 11% of mortality. Additionally, a comparative prospective cohort of congenitally infected children from Brazil and Europe found that in Brazilian children eye lesions were larger, more numerous and more likely to affect the area of the retina responsible for central vision that their counterpart in Europe. The presence of Toxoplasma strains genetically different to those found in North America and Europe could explain the higher severity of congenital toxoplasmosis in South America. Conclusions: Congenital toxoplasmosis in South America seems to be more frequent and infected children are more symptomatic than in Europe and in North America. Research for new drugs and candidate vaccines are a priority to improve indicators of health in children of South America.

Objetivos: revisar o conhecimento atual sobre toxoplasmose congênita na América do Sul e traçar algumas hipóteses para futura pesquisa. Fonte de dados: busca nas bases de dados Pubmed e Scielo por artigos sobre características clínicas de coortes de crianças com toxoplasmose congênita na América do Sul e estudos comparativos entre América do Sul e outros continentes. Síntese dos dados: uma análise sistemática de dados primários obtidos durante programas de triagem mostrou que o risco de lesões oculares foi muito maior na coorte de crianças da América do Sul (47%, 18/38) do que nas européias (14%, 79/550). O risco bruto de lesões intracranianas foi muito maior na coortes da América do Sul (53%, 20/38) do que nas da Europa (9%, 49/550). Em uma coorte colombiana constatou-se 11% de mortalidade. Adicionalmente, uma coorte prospectiva, que comparou crianças com toxoplasmose congênita do Brasil e da Europa, mostrou que nas crianças brasileiras as lesões oculares foram maiores, mais numerosas e com maior probabilidade de atingir o polo posterior da retina do que nas européias. A presença de cepas de Toxoplasma gondii diferentes das da Europa e dos Estados Unidos pode explicar a maior gravidade da toxoplasmose congênita na América do Sul. Conclusões: a toxoplasmosis congênita na América do Sul parece ser mais frequente e as crianças infectadas são mais sintomáticas do que na Europa e na América do Norte. A pesquisa sobre novas drogas e vacinas deve ser prioritária, para melhorar os indicadores de saúde nas crianças da América do Sul.

Congenital toxoplasmosis and DALYs in the Netherlands

The calculation of disability-adjusted life years (DALYs) enables public health policy makers to compare the burden of disease of a specific disease with that of other (infectious) diseases. The incidence of a disease is important for the calculation of DALYs. To estimate the incidence of congenital toxoplasmosis (CT), a random sample of 10,008 dried blood spot filter paper cards from babies born in 2006 in the Netherlands were tested for Toxoplasma gondii-specific IgM antibodies. Eighteen samples were confirmed as positive for IgM, resulting in an observed birth incidence of CT of 1.8 cases per 1,000 live-born children in 2006 and an adjusted incidence of 2.0 cases per 1,000. This means that 388 infected children were born in 2006. The most likely burden of disease is estimated to be 2,300 DALYs (range 820-6,710 DALYs). In the previous calculations, using data from a regional study from 1987, this estimate was 620 DALYs (range 220-1,900 DALYs). The incidence of CT in the Netherlands is much higher than previously reported; it is 10 times higher than in Denmark and 20 times higher than in Ireland, based on estimates obtained using the same methods. There is no screening program in the Netherlands; most children will be born asymptomatic and therefore will not be detected or treated.