Psicofísica visual em caso de toxoplasmose ocular congênita / Visual psychophysics of congenital ocular toxoplasmosis case

Resumo A toxoplasmose ocular congênita é uma manifestação da infecção pelo parasita Toxoplasma gondii que ocorrer por meio placentário. Essa doença pode provocar importantes sequelas visuais. Este trabalho descreve um estudo de caso que utilizou avaliação psicofísica visual para descrever alterações funcionais decorrentes da toxoplasmose ocular congênita. A avaliação foi realizada em paciente de 30 anos, sexo masculino, residente em São Luís (MA), hígido com histórico da mãe ter apresentado infecção por toxoplasmose no período gestacional. Somente aos 26 anos foi feita uma avaliação médica detalhada que descreveu lesão na fóvea do olho direito. Na avaliação clínica clássica e na avaliação psicofísica visual, o paciente apresentou visão normal para o olho esquerdo. O olho direito apresentou baixa acuidade visual (valor decimal: 0,028), campo visual com escotomas localizados até 20º de ângulo visual e alteração da visão de cor. O estudo fornece informações médicas seguras e relevantes para o diagnóstico de toxoplasmose ocular congênita utilizando testes eficazes, de baixo custo e boa portabilidade, possibilitando uma alternativa de diagnóstico funcional para ser aplicada em locais de difícil acesso pelo interior do Brasil.

Abstract Congenital ocular toxoplasmosis is a manifestation of infection by the parasite Toxoplasma gondii that occurs through the placenta. This disease can lead to important visual sequelae. This paper describes a case report that uses visual psychophysics for the alterations of congenital ocular toxoplasmosis. The evaluation was performed in a 30-year-old man, a resident of São Luís (MA), with a history of his mother have had toxoplasmosis in the gestational period. Only at 26 years-old he did the detailed medical evaluation that described a lesion the fovea of the right eye. In the classic clinical examination and in visual psychophysical evaluation, the patient presented normal vision for the left eye. The right eye had low visual acuity (decimal value: 0.028), visual field with scotomas up to 20º of visual angle and alteration of color vision. The study offers safe and relevant medical information for the diagnosis of congenital ocular toxoplasmosis using a low-cost evaluation and with good portability, allowing a functional diagnostic alternative to be applied in places difficult to access in the interior of Brazil.

Prevalencia de toxoplasmosis en estudiantes de la Universidad Nacional de Chimborazo en Ecuador / Prevalence of toxoplasmosis in students of the National University of Chimborazo in Ecuador

Introducción: La infección por Toxoplasma gondii durante la edad fértil de la mujer, es un problema de salud no bien entendido en la población, círculos médicos y decisores dentro de los sistemas de salud; al no considerar importante las formas de adquirirla y el riesgo que implica infectarse durante el embarazo. En Ecuador no existen datos consistentes de la circulación y endemicidad de esta parasitosis, siendo esta la situación problémica el motivo de este trabajo. Objetivo: Conocer la seroprevalencia de Toxoplasma gondii en mujeres jóvenes en edad fértil y su relación con el nivel de conocimiento sobre la enfermedad. Métodos: Se evaluó el comportamiento serológico de T. gondii en 105 muestras de sueros de alumnas de la Universidad Nacional de Chimborazo de la Carrera de Laboratorio Clínico e Histopatológico, mediante la determinación de IgG anti T. gondii utilizando la Técnica de Quimioluminiscencia. Resultados: 38 alumnas (36,0 por ciento) resultaron ser positivas para anticuerpos contra T. gondii, lo que indica el contacto con el parásito en algún momento de su vida. La falta de conocimiento sobre las principales vías de contagio puede ser la causa de la seropositividad demostrada, lo que representa un riesgo para las seronegativas durante el embarazo. Conclusiones: Se demuestra seroprevalencia de la infección por T. gondii en la población estudiada y la endemicidad del parásito(AU)

Introduction : Toxoplasma gondii is the infection that occurs during the fertile age of women and is a health problem not well understood by the people, doctors and leaders of the health systems of some countries; as it does not consider important the ways of acquiring it and the risk involved in becoming infected during pregnancy. In Ecuador there aren´t consistent data on the circulation and endemicity of this parasitosis, being this problematic situation the reason for this work. Objective : The purpose of the present study was to determine the seroprevalence of Toxoplasma gondii in young women of childbearing age and their relation with the level of knowledge about the disease. Methods: The serological behavior of T. gondii was evaluated in 105 samples of sera from the National University of Chimborazo of the Clinical and Histopathological Laboratory, by the determination of IgG anti T. gondii using the Chemiluminescence Technique. Results: Of the study population, 38 students (36.0 percent) were found to be positive for antibodies to T. gondii, indicating contact with the parasite at some point in their life. The demonstrated seropositivity may be due to the lack of knowledge about the main routes of infection, the risk of being seronegative during pregnancy and the high endemicity of the parasite. Conclusions : The seroprevalence of T. gondii infection in the studied population were demonstrated(AU)

Toxoplasmosis diseminada en un paciente con trasplante de corazón a pesar de la profilaxis con trimetoprim-sulfametoxazol / Disseminated toxoplasmosis in a heart transplant patient despite cotrimoxazole prophylaxis: A case report

Resumen Se reporta el caso de un paciente de sexo masculino, de 61 años de edad, quien ocho meses después de someterse a un trasplante de corazón presentó una enfermedad sistémica con compromiso del sistema nervioso central y del sistema inmunológico, así como de pulmón, riñón, colon y piel, y a quien finalmente se le diagnosticó toxoplasmosis diseminada, a pesar de haber recibido profilaxis con trimetoprim-sulfametoxazol, debido a que el órgano provenía de un donante positivo para toxoplasmosis siendo él un receptor negativo. Se discuten las opciones de profilaxis en nuestro medio.

Abstract We report the case of a 61 year-old male who underwent heart transplantation eight months before developing a systemic condition with central nervous system, lung, kidney, colonic, cutaneous, and hematologic involvement, found to be secondary to a systemic toxoplasmosis despite co-trimoxazole prophylaxis in a previous-to-transplant seronegative patient receiving a heart from a seropositive donor. A review of prophylactic options in our environment is discussed.

Soroprevalência para toxoplasmose, sífilis, hepatite b, hepatite c, rubéola,citomegalovírus e vírus da imunodeficiência humana em gestantes atendidas no hospital universitário Antônio Pedro, Niterói (RJ) entre 2008 e 2012 / Seroprevalence of toxoplasmosis, syphilis, hepatitis b, hepatitisc, rubella, cytomegalovirosis and human immunodeficiency virus infection among pregnant patients followed up from 2008 to 2012 at hospital universitário Antônio Pedro, Niterói (RJ)

A triagem e o tratamento das doenças infecciosas em gestantes são de grande importância para o planejamento de ações preventivas e a elaboração de políticas de saúde materno-infantil. Objetivo: Determinar a soroprevalência de toxoplasmose, sífilis, hepatite B, hepatite C, rubéola, citomegalovírus (CMV) e infecção pelo vírus da imunodeficiência humana (HIV) em gestantes acompanhadas no Hospital Universitário Antônio Pedro, Niterói (RJ). Métodos: Foi feito um estudo transversal por meio de revisão de testes sorológicos registrados nos prontuários médicos de gestantes atendidas, de 2008 a 2012, no Ambulatório de Pré-Natal. Resultados: As prevalências encontradas foram: 61,4 (IgG) e 2,4% (IgM) para toxoplasmose; 95,1 (IgG) e 0,5% (IgM) para rubéola; 95,1 (IgG) e 1,2% (IgM) para CMV; 0,9% para hepatite B (HBsAg); 1,6% para hepatite C; 1,5% para sífilis; e 5,8% para infecção pelo HIV. Não houve, entre gestantes infectadas e não infectadas pelo HIV, diferenças estatisticamente significativas nas frequências das infecções estudadas. As taxas de transmissão vertical foram de 4,2% (2/48) para o HIV; 33,3% (5/15) para toxoplasmose; e 22,2% (2/9) para sífilis. Foram detectadas alterações compatíveis com rubéola congênita em 1/5 crianças cuja mãe apresentava IgM e IgG positivas para tal infecção durante a gestação. A coinfecção HIV/toxoplasmose ocorreu em uma criança. Conclusão: O número de gestantes susceptíveis à toxoplasmose (38,8%) e ao vírus da hepatite B (VHB) (66,3%) revela a necessidade de medidas diagnósticas e preventivas da toxoplasmose durante a gestação e vacinação para o VHB, visando diminuir o risco dessas infecções durante a gravidez, melhorando, assim, a saúde materno-infantil.

Screening and treatment of infectious diseases in pregnant women have great importance in planning preventive actions and development of maternal and child health policies. Objective: To evaluate the seroprevalence of toxoplasmosis, syphilis, hepatitis B, hepatitis C, rubella, cytomegalovirosis and human immunodeficiency virus (HIV) infection among pregnant women followed up at a University Hospital of Niterói, RJ. Methods: A cross-sectional study was done by reviewing serological tests recorded in the medical records of pregnant women attending the antenatal service of the Hospital Antônio Pedro, Universidade Federal Fluminense, from 2008 to 2012. Results: The seroprevalences found were 61.4 (IgG) and 2.4% (IgM) for toxoplasmosis; 95.1 (IgG) and 0.5% (IgM) for rubella; 95.1 (IgG) and 1.2% (IgM) for cytomegaloviruosis; 0.9% for hepatitis B surface antigen; 1.6% for hepatitis C virus; 1.5% for syphilis and 5.8% for HIV infection. There were no statistically significant differences between seroprevalences of patients with or without HIV infection. The rates of congenital transmission were 4.2% (2/48) for HIV, 33.3% (5/15) for toxoplasmosis, and 22.2% (2/9) for syphilis. There were congenital abnormalities in 1/5 newborn whose mother was seropositive for rubella IgG and/or IgM in the prenatal routine. Coinfection HIV/toxoplasmosis was found in one newborn. Conclusion: The large proportion of pregnant women susceptible to toxoplasmosis (38.8%) and hepatitis B (66.3%) shows the necessity of diagnostic and preventive measures for toxoplasmosis and HBV vaccination to reduce the risk of vertical transmission of these infections, thus improving the health of mother and newborn.

ACUTE TOXOPLASMOSIS IN A BREASTFED INFANT WITH POSSIBLE TRANSMISSION BY WATER / Toxoplasmose aguda em um lactente durante a amamentação, com possível transmissão pela água

Toxoplasma gondii transmission via breastfeeding has been discussed; however, no cases have been confirmed to date. This article describes a case of acute toxoplasmosis diagnosed in a mother and her six-month-old breastfed infant. The study accounts for the possibility of breast milk transmission and directs both clinicians and pediatricians to the hypothesis that both patients acquired toxoplasmosis via water ingestion.

A transmissão do Toxoplasma gondii através do aleitamento materno tem sido discutida; no entanto, até o momento nenhum caso foi confirmado. Este artigo relata um caso de toxoplasmose aguda diagnosticada na mãe e no seu bebê com seis meses de vida, que estava em amamentação exclusiva. Embora apresente a possibilidade de transmissão pelo leite materno, o estudo chama a atenção de clínicos e pediatras para a mais provável hipótese de que ambos adquiriram toxoplasmose pela ingestão de água.

Waterborne toxoplasmosis investigated and analysed under hydrogeological assessment: new data and perspectives for further research

We present a set of data on human and chicken Toxoplasma gondiiseroprevalence that was investigated and analysed in light of groundwater vulnerability information in an area endemic for waterborne toxoplasmosis in Brazil. Hydrogeological assessment was undertaken to select sites for water collection from wells for T. gondiioocyst testing and for collecting blood from free-range chickens and humans for anti-T. gondiiserologic testing. Serologic testing of human specimens was done using conventional commercial tests and a sporozoite-specific embryogenesis-related protein (TgERP), which is able to differentiate whether infection resulted from tissue cysts or oocysts. Water specimens were negative for the presence of viable T. gondiioocysts. However, seroprevalence in free-range chickens was significantly associated with vulnerability of groundwater to surface contamination (p < 0.0001; odds ratio: 4.73, 95% confidence interval: 2.18-10.2). Surprisingly, a high prevalence of antibodies against TgERP was detected in human specimens, suggesting the possibility of a continuous contamination of drinking water with T. gondiioocysts in this endemic setting. These findings and the new proposed approach to investigate and analyse endemic toxoplasmosis in light of groundwater vulnerability information associated with prevalence in humans estimated by oocyst antigens recognition have implications for the potential role of hydrogeological assessment in researching waterborne toxoplasmosis at a global scale.

HUMAN TOXOPLASMOSIS OUTBREAKS AND THE AGENT INFECTING FORM. FINDINGS FROM A SYSTEMATIC REVIEW / Surtos de toxoplasmose humana e a forma infectante do agente. Achados de revisão sistemática

SUMMARY Toxoplasmosis, a worldwide highly prevalent zoonotic infection, is transmitted either by the oocysts, from water and soil, or the tissue cysts, in raw or undercooked infected meat, of Toxoplasma gondii. An ongoing debate is whether there are differences between the clinical and epidemiological characteristics of the outbreaks due to one or the other infective form of the agent. We performed a systematic review, recovering 437 reported outbreaks of which 38 were selected. They were complete reports containing ascribed Toxoplasma infecting form, and clinical and demographic data. There was no gender or age group selection in the outbreaks, which were described more often in the Americas. A large number of individuals were affected when oocysts, associated with soil and water contaminated with cat feces, were considered the transmission source. Onset of symptoms occurred early when the infection was ascribed to meat tissue cysts (11.4 ± 6.7 days) with sharpened temporal distribution of cases, while a broader and prolonged appearance of new cases was observed when oocysts in water were the source of the infection (20 ± 7 days, p < 0.001). Such information may be useful in the design and implementation of control strategies.

RESUMO Toxoplasmose, infecção zoonótica altamente prevalente no mundo, é transmitida pela ingestão de oocistos em água e solo ou cistos teciduais em carne crua ou mal cozida. Um debate em andamento é se há diferenças nas características clínicas e epidemiológicas de surtos devido a uma ou outra forma infectante do agente. Realizamos revisão sistemática a partir de 437 relatos de surtos da doença, selecionando 38 artigos completos que descreveram a forma infectante do Toxoplasmacom dados clínicos e epidemiológicos. Não houve seleção por gênero ou faixa etária nos surtos, descritos mais frequentemente nas Américas. Quantidade maior de indivíduos foi afetada quando oocistos, associados com solo ou água contaminados com fezes de gato, foram considerados a fonte de transmissão. O início dos sintomas ocorreu mais precocemente quando a infecção foi atribuída a cistos na carne (11,4 ± 6,7 dias) com distribuição temporal nítida de casos, embora um aspecto mais amplo e prolongado de novos casos foi observado quando oocistos na água foram a fonte de infecção (20 ± 7 dias, p< 0.001). Essas informações podem ser úteis no desenvolvimento e implantação de estratégias de controle.

Estudio retrospectivo de la aplicación de la amplificación génica cualitativa en muestras biológicas para el seguimiento de la toxoplasmosis en pacientes pediátricos receptores de trasplante de células progenitoras hematopoyéticas / Retrospective study of the implementation of the qualitative PCR technique in biological samples for monitoring toxoplasmosis in pediatric patients receiving hematopoietic stem cell transplantion

La toxoplasmosis es una infección oportunista causada por el parásito Toxoplasma gondii; su infección es grave y de difícil diagnóstico en pacientes que reciben un trasplante alogénico de células progenitoras hematopoyéticas (TCPH). En el Hospital de Pediatría S.A.M.I.C. "Profesor Dr. Juan P. Garrahan" se realizó la vigilancia postrasplante de 12 pacientes receptores de TCPH mediante la técnica de PCR cualitativa. La necesidad de seguimiento de estos pacientes fue definida por el antecedente de serología positiva para toxoplasmosis en el donante o receptor y ante la imposibilidad de iniciar el uso profiláctico de trimetoprima-sulfametoxazol a causa de la condición hematológica. Dos pacientes presentaron signos de enfermedad por T. gondii con resultado de PCR positivo y recibieron tratamiento con pirimetamina-clindamicina. En otros dos, la toxoplasmosis fue causa de muerte y hallazgo de autopsia, con resultado de PCR negativo. Cuatro pacientes recibieron tratamiento contra toxoplasmosis por la detección de una PCR positiva, sin manifestaciones clínicas. En los cuatro pacientes restantes no se detectaron signos de enfermedad por toxoplasmosis, con resultados de PCR negativos durante el seguimiento. La técnica de PCR cualitativa demostró ser útil para detectar la reactivación de la toxoplasmosis en receptores de TCPH, pero tiene limitaciones para el seguimiento y la toma de decisiones clínicas en pacientes con PCR positiva que persiste en el tiempo y manifestaciones de toxicidad por el tratamiento.

Toxoplasmosis is an opportunistic infection caused by the parasite Toxoplasma gondii. The infection is severe and difficult to diagnose in patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Twelve patients receiving HSCT were monitored post-transplant, by qualitative PCR at the Children's Hospital S.A.M.I.C. "Prof. Dr. Juan P. Garrahan". The monitoring of these patients was defined by a history of positive serology for toxoplasmosis in the donor or recipient and because their hematologic condition did not allow the use of trimethoprim-sulfamethoxazole for prophylaxis. During the patients' monitoring, two of them with positive PCR results showed signs of illness by T. gondii and were treated with pyrimethamine-clindamycin. In two other patients, toxoplasmosis was the cause of death and an autopsy finding, showing negative PCR results. Four patients without clinical manifestations received treatment for toxoplasmosis because of positive PCR detection. In four patients there were no signs of toxoplasmosis disease and negative PCR results during follow-up. The qualitative PCR technique proved useful for the detection of toxoplasmosis reactivation in HSCT recipients, but has limitations in monitoring and making clinical decisions due to the persistence of positive PCR over time and manifestations of toxicity caused by the treatment.

Infeccoes de transmissao vertical em material abortivo e sangue com enfase em Toxoplasmose gondii / Vertical transmission from abortive material and blood with emphasis on Toxoplasma gondii

OBJETIVO: Analisar os resultados sorológicos, anatomopatológicos e parasitológicos de material abortivo para infecções com risco de transmissão vertical, com ênfase na toxoplasmose. MÉTODOS: Foi realizado um estudo coorte-transversal tratando da prevalência das doenças infectoparasitárias. Participaram da pesquisa 105 mulheres que sofreram aborto espontâneo completo e/ou incompleto; elas foram entrevistadas por meio de um questionário, e foram coletadas amostras de sangue e material abortivo. Foram realizados testes imunológicos para toxoplasmose, doença de Chagas, rubéola, citomegalovírus e sífilis e análise anatomopatológica nos restos ovulares. RESULTADOS: 55% das mulheres tinham entre 20 e 30 anos de idade. A maioria (68%) apresentou idade gestacional entre a 7ª e a 14ª semanas. 54,3% das mulheres tinham o ensino médio completo ou incompleto. Pela análise da sorologia, a infecção com risco de transmissão vertical mais frequente foi o citomegalovírus (CMV) com 97,1% de positividade, e em seguida a rubéola, com 95,2%. A toxoplasmose teve um percentual de 54,3%, a doença de Chagas, de 1,9% e a sífilis, de 0,95%. A análise dos laudos de biópsia demonstrou que 63,1% apresentaram inflamação e 34%, ausência de inflamação. Das análises sorológica, anatomopatológica e parasitológica das 105 mulheres, 57 foram soropositivas para T. gondii, e nenhuma teve resultado positivo para a Reação em Cadeia da Polimerase (PCR) e para inoculação em camundongos. CONCLUSÕES: A prevalência de doenças com risco de transmissão congênita nas mulheres com abortamento espontâneo é importante, sendo necessárias pesquisas visando esclarecer a etiologia do aborto. .

PURPOSE: To analyze the serological, anatomopathological and parasitological results obtained from abortive material in order to detect infections with the risk of vertical transmission, with emphasis on toxoplasmosis. METHODS: A cross-sectional cohort study was conducted in order to determine the prevalence of infectoparasitic diseases. A total of 105 women who suffered spontaneous complete or incomplete abortion participated in the study. The women were interviewed, answered a questionnaire and had their blood and abortive material collected. Immunological tests were carried out in order to detect toxoplasmosis, Chagas disease, rubeola, cytomegalovirus and syphilis, and anatomopathological analysis of the ovular remains was performed. RESULTS: 55% of the women studied were 20 to 30 years old. Most of them (68%) presented a gestational age between the 7th and 14th week. 54.3% of the women had complete or incomplete high school education. Serological analysis showed cytomegalovirus (CMV) as the most common vertically transmitted infection with 97.1% positivity, followed by rubeola with 95.2%. Toxoplasmosis showed 54.3% positivity, Chagas disease 1.9% and syphilis 0.95%. Anatomopathological analysis showed inflammation in 63.1% of the cases and absence of inflammation in 34%. The results of the serological, anatomopathological and parasitological analysis of the 105 participants showed that 57 women were T. gondii positive. However, none showed positivity in the polymerase chain reaction (PCR) or in mouse inoculation. CONCLUSIONS: The prevalence of diseases with the risk of vertical transmission is important in women with spontaneous abortion, indicating the need for more research in order to investigate the etiology of abortion. .

Estudio seroepidemiológico para estimar el riesgo de infección congénita por toxoplasma gondii en Guayaquil, Ecuador / Serological and epidemiological screening to estimate congenital toxoplasma gondii infection in Guayaquil, Ecuador

Exámenes serológicos, por Hemaglutinación indirecta (HAI) y Elisa para anticuerpos anti Toxoplasma gondii se practicaron a niños y adolescentes, distribuidos en 4 grupos: 0 < 5 .años, 5 < 10, 10 < 15 y de 15 < 20, para obtener los datos de prevalencia e incidencia quinquenal, así como, por entrevista para identificar factores de riesgo; los datos se analizaron estadísticamente, como variables independientes y correlaciones bivariadas. Se examinaron 578: 285 varones y 292 mujeres, (1 no consignado), promedio de edad 9,7 años. La prevalencia encontrada es 60,2 con descenso de 18 porciento respecto a 1989. Se discuten hipótesis para explicar esta disminución. La incidencia aumenta rápido hasta los 10 años. No se estableció ninguna correlación con los factores de riesgo incluidos, excepto en el contacto con gatos menores de 6 meses (gatitos). El riesgo de transmisión congénita se estima en 18 por diez mil; en consecuencia se esperarían 106 casos anuales, con 69 asintomáticos (65 porciento), y 37 (35 porciento) con síntomas: 17 con daños leves, 11 con graves y 9 mortinatos. Los 28 niños con lesiones manifiestas, más un número no determinado con lesiones tardías de los 69 asintomáticos incorporan una población que causa un impacto económico y social aún no establecido...

Serological testing, by indirect haemagglutination and ELISA was performed in 4 age groups: 0 to <5, 5 to <10, 10 to <15 and 15 to <20 years old, to find prevalence and quinquennial incidence. An interview to assess risk factors was performed. The statistical analysis was performed for independent variables and bivariate correlations to calculate the odds ratio. The total number of observations was 578: 285 male and 292 female (1 not determined) and median age was 9.7. An increase in the prevalence was related to age, reaching 60.2 percent in the group between 15 and 20 years old, when compared to the same age group in 1989 (78.3 percent) showing an 18 percent decrease. Several hypotheses to explain this decrease were proposed. There is a steep increase at the age of 10. The statistical analysis does not demonstrate a direct correlation with any of the risk factors consigned in the interview, with the exception of exposure to young felines (kittens). The risk for acquiring congenital toxoplasmosis was estimated as 1.8 per thousand (18 per ten thousand), hence 106 cases are expected per year, with 69 (65 percent) of them being asymptomatic, and 37 with different degrees of severity: 17 with mild, 11 severe and 9 with death at birth. Each year there would be 28 newborns with evident lesions and additionally an undetermined number of cases with late onset lesions within the initially asymptomatic group (65 percent), with unknown socioeconomic impact...

Ocorrência de anticorpos anti-toxoplasma gondii associada a fatores de risco em gatos com esporotricose oriundos da região metropolitana do Rio de Janeiro / Occurrence of anti-toxoplasma gondii antibodies associated with risk factors in cats with sporotrichosis in the metropolitan Rio de Janeiro

A toxoplasmose é uma zoonose causada pelo protozoário Toxoplasma gondii que acomete várias espécies de vertebrados, inclusive o ser humano. Os gatos, assim como os outros felinos, têm papel de suma importância na epidemiologia da infecção, pois são os hospedeiros definitivos do T. gondii...

Toxoplasmosis is a zoonotic disease caused by the Toxoplasma gondii protozoan that affects several species of vertebrates, including humans. Cats, as well as other felines, are important in the epidemiology of the infection because they are the definite hosts of T. gondii...

Participação da autofagia na interação Toxoplasma gondii-célula hospedeira / Autophagy participation in Toxoplasma gondii-cell interaction host

Toxoplasma gondii é um protozoário parasito intracelular obrigatório, agente causador da toxoplasmose, uma das zoonoses mais difundidas no mundo, podendo ser transmitido por via transplacentária, fecal-oral ou por carnivorismo. Durante a resposta imune do hospedeiro, ocorre a formação de cistos teciduais, possibilitando assim a manutenção do parasito no interior da célula hospedeira, sem ocorrência da fusão fagolisossomal. A autofagia, processo de degradação de componentes celulares, é crucial para a homeostase celular. Recentemente, vem sendo proposta a participação da via autofágica na interação de diferentes patógenos, como o T. gondii, com suas células hospedeiras. Assim, o presente trabalho teve como objetivo avaliar o papel da via autofágica na interação de T. gondii com macrófagos e células musculares esqueléticas (CME e C2C12), células envolvidas na infecção natural in vivo. A autofagia nas células hospedeiras foi avaliada na presença ou na ausência de indutores autofágicos (rapamicina ou estresse nutricional), durante a infecção pelo T. gondii. Ambos os estímulos foram capazes de inibir a infecção e a proliferação intracelular do parasito nos diferentes tipos celulares. Foi observado ainda que a infecção na presença ou na ausência de estímulo induziu a autofagia em macrófagos e CME, indicando que este processo possa regular naturalmente a manutenção intracelular do parasito, auxiliando-o, por exemplo, na captação de nutrientes da célula hospedeira. Adicionalmente, os aspectos morfológicos das culturas de macrófagos e CME infectadas tratadas com rapamicina ou submetidas a estresse nutricional sugerem a eliminação do T. gondii por mecanismos que envolvem tanto a autofagia da célula hospedeira quanto a do parasito...

Toxoplasma gondii is an obligate intracellular protozoan parasite, the causative agent of toxoplasmosis, one of the most widespread zoonoses in the world and can be transmitted by transplacental, fecal-oral or carnivorism routes. During the host immune response, there is the formation of tissue cysts, thus enabling the maintenance of parasite within the host cell without occurrence of phagolysosomal fusion. Autophagy, the degradation process of cellular components, is critical for cellular homeostasis. Recently, the autophagy has been proposed to participate during the interaction between different pathogens, such as T. gondii, with their host cell. Thus, the present study aimed to evaluate the role of the autophagic pathway in the interaction of T. gondii with macrophages and skeletal muscle cells (C2C12 and CME), cells involved in natural infection in vivo. Host cells autophagy was assessed in the presence or absence of autophagic inductors (rapamycin or nutritional stress) during the infection with T. gondii. Both stimuli were able to inhibit infection and proliferation of the intracellular parasite in different cell types. It was also observed that the infection in the presence or absence of stimulation induced autophagy in macrophages and CME, indicating that this process may naturally regulate the maintenance of intracellular parasites, assisting him, for example, in the nutrients uptake from the host cell. Additionally, the morphological aspects of cultures of infected macrophages and CME treated with rapamycin or subjected to nutritional stress suggest the elimination of T. gondii by mechanisms involving both, host cell and parasite autophagy...

Case-control study of an outbreak of acute toxoplasmosis in an industrial plant in the state of São Paulo, Brazil / Estudo caso-controle de surto de toxoplasmose aguda em indústria no estado de São Paulo, Brasil

Foodborne diseases represent operational risks in industrial restaurants. We described an outbreak of nine clustered cases of acute illness resembling acute toxoplasmosis in an industrial plant with 2300 employees. These patients and another 36 similar asymptomatic employees were diagnosed with anti-T. gondii IgG titer and avidity by ELISA. We excluded 14 patients based on high IgG avidity and chronic toxoplasmosis: 13 from controls and one from acute disease other than T. gondii infection. We also identified another three asymptomatic employees with T.gondii acute infection and also anti-T. gondii IgM positive as remaining acute cases. Case control study was conducted by interview in 11 acute infections and 20 negative controls. The ingestion of green vegetables, but not meat or water, was observed to be associated with the incidence of acute disease. These data reinforce the importance of sanitation control in industrial restaurants and also demonstrate the need for improvement in quality control regarding vegetables at risk for T. gondii oocyst contamination. We emphasized the accurate diagnosis of indexed cases and the detection of asymptomatic infections to determine the extent of the toxoplasmosis outbreak.

Doenças transmitidas por alimentos representam riscos operacionais em restaurantes industriais. Descrevemos surto de nove casos agrupados de doença aguda semelhante à toxoplasmose em indústria de 2300 funcionários. Estes pacientes e outros 36 funcionários assintomáticos foram diagnosticados por ELISA para o título e avidez de IgG anti-T. gondii. Foram excluídos 14 pacientes com toxoplasmose crônica e alta avidez: 13 de controles e um de doença aguda não relacionada à infecção por T. gondii. Também identificamos três empregados assintomáticos com infecção aguda por T.gondii, que como os restantes agudos apresentavam anti-T.gondii IgM ELISA positivo. Conduzimos estudo caso controle por entrevista em 11 infecções agudas e 20 controles negativos. A ingestão de vegetais, mas não de carne ou água, foi associada com a incidência da doença aguda. Esses dados reforçam a importância do controle sanitário em restaurantes industriais e também demonstram a necessidade de melhoria no controle de qualidade sobre vegetais em risco de contaminação por oocistos de T. gondii. Enfatizamos o diagnóstico preciso de casos e a detecção de infecções assintomáticas para determinar a extensão do surto de toxoplasmose.

Toxoplasma gondii antibody profile in HIV-1-infected and uninfected pregnant women and the impact on congenital toxoplasmosis diagnosis in Rio de Janeiro, Brazil

OBJECTIVE: Compare the anti-T. gondii IgG titer between HIV-1 infected and non HIV-1 infected pregnant women and report three cases of congenital toxoplasmosis resulting from reactivation of infection during pregnancy of HIV-1 infected women. METHODS: This study was conducted among 2,270 pregnant women with chronic Toxoplasma gondii infection (absence of IgM and presence of IgG), including 82 HIV-1 infected and 2,188 non-infected women. RESULTS: The average anti-T. gondii IgG titer was 127 for the 2,188 non-HIV-1 infected women, and 227 for the 82 HIV-1-infected women (p = 0,007). These results suggested that higher anti-T. gondii IgG titers in HIV-1-infected pregnant women may not be indicative of an elevated risk for fetal infection. In this study three cases of congenital toxoplasmosis that resulted from infection reactivation during pregnancy of HIV-1-infected women were manifested by fetal death, symptomatic infection, and infant without symptoms, respectively. In two of these women, a ten-fold increase in IgG levels above used cutoff was observed (2,320 UI/mL and 3,613 UI/mL, respectively). In the third pregnant women anti-T. gondii IgG titers during pregnancy did not rise despite the occurrence of congenital toxoplasmosis (204; 198; 172 UI/mL). CONCLUSIONS: Congenital toxoplasmosis resulting reactivation of infection during pregnancy in the studied group leads us to believe that it is a public health problem, especially in our population, in which seroprevalence of T. gondii infections is high. These findings also suggest that special attention is necessary during pregnancy, because the serologic diagnosis may not be indicative of toxoplasmosis reactivation.

Seroprevalencia de toxoplasmosis en mujeres no embarazadas / Seroprevalence of Toxoplasma gondii infection in non pregnant women

El diagnóstico de toxoplasmosis en mujeres no embarazadas permite iniciar medidas preventivas y de vigilancia, para reducir la manifestación de la enfermedad y la transmisión congénita. El estudio serológico debe extenderse a embarazadas y completarse con datos epidemiológicos para establecer los principales factores de riesgo

Fatores de risco da transmissão de zoonoses por costumes da população de Ilha Solteira, Brasil / Zoonosis transmission risk factors according to population habits inIlha Solteira city, Brazil / Factores de riesgo de transmisión de zoonosis por costumbres de la población de Ilha Solteira, Brasil

Objetivo Determinar condições geradoras de possíveis transmissões de zoonoses com base nos costumes dos moradores de Ilha Solteira-São Paulo, para formular recomendações concretas às autoridades correspondentes para reduzir os fatores de risco. Métodos Foram realizadas 100 entrevistas dirigidas no perímetro urbano da cidade de Ilha Solteira no mês de abril de 2008. O público alvo foram pessoas maiores de idade que morassem ou trabalhassem na casa em estudo. Resultados Na pesquisa foram encontrados valores elevados de proprietários de cachorros e gatos que permitem a permanência das mascotes dentro das casas; não destinam um local específico para que os animais disponham as fezes e urina ou não fazem uma disposição apropriada das fezes. Conclusão É necessário um maior esforço das autoridades locais na informação e educação dos proprietários de mascotes de Ilha Solteira e de um maior compromisso e sensibilidade cidadã para melhorar os costumes em relação à criação de animais de estimação e diminuir os fatores de risco de transmissão de zoonoses.

Objective Determining conditions regarding possible zoonosis transmission risk based on Ilha Solteira-São Paulo citizens' habits aimed at establishing concrete recommendations for the corresponding local authorities to reduce some risk factors. Methods 100 focalized interviews were held on Ilha Solteira's urban perimeter during April 2008. The people interviewed were adults who lived or worked in houses in the study area. Results This research found a significant number of cat and/or dog owners who allowed their pets to stay in internal areas of their houses. They did not define a specific place for animals to defecate and/or urinate or did not arrange appropriate final disposal of such waste. Conclusion Local authorities must make greater efforts at educating Ilha Solteira pets' owners and providing them with information and encouraging greater citizen commitment and awareness to improve habits related to caring for pets/animal sand reducing zoonosis transmission risk factors.

Objetivo Determinar condiciones generadoras de posibles transmisiones de zoonosis con base en las costumbres de los habitantes de Ilha Solteira-São Paulo para formular recomendaciones concretas a las autoridades correspondientes para reducir los factores de riesgo. Métodos Se realizaron 100 entrevistas dirigidas en el perímetro urbano de la ciudad de Ilha Solteira SP en el mes de abril de 2008. El público objetivo fueron personas mayores de edad que vivieran o trabajaran en la casa en estudio. Resultados En la investigación se encontraron valores elevados de propietarios de perros y gatos que permiten la permanencia de las mascotas dentro de las casas; no destinan un lugar específico para que los animales dispongan las heces y orina o no realizan una disposición apropiada de las heces. Conclusión Es necesario un mayor esfuerzo de las autoridades locales en la información y educación de los propietarios de mascotas de Ilha Solteira y de un mayor compromiso y sensibilidad ciudadana para mejorar sus costumbres en relación con la cría de mascotas y disminuir los factores de riesgo de transmisión de zoonosis.

Anti-Toxoplasma gondii antibodies in pregnant women and their newborn infants in the region of São José do Rio Preto, São Paulo, Brazil / Anticorpos anti-Toxoplasma gondii em gestantes e seus neonatos na região de São José do Rio Preto, São Paulo, Brazil

CONTEXT AND OBJECTIVE: Toxoplasmosis transmission during pregnancy can cause severe sequelae in fetuses and newborns. Maternal antibodies may be indicators of risk or immunity. The aim here was to evaluate seropositivity for anti-Toxoplasma gondii (anti-T. gondii) immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies and IgG avidity in pregnant women and their newborn infants. DESIGN AND SETTING: Cross-sectional study in a high-risk pregnancy outpatient clinic. METHODS: Serum samples from pregnant women (n = 87) and their respective newborns (n = 87) were evaluated for anti-T. gondii antibodies using indirect immunofluorescence (IIF) (IgM and IgG), enzyme-linked immunosorbent assay (ELISA) (IgG) and an avidity test. RESULTS: Anti-T. gondii antibodies were identified in 64.4 percent of the serum samples from the mothers and their infants (56/87). Except for two maternal serum samples (2.3 percent), all others were negative for anti-T. gondii IgM antibodies, using IIF. The results showed that 92.9 percent of the pregnant women had high IgG avidity indexes (> 30 percent) and four samples had avidity indexes between 16 and 30 percent. Two women in the third trimester of pregnancy were positive for anti-T. gondii IgM antibodies; their babies had avidity indexes between 16 and 30 percent. The avidity indexes of serum from the other 83 newborns were similar to the results from their mothers. CONCLUSIONS: The results showed that 2 percent of the pregnant women were at risk of T. gondii transmission during the gestational period. These data seem to reflect the real situation of gestational toxoplasmosis in the northwestern region of the state of São Paulo.

CONTEXTO E OBJETIVOS: A toxoplasmose, quando transmitida durante a gestação, pode causar graves sequelas em fetos e neonatos. Anticorpos maternos podem ser indicadores de risco ou de imunidade. O objetivo foi avaliar a positividade dos anticorpos das classes imunoglobulina M (IgM) e imunoglobulina G (IgG) anti-Toxoplasma gondii (anti-T. gondii), bem como a avidez de IgG em gestantes e seus neonatos. TIPO DE ESTUDO E LOCAL: Estudo transversal em ambulatório de gestação de alto risco. MÉTODOS: Anticorpos anti-T. gondii foram avaliados em amostras de soro de gestantes (n = 87) e seus respectivos neonatos (n = 87) com o uso dos métodos imunofluorescência indireta (IFI) (IgM e IgG), ensaio imunoenzimático (ELISA) (IgG) e avidez. RESULTADOS: Anticorpos anti-T. gondii foram identificados em 64,4 por cento das amostras de soro das mães e seus bebês (56/87). Com exceção de duas amostras de soro materno (2,3 por cento), todas as demais foram negativas anticorpos IgM anti-T. gondii determinado pela IFI. Os resultados mostraram que 92,9 por cento das gestantes tinham índices elevados de avidez de IgG (> 30 por cento) e 4 amostras apresentaram índices de avidez entre 16-30 por cento. Duas gestantes no terceiro trimestre da gravidez eram positivas IgM anti-T. gondii; seus bebês apresentaram índices de avidez entre 16 e 30 por cento. Os índices de avidez dos soros dos outros 83 recém-nascidos foram semelhantes àqueles encontrados nas amostras maternas. CONCLUSÕES: Os resultados mostraram que 2 por cento das gestantes estavam sob risco de transmissão de T. gondii durante o período gestacional. Estes dados parecem refletir a real situação da toxoplasmose gestacional na região noroeste do Estado de São Paulo.

Avaliação de um folheto educativo abordamento o conhecimento sobre toxoplasmose / Evaluation of an educational handout on knowledge about toxoplasmosis

Aims: The study sought to determine the factors associated with prior knowledge about toxoplasmosis, and to assess what participants learned after reading an educational handout. Methods: Participants were recruited at two sites in California: a public meeting about water quality in Morro Bay; and at the Women Infants and Children?s Nutrition Program office or La Leche League meetings in Yolo County. Demographic differences between sites were compared using Fisher?s exact test, and change in knowledge before and after reading the handout using Mantel-Haenszel methodology. Results: Non-Hispanic white participants were more likely than those of Hispanic ethnicity (62% vs. 20%, respectively) to have prior knowledge about toxoplasmosis. The most common source of information was newspapers (36%). Only 16% had obtained information from medical professionals. After reading the handout, 85% of participants identified Toxoplasma gondii as a parasite and 98% identified cats as the source of oocysts. Ninety-eight percent of participants who read the handout were aware they could acquire infection from cat faeces, 94% from meat, 78% from soil or in utero, and 69% from unwashed vegetables. Fewer (59%) recognized all sources. Conclusions: Knowledge about Toxoplasma gondii increased in all areas evaluated, but gaps remained, particularly with regard to environmental sources of Toxoplasma gondii infection and clinical manifestations of disease. In addition to care in handling cat faeces/litter and avoidance of undercooked meat, healthcare providers counseling pregnant women should emphasize the importance of wearing gloves when gardening, hand washing after handling soil or meat, and rinsing fresh vegetables thoroughly before consumption.

Prevalence of toxoplasmosis, HIV, syphilis and rubella in a population of puerperal women using Whatman 903® filter paper

OBJECTIVES: to determine the seroprevalence rate of toxoplasmosis, HIV, syphilis and rubella in a population of puerperal women. METHODS: a prospective, cross-sectional study was performed from February 2007 to April 2008 at Hospital Geral, Universidade de Caxias do Sul in a population of 1,510 puerperal women. Women that gave birth to live born or stillborn infants were included in the study; maternal and perinatal variables were analyzed. Descriptive statistics and Pearson's chi-square with occasional Fisher's correction were used for comparisons. Alpha was set in 5 percent. RESULTS: a total of 148 cases of congenital infection (9.8 percent) were identified: 66 cases of syphilis (4.4 percent), 40 cases of HIV (2.7 percent), 27 cases of toxoplasmosis (1.8 percent) and 15 cases of rubella (1.0 percent). In ten cases there was co-infection (four cases of HIV and syphilis, two cases of HIV and rubella, one case of HIV and toxoplasmosis, two cases of rubella and syphilis, and one case of toxoplasmosis and rubella). In a comparison between puerperal women with and without infection there was no statistical significance in relation to incidence of abortions, small for gestational age, prematurity, live births and stillbirths, and prenatal care. Need of neonatal intensive care unit (NICU), maternal schooling, maternal age higher than 35 years and drug use (alcohol, cocaine and crack) had statistical significance. CONCLUSION: the prevalence rate of infections was 9.8 percent. Need of NICU, maternal schooling lower than eight years, maternal age higher than 35 years and drug use were significantly associated with occurrence of congenital infection.