Toxoplasmosis in patients with an autoimmune disease and immunosuppressive agents: A multicenter study and literature review.

BACKGROUND: Cases of Toxoplasma reactivation or more severe primary infection have been reported in patients receiving immunosuppressive (IS) treatment for autoimmune diseases (AID). The purpose of this study was to describe features of toxoplasmosis occurring in patients with AID treated by IS therapy, excluded HIV-positive and transplant patients. METHODS: A multicenter descriptive study was conducted using data from the French National Reference Center for Toxoplasmosis (NRCT) that received DNA extracts or strains isolated from patients, associated with clinical data. Other cases were retrieved through a questionnaire sent to all French parasitology and internal medicine departments. Furthermore, a systematic literature review was conducted. RESULTS: 61 cases were collected: 25 retrieved by the NRCT and by a call for observations and 36 from a literature review. Half of the cases were attributed to reactivation (50.9%), and most of cases (49.2%) were cerebral toxoplasmosis. The most common associated AID were rheumatoid arthritis (28%) and most frequent treatments were antimetabolites (44.3%). Corticosteroids were involved in 60.7% of cases. Patients had a favorable outcome (50.8%) but nine did not survive. For 12 cases, a successful Toxoplasma strain characterization suggested the possible role of this parasitic factor in ocular cases. CONCLUSION: Although this remains a rare condition, clinicians should be aware for the management of patients and for the choice of IS treatment.

Congenital toxoplasmosis in the United States: clinical and serologic findings in infants born to mothers treated during pregnancy.

We assessed clinical and serologic findings in 25 infants with congenital toxoplasmosis born to mothers treated during pregnancy in the United States. Results indicate a lower prevalence of eye findings and hydrocephalus in the group of infants born to treated mothers (62.5% and 38.5%, respectively) compared to results on the same pathologies reported in our previous cohort of infants born to untreated mothers (92.2% and 67.7%, respectively). The sensitivity of the IgM ISAGA and IgA ELISA in the present study were lower (44% and 60%, respectively) compared to sensitivity of these methods in our previously studied group of infants born to untreated mothers (86.6% and 76.5%, respectively). These findings provide further evidence that anti-parasitic treatment if administered during pregnancy can contribute to better clinical outcomes, even in countries where systematic screening and treatment have not been routinely implemented.

Toxoplasmosis congénita: aspectos clínicos y epidemiológicos de la infección durante el embarazo / Congenital toxoplasmosis: clinical and epidemiological aspects of the infection during pregnancy

Se presenta una revisión actualizada sobre la toxoplasmosis durante el embarazo y de su consecuencia la toxoplasmosis congénita. Se pretende ilustrar a los profesionales de la salud con los diferentes aspectos tanto epidemiológicos como clínicos concernientes a esta enfermedad. Se revisan conceptos actuales de la parasitología y de la epidemiología de la transmisión materno-fetal, así como la presentación clínica de la infección perinatal. Se discuten nuevos adelantos en el diagnóstico y su influencia en el tratamiento de la mujer embarazada, del feto y del recién nacido. También se discuten las controversias recientes sobre las diversas estrategias de prevención primaria y secundaria durante el embarazo.

We present an updated review on toxoplasmosis during the pregnancy and its more feared outcome, the damage to the fetus and the newborn. The scope of this review is to summarize current and important epidemiological and clinical aspects concerning this disease. Several new parasitological and epidemiological concepts are reviewed, as well as the clinical presentation of the perinatal infection. In addition, we discussed current diagnostic approaches and treatment of the pregnant woman, fetus and newborn. Recent controversies on the different strategies for primary and secondary prevention of toxoplasmosis during the pregnancy are also discussed.

Practica comunitária en unidades de atención primaria a nível rural: una experiencia con estudiantes de medicina / Community practice in rural primary care units: experimental exercise with medical students

Durante tres semanas de mayo de 1982, correspondientes al período de vacaciones del sexto semestre de medicina, un grupo de seis estudiantes y una profesora del Departamento de Medicina Social de la Universidad del Valle, Colombia, llevaron a cabo una experiencia práctica voluntaria que tuvo como centro la Administración del Hospital Regional de Tuluá en el Departamento del Valle del Cauca y como área de trabajo algunas de sus unidades de atención primaria en el área rural. El objetivo de la práctica, denominada "Ruralito", consistía en elaborar un censo de salud, con las características generales de las comunidades rurales que constituyen el ámbito de la atención primaria en salud. El proceso didáctico seguido permitió estimular en los estudiantes iniciativas propias y formas de trabajo, así como intercambiar experiencias y definir acciones aun después de haber finalizado el período de las tres semanas de práctica voluntaria. El artículo recoge los aspectos más relevantes de la relación entre la práctica pedagógica y la práctica de salud pública en esta primera experiencia, en la cual se introdujo un nuevo marco docente para el área de la medicina; la opinión muy favorable de los estudiantes sobre esta experiencia y los importantes logros alcanzados permiten esperar que sirva de ejemplo para futuras prácticas de los estudiantes en procesos similares