Increased levels of IL-17A in serum and amniotic fluid of pregnant women with acute toxoplasmosis.

This study detected and compared the levels of Il-17A, IFN-gamma and IL-10 in the amniotic fluid (AF) and serum of pregnant women with acute toxoplasmosis in southern Brazil. It also compared the serum levels of these mediators in pregnant women with acute or chronic toxoplasmosis and with uninfected women. The serological investigations of anti-T. gondii IgM and IgG from the 60 pregnant women were determined by chemiluminescence microparticle immunoassay (CMIA). Twenty patients were uninfected, twenty were in the chronic phase and twenty were in the acute phase of toxoplasmosis. The 20 pregnant women in acute phase all agreed with amniocentesis. Serum and AF cytokines were evaluated by sandwich enzyme-linked immunosorbent assay. The analyzed cytokines showed no significant difference in blood versus amniotic fluid levels of pregnant women in the acute toxoplasmosis. Furthermore, we observed that serum IL-17A was significantly higher in pregnant women in the acute phase of infection compared to pregnant women with chronic toxoplasmosis and seronegative pregnant women. T. gondii DNA was not amplified in any of the samples of amniotic fluid by the nested-PCR reaction. Serum IL-10 levels were also higher in negative pregnant women than in infected pregnant women. Our findings indicate the activation of an inflammatory response to infection by T. gondii and suggest that increased production of IL-17A may be a protective factor against infection of the fetus.

Prospective evalution of pregnant women with suspected acute toxoplasmosis treated in a reference prenatal care clinic at a university teaching hospital in Southern Brazil.

Infection by the protozoan Toxoplasma gondii during pregnancy demands greater attention from the health authorities due to the risk of placental transmission, which can have devastating consequences to the foetus and newborn. This study was conducted in a high-risk prenatal care outpatient clinic of a university teaching hospital. Pregnant women screened for specific IgM and IgG anti -T. gondii, attended from January 2009 to August 2018 were included. From 530 suspected patients, 218 were followed up and they presented positive IgM and IgG anti- T. gondii. From these patients, 83 (38.0%) had low IgG avidity, 39 (18%) seroconverted in the second or third trimester of pregnancy, 19 (8.7%) had no avidity test, 69 (31.6%) had high IgG avidity after 16 weeks of gestation, five had recurrent chorioretinitis (2.2%) and three (1.3%) were seropositive to HIV. Complementary diagnoses were made in 30/48 (62.5%) of the patients revealing the presence of specific IgA antibodies raised to T. gondii; 3/63 (4.8%) peripheral blood samples and 1/57 (1.8%) amniotic fluid sample. There were eight foetal deaths, one case of neonatal hepatomegaly and one case of T. gondii DNA detected in a peripheral blood sample. Of the 139 newborn deliveries at the teaching hospital, there was a 38% loss of follow-up. The prevalence of congenital toxoplasmosis was 1.2 cases/1,000 live births in this study area, according to the retrospective survey of cases. Prenatal treatment may have helped to reduce the risk of vertical transmission.

Analysis of cytokines IFN-γ, TNF-α, TGF-ß and nitric oxide in amniotic fluid and serum of pregnant women with toxoplasmosis in southern Brazil.

This study detected and compared the levels of IFN-γ, TNF-α, TGF-ß and nitric oxide (NO) in amniotic fluid (AF) and serum of pregnancies with acute toxoplasmosis, Southern Brazil. It also was compared the levels of the same mediators in the serum of pregnancies in acute and chronic toxoplasmosis with non-infected. Serological investigation, anti-T gondii IgM and IgG, of the 67 pregnancies was determined by Elisa MEIA. Forty two were uninfected, eight in chronic phase and 17 in acute phase. Among the acute phase, seven agreed to amniocentesis. The cytokines, in serum and in AF, were assessed by sandwich ELISA, and NO was estimated from the nitrite measurement with Griess reagent. The IFN-γ and TGF-ß levels in the AF and blood were similar, while TNF-α levels was lower in the AF. On the other hand, NO was higher in the AF. Chronically infected pregnant women have showed lower levels of INF-γ than those in acute and uninfected pregnancies. The serological levels of TNF-α were lower in pregnancies with toxoplasmosis, when compared with non-infected. TGF-ß levels were higher in pregnancies in acute phase when compared with uninfected or chronically infected. NO in the serum of the infected had lower levels than those non-infected. In summary, higher concentrations of NO and lower levels of TNF-α were observed in the AF than in the serum of acute pregnancies, while TGF-ß e INF-γ levels were similar in both biological material. In the serum of infected pregnancies was observed decrease in inflammatory mediators and increase of TGF-ß.

Análise do controle da toxoplasmose gestacional e ocular nos serviços de Atenção Primária da 15ª Regional de Saúde do Paraná / Control analysis of pregnancy and ocular toxoplasmosis in Primary Care centers of the 15th Health Division of the state of Parana

Introdução: A primo-infecção pelo Toxoplasma gondii na gestação causa um risco de transmissão fetal entre 10% e 100%. Em 2006, a 15ª Regional de Saúde do Paraná criou a Rede de Controle da Toxoplasmose Gestacional e Congênita com referência para o Hospital Universitário de Maringá. Objetivo: avaliar as medidas adotadas pelos profissionais da Atenção Primária, para o controle da toxoplasmose gestacional e ocular. Método: Foram sorteadas 20% das 39 Unidades Básicas de Saúde de quatro municípios pertencentes à 15ª Regional de Saúde. A abordagem aos profissionais que assistiam as gestantes foi mediada por um questionário estruturado. Os dados coletados foram sobre as medidas realizadas: com gestantes soro não reagentes, com suspeita aguda, e com toxoplasmose ocular. Resultados: A maioria dos profissionais desconhecia a rede de controle, maneiras de infecção e medidas profiláticas para toxoplasmose. Conclusão: Isto mostra a importância da atualização profissional e perseverança da educação continuada (AU)

INTRODUCTION The primary infection by Toxoplasma gondii in pregnancy leads to a 10%--100% risk of fetal transmission. In 2006, the15th Health Division of the state of Paraná created the Network for Gestational and Congenital Toxoplasmosis Control with reference to the University Hospital of the city of Maringá. OBJECTIVE to evaluate the measures taken by primary care professionals regarding the control of gestational and ocular toxoplasmosis. METHOD Twenty percent of the 39 Basic Health Units in four municipalities belonging to the 15th Health Division of Paraná. The professionals who attended the pregnant women were interviewed through structured questionnaires. Data were collected on the measures carried out with non-reactive pregnant women, with acute suspicion, and ocular toxoplasmosis. RESULTS Most professionals were unaware of this control network, of the mode of infection, and the toxoplasmosis prophylactic measures. CONCLUSION This shows the importance of professional updating, and perseverance in continuing education (AU)

Toxoplasma gondii genotypes isolated from pregnant women with follow-up of infected children in southern Brazil.

BACKGROUND: Toxoplasma gondii populations that perpetuate in South America's natural ecosystems display broad genetic diversity, but the impact of this diversity on humans is generally unknown. In this short communication, we depict the genotypic traits of four isolates related to congenital parasitism as it emerges in Southern Brazil. METHODS: Using the PCR-restriction fragment length polymorphism markers SAG1, 5'3'SAG2, alt. SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, Apico, and CS3. Three of the four strains (TgCTBral, TgCTBrv, and TgCTBrac) were identified as ToxoDB genotype #166. RESULTS: Three children displayed normal cognitive/psychomotor development, and one child displayed Sabin's tetrad (TgCTBral). CONCLUSION: Vertical transmission of the two genotypes was observed and contributes to knowledge of T. gondii strains isolated from humans in Brazil.

Relato de dois casos de toxoplasmose em gestantes atendidas no noroeste do Paraná, Brasil / Report of two cases of toxoplasmosis in pregnant women from the northwest of Parana state, Brazil

Paraná em acompanhar adequadamente gestantes com suspeita de toxoplasmose aguda, como observado nestes relatos, com um caso de toxoplasmose congênita e outro de reagudização ocular severa. Descrição dos casos: no primeiro caso, a gestante apresentou IgM, IgG e IgA Toxoplasma gondii-específicas reagentes e líquido amniótico com pesquisa de DNA e inoculação em camundongos positivas para Toxoplasma gondii. Houve acometimento fetal, com achados ultrassonográficos de placentomegalia e calcificações cerebrais. O recém-nascido apresentou a tétrade de Sabin. No outro caso, uma gestante imunocompetente, IgG anti-Toxoplasma gondii reagente e IgM não reagente, apresentou reagudização ocular grave. Ambas procuraram o serviço de saúde no primeiro trimestre de gestação, mas os encaminhamentos ocorreram entre 20 e 32 semanas de gestação. Conclusões: a falta de agilidade e de conhecimento entre os vários níveis de assistência no controle da toxoplasmose gestacional retardaram a tomada de decisão por parte dos profissionais de saúde. A ocorrência desses casos de toxoplasmose em gestantes evidencia a importância de integração vertical e aplicação de medidas que possam proporcionar a formação de uma rede de controle ágil e com infra-estrutura adequada para sua gestão.

Aims: To highlight the difficulty of the various services that comprise the public health system from the Northwest of Paraná in the monitoring of pregnant women with suspected toxoplasmosis, as observed in the present reports, one of a case of congenital toxoplasmosis and the other of severe ocular reagudization. Cases description: In the first case, the pregnant women had positive serum Toxoplasma gondii-specific IgM, IgG and IgA, and PCR and inoculation in mice positive for Toxoplasma gondii in amniotic fluid. The fetus had ultrasound findings of placentomegalia and cerebral calcifications, and the newborn presented the Sabin tetrad. In the other case, an immunocompetent pregnant woman, with positive Toxoplasma gondii-specific IgG and negative IgM from serum, presented with severe ocular reagudization. Both patients sought the health service in the first trimester of pregnancy, but the referrals occurred between 20 and 32 weeks of gestation. Conclusions: The lack of agility and knowledge between the various levels of assistance in the control of gestational toxoplasmosis delayed a decision on the part of health professionals. The occurrence of toxoplasmosis in these pregnant women highlights the importance of vertical integration and of implementing strategies that can provide the development of a network of control and adequate management.

A prospective study of Toxoplasma-positive pregnant women in southern Brazil: a health alert.

We evaluated anti-Toxoplasma gondii IgM-reactive pregnant women seen at a high-risk pregnancy outpatient clinic. From March 2005 to January 2008 in Paraná, Brazil, pregnant women seen by the Brazilian Public Health System, in any gestational period, who were anti-T. gondii IgM-positive, were followed. Clinical symptoms were noted, and tests performed including IgA, IgG avidity, ultrasonogram, and amniocentesis (PCR/inoculation in mice). Of 75 patients, 8 showed low, 3 intermediate and 31 high IgG avidity. Of those who underwent the avidity test, 31 (70.5%) were in the second trimester of pregnancy. Thirty-two (42.7%) pregnant women received specific treatment. Six received triple combination treatment; in three, tachyzoites were isolated, although only one was PCR-positive, showing changes in the cerebral sonogram, borderline IgA, and the Sabin tetrad. One fetus died, and one non-reactive IgM pregnant woman showed ocular recurrence. The municipality of residence, contact with cats during adulthood, and ingestion of unpasteurized milk were shown to be important risk factors. Congenital toxoplasmosis was observed in a pregnancy referred late for treatment. Follow-up of children born to mothers with diagnosed or suspected acute toxoplasmosis is crucial in the management of the changes that toxoplasmosis may cause.

Análise retrospectiva das gestações múltiplas no Hospital Universitário Regional de Maringá no período de janeiro de 2000 a julho de 2003 / Retrospective analysis of multiple gestation in the Regional University Hospital of Maringá (HURM) between January 2000 and July 2003

A gestação múltipla representa um dos maiores desafios ao manejo obstétrico por estar associada a um pior prognóstico tanto materno quanto fetal. Esse estudo tem como objetivo analisar e comparar as complicações obstétricas e neonatais em gemelares e em não gemelares nascidos no HURM no período de janeiro de 2000 a julho de 2003. A amostra estudada é composta por 50 gestações múltiplas e 2.229 gestações únicas. A incidência de gemelares foi de 1 a cada 50 gestações e de trigemelares 1 a cada 1.250. A ocorrência de trabalho de parto prematuro, ruptura prematura de membranas e diabetes gestacional foi significativamente maior em gemelares em relação a não gemelares. A principal complicação das gestações múltiplas neste estudo foi a prematuridade, a qual costuma estar associada a outras condições e comorbidades como o baixo peso e o muito baixo peso ao nascer, a doença da membrana hialina, taquipnéia transitória do recémnascido, distúrbios metabólicos, infecções e hipóxia neonatal sendo responsável por um aumento no tempo de internação e maior mortalidade desses lactentes. Ocorreram 6 óbitos em 50 gestações múltiplas, sendo 3 intraútero e 3 neonatais. Concluindo, a gemelaridade está associada a um risco maior de complicações tanto para a mãe quanto para o feto