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Araujo Coelho DR, Oliveira da Luz R, Soares Melegario C, Vieira WF, Bahia-Oliveira LMG. Knowledge Gaps and Educational Opportunities in Congenital Toxoplasmosis: A Narrative Review of Brazilian and Global Perspectives. Trop Med Infect Dis 2024; 9:137. [PMID: 38922049 PMCID: PMC11209368 DOI: 10.3390/tropicalmed9060137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
Congenital toxoplasmosis is a parasitic disease caused by the transmission of the protozoan Toxoplasma gondii during pregnancy that can potentially cause severe consequences for the fetus or neonates. The disease disproportionately impacts the global population and is generally correlated with the Human Development Index. Despite its prevalence, there are knowledge gaps among pregnant women and healthcare providers regarding the prevention, diagnosis, and treatment of this condition. This narrative review aimed to examine the current state of knowledge of toxoplasmosis among both groups, with a focus on exploring the Brazilian and global perspectives and highlighting opportunities for enhancing education and communication. A search was conducted across five databases, and 60 studies were selected (23 in Brazil and 37 worldwide). Quantitative analysis revealed that general knowledge of toxoplasmosis among pregnant women is notably poor, with 66% of Brazilian women and 72% of women worldwide lacking sufficient understanding. Among those with some knowledge, the most recognized association is with cats (46% in Brazil and 38% worldwide), followed by raw or undercooked meat (27% in Brazil and 25% worldwide), and improperly sanitized vegetables or water (15% in Brazil and 21% worldwide). Similarly, gaps in knowledge were found among healthcare providers. Difficulty with IgG avidity test interpretation is higher in Brazil (43%) compared to worldwide (18%). The most recognized association is with cats (66% in Brazil and 74% worldwide), followed by raw or undercooked meat (49% in Brazil and 70% worldwide), and improperly sanitized vegetables or water (31% in Brazil and 32% worldwide). These findings emphasize the need for tailored local and global public health educational initiatives to enhance knowledge of toxoplasmosis among pregnant women and healthcare providers.
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Affiliation(s)
| | - Rogerio Oliveira da Luz
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-971, RJ, Brazil
| | - Catiucia Soares Melegario
- Department of Medicine, Institute of Medical Science, Federal University of Rio de Janeiro, Macaé 27930-560, RJ, Brazil
| | - Willians Fernando Vieira
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, SP, Brazil
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Miguel-Vicedo M, Cabello P, Ortega-Navas MC, González-Barrio D, Fuentes I. Prevalence of Human Toxoplasmosis in Spain Throughout the Three Last Decades (1993-2023): A Systematic Review and Meta-analysis. J Epidemiol Glob Health 2024:10.1007/s44197-024-00258-w. [PMID: 38864976 DOI: 10.1007/s44197-024-00258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024] Open
Abstract
Humans are infected by Toxoplasma gondii worldwide and its consequences may seriously affect an immune deprived population such as HIV and transplanted patients or pregnant women and foetuses. A deep knowledge of toxoplasmosis seroprevalence in Spain is needed in order to better shape health policies and educational programs. We present the results of the first systematic review and meta-analysis on the human prevalence for this disease in Spain. Databases (PubMed, Web of Science, SCOPUS and Teseo) were searched for relevant studies that were published between January 1993 and December 2023 and all population-based cross-sectional and longitudinal studies reporting the human seroprevalence in Spain were revised. Within the population analysed, our targeted groups were immunocompetent population, pregnant women and immunocompromised patients. Among 572 studies and 35 doctoral theses retrieved, 15 studies and three doctoral theses were included in the meta-analysis. A random effects model was used for the meta-analyses due to the high heterogeneity found between studies (I2: 99.97), since it is a statistically conservative model, in addition to allowing better external validity. The global pooled seroprevalence was 32.3% (95% CI 28.7-36.2%). Most of the studies carried out were in pregnant women and the meta-analysis reported that the pooled seroprevalence of toxoplasmosis in pregnant women in Spain was 24.4% (24,737/85,703, 95% CI 21.2-28.0%), based on the random effects model. It is recommended to continue monitoring the seroprevalence status of T. gondii in order to obtain essential guidelines for the prevention and control of the infection in the population.
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Affiliation(s)
- Mariola Miguel-Vicedo
- Toxoplasmosis and Protozoosis Unit, Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
- Department of Educational Theory and Social Pedagogy, National University of Distance Education (UNED) Madrid, Madrid, Spain
- Ph.D. Program in Biomedical Science and Public Health. IMIENS, National University of Distance Education (UNED) Madrid, Madrid, Spain
| | - Paula Cabello
- International University of Valencia-VIU, 46002, Valencia, Spain
| | - M Carmen Ortega-Navas
- Department of Educational Theory and Social Pedagogy, National University of Distance Education (UNED) Madrid, Madrid, Spain
| | - David González-Barrio
- Toxoplasmosis and Protozoosis Unit, Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain.
| | - Isabel Fuentes
- Toxoplasmosis and Protozoosis Unit, Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain.
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Losa A, Carvalho I, Sousa B, Ashworth J, Guedes A, Carreira L, Pinho L, Godinho C. Diagnosis of Congenital Toxoplasmosis: Challenges and Management Outcomes. Cureus 2024; 16:e52971. [PMID: 38406029 PMCID: PMC10894009 DOI: 10.7759/cureus.52971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Congenital toxoplasmosis (CT), despite being mostly subclinical at birth, can cause disabling disease in the fetus and lead to long-term sequelae. It is an important cause of chorioretinitis in infants and adolescents. Data on postnatal treatment are controversial, and there is a lack of universal guidelines. Methods A cross-sectional study of newborns with suspected CT was conducted between January 2007 and December 2021. Results Seventy-one patients with suspected CT were included. During pregnancy, 64 (90.1%) of the mothers underwent therapy, of which 59 (83.1%) with spiramycin. Amniocentesis identified one positive polymerase chain reaction assay. Most newborns were asymptomatic with normal laboratory, ophthalmological, and hearing screening. There was one case of hyperproteinorrachia. Fifty-seven patients (80.3%) started treatment: 42 (73.7%) with spiramycin, seven (12.3%) with pyrimethamine, sulfadiazine, and folinic acid (P+S+FA), and eight (14%) with P+S+FA intercalated with spiramycin. Adverse effects were found in 11 (19.3%) cases, mainly neutropenia. After investigation, we found three confirmed CT cases corresponding to 4.2% of suspected cases and an incidence of 0.4 per 10,000 births. All had normal clinical and laboratory exams in the neonatal period and started P+S+FA, fulfilling 12 months of therapy. During the follow-up, all presented normal psychomotor development without any long-term sequelae. Conclusion The lower incidence in our study, compared to the incidence in Europe, may be related to the decline in the prevalence of toxoplasmosis as well as the effectiveness of measures to prevent primary infection and a well-established program of antenatal screening, followed by the early initiation of treatment during pregnancy to prevent vertical transmission.
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Affiliation(s)
- Ana Losa
- Pediatrics Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Indira Carvalho
- Pediatrics Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Bebiana Sousa
- Pediatrics Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Joanna Ashworth
- Pediatrics Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Ana Guedes
- Neonatology Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Luísa Carreira
- Neonatology Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Liliana Pinho
- Neonatology Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Cristina Godinho
- Neonatology Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Calero-Bernal R, Gennari SM, Cano S, Salas-Fajardo MY, Ríos A, Álvarez-García G, Ortega-Mora LM. Anti- Toxoplasma gondii Antibodies in European Residents: A Systematic Review and Meta-Analysis of Studies Published between 2000 and 2020. Pathogens 2023; 12:1430. [PMID: 38133313 PMCID: PMC10745778 DOI: 10.3390/pathogens12121430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Toxoplasmosis has a major impact on animal and public health. Information regarding the seroprevalence of human Toxoplasma gondii infections from a European perspective has not yet been compiled to date. Thus, the present review summarized available resident data from the period 2000-2020. The overall seroprevalence of anti-T. gondii IgG was 32.1%, with great variability between countries (n = 30). The subgroup analysis identified different pooled prevalence data depending on the geographic area (p < 0.0001), target population (p = 0.0147), and serological diagnosis assays used (p = 0.0059). A high heterogeneity (I2 = 100%, p < 0.001; Q = 3.5e+05, d.f. = 135, p < 0.001) and degree of publication bias (Egger's test = 6.14, p < 0.001) were observed among the 134 studies considered. The occurrence of anti-T. gondii IgM, which was reported in 64.7% of studies, reached a pooled seroprevalence of 0.6%. In addition, among the eight main risk factors identified, "contact with soil", "consumption of undercooked beef", and "intake of unwashed vegetables" were the most significantly associated with infections. The fact that one-third of the European population has been exposed to T. gondii justifies extra efforts to harmonize surveillance systems and develop additional risk-factor analyses based on detailed source attribution assessment.
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Affiliation(s)
- Rafael Calero-Bernal
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
| | - Solange María Gennari
- PhD Program in One Health, Faculty of Veterinary Medicine, University of Santo Amaro, São Paulo 04829-300, SP, Brazil;
- Faculty of Veterinary Medicine, University of São Paulo, São Paulo 05508-270, SP, Brazil
| | - Santiago Cano
- Computing Services, Research Support Center, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Martha Ynés Salas-Fajardo
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
| | - Arantxa Ríos
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
| | - Gema Álvarez-García
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
| | - Luis Miguel Ortega-Mora
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
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Damar Çakırca T, Can İN, Deniz M, Torun A, Akçabay Ç, Güzelçiçek A. Toxoplasmosis: A Timeless Challenge for Pregnancy. Trop Med Infect Dis 2023; 8:tropicalmed8010063. [PMID: 36668970 PMCID: PMC9867407 DOI: 10.3390/tropicalmed8010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
This study aimed to evaluate the prevalence of toxoplasmosis in pregnant women, as well as the general characteristics, clinical and laboratory findings, and pregnancy and fetal outcomes of pregnant women diagnosed with acute toxoplasma infection (ATI). The toxoplasma IgM, IgG, and IgG avidity test results of pregnant women who applied to our referral hospital between January 2016 and June 2022, and among them, those diagnosed with ATI, were analyzed. The 119 patients diagnosed with ATI during this time period were included for further analysis. The prevalence of toxoplasmosis in pregnant women was found to be 46.2%, and the rate of ATI was 4%. The total mother-to-child transmission rate was 5% (5/101). Congenital toxoplasmosis (CT) was observed in 1 (1.1%) child of the 87 pregnant women who received spiramycin prophylaxis, though it was found in 4 (30.8%) of the children of the 13 untreated mothers. With respect to prenatal treatment, CT rates were significantly higher in the children born to untreated mothers (p = 0.001). In conclusion, although toxoplasma seroprevalence was found to be high in our region, there was a paucity in diagnosis, follow-up, and treatment. Our findings support that prenatal spiramycin prophylaxis is effective in preventing the transmission of parasites from mother to child.
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Affiliation(s)
- Tuba Damar Çakırca
- Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
- Correspondence:
| | - İlkay Nur Can
- Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Melis Deniz
- Department of Pediatric Infectious Diseases, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Ayşe Torun
- Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Çiğdem Akçabay
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Ahmet Güzelçiçek
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa 63290, Turkey
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Robertson LJ, Romig T. Foodborne and waterborne parasites at the 2020/2021 European Multicolloquium of Parasitology (EMOP). Food Waterborne Parasitol 2022; 28:e00179. [PMID: 36132068 PMCID: PMC9483569 DOI: 10.1016/j.fawpar.2022.e00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022] Open
Abstract
This Special Issue in Food and Waterborne Parasitology consists of six articles derived from presentations at the 13th European Multicolloquium of Parasitology (EMOP), that was held in Belgrade, Serbia in October 2021. Within the broad scope of parasitology presented at EMOP 2020/2021, the focus of several sessions, seminars, and presentations was on foodborne and waterborne parasites, with different aspects concerned with Cryptosporidium, Toxoplasma, Trichinella, and Opisthorchis all featuring. Although only a few manuscripts on foodborne and waterborne parasites are presented in this SI, the wide-ranging scope of the articles and, more broadly, of the presentations at EMOP 2020/2021, suggests that the topic of parasites transmitted by food and/or water remains of interest in the European parasitology community. We believe this is likely to be the case for years to come, and the topic is likely to feature prominently in the next (14th) EMOP, scheduled to be held in Poland in 2024. This interest, along with some obvious gaps in the articles on foodborne and waterborne parasites of both European and global importance (such as tapeworms, particularly Echinococcus spp. and Taenia solium), suggests to us that another SI on the subject could be of value as an outcome of the 14th EMOP.
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Affiliation(s)
- Lucy J Robertson
- Parasitology, Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Postboks 5003, 1432 Ås, Norway
| | - Thomas Romig
- Universität Hohenheim, Parasitologie 190p, 70599 Stuttgart, Germany
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