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Lopes-Mori FMR, Mitsuka-Breganó R, Capobiango JD, Inoue IT, Reiche EMV, Morimoto HK, Casella AMB, Bittencourt LHFDB, Freire RL, Navarro IT. Programs for control of congenital toxoplasmosis. Rev Assoc Med Bras (1992) 2012; 57:594-9. [PMID: 22012297 DOI: 10.1590/s0104-42302011000500021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/15/2011] [Indexed: 11/21/2022] Open
Abstract
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% to 35% and 84% to 44%, 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% reduction in the number of pregnant women and 42% 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% reduction in consumption of folic acid and 67% 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.
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Affiliation(s)
- Fabiana Maria Ruiz Lopes-Mori
- Departamento de Ciências Patológica, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, PR, Brazil.
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Dias RCF, Lopes-Mori FMR, Mitsuka-Breganó R, Dias RAF, Tokano DV, Reiche EMV, Freire RL, Navarro IT. Factors associated to infection by Toxoplasma gondii in pregnant women attended in Basic Health Units in the city of Rolândia, Paraná, Brazil. Rev Inst Med Trop Sao Paulo 2012; 53:185-91. [PMID: 21915460 DOI: 10.1590/s0036-46652011000400002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 06/09/2011] [Indexed: 11/22/2022] Open
Abstract
The aim of the present work was to determine the prevalence of IgG and IgM anti-Toxoplasma gondii antibodies and the factors associated to the infection in pregnant women attended in Basic Health Units in Rolândia, Paraná, Brazil. The sample was divided in two groups: group I (320 pregnant women who were analyzed from July 2007 to February 2008) and group II (287 pregnant women who were analyzed from March to October 2008). In group I, it was found 53.1% of pregnant women with IgG reactive and IgM non-reactive, 1.9% with IgG and IgM reactive, 0.3% with IgG non-reactive and IgM reactive and 44.7% with IgG and IgM non-reactive. In group II, it was found 55.1% with IgG reactive and IgM non-reactive and 44.9% with IgG and IgM non-reactive. The variables associated to the presence of IgG antibodies were: residence in rural areas, pregnant women between 35-40 years old, low educational level, low family income, more than one pregnancy, drinking water which does not originate from the public water supply system and the habit of handling soil or sand. Guidance on primary prevention measures and the quarterly serological monitoring of the pregnant women in the risk group are important measures to prevent congenital toxoplasmosis.
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Lopes-Mori FMR, Mitsuka-Breganó R, Capobiango JD, Inoue IT, Vissoci Reiche EM, Morimoto HK, Barbante Casella AM, de Barros Bittencourt LHF, Freire RL, Navarro IT. Programs for control of congenital toxoplasmosis. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70117-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Lopes-Mori FMR, Mitsuka-Breganó R, Capobiango JD, Inoue IT, Vissoci Reiche EM, Morimoto HK, Barbante Casella AM, de Barros Bittencourt LHF, Freire RL, Navarro IT. Programs for control of congenital toxoplasmosis. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s2255-4823(11)70117-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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de Mattos CDCB, Spegiorin LCJF, Meira CDS, Silva TDC, Ferreira AIDC, Nakashima F, Pereira-Chioccola VL, de Mattos LC. Anti-Toxoplasma gondii antibodies in pregnant women and their newborn infants in the region of São José do Rio Preto, São Paulo, Brazil. SAO PAULO MED J 2011; 129:261-6. [PMID: 21971902 PMCID: PMC10896019 DOI: 10.1590/s1516-31802011000400010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 07/19/2010] [Accepted: 04/01/2011] [Indexed: 11/21/2022] Open
Abstract
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% of the serum samples from the mothers and their infants (56/87). Except for two maternal serum samples (2.3%), all others were negative for anti-T. gondii IgM antibodies, using IIF. The results showed that 92.9% of the pregnant women had high IgG avidity indexes (> 30%) and four samples had avidity indexes between 16 and 30%. 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%. The avidity indexes of serum from the other 83 newborns were similar to the results from their mothers. CONCLUSIONS The results showed that 2% 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.
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Affiliation(s)
- Cinara de Cássia Brandão de Mattos
- MSc. Doctoral student in Health Sciences, Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - Lígia Cosentino Junqueira Franco Spegiorin
- MD, MSc. Doctoral student in Health Sciences, Department of Gynecology and Obstetrics, Faculdade de Medicina de São José do Rio Preto (Famerp), Hospital de Base, Fundação Faculdade Regional de Medicina (Funfarme), São José do Rio Preto, São Paulo, Brazil.
| | | | | | - Ana Iara da Costa Ferreira
- MSc. Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - Fabiana Nakashima
- MSc. Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - Vera Lúcia Pereira-Chioccola
- PhD. Scientific Researcher, Laboratory of Molecular Biology of Parasites, Instituto Adolfo Lutz, São Paulo, Brazil.
| | - Luiz Carlos de Mattos
- PhD. Full Professor, Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
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Mioranza SDL, Meireles LR, Mioranza EL, Andrade Júnior HFD. Evidência sorológica da infecção aguda pelo Toxoplasma gondii em gestantes de Cascavel, Paraná. Rev Soc Bras Med Trop 2008; 41:628-34. [DOI: 10.1590/s0037-86822008000600014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 10/29/2008] [Indexed: 11/21/2022] Open
Abstract
Para verificar a ocorrência da toxoplasmose em Cascavel, Paraná, cidade próxima a região onde ocorreu o maior surto epidêmico descrito mundialmente, 334 amostras de soros de gestantes foram triadas pelo ensaio imunoenzimático comercial IgG no Laboratório Municipal de Cascavel, e confirmadas no Instituto de Medicina Tropical de São Paulo por imunofluorescência IgG, ensaio imunoenzimático e avidez de IgG in house. A soropositividade pelo IgG comercial foi 54,2%, pela imunofluorescência 54,8% e pelo IgG in house 53,9%, com boa concordância entre imunofluorescência/IgG comercial (Kappa=0,963781; co-positividade=97,8%; co-negatividade=98,7%) e imunofluorescência/IgG in house (Kappa=0,975857; co-positividade=97,8%; co-negatividade=100%). A evidência de infecção aguda nas gestantes foi similar tanto pela avidez de IgG (2,4% ao ano) como pela análise estatística de tendência (teste χ2) por faixa etária (2% ao ano), sugerindo que a triagem sorológica pré-natal e a vigilância epidemiológica são imprescindíveis para redução do risco da toxoplasmose na região, embora sem evidência de surto epidêmico.
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Elsheikha HM. Congenital toxoplasmosis: priorities for further health promotion action. Public Health 2007; 122:335-53. [PMID: 17964621 DOI: 10.1016/j.puhe.2007.08.009] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 06/09/2007] [Accepted: 08/10/2007] [Indexed: 10/22/2022]
Abstract
Toxoplasmosis is a disease of considerable public health impact. As the transmission, occurrence and phenotype of this disease are influenced in a complex way by host genetics, immunity, behaviour and by the agent characteristics, prevention will not be simple. This article aimed to review studies defining seroprevalence of and characteristic sociodemographic, biological and lifestyle risk factors for Toxoplasma gondii infection in pregnant women, to evaluate screening and educational programmes, and to assemble recommendations for combating toxoplasmosis in populations at risk. Electronic databases were searched, using a specific search strategy, from 1975 to 2007. There is a high prevalence of T. gondii antibodies in pregnant women worldwide, with some geographic discrepancies attributed to climatic conditions, local food customs, hygiene, lifestyle and cultural differences. The main risk factors for toxoplasmosis in pregnant women are unsanitary feeding habits, poor immune system, contact with cats, contact with soil, pregnancy, number of births, older age, race, travelling outside the country, drinking beverages prepared with unboiled water, consumption of municipal or uncontrolled (well/spring) water and T. gondii strain virulence. Knowledge of these risk factors helps to identify priorities for further epidemiological work and defines effective preventive measures along five main themes of action: information and health education; screening of pregnant women and infants; limiting harm from risk behaviour; treatment of cases found to be at risk; and vaccination.
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Affiliation(s)
- H M Elsheikha
- Division of Veterinary Medicine, The University of Nottingham, Leicestershire LE12 5RD, UK.
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