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Seroprevalence and Molecular Investigation of Toxoplasmosis among Working Children in Tehran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2022. [DOI: 10.5812/pedinfect-129575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Toxoplasma gondii is a pathogenic protozoan that causes toxoplasmosis and spreads worldwide. Objectives: This study aimed to investigate the prevalence of toxoplasmosis by serological and molecular methods in working children and a control group in Tehran. Methods: The study participants comprised 460 children aged 7 - 14 years, including 278 working children and 182 age-matched controls. Blood samples were collected, and a serological test was performed to evaluate IgM and IgG antibodies against T. gondii. Peripheral blood mononuclear cells (PBMCs) were isolated from the blood specimens by gradient centrifugation method. Real-time polymerase chain reaction (PCR) was performed using primer B1 on PBMC samples in children’s blood to determine the status of Toxoplasma infection. Results: Seroprevalence of IgG and IgM antibodies against T. gondii was 24.8% and 0.7%, respectively, in working children; however, in the control group, 12.1% and 2.2% had IgG and IgM antibodies against T. gondii, respectively. The mean IgG titer was 160 ± 86.39 IU/mL and 69.36 ± 88 IU/mL for working children and the control group, respectively (P < 0.0001); however, the mean IgM titer was 4.65 ± 3.04 IU/mL and 3.85 ± 4 IU/mL for working children and control group, respectively (P = 0.8187). Real-time PCR results indicated two (0.7%) positive cases among working children and three (1.65%) samples in the control group. The present study showed a significant difference between working children and the control group regarding the frequency of IgG antibodies (P = 0.0012). However, there was no significant difference in the frequency of IgM antibodies in the two mentioned groups. Conclusions: Seroprevalence of IgG antibody against T. gondii was more in working children than in the control group in Tehran. This investigation revealed a significant difference in frequency and titer of IgG antibodies between working children and the control group. More exposure to the soil and contaminated hands before drinking water or food may be considered factors in the development of toxoplasmosis infection in these children.
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Oliveira-Scussel ACDM, Ferreira PTM, Resende RDS, Ratkevicius-Andrade CM, Gomes ADO, Paschoini MC, De Vito FB, Farnesi-de-Assunção TS, da Silva MV, Mineo JR, Rodrigues DBR, Rodrigues V. Association of gestational diabetes mellitus and negative modulation of the specific humoral and cellular immune response against Toxoplasma gondii. Front Immunol 2022; 13:925762. [PMID: 36203592 PMCID: PMC9531261 DOI: 10.3389/fimmu.2022.925762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Abstract
In order to evaluate and compare the specific immune response of pregnant women (PW) chronically infected with Toxoplasma gondii, with and without gestational diabetes mellitus (GDM), and the humoral response of their respective newborns (NB), the study was carried out on 81 PW (34 GDM and 47 controls) from whose medical records the results of the oral glucose tolerance test (OGTT) were obtained, and blood samples were collected at the third trimester of pregnancy; also, on 45 NBs (20 GDM and 25 controls) from whom umbilical cord blood samples were obtained. Humoral immunity was analyzed by measuring anti-T. gondii total IgG, IgG subclasses and IgG avidity. To evaluate cellular immunity, peripheral blood mononuclear cells (PBMC) from 32 PW (16 GDM and 16 controls) were cultured, supernatant cytokines were determined, and flow cytometry was performed to analyze the expression at lymphocytes of surface molecules, cytokines and transcription factors. All PW and NBs were positive for total IgG, and the prevalent subclass was IgG1. There was a negative correlation between the OGTT glycemia of PW and the levels of total IgG, IgG1 and IgG avidity. The IgG avidity of the GDM group was significantly lower than the control group. Patients from the GDM group had a higher number of T lymphocytes expressing markers of cell activation and exhaustion (CD28 and PD-1). In the presence of T. gondii soluble antigen (STAg) the amount of CD4+ T cells producing IFN-γ, IL-10 and IL-17 was significantly lower in the GDM group, while there was no difference between groups in the number of CD4+ CD25HighFOXP3+LAP+ functional Treg cells. Additionally, under STAg stimulus, the secretion of IL-17, IL-4, TNF and IL-2 cytokines at PBMCs culture supernatant was lower in the GDM group. In conclusion, there was a correlation between the increase in blood glucose and the decrease in levels of anti-T. gondii antibodies, associated with the decreased IgG avidity in patients who develop GDM. Also, the GDM group had decreased immune responses in Th1, Th2 and Th17 profiles, suggesting an association between GDM and the negative modulation of the humoral and cellular immune responses against T. gondii.
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Affiliation(s)
- Ana Carolina de Morais Oliveira-Scussel
- Laboratory of Immunology, Institute of Biological and Natural Sciences, Department of Microbiology, Immunology and Parasitology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Paula Tatiana Mutão Ferreira
- Laboratory of Immunology, Institute of Biological and Natural Sciences, Department of Microbiology, Immunology and Parasitology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Renata de Souza Resende
- Laboratory of Immunology, Institute of Biological and Natural Sciences, Department of Microbiology, Immunology and Parasitology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Cristhianne Molinero Ratkevicius-Andrade
- Laboratory of Immunology, Institute of Biological and Natural Sciences, Department of Microbiology, Immunology and Parasitology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Angelica de Oliveira Gomes
- Laboratory of Cellular Interactions, Institute of Biological and Natural Sciences, Department of Structural Biology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Marina Carvalho Paschoini
- Institute of Health Sciences, Department of Obstetricy, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Fernanda Bernadelli De Vito
- Laboratory of Hematology and Hemotherapy, Institute of Health Sciences, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Thaís Soares Farnesi-de-Assunção
- Laboratory of Immunology, Institute of Biological and Natural Sciences, Department of Microbiology, Immunology and Parasitology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Marcos Vinícius da Silva
- Laboratory of Parasitology, Institute of Biological and Natural Sciences, Department of Microbiology, Immunology and Parasitology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - José Roberto Mineo
- Laboratory of Immunology “Dr. Mário Endsfeldz Camargo”, Institute of Biomedical Sciences, Universidade Federal de Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | | | - Virmondes Rodrigues
- Laboratory of Immunology, Institute of Biological and Natural Sciences, Department of Microbiology, Immunology and Parasitology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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Storchilo HR, Rezende HHA, Gomes TC, de Souza JY, Gomes AR, Avelino MM, do Amaral WN, de Castro AM. Basic heel prick test: inclusion of screening, diagnosis and criteria for early confirmation of congenital infection by Toxoplasma gondii. Rev Inst Med Trop Sao Paulo 2019; 61:e30. [PMID: 31241659 PMCID: PMC6592012 DOI: 10.1590/s1678-9946201961030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/15/2019] [Indexed: 11/22/2022] Open
Abstract
Toxoplasma gondii can cross the placental barrier, causing fetal infection with potentially severe sequelae. The aim of this study was to evaluate whether the serological screening for toxoplasmosis should be included in the basic neonatal heel prick test in order to establish criteria for the confirmation and/or exclusion of the diagnosis of congenital infection in newborns treated at three public health units in the metropolitan region of Goiania, Goias State, Brazil. Blood samples were collected on filter paper from newborns and later, peripheral blood samples from the mothers and their respective children were obtained to confirm or exclude the diagnosis of suspected congenital infection, by means of an enzyme-linked immunosorbent assay (IgM and IgG) and a polymerase chain reaction assay. From a total of 1,159 blood samples collected on filter paper, 43.92% were reactive to IgG and 0.17% to anti-T. gondii IgM and IgG. One hundred and twenty-seven paired samples (mother and child) were collected following consensual protocols for peripheral blood collection. Results obtained from the filter paper and peripheral blood of the newborns were 90.55% concordant. A comparison of the mother and child blood test results showed agreement regarding the detection of IgG in 90.48% of the samples. The parasite DNA was detected in the peripheral blood of one child. In view of the results obtained in this study, the inclusion of the serological screening for toxoplasmosis in the newborn heel prick test proved to be effective for the early detection of congenital T. gondii infection.
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Affiliation(s)
- Heloisa Ribeiro Storchilo
- Universidade Federal de Goiás, Instituto de Patologia Tropical e
Saúde Pública, Goiânia, Goiás, Brazil
| | | | - Taynara Cristina Gomes
- Universidade Federal de Goiás, Instituto de Patologia Tropical e
Saúde Pública, Goiânia, Goiás, Brazil
| | - Jéssica Yonara de Souza
- Universidade Federal de Goiás, Instituto de Patologia Tropical e
Saúde Pública, Goiânia, Goiás, Brazil
| | - Antonio Roberto Gomes
- Universidade Federal de Goiás, Instituto de Patologia Tropical e
Saúde Pública, Goiânia, Goiás, Brazil
| | - Mariza Martins Avelino
- Universidade Federal de Goiás, Faculdade de Medicina, Hospital das
Clínicas, Goiânia, Goiás, Brazil
| | - Waldemar Naves do Amaral
- Universidade Federal de Goiás, Faculdade de Medicina, Hospital das
Clínicas, Goiânia, Goiás, Brazil
| | - Ana Maria de Castro
- Universidade Federal de Goiás, Instituto de Patologia Tropical e
Saúde Pública, Goiânia, Goiás, Brazil
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Abstract
The goal of this study was to investigate the importance of IgG avidity testing in newborns (NBs) diagnosed with early congenital toxoplasmosis. We collected samples from 88 puerperae infected by Toxoplasma gondii (T. gondii) and their NBs (48 acutely-infected puerperae (AIP) and 40 chronically-infected puerperae (CIP)), from two public maternity hospitals in Goiania city, Goias, Brazil, from 2010 to 2015. Specific anti-T. gondii IgM and IgG serum levels and IgG avidity tests were evaluated using chemiluminescence. Congenital toxoplasmosis was observed in 66.66% (n = 32) of NBs with AIP, 94.1% presenting low avidity (LA) and 51.61% presenting high avidity (HA) test results. The IgG and IgM levels of NBs with LA and their puerperae were higher in comparison with HA NBs and puerperae (p = 0.0001). The avidity tests showed 100% specificity and 50% sensitivity (p = 0.0001). NBs with LA had a 15-fold increased risk of developing congenital toxoplasmosis in comparison with HA NBs. The IgG avidity test could be used to assist in early congenital toxoplasmosis diagnoses in NBs and LA, identifying a greater probability of vertical transmission.
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Evaluation of serological and molecular tests used to identify Toxoplasma gondii infection in pregnant women attended in a public health service in São Paulo state, Brazil. Diagn Microbiol Infect Dis 2017; 89:13-19. [PMID: 28689893 DOI: 10.1016/j.diagmicrobio.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 11/23/2022]
Abstract
Toxoplasmosis during pregnancy can have severe consequences. The use of sensitive and specific serological and molecular methods is extremely important for the correct diagnosis of the disease. We compared the ELISA and ELFA serological methods, conventional PCR (cPCR), Nested PCR and quantitative PCR (qPCR) in the diagnosis of Toxoplasma gondii infection in pregnant women without clinical suspicion of toxoplasmosis (G1=94) and with clinical suspicion of toxoplasmosis (G2=53). The results were compared using the Kappa index, and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. The results of the serological methods showed concordance between the ELISA and ELFA methods even though ELFA identified more positive cases than ELISA. Molecular methods were discrepant with cPCR using B22/23 primers having greater sensitivity and lower specificity compared to the other molecular methods.
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Fochi MML, Baring S, Spegiorin LCJF, Vaz-Oliani DCM, Galão EA, Oliani AH, de Mattos LC, de Mattos CCB. Prematurity and Low Birth Weight did not Correlate with Anti-Toxoplasma gondii Maternal Serum Profiles--a Brazilian Report. PLoS One 2015; 10:e0132719. [PMID: 26192182 PMCID: PMC4508015 DOI: 10.1371/journal.pone.0132719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/17/2015] [Indexed: 01/27/2023] Open
Abstract
Gestational Toxoplasma gondii infection is considered a major risk factor for miscarriage, prematurity and low birth weight in animals. However, studies focusing on this topic in humans are scarce. The objective of this study is to determine whether anti-Toxoplasma gondii maternal serum profiles correlate prematurity and low birth weight in humans. The study examined 213 pregnant women seen at the High-Risk Pregnancy Hospital de Base, São José do Rio Preto, São Paulo, Brazil. All serological profiles (IgM-/IgG+; IgM-/IgG-; IgM+/IgG+) were determined by ELISA commercial kits. Maternal age, gestational age and weight of the newborn at birth were collected and recorded in the Statement of Live Birth. Prematurity was defined as gestational age <37 weeks and low birth weight ≤ 2499 grams. The t-test was used to compare values (p < 0.05). The mean maternal age was 27.6±6.6 years. Overall, 56.3% (120/213) of the women studied were IgM-/IgG+, 36.2% (77/213) were IgM-/IgG- and 7.5% (16/213) were IgM+/IgG+. The average age of the women with serological profile IgM+/IgG+ (22.3±3.9 years) was different from women with the profile IgM-/IgG+ (27.9±6.7 years, p = 0.0011) and IgM-/IgG- (27.9±6.4 years, p = 0.0012). There was no statistically significant difference between the different serological profiles in relation to prematurity (p = 0.6742) and low birth weight (p = 0.7186). The results showed that prematurity and low birth weight did not correlate with anti-Toxoplasma gondii maternal serum profiles.
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Affiliation(s)
- Mariana Machado Lemos Fochi
- Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
- FAMERP Toxoplasma Research Group, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
| | - Sabrina Baring
- Obstetrics and Gynecology Service, Hospital de Base, Fundação Faculdade Regional de Medicina de São José do Rio Preto–HB-FUNFARME, São José do Rio Preto, São Paulo, Brazil
| | - Lígia Cosentino Junqueira Franco Spegiorin
- Obstetrics and Gynecology Service, Hospital de Base, Fundação Faculdade Regional de Medicina de São José do Rio Preto–HB-FUNFARME, São José do Rio Preto, São Paulo, Brazil
- Department of Gynecology and Obstetrics, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
- Hospital da Criança e Maternidade de São José do Rio Preto–HCM, São José do Rio Preto, São Paulo, Brazil
- FAMERP Toxoplasma Research Group, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
| | - Denise Cristina Mós Vaz-Oliani
- Obstetrics and Gynecology Service, Hospital de Base, Fundação Faculdade Regional de Medicina de São José do Rio Preto–HB-FUNFARME, São José do Rio Preto, São Paulo, Brazil
- Department of Gynecology and Obstetrics, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
- Hospital da Criança e Maternidade de São José do Rio Preto–HCM, São José do Rio Preto, São Paulo, Brazil
| | - Eloisa Aparecida Galão
- Obstetrics and Gynecology Service, Hospital de Base, Fundação Faculdade Regional de Medicina de São José do Rio Preto–HB-FUNFARME, São José do Rio Preto, São Paulo, Brazil
- Department of Gynecology and Obstetrics, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
- Hospital da Criança e Maternidade de São José do Rio Preto–HCM, São José do Rio Preto, São Paulo, Brazil
| | - Antonio Hélio Oliani
- Department of Gynecology and Obstetrics, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
- Hospital da Criança e Maternidade de São José do Rio Preto–HCM, São José do Rio Preto, São Paulo, Brazil
| | - Luiz Carlos de Mattos
- Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
- FAMERP Toxoplasma Research Group, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
| | - Cinara Cássia Brandão de Mattos
- Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
- FAMERP Toxoplasma Research Group, Faculdade de Medicina de São José do Rio Preto–FAMERP, São José do Rio Preto, São Paulo, Brazil
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Sharif M, Daryani A, Ebrahimnejad Z, Gholami S, Ahmadpour E, Borhani S, Lamsechi N. Seroprevalence of anti-Toxoplasma IgG and IgM among individuals who were referred to medical laboratories in Mazandaran province, northern Iran. J Infect Public Health 2015; 9:75-80. [PMID: 26159578 DOI: 10.1016/j.jiph.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/24/2015] [Accepted: 06/12/2015] [Indexed: 11/28/2022] Open
Abstract
Toxoplasma gondii (T. gondii) is a protozoan parasite that can cause toxoplasmosis in humans. However, there is no current data regarding Toxoplasma infection among individuals who were referred to medical laboratories in Mazandaran province (northern Iran). Therefore, we performed a population-based study of Toxoplasma seroprevalence in this region. A total of 1832 sera samples (from 654 men and 1178 women) were collected from people who were referred to medical laboratories in different cities throughout Mazandaran province between March and July 2012. The serum titers of anti-T. gondii IgG and IgM were measured using enzyme-linked immunosorbent assays. The seroprevalence of anti-Toxoplasma IgG was 55.5%; and 14.4% of the positive samples were seropositive for anti-Toxoplasma IgM. The highest seroprevalence was observed among people who were >50 years old (90.6%), and the lowest seroprevalence was observed among children who were 0-9 years old (9.4%; P<0.001). There was no significant difference in the seroprevalences for each sex in the study population. However, a regional sex-specific difference in seroprevalence was observed between men (54.1%) and women (70.6%; P=0.003) in the western cities of Mazandaran. As the seroprevalence of T. gondii in western and eastern Mazandaran was higher than that in the central cities, there is a need to evaluate the nature of the infection chain in these areas.
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Affiliation(s)
- Mehdi Sharif
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; Department of Parasitology and Mycology, Sari Medical School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; Department of Parasitology and Mycology, Sari Medical School, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Zahra Ebrahimnejad
- Department of Parasitology and Mycology, Sari Medical School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shirzad Gholami
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; Department of Parasitology and Mycology, Sari Medical School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ehsan Ahmadpour
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samaneh Borhani
- Department of Parasitology and Mycology, Sari Medical School, Mazandaran University of Medical Sciences, Sari, Iran
| | - Narges Lamsechi
- Department of Parasitology and Mycology, Sari Medical School, Mazandaran University of Medical Sciences, Sari, Iran
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Abstract
The aim of this study was to investigate risk factors for ocular toxoplasmosis (OT) in patients who received medical attention at a public health service. Three hundred and forty-nine consecutive patients, treated in the Outpatient Eye Clinic of Hospital de Base, São José do Rio Preto, São Paulo state, Brazil, were enrolled in this study. After an eye examination, enzyme-linked immunosorbent assay (ELISA) was used to determine anti-Toxoplasma gondii antibodies. The results showed that 25·5% of the patients were seronegative and 74·5% were seropositive for IgG anti-T. gondii antibodies; of these 27·3% had OT and 72·7% had other ocular diseases (OOD). The presence of cats or dogs [odds ratio (OR) 2·22, 95% confidence interval (CI) 1·24–3·98, P = 0·009] and consumption of raw or undercooked meat (OR 1·77, 95% CI 1·05–2·98, P = 0·03) were associated with infection but not with the development of OT. Age (OT 48·2 ± 21·2 years vs. OOD: 69·5 ± 14·7 years, P < 0·0001) and the low level of schooling/literacy (OT vs. OOD: OR 0·414, 95% CI 0·2231–0·7692, P = 0·007) were associated with OT. The presence of dogs and cats as well as eating raw/undercooked meat increases the risk of infection, but is not associated with the development of OT.
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Toxoplasmosis in humans and animals in Brazil: high prevalence, high burden of disease, and epidemiology. Parasitology 2012; 139:1375-424. [PMID: 22776427 DOI: 10.1017/s0031182012000765] [Citation(s) in RCA: 336] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infections by the protozoan parasite Toxoplasma gondii are widely prevalent in humans and animals in Brazil. The burden of clinical toxoplasmosis in humans is considered to be very high. The high prevalence and encouragement of the Brazilian Government provides a unique opportunity for international groups to study the epidemiology and control of toxoplasmosis in Brazil. Many early papers on toxoplasmosis in Brazil were published in Portuguese and often not available to scientists in English-speaking countries. In the present paper we review prevalence, clinical spectrum, molecular epidemiology, and control of T. gondii in humans and animals in Brazil. This knowledge should be useful to biologists, public health workers, veterinarians, and physicians. Brazil has a very high rate of T. gondii infection in humans. Up to 50% of elementary school children and 50-80% of women of child-bearing age have antibodies to T. gondii. The risks for uninfected women to acquire toxoplasmosis during pregnancy and fetal transmission are high because the environment is highly contaminated with oocysts. The burden of toxoplasmosis in congenitally infected children is also very high. From limited data on screening of infants for T. gondii IgM at birth, 5-23 children are born infected per 10 000 live births in Brazil. Based on an estimate of 1 infected child per 1000 births, 2649 children with congenital toxoplasmosis are likely to be born annually in Brazil. Most of these infected children are likely to develop symptoms or signs of clinical toxoplasmosis. Among the congenitally infected children whose clinical data are described in this review, several died soon after birth, 35% had neurological disease including hydrocephalus, microcephaly and mental retardation, 80% had ocular lesions, and in one report 40% of children had hearing loss. The severity of clinical toxoplasmosis in Brazilian children may be associated with the genetic characteristics of T. gondii isolates prevailing in animals and humans in Brazil.
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