RESUMO
Resumen La transmisión vertical de la infección por Toxoplasma gondii ocurre cuando la madre se infecta por primera vez en el transcurso del embarazo. El diagnóstico de la infección materna y la del re cién nacido se logra con el conjunto de pruebas serológicas, hallazgos clínicos y ecográficos. El reconocimiento temprano de la infección materna permite un tratamiento que reduce la tasa de transmisión y el riesgo de daño en el producto de la concepción. El objetivo de este consenso de expertos fue revisar la literatura científica para actualizar las recomendaciones de práctica clínica respecto de la prevención, el diagnóstico y el tratamiento de la toxoplasmosis congénita en nuestro país.
Abstract Mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. Diag nosis of maternal infection and the newborn is achieved by a combination of serological tests, clinical features and ultrasound images. An early diagnosis of maternal infection allows treatment that offers a reduction both in transmission rate and risk of congenital damage. The aim of this expert consensus was to review the scientific literature which would enable an update of the clinical practice guideline of prevention, diagnosis and treatment of congenital toxoplasmosis in our country.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Criança , Toxoplasma , Toxoplasmose , Toxoplasmose Congênita/diagnóstico , Toxoplasmose Congênita/prevenção & controle , Toxoplasmose Congênita/tratamento farmacológico , Complicações Parasitárias na Gravidez , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Consenso , AnamneseRESUMO
Mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. Diagnosis of maternal infection and the newborn is achieved by a combination of serological tests, clinical features and ultrasound images. An early diagnosis of maternal infection allows treatment that offers a reduction both in transmission rate and risk of congenital damage. The aim of this expert consensus was to review the scientific literature which would enable an update of the clinical practice guideline of prevention, diagnosis and treatment of congenital toxoplasmosis in our country.
La transmisión vertical de la infección por Toxoplasma gondii ocurre cuando la madre se infecta por primera vez en el transcurso del embarazo. El diagnóstico de la infección materna y la del recién nacido se logra con el conjunto de pruebas serológicas, hallazgos clínicos y ecográficos. El reconocimiento temprano de la infección materna permite un tratamiento que reduce la tasa de transmisión y el riesgo de daño en el producto de la concepción. El objetivo de este consenso de expertos fue revisar la literatura científica para actualizar las recomendaciones de práctica clínica respecto de la prevención, el diagnóstico y el tratamiento de la toxoplasmosis congénita en nuestro país.
Assuntos
Complicações Parasitárias na Gravidez , Toxoplasma , Toxoplasmose Congênita , Toxoplasmose , Criança , Consenso , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Anamnese , Gravidez , Toxoplasmose Congênita/diagnóstico , Toxoplasmose Congênita/tratamento farmacológico , Toxoplasmose Congênita/prevenção & controleRESUMO
We analyzed the presence of IgG and IgM anti-Toxoplasma gondii, as a measure of infection, in pregnant women attending seven hospitals in the Metropolitan Area of Buenos Aires during 2006 and 2017. T. gondii seroprevalence in 2006 vs. 2017, was: Hospital Alemán: 22 and 17% (p = 0.004), Hospital Fiorito: 44 and 33% (p < 0.001), Hospital Gandulfo: 30 and 34% (p 0.025), Hospital Grierson 60 and 44% (p < 0.001), Hospital Rivadavia: 59 and 51% (p = 0.003), Hospital Sardá: 47 and 39% (p < 0.001), and Hospital Thompson: 61 and 51% (p < 0.001). The comparison showed a significant decrease in seroprevalence in six hospitals. We also observed a significant decrease in the reactivity for IgM in 2017 compared to 2006 and in the seroprevalence for T. gondii in the overall population of pregnant women in the study. This means that a greater number of women are susceptible to develop acute infection during pregnancy.
Se analizó de forma retrospectiva la presencia de anticuerpos séricos IgG e IgM anti-Toxoplasma gondii en las embarazadas que concurrieron a siete hospitales del área Metropolitana de Buenos Aires durante 2006 y 2017. La prevalencia de infección, medida como presencia de anticuerpos, en 2006 vs. 2017, fue: Hospital Alemán: 22 y 17% (p = 0.004), Hospital Fiorito: 44 y 33% (p < 0.001), Hospital Gandulfo: 30 y 34% (p 0.025), Hospital Grierson: 60 y 44% (p < 0.001), Hospital Rivadavia: 59 y 51% (p=0.003), Maternidad Sardá 47 y 39% (p < 0.001) y Hospital Thompson: 61 y 51% (p < 0.001). La comparación demostró una disminución estadísticamente significativa de la seroprevalencia en seis hos pitales. También disminuyeron significativamente la reactividad para IgM en 2017 respecto de 2006 y la seroprevalencia para T. gondii en el total de la población de embarazadas estudiadas, lo que significa un mayor número de mujeres susceptible de desarrollar infección aguda durante el embarazo.
Assuntos
Anticorpos Antiprotozoários/sangue , Complicações Infecciosas na Gravidez/imunologia , Toxoplasma/imunologia , Toxoplasmose/imunologia , Adulto , Distribuição por Idade , Anticorpos Antiprotozoários/imunologia , Argentina/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estudos Soroepidemiológicos , Fatores de Tempo , Toxoplasmose/sangue , Toxoplasmose/epidemiologia , Adulto JovemRESUMO
Se analizó; de forma retrospectiva la presencia de anticuerpos só;©ricos IgG e IgM anti-Toxoplasma gondii en las embarazadas que concurrieron a siete hospitales del ó;rea Metropolitana de Buenos Aires durante 2006 y 2017. La prevalencia de infecció;n, medida como presencia de anticuerpos, en 2006 vs. 2017, fue: Hospital Alemán: 22 y 17% (p = 0.004), Hospital Fiorito: 44 y 33% (p < 0.001), Hospital Gandulfo: 30 y 34% (p 0.025), Hospital Grierson: 60 y 44% (p < 0.001), Hospital Rivadavia: 59 y 51% (p=0.003), Maternidad Sardá 47 y 39% (p < 0.001) y Hospital Thompson: 61 y 51% (p < 0.001). La comparació;n demostró; una disminució;n estadísticamente significativa de la seroprevalencia en seis hos pitales. Tambín disminuyeron significativamente la reactividad para IgM en 2017 respecto de 2006 y la seroprevalencia para T. gondii en el total de la població;n de embarazadas estudiadas, lo que significa un mayor nó;ºmero de mujeres susceptible de desarrollar infecció;n aguda durante el embarazo.
We analyzed the presence of IgG and IgM anti- Toxoplasma gondii, as a measure of infection, in pregnant women attending seven hospitals in the Metropolitan Area of Buenos Aires during 2006 and 2017. T. gondii seroprevalence in 2006 vs. 2017, was: Hospital Alemán: 22 and 17% (p = 0.004), Hospital Fiorito: 44 and 33% (p < 0.001), Hospital Gandulfo: 30 and 34% (p 0.025), Hospital Grierson 60 and 44% (p < 0.001), Hospital Rivadavia: 59 and 51% (p = 0.003), Hospital Sardá: 47 and 39% (p < 0. 001), and Hospital Thompson: 61 and 51% (p < 0.001). The comparison showed a significant decrease in seroprevalence in six hospitals. We also observed a significant decrease in the reactivity for IgM in 2017 compared to 2006 and in the seroprevalence for T. gondii in the overall population of pregnant women in the study. This means that a greater number of women are susceptible to develop acute infection during pregnancy.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Complicações Infecciosas na Gravidez/imunologia , Toxoplasma/imunologia , Anticorpos Antiprotozoários/sangue , Toxoplasmose/imunologia , Argentina/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Fatores de Tempo , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Anticorpos Antiprotozoários/imunologia , Estudos Soroepidemiológicos , Toxoplasmose/sangue , Toxoplasmose/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Distribuição por Idade , Hospitais/estatística & dados numéricosRESUMO
Toxoplasmosis, a worldwide distributed zoonosis, can be transmitted congenitally affecting fetuses and developing variable clinical signs. Different Toxoplasma gondii genotypes and infective dose are related factors with different clinical manifestations. Several studies indicate that atypical strains could produce more severe clinical manifestations compared to typical strains. Umbilical cord blood (nâ¯=â¯37) and placenta (nâ¯=â¯19) were collected at birth from women with acute T. gondii infection and processed for isolation by mice bioassay. Six isolates were obtained and identified as TgHm14-4Arg, TgHm15-02Arg, TgHm16-01Arg, TgHm16-02Arg, TgHm17-01Arg and TgHm17-02Arg. Three genotypes described previously on Toxo-DB were identified: #138 identified in chickens from Brazil, #182 isolated from eared doves from Brazil, #14 from wallaby kangaroos and chickens from Argentina, chickens from Brazil, Colombia, Chile and Venezuela, cats and dogs from Brazil and Colombia and also coyotes from USA indicating worldwide distribution of these genotypes. Two new allele combinations were obtained showing high genotypes diversity in Argentina. Four of the isolates (TgHm14-4Arg, TgHm15-02Arg, TgHm16-01Arg, TgHm16-02Arg) and two of them (TgHm17-01Arg, TgHm17-02Arg) produced chronic and acute infections in mice, respectively. Until now, seven T. gondii isolates have been obtained from humans in Argentina, and all were atypical or non-clonal genotypes. The identification of atypical strains causing congenital toxoplasmosis and circulating in our region, make important to perform the serological screenings according Argentine Consensus of Toxoplasmosis and to apply and monitoring treatments earlier in pregnancy. To achieve this aim, it is necessary to inform general population about T. gondii infection, diagnostics and control measures. These results should serve to generate awareness about congenital toxoplasmosis in South America.
Assuntos
Genótipo , Toxoplasma/genética , Toxoplasmose Congênita/epidemiologia , Toxoplasmose Congênita/parasitologia , Doença Aguda/epidemiologia , Animais , Anticorpos Antiprotozoários/sangue , Argentina/epidemiologia , Bioensaio , Doenças do Gato/epidemiologia , Doenças do Gato/parasitologia , Gatos , Galinhas , DNA de Protozoário/genética , Doenças do Cão/epidemiologia , Doenças do Cão/parasitologia , Cães , Feminino , Sangue Fetal/parasitologia , Humanos , Recém-Nascido , Camundongos , Placenta/parasitologia , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição/genética , Doenças das Aves Domésticas/epidemiologia , Doenças das Aves Domésticas/parasitologia , Gravidez , América do Sul/epidemiologia , Toxoplasma/imunologia , Toxoplasma/isolamento & purificação , Toxoplasmose Animal/parasitologia , Toxoplasmose Congênita/sangueRESUMO
BACKGROUND: Congenital toxoplasmosis diagnosis in the newborn is a very important issue due to the need for early treatment to prevent future sequels. Aim To compare available methods at the institution for the diagnosis of congenital toxoplasmosis. Material and Methods In this study we have evaluated the different diagnostic tests used in 67 congenital exposed newborns, including serological tests, PCR, parasite isolation and molecular characterization. Results The ISAGA IgM and IgA tests showed sensitivity (Se) of 87 and 91%, respectively, and specificity (Sp) of 100%. When ISAGA IgM and IgA were performed simultaneously, the Se increased to 98% and the Sp was 100%. The presence of IgE contributed to the diagnosis when it was detected in the child's serum but not in maternal blood. In four congenital infected children the parasite was isolated and genotyped: one was genotype II and the other three were "atypical" genotypes. No parasite was isolated in children without congenital toxoplasmosis. Discussion Overall, serological tests showed a good diagnostic performance although in one case they were all negative and isolation was the only tool to identify the infection. We conclude that it is essential to use all diagnostic tests in every single exposed child, including if possible, molecular characterization due to its epidemiological implication.
Assuntos
Reação em Cadeia da Polimerase/métodos , Testes Sorológicos/métodos , Toxoplasma/isolamento & purificação , Toxoplasmose Congênita/diagnóstico , Anticorpos Antiprotozoários/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Técnicas de Genotipagem , Humanos , Isotipos de Imunoglobulinas/sangue , Recém-Nascido , Masculino , Gravidez , Complicações Parasitárias na Gravidez/diagnóstico , Complicações Parasitárias na Gravidez/parasitologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Toxoplasma/genética , Toxoplasma/patogenicidade , Toxoplasmose Congênita/imunologia , Toxoplasmose Congênita/parasitologiaRESUMO
Resumen Introducción El diagnóstico de toxoplasmosis congénita (TC) en el recién nacido es muy importante porque debe recibir tratamiento siempre, sintomático o no, para evitar o aminorar las secuelas de la enfermedad. Objetivo Evaluación comparativa de los métodos disponibles en la institución para el diagnóstico de TC. Materiales y Métodos Se evaluaron métodos diagnósticos en 67 niños cuyas madres cursaron toxoplasmosis aguda durante el embarazo. Se utilizó la técnica de Sabin Feldman para IgG al nacimiento y durante el seguimiento serológico hasta el año de vida. Para determinar IgM, IgA e IgE se utilizó la técnica immunosorbent agglutination assay (ISAGA). El diagnóstico directo se realizó por reacción de polimerasa en cadena (RPC), aislamiento y caracterización molecular del parásito. Resultados La sensibilidad (S) de ISAGA IgM fue 87%, ISAGA IgA 91% y la especificidad (E) fue 100% para ambas; cuando se realizaron en conjunto, la S aumentó a 98%. La detección de IgE contribuyó al diagnóstico cuando se la detectó sólo en la sangre del neonato y no en sangre materna. Se aisló el parásito en cuatro casos de TC, uno fue genotipo II y los otros tres, genotipos "atípicos". La S del aislamiento fue 80% y la E 100%. Conclusión Los métodos serológicos utilizados mostraron una buena eficacia diagnóstica. Un caso fue detectado sólo por el aislamiento y la caracterización molecular tiene gran valor epidemiológico.
Background. Congenital toxoplasmosis diagnosis in the newborn is a very important issue due to the need for early treatment to prevent future sequels. Aim To compare available methods at the institution for the diagnosis of congenital toxoplasmosis. Material and Methods In this study we have evaluated the different diagnostic tests used in 67 congenital exposed newborns, including serological tests, PCR, parasite isolation and molecular characterization. Results The ISAGA IgM and IgA tests showed sensitivity (Se) of 87 and 91%, respectively, and specificity (Sp) of 100%. When ISAGA IgM and IgA were performed simultaneously, the Se increased to 98% and the Sp was 100%. The presence of IgE contributed to the diagnosis when it was detected in the child's serum but not in maternal blood. In four congenital infected children the parasite was isolated and genotyped: one was genotype II and the other three were "atypical" genotypes. No parasite was isolated in children without congenital toxoplasmosis. Discussion Overall, serological tests showed a good diagnostic performance although in one case they were all negative and isolation was the only tool to identify the infection. We conclude that it is essential to use all diagnostic tests in every single exposed child, including if possible, molecular characterization due to its epidemiological implication.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Toxoplasma/isolamento & purificação , Testes Sorológicos/métodos , Toxoplasmose Congênita/diagnóstico , Reação em Cadeia da Polimerase/métodos , Toxoplasma/genética , Toxoplasma/patogenicidade , Isotipos de Imunoglobulinas/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Anticorpos Antiprotozoários/sangue , Toxoplasmose Congênita/imunologia , Toxoplasmose Congênita/parasitologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Complicações Parasitárias na Gravidez/diagnóstico , Complicações Parasitárias na Gravidez/parasitologia , Técnicas de GenotipagemRESUMO
A prevalence study of antibodies anti Toxoplasma gondii in voluntary blood donors who attended the hemotherapy service at the Hospital Alemán during the first four months of the years 1997, 2007 and 2017 was carried out and the results were compared to the study carried out in 1967. The sera where processed with the Sabin Feldman Dye Test. The global average seroprevalence in 1967 was 67.0% (CI95%, 64.4%-69.6%); in 1997, 35.0% (CI95%, 33.3%-38.3%); in 2007, 31.9% (CI95%, 29.6%-34.2%) and in 2017, 21.2% (CI95%, 19.0%-23.3%). In the fifty years covered by the study the decline in prevalence was 45.8%, which represents an average annual decline of 0.9%.The decline was statistically significant between 1967 and 1997, and between 2007 and 2017. The four studies demonstrate that infection prevalence increased depending on age. The infection rate for 1967 was 1.0% per year and declined in the next studies to 0.8% in 1997, 0.8% in 2007, and 0.5% in 2017. Donors from the last study responded to a survey that showed a statistically significant correlation between seroprevalence of Toxoplasma gondii antibodies and lack of tap water, unfinished secondary studies or residence in the western or southern part of the Buenos Aires metropolitan area. No significant association was found with having a cat as a pet, the consumption of undercooked meat or the practice of gardening.
Assuntos
Anticorpos Antiprotozoários/sangue , Doadores de Sangue/estatística & dados numéricos , Imunoglobulina G/sangue , Toxoplasma/imunologia , Toxoplasmose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Argentina/epidemiologia , Gatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Inquéritos e Questionários , Toxoplasmose/diagnóstico , Adulto JovemRESUMO
Se estudió la prevalencia de anticuerpos anti Toxoplasma gondii a los dadores voluntarios de sangre que concurrieron durante el primer cuatrimestre de los años 1997, 2007 y 2017 al Servicio de Hemoterapia del Hospital Alemán de Buenos Aires y se compararon los resultados con el estudio efectuado en el año 1967. Los sueros fueron procesados con el Sabin Feldman Dye Test. La seroprevalencia promedio en 1967 fue 67.0% (IC95%, 64.4%-69.6%), en 1997, 35% (IC95%, 33.3%-38.3%), en 2007, 31.9 % (IC95%, 29.6%-34.2%) y en 2017, 21.2% (IC95%, 19.0%-23.3%). En los cincuenta años que abarca el estudio la disminución de la prevalencia fue de 45.8%, que representa una declinación anual promedio del 0.9%. El descenso fue estadísticamente significativo entre los años 1967 y 1997 y entre 2007 y 2017. En los cuatro estudios se observó un incremento de la prevalencia de infección en función de la edad. La tasa de infección calculada para el año 1967 fue 1.0% y disminuyó en los estudios posteriores, a 0.8% en 1997, 0.7% en 2007 y 0.5% en 2017. Los donantes del último estudio respondieron una encuesta que mostró una correlación estadísticamente significativa entre seroprevalencia de anticuerpos anti-Toxoplasma gondii y la carencia de agua corriente, estudios secundarios no concluidos o la residencia en zona oeste o sur del conurbano bonaerense. No se encontró una asociación significativa con tener un gato como mascota, consumo de carne poco cocida o práctica de jardinería.
A prevalence study of antibodies anti Toxoplasma gondii in voluntary blood donors who attended the hemotherapy service at the Hospital Alemán during the first four months of the years 1997, 2007 and 2017 was carried out and the results were compared to the study carried out in 1967. The sera where processed with the Sabin Feldman Dye Test. The global average seroprevalence in 1967 was 67.0% (CI95%, 64.4%-69.6%); in 1997, 35.0% (CI95%, 33.3%-38.3%); in 2007, 31.9% (CI95%, 29.6%-34.2%) and in 2017, 21.2% (CI95%, 19.0%-23.3%). In the fifty years covered by the study the decline in prevalence was 45.8%, which represents an average annual decline of 0.9%.The decline was statistically significant between 1967 and 1997, and between 2007 and 2017. The four studies demonstrate that infection prevalence increased depending on age. The infection rate for 1967 was 1.0% per year and declined in the next studies to 0.8% in 1997, 0.8% in 2007, and 0.5% in 2017. Donors from the last study responded to a survey that showed a statistically significant correlation between seroprevalence of Toxoplasma gondii antibodies and lack of tap water, unfinished secondary studies or residence in the western or southern part of the Buenos Aires metropolitan area. No significant association was found with having a cat as a pet, the consumption of undercooked meat or the practice of gardening.
Assuntos
Humanos , Animais , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Gatos , Adulto Jovem , Toxoplasma/imunologia , Doadores de Sangue/estatística & dados numéricos , Imunoglobulina G/sangue , Anticorpos Antiprotozoários/sangue , Toxoplasmose/epidemiologia , Argentina/epidemiologia , Toxoplasmose/diagnóstico , Prevalência , Inquéritos e Questionários , Fatores de RiscoRESUMO
Blood sample and placenta were taken from a 37-week pregnant woman; serologic results indicated acute toxoplasmosis. Placenta was inoculated into mice. Seropositive mice were sacrificed and tissue cysts from brain were inoculated into new mice. Specific DNA was detected by PCR, and the isolate was characterized as Type II by nPCR-RFLP for nSAG2, SAG3, BTUB, GRA6, c29-2, c22-8, L358, PK1 and Apico markers. This is the first isolation and molecular characterization of Toxoplasma gondii from humans in Argentina.