Freqüência e fatores de risco associados à toxocaríase em crianças de ambulatório pediátrico na região sudeste do Brasil

Para determinar a frequência de anticorpos anti-Toxocara sp. e os fatores de risco associados à infecção, soros de 242 crianças de ambos os sexos, com idade entre um a 15 anos, atendidas no ambulatório do Hospital da Universidade Federal de Uberlândia, Minas Gerais, Brasil, foram analisados pelo ELISA. Questionários foram aplicados, para obter informações sobre os pacientes. As informações sobre as alterações clínicas, de 187 pacientes, foram obtidas no prontuário médico. Do total das 242 amostras, 21 (8,7%) foram positivas para anticorpos anti-Toxocara sp.. A presença de cães e gatos e a variável escola (local de contato) sugerem associação significativa (p ; 20%) mostram correlação positiva com a soropositividade para Toxocara sp.. A idade, sexo, sintomas como dor de cabeça, dor estomacal, crises convulsivas e anemia não apresentaram associação com toxocaríase.To estimate the frequency of anti-Toxocara sp. antibodies, and evaluate factors associated with this infection, sera from 242 male and female children, aged from one to fifteen years old, attended at the Hospital of the Federal University of Uberlândia, Minas Gerais State, Brazil, were analyzed by ELISA. Information on the patients was collected and registered using an investigative questionnaire, and details on possible clinical alterations were obtained from the medical charts of 187 patients. Of a total of 242 samples, 21 (8.7%) were positive for anti-Toxocara sp. antibodies. The presence of dogs and cats and the school variable (place of contact), appeared to be significantly associated (p < 0.05) with a positive serology. Respiratory symptoms and eosinophil counts greater than 20% also showed a positive statistical correlation with a positive serology for Toxocara sp.. Factors such as sex and age, and symptoms like headache, stomach ache, convulsive crises and anemia were not associated with toxocariasis

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Toxoplasma gondii Strains Defective in Oral Transmission Are Also Defective in Developmental Stage Differentiation

Toxoplasma gondii undergoes differentiation from rapidly growing tachyzoites to slowly growing bradyzoites during its life cycle in the intermediate host, and conversion can be induced in vitro by stress. Representative strains of the three clonal lineages showed equal capacity to differentiate into bradyzoites in vitro, as evidenced by induction of bradyzoite antigen 1, staining with Dolichos biflorus lectin (DBL), pepsin resistance, and oral infectivity in mice. We also examined several recently described exotic strains of T. gondii, which are genetically diverse and have a different ancestry from the clonal lineages. The exotic strain COUG was essentially like the clonal lineages and showed a high capacity to induce bradyzoites in vitro and in vivo, consistent with its ability to be efficiently transmitted by the oral route. In contrast, exotic strains MAS and FOU, which are defective in oral transmission, showed a decreased potential to develop into bradyzoites in vitro. This defect was evident from reduced staining with DBL and the cyst antigen CST1, failure to down-regulate tachyzoite antigens, such as tachyzoite surface antigens 1 and 2A, and decreased resistance to pepsin treatment. Despite normal in vitro differentiation, the exotic strains CAST and GPHT also showed decreased oral transmission, due to formation of smaller cysts and a lower tissue burden during chronic infection, traits also shared by MAS and FOU. Collectively, these findings reveal that the limited oral transmission in some strains of T. gondii is due to inefficient differentiation to the bradyzoite form, leading to defects in the formation of tissue cysts

Aspectos epidemiológicos da toxoplasmose e avaliação de sua soroprevalência em gestantes

Submitted by Nuzia Santos ([email protected]) on 2014-03-21T13:56:37Z No. of bitstreams: 1 Epidemiologic aspects of toxoplasmosis and evaluation of its seroprevalence in pregnant women.pdf: 2141402 bytes, checksum: 4d92c25ebce36a7f86c7f3c08cfb4720 (MD5)Made available in DSpace on 2014-03-21T13:56:37Z (GMT). No. of bitstreams: 1 Epidemiologic aspects of toxoplasmosis and evaluation of its seroprevalence in pregnant women.pdf: 2141402 bytes, checksum: 4d92c25ebce36a7f86c7f3c08cfb4720 (MD5) Previous issue date: 2012Universidade Estadual de Minas Gerais. Fundação Educacional de Divinópolis. Curso de Ciências Biológicas. Divinópolis, MG, BrasilUniversidade Estadual de Minas Gerais. Fundação Educacional de Divinópolis. Curso de Ciências Biológicas. Divinópolis, MG, BrasilUniversidade Federal do Espírito Santo. Departamento de Patologia. Vitória, ESUniversidade Federal de São João Del Rey. Departamento de Parasitologia. São João Del Rey, MG, BrasilInstituto de Ensino Superior e Pesquisa. Fundação Educacional de Divinópolis. Divinópolis, MG,Brasil/Universidade Estadual de Minas Gerais. Divinópolis, MG,BrasilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Educação em Saúde e Ambiente. Belo Horizonte, MG, Brasil/Universidade Estadual de Minas Gerais. Núcleo de Saúde Coletiva. Fundação Educacional de Divinópolis. Belo Horizonte, MG, BrasilINTRODUÇÃO: O objetivo deste trabalho foi estudar os fatores de riscos da toxoplasmose e investigar o nível de conhecimento das gestantes atendidas pelo Sistema Único de Saúde (SUS), no município de Divinópolis, Brasil. MÉTODOS: Para isso, foram analisados os exames pré-natais de 2.136 gestantes durante o período de outubro de 2007 a setembro de 2008. RESULTADOS: Das 2.136 gestantes avaliadas, 200 foram entrevistadas; destas, 49,5% foram soropositivas para IgG e 3,6% para IgM. A análise comparativa dos casos de toxoplasmose congênita, entre as 11 regiões que compõem o município, demonstrou uma distribuição irregular da enfermidade entre as localidades (p<0,01). As respostas dos questionários demonstraram que 93% das gestantes conhecem quase nada sobre toxoplasmose sendo que 24% apresentaram sorologia positiva sem manifestações clínicas. A análise de correlação entre gestantes IgG positivas e presença de animais de estimação foi estatisticamente significativa (p<0,05), reforçando a possibilidade da transmissão da enfermidade ocorrer no ambiente doméstico. CONCLUSÕES: É sugerida a implementação de um programa de triagem das gestantes, Educação em Saúde, que amplie e estimule a utilização dos serviços prestados pelo SUSINTRODUCTION: The aim of the present study was to analyze the exposure to risk factors for toxoplasmosis disease and the level of knowledge in pregnant women who were treated by the Public Health Care System (SUS) from October 2007 to September 2008 in Divinópolis City, Brazil. METHODS: We analyzed 2,136 prenatal exams of pregnant women that were treated from October 2007 to September 2008. RESULTS: Out of the 2,136 pregnant women evaluated, 200 answered a quantitative questionnaire; 49.5% were seropositive for immunoglobulin (Ig) G and 3.6% for IgM. Comparative analysis of congenital toxoplasmosis cases were evaluated in 11 regions and showed an irregular distribution (p < 0.01). This difference was also observed among the pregnant women observed in each location. The results from the questionnaire show that 93% of the pregnant women had no knowledge about toxoplasmosis, and 24% presented with positive serology, but no clinical manifestation. Analysis for pregnant IgG-positive women and the presence of pets showed a statistically significant correlation (p < 0.05), suggesting that the transmission of this disease might occur in the domestic environment. CONCLUSIONS: We suggest the implementation of a triage program for pregnant women and health education to encourage their use of SUS service

Molecular characterization of Trypanosoma cruzi samples derived from Triatoma vitticeps and Panstrongylus geniculatus of the Atlantic rainforest, southeast Brazil

Background: In rural areas of Espírito Santo state, southeast Brazil, triatomine species attracted by light frequently invade residences. The aim of this study was to investigate the Trypanosoma cruzi discrete typing units (DTUs) harbored by these triatomines. Methods: Triatomine’s intestinal contents were examined, inoculated in mice, and the positive samples were cultivated. Flagellates obtained from infected mice hemoculture were submitted to DNA extraction using a salting-out method and to TcSC5D gene amplification. The amplified samples were sequenced, and polymorphism was analyzed for DTU identification. Results: Three hundred and ninety-four triatomines were identified: Triatoma vitticeps (90.03%), Panstrongylus geniculatus (8.89%), Panstrongylus megistus (0.54%), Panstrongylus diasi (0.27%), and Triatoma tibiamaculata (0.27%). Among the specimens, 251/394 (67.65%) presented flagellated forms similar to T. cruzi. After triatomine intestinal content inoculation into mice, 134 mice presented T. cruzi-like trypomastigotes from Tr. vitticeps and P. geniculatus and 89 samples were positive in hemoculture. Sixty-two samples were analyzed for the TcSC5D gene and TcI, TcII, TcIII, and TcIV DTUs were identified. Conclusions: We observed T. cruzi DTU diversity in Tr. vitticeps and P. geniculatus, which showed the predominance of TcII and occurrence of TcI, TcIII and TcIV. Triatomines presented high T. cruzi infection rates. Since little is known regarding the possible mammalian hosts that maintain the T. cruzi cycle, further studies are necessary to obtain a better understanding of the parasite transmission cycle in this region

Frequency of anti-Toxoplasma gondii antibodies in dogs and cats from the metropolitan region of Vitória, Espírito Santo, Brazil

Toxoplasmosis, an infection caused by Toxoplasma gondii, is widely distributed worldwide. Seroprevalence in pets is a reliable tool to determine environmental parasite presence and  human risk of infection due to proximity to these animals. In this context, the frequency of anti-T. gondii IgG antibodies in sera of dogs and cats from Espirito Santo, Brazil and risk factors associated with the infection (sex, age, allocation, and breed) were assessed. Antibodies against T. gondii were detected in 39.4% (149/378) and 38.1% (142/373) of the dogs by enzyme-linked immunosorbent assay (ELISA) and by indirect immunofluorescence antibody test (IFAT), respectively. In cats, antibodies were detected in 15.2% (12/79) by ELISA and 7.6% (6/79) by IFAT. Canine infection was associated with stray origin and older ages. Feline females showed a higher chance of infection. There was an agreement between techniques in the detection of antibodies in dogs (k = 0.82) and cats (k = 0.63). These results indicate the parasite presence in the urban environment, suggesting the possibility of infection to humans and other animals. However, this risk is lower while considering pet domiciled animals with a more controlled diet and better hygiene conditions

Molecular characterization of

Background: In rural areas of Espírito Santo state, southeast Brazil, triatomine species attracted by light frequently invade residences. The aim of this study was to investigate the Trypanosoma cruzi discrete typing units (DTUs) harbored by these triatomines. Methods: Triatomine’s intestinal contents were examined, inoculated in mice, and the positive samples were cultivated. Flagellates obtained from infected mice hemoculture were submitted to DNA extraction using a salting-out method and to TcSC5D gene amplification. The amplified samples were sequenced, and polymorphism was analyzed for DTU identification. Results: Three hundred and ninety-four triatomines were identified: Triatoma vitticeps (90.03%), Panstrongylus geniculatus (8.89%), Panstrongylus megistus (0.54%), Panstrongylus diasi (0.27%), and Triatoma tibiamaculata (0.27%). Among the specimens, 251/394 (67.65%) presented flagellated forms similar to T. cruzi. After triatomine intestinal content inoculation into mice, 134 mice presented T. cruzi-like trypomastigotes from Tr. vitticeps and P. geniculatus and 89 samples were positive in hemoculture. Sixty-two samples were analyzed for the TcSC5D gene and TcI, TcII, TcIII, and TcIV DTUs were identified. Conclusions: We observed T. cruzi DTU diversity in Tr. vitticeps and P. geniculatus, which showed the predominance of TcII and occurrence of TcI, TcIII and TcIV. Triatomines presented high T. cruzi infection rates. Since little is known regarding the possible mammalian hosts that maintain the T. cruzi cycle, further studies are necessary to obtain a better understanding of the parasite transmission cycle in this region