Seroprevalencia y factores de riesgo asociados a toxoplasmosis gestacional en el Nororiente Colombiano
DOI:
https://doi.org/10.15649/cuidarte.2287Palabras clave:
Factores de riesgo, Inmunidad, Mujeres embarazadas, Seroprevalencia, ToxoplasmosisResumen
Highlights:
La toxoplasmosis gestacional podría constituir una grave problemática en ascenso en la población atendida en zona fronteriza nororiental de Colombia.
La incrementada reactividad IgM específica a T.gondii en mujeres gestantes representa una alarma para la generación de estrategias de impacto en la prevención de esta problemática, como población priorizada.
La seronegatividad frente a T.gondii, aún predominante en población gestante evaluada en región nororiental de Colombia, constituye un factor de riesgo relevante de toxoplasmosis gestacional, reflejado en alta susceptibilidad.
La considerable exposición a factores de riesgo de toxoplasmosis en el embarazo implica una clara oportunidad de mejora de la calidad del control prenatal, mediante atención integral.
Introducción:La toxoplasmosis es una zoonosis prevalente en un tercio de la población mundial, que afecta negativamente la salud materno-fetal causando daños de grado variable al feto. Objetivo: Se propuso evaluar el estado serológico IgG e IgM anti-Toxoplasma gondii y factores de riesgo relacionados, en mujeres gestantes de primer trimestre en Cúcuta, Colombia, en el año 2018. Materiales y métodos: Estudio transversal y correlacional en 111 mujeres participando voluntariamente, a quienes se testeó para IgM e IgG específicas por inmunoensayo LIA. Resultados: Se halló 19,8% y 35,1% de seropositividad total para IgM e IgG, respectivamente, 11,7% lo fue únicamente para IgM y 53,2% corresponde a la frecuencia de seronegatividad global para T.gondii; Se identificaron factores de riesgo (IC=95%) como consumo de carne mal cocida (54,1% de los casos, OR=1,8, p=0,120), de agua del grifo (48,6%, OR=1,4, p=0,421), de leche cruda de cabra o de vaca (39,6%, OR=0,78, p=0,553), además de convivencia con gatos (23,4%), éste último asociado significativamente a seropositividad al parásito (OR=2,8, p=0,025). Discusión y Conclusiones: Nuestros hallazgos revelan un posible riesgo de primo-infección en más de la mitad de la población gestante dada su seronegatividad frente al parásito, pero también una frecuencia considerable de casos con sospecha de infección muy reciente, lo que además de asociarse a un factor de riesgo previamente reconocido, deja entrever otros aspectos de riesgo en torno a la alimentación que deben impactarse mediante estrategias de prevención durante el control prenatal, sugiriendo la necesidad de fortalecer la vigilancia en torno al evento.
Como citar este artículo: Cárdenas Sierra Denny Miley, Domínguez Julio Camila, Blanco Oliveros María Ximena, Soto Javier Andrés, Tórres Morales Elizabeth. Seroprevalencia y factores de riesgo asociados a toxoplasmosis gestacional en el Nororiente Colombiano. Revista Cuidarte. 2023;14(1):e2287. http://dx.doi.org/10.15649/cuidarte.2287
Referencias
Flegr J. How and why Toxoplasma makes us crazy. Trends Parasitol. 2013; 29(4): 156-163. https://doi.org/10.1016/j.pt.2013.01.007
Pérez JE, Villada Gomez J, Naranjo Pérez O, Castaño SV. Formas alternas de transmisión de Toxoplasma gondii. Biosalud. 2011; 10(2): 123-137. http://vip.ucaldas.edu.co/biosalud/downloads/Revista_Biosalud_10(2)_COMPLETA.pdf#page=123
Belluco S, Simonato G, Mancin M, Pietrobelli M, Ricci A. Toxoplasma gondii infection and food consumption: a systematic review and meta-analysis of case-controlled studies. Crit Rev Food Sci Nutr. 2018; 58(18): 3085-3096. https://doi.org/10.1080/10408398.2017.1352563
Guo M, Dubey JP, Hill D, Buchanan RL, Gamble HR, Jones JL, et al. Prevalence and risk factors for Toxoplasma gondii infection in meat animals and meat products destined for human consumption. J Food Prot. 2015; 78(2): 457-476. https://doi.org/10.4315/0362-028X.JFP-14-328
da Costa MA, Pinto‐Ferreira F, de Almeida RPA, Martins FDC, Pires AL, Mareze M, et al. Artisan fresh cheese from raw cow's milk as a possible route of transmission in a toxoplasmosis outbreak, in Brazil. Zoonoses Public Health. 2019; 00: 1-8. https://doi.org/10.1111/zph.12660
Lange A, Thyrian J, Wetzka S, Flessa S, Hoffmann W, Zygmunt M, et al. The impact of socioeconomic factors on the efficiency of voluntary toxoplasmosis screening during pregnancy: a population-based study. BMC Pregnancy Childbirth. 2016; 16(197): 1-9. https://doi.org/10.1186/s12884-016-0966-0
Mareze M, do Nascimento Benitez A, Brandão APD, Pinto-Ferreira F, Miura AC, Martins FDC, et al. Socioeconomic vulnerability associated to Toxoplasma gondii exposure in southern Brazil. PLoS One. 2019; 14(2): 1-14. https://doi.org/10.1371/journal.pone.0212375
Bresciani KDS, Galvão ALB, Vasconcellos ALd, Soares JA, Matos LVSd, Pierucci JC, et al. Relevant aspects of human toxoplasmosis. Res J Infect Dis. 2013; 1(1): 1-5. http://dx.doi.org/10.7243/2052-5958-1-7
Egorov AI, Converse R, Griffin SM, Styles J, Klein E, Sams E, et al. Environmental risk factors for Toxoplasma gondii infections and the impact of latent infections on allostatic load in residents of Central North Carolina. BMC Infect Dis. 2018; 18(421): 1-11. https://doi.org/10.1186/s12879-018-3343-y
Belluco S, Mancin M, Conficoni D, Simonato G, Pietrobelli M, Ricci A. Investigating the determinants of Toxoplasma gondii prevalence in meat: a systematic review and meta-regression. PLoS One. 2016; 11(4): 1-24. http://dx.doi.org/10.1371/journal.pone.0153856
Dard C, Fricker-Hidalgo H, Brenier-Pinchart M-P, Pelloux H. Relevance of and New Developments in Serology for Toxoplasmosis. Trends Parasitol. 2016; 32(6): 492-506. https://doi.org/10.1016/j.pt.2016.04.001
Daryani A, Sarvi S, Aarabi M, Mizani A, Ahmadpour E, Shokri A, et al. Seroprevalence of Toxoplasma gondii in the Iranian general population: A systematic review and meta-analysis. Acta Trop. 2014; 137: 185-194. https://doi.org/10.1016/j.actatropica.2014.05.015
Montoya J, Liesenfeld O. Toxoplasmosis. The Lancet. 2004; 363: 1965-1976. https://doi.org/10.1016/S0140-6736(04)16412-X
Jones JL, Kruszon-Moran D, Elder S, Rivera HN, Press C, Montoya JG, et al. Toxoplasma gondii infection in the United States, 2011–2014. Am J Trop Med Hyg. 2018; 98(2): 551-557. https://doi.org/10.4269/ajtmh.17-0677
Furtado JM, Smith JR, Belfort R, Gattey D, Winthrop KL. Toxoplasmosis: a global threat. J Glob Infect Dis. 2011; 3(3): 281-284. https://www.nureinvestigacion.es/OJS/index.php/nure/article/view/1023
Dubey J. Advances in the life cycle of Toxoplasma gondii. Int J Parasitol. 1998; 28(7): 1019-1024.https://doi.org/10.1016/S0020-7519(98)00023-X
Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: from animals to humans. Int J Parasitol. 2000; 30(12-13): 1217-1258. https://doi.org/10.1016/S0020-7519(00)00124-7
Peyron F, Lobry JR, Musset K, Ferrandiz J, Gomez-Marin JE, Petersen E, et al. Serotyping of Toxoplasma gondii in chronically infected pregnant women: predominance of type II in Europe and types I and III in Colombia (South America). Microbes Infect. 2006; 8(9-10): 2333-2340. . https://doi.org/10.1016/j.micinf.2006.03.023
Goldstein EJ, Montoya JG, Remington JS. Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis. 2008; 47(4): 554-566. https://doi.org/10.1086/590149
Carral L, Kaufer F, Olejnik P, Freuler C, Durlach R. Prevention of congenital toxoplasmosis in a Buenos Aires hospital. Medicina. 2013; 73(3): 238-242. http://www.medicinabuenosaires.com/PMID/23732199.pdf
Robert-Gangneux F. It is not only the cat that did it: how to prevent and treat congenital toxoplasmosis. J Infect. 2014; 68(1): 125-133. https://doi.org/10.1016/j.jinf.2013.09.023
Gómez-Sánchez PI, Arévalo-Rodríguez I, Rubio-Romero JA, Amaya-Guío J, Osorio-Castaño JH, Buitrago-Gutiérrez G. Guías de Práctica Clínica para la prevención, detección temprana y tratamiento de las complicaciones del embarazo, parto o puerperio: introducción y metodología. Rev Colomb Obstet Ginecol. 2013; 64(3): 234-244. https://doi.org/10.18597/rcog.105
Social MdSyP. Resolución número 3280 Por medio de la cual se adoptan los lineamientos técnicos y operativos de la Ruta Integral de Atención para la Promoción y Mantenimiento de la Salud y la Ruta Integral de Atención en Salud para la Población Materno Perinatal y se establecen las directrices para su operación. 2018. https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No.%203280%20de%2020183280.pdf
Jones JL, Ogunmodede F, Scheftel J, Kirkland E, Lopez A, Schulkin J, et al. Toxoplasmosis-related knowledge and practices among pregnant women in the United States. Infect Dis Obstet Gynecol. 2003; 11(3): 139-145. https://doi.org/10.1080/10647440300025512
Ben-Harari RR, Connolly MP. High burden and low awareness of toxoplasmosis in the United States. Postgrad Med. 2019; 131(2): 103-108. https://doi.org/10.1080/00325481.2019.1568792
Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The lancet. 1997; 349(9063): 1436-1442. https://doi.org/10.1016/S0140-6736(96)07495-8
Bobic B, Šibalić D, Djurkovic-Djakovic O. High levels of IgM antibodies specific for Toxoplasma gondii in pregnancy 12 years after primary toxoplasma infection. Gynecol Obstet Invest. 1991; 31(3): 182-184. https://doi.org/10.1159/000293151
Gras L, Gilbert R, Wallon M, Peyron F, Cortina-Borja M. Duration of the IgM response in women acquiring Toxoplasma gondii during pregnancy: implications for clinical practice and cross-sectional incidence studies. Epidemiol Infect. 2004; 132(3): 541-548. https://doi.org/10.1017/S0950268803001948
Cárdenas DM. Seroprevalencia y factores de riesgo asociados a toxoplasmosis gestacional en el Nororiente Colombiano. Mendeley Data, V1. 2022. https://doi.org/10.17632/rwgsysdbgz.1
Deng H, Devleesschauwer B, Liu M, Li J, Wu Y, van der Giessen JW, et al. Seroprevalence of Toxoplasma gondii in pregnant women and livestock in the mainland of China: a systematic review and hierarchical meta-analysis. Sci Rep. 2018; 8(6218): 1-10. https://doi.org/10.1038/s41598-018-24361-8
Mahmoudvand H, Saedi Dezaki E, Soleimani S, Baneshi MR, Kheirandish F, Ezatpour B, et al. Seroprevalence and risk factors of T oxoplasma gondii infection among healthy blood donors in south‐east of Iran. Parasite Immunol. 2015; 37(7): 362-367. https://doi.org/10.1111/pim.12198
Pardini L, Bernstein M, Carral LA, Kaufer FJ, Dellarupe A, Gos ML, et al. Congenital human toxoplasmosis caused by non-clonal Toxoplasma gondii genotypes in Argentina. Parasitol Int. 2019; 68(1): 48-52.https://doi.org/10.1016/j.parint.2018.10.002
Torgerson PR, Mastroiacovo P. The global burden of congenital toxoplasmosis: a systematic review. Bull World Health Org. 2013; 91: 501-508. http://dx.doi.org/10.2471/BLT.12.111732
McLeod R, Lykins J, Noble AG, Rabiah P, Swisher CN, Heydemann PT, et al. Management of congenital toxoplasmosis. Curr Pediatr Rep. 2014; 2(3): 166-194. https://doi.org/10.1007/s40124-014-0055-7
Melamed J, Eckert G, Spadoni V, Lago E, Uberti F. Ocular manifestations of congenital toxoplasmosis. Eye. 2010; 24: 528-534. https://doi.org/10.1038/eye.2009.140
Dunn D, Wallon M, Peyron F, Petersen E, Peckham C, Gilbert R. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling. The Lancet. 1999; 353(9167): 1829-1833. https://doi.org/10.1016/S0140-6736(98)08220-8
McCabe R, Chirurgi V. Issues in toxoplasmosis. Infect Dis Clin North Am. 1993; 7(3): 587-604. https://doi.org/10.1016/S0891-5520(20)30544-4
Elsheikha H. Congenital toxoplasmosis: priorities for further health promotion action. Public Health. 2008; 122(4): 335-353. https://doi.org/10.1016/j.puhe.2007.08.009
Trotta M, Borchi B, Zammarchi L, Sterrantino G, Brogi M, Kiros ST, et al. Immunoglobulin M indirect‐fluorescent antibody test for the diagnosis of acute toxoplasmosis during pregnancy in the avidity era: A 14‐year experience at the Tuscany Reference Center for Infectious Diseases in Pregnancy, Florence, Italy. J Obstet Gynaecol Res. 2016; 42(12): 1699-1703. https://doi.org/10.1111/jog.13144
Soares JAS, Caldeira AP. Congenital toxoplasmosis: the challenge of early diagnosis of a complex and neglected disease. Rev Soc Bras Med Trop. 2019; 52(20180228): 1-3. https://doi.org/10.1590/0037-8682-0228-2018
Cárdenas, Lozano C, Castillo Z, Cedeño J, Galvis V, Rios J, et al. Frecuencia de anticuerpos anti Toxoplasma gondii en gestantes de Cúcuta, Colombia. Rev Med Hered. 2015; 26: 230-237. http://www.scielo.org.pe/pdf/rmh/v26n4/a05v26n4.pdf
Gómez Marín JE. Toxoplasmosis: Un problema de salud pública en Colombia. Rev Salud Pública (Bogotá). 2002; 4(1): 7-10. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0124-00642002000400003
Angel-Müller E, Hougton MP, Eslava C, Riaño J, Rey GE, Gómez-Marín JE. Gestational and congenital toxoplasmosis in two hospitals in Bogota, Colombia. Rev Fac Med Univ Nac Colomb. 2014; 62(2): 179-185. http://dx.doi.org/10.15446/revfacmed.v62n2.45430
Chandramathi S, Nissapatorn V. Prevalence and risk factors of Toxoplasma infection–an update in Malaysian pregnant women. Trop Biomed. 2019; 36(3): 694-702. http://msptm.org/files/Vol36No3/694-702-Nissapatorn-V.pdf
Naheen C, Tarafder S, Khan S. Toxoplasma gondii Seropositivity and its Possible Associated Risk Factors among Pregnant Women Attending Antenatal Clinic in a Tertiary Care Hospital of Dhaka, Bangladesh. Mymensingh Med J. 2018; 27(2): 336-343. https://europepmc.org/article/med/29769499
Ramírez AM, Ríos YK, Galvis NF, Entrena E, Mariño NV, Rangel DM, et al. Seroprevalencia y detección molecular de Toxoplasma gondii en donantes de un banco de sangre de Cúcuta, Colombia. Biomédica. 2019; 39(2): 144-156. https://doi.org/10.7705/biomedica.v39i4.4288
Saki J, Foroutan M, Khodkar I, Khodadadi A, Nazari L. Seroprevalence and molecular detection of Toxoplasma gondii in healthy blood donors in southwest Iran. Transfus Sci. 2019; 58(1): 79-82. https://doi.org/10.1016/j.transci.2018.12.003
Mimica F, Muñoz-Zanzi C, Torres M, Padilla O. Toxoplasmosis, zoonosis parasitaria prevalente en Chile: recuento y desafíos. Rev Chilena Infectol, 2015; 32(5): 541-549. http://dx.doi.org/10.4067/S0716-10182015000600008
Muñoz-Zanzi CA, Fry P, Lesina B, Hill D. Toxoplasma gondii oocyst–specific antibodies and source of infection. Emerg Infect Dis. 2010; 16(10): 1591-1593. http://dx.doi.org/10.3201/eid1610.091674
Jula J, Girones G, Edao B, Deme C, Cebrian J, Butrón L, et al. Seroprevalence of Toxoplasma gondii infection in pregnant women attending antenatal care in southern Ethiopia. Rev Esp Quimioter. 2018; 31(4): 363-366. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172689/pdf/revespquimioter-31-363.pdf
Maldonado YA, Read JS. Diseases CoI. Diagnosis, treatment, and prevention of congenital toxoplasmosis in the United States. Pediatrics. 2017; 139(2): 1-53. https://doi.org/10.1542/peds.2016-3860
López-Castillo CA, Díaz-Ramírez J, Gómez-Marín JE. Risk factors for Toxoplasma gondii infection in pregnant women in Armenia, Colombia.Rev Salud Pública (Bogotá). 2005; 7(2): 180-190. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0124-00642005000200006
Villena I, Aubert D, Gomis P, Ferté H, Inglard J-C, Denis-Bisiaux H, et al. Evaluation of a strategy for Toxoplasma gondii oocyst detection in water. Appl Environ Microbiol. 2004; 70(7): 4035-4039. https://doi: 10.1128/AEM.70.7.4035-4039.2004
Lass A, Pietkiewicz H, Szostakowska B, Myjak P. The first detection of Toxoplasma gondii DNA in environmental fruits and vegetables samples. Eur J Clin Microbiol Infect Dis. 2012; 31: 1101-1108. https://doi.org/10.1007/s10096-011-1414-8
Hussain M, Stitt V, Szabo E, Nelan B. Toxoplasma gondii in the Food Supply. Pathogens 2017; 6(2): 1-7. https://doi.org/10.3390/pathogens6020021
da Silva JG, Alves BHL, Melo RPB, Kim PCP, Neto OLS, Bezerra MJG, et al. Occurrence of anti-Toxoplasma gondii antibodies and parasite DNA in raw milk of sheep and goats of local breeds reared in Northeastern Brazil. Acta Trop. 2015; 142: 145-148. https://doi.org/10.1016/j.actatropica.2014.11.011
Saad NM, Hussein AA, Ewida RM. Occurrence of Toxoplasma gondii in raw goat, sheep, and camel milk in Upper Egypt. Vet World. 2018; 11(9): 1262-1265. https://doi.org/10.14202/vetworld.2018.1262-1265
Jones JL, Dargelas V, Roberts J, Press C, Remington JS, Montoya JG. Risk factors for Toxoplasma gondii infection in the United States. Clin Infect Dis. 2009; 49(6): 878-884. https://doi.org/10.1086/605433
Boughattas S. Toxoplasma infection and milk consumption: Meta-analysis of assumptions and evidences. Crit Rev Food Sci Nutr. 2017; 57(13): 2924-2933. https://doi.org/10.1080/10408398.2015.1084993
Dubey J, Verma S, Ferreira L, Oliveira S, Cassinelli A, Ying Y, et al. Detection and survival of Toxoplasma gondii in milk and cheese from experimentally infected goats. J Food Prot. 2014; 77(10): 1747-1753. https://doi.org/10.4315/0362-028X.JFP-14-167
Koethe M, Schade C, Fehlhaber K, Ludewig M. Survival of Toxoplasma gondii tachyzoites in simulated gastric fluid and cow’s milk. Vet Parasito.l 2017; 233: 111-114. https://doi.org/10.1016/j.vetpar.2016.12.010
Hill D, Dubey J. Update on Toxoplasma gondii as a parasite in food: analysis and control. In Advances in Microbial Food Safety. Volume 2. 2th edition: Elsevier; 2015: 59-80.
Havelaar AH, Haagsma JA, Mangen M-JJ, Kemmeren JM, Verhoef LP, Vijgen SM, et al. Disease burden of foodborne pathogens in the Netherlands, 2009. Int J Food Microbiol. 2012; 156(3): 231-238. https://doi.org/10.1016/j.ijfoodmicro.2012.03.029
Hoffmann S, Batz MB, Morris JG. Annual cost of illness and quality-adjusted life year losses in the United States due to 14 foodborne pathogens. J Food Prot. 2012; 75(7): 1292-1302. https://doi.org/10.4315/0362-028X.JFP-11-417
Grether JK, Ashwood P, Van de Water J, Yolken RH, Anderson MC, Torres AR, et al. Prenatal and newborn immunoglobulin levels from mother-child pairs and risk of autism spectrum disorders. Front Neurosci. 2016; 10(218): 1-10. https://doi.org/10.3389/fnins.2016.00218
Sagel U, Krämer A, Mikolajczyk RT. “Blind periods” in screening for toxoplasmosis in pregnancy in Austria–a debate. BMC Infect Dis. 2012; 12(118): 1-4. https://doi.org/10.1186/1471-2334-12-118
Rusindo Hernández N, Ginorio Gavito DE, Álvarez Gainza D, Matamoro Rodríguez DdlC, Castellanos Santos I. Conocimientos sobre toxoplasmosis de las mujeres en edad fértil de un consultorio médico en Trinidad. Rev Cubana Med Gen Integr. 2014; 30: 217-224. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252014000200007
Tomasoni L, Messina G, Genco F, Scudeller L, Prestia M, Spinoni V, et al. Risk of congenital toxoplasmosis in women with low or indeterminate anti-Toxoplasma IgG avidity index in the first trimester of pregnancy: an observational retrospective study. Clin Microbiol Infect. 2019; 25(6): 769-713. https://doi.org/10.1016/j.cmi.2018.09.024
MdS. Resolución número 8430 por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud. 1993. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF
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