Carellos Ericka Viana Machado, de Andrade Gláucia Manzan Queiroz, Vasconcelos-Santos Daniel Vitor, Januário José Nélio, Romanelli Roberta Maia Castro, Abreu Mery Natali Silva, da Silva Fabiana Maria, Loures Ivy Rosa Coelho, de Andrade Juliana Queiroz, Caiaffa Waleska Teixeira
Department of Pediatrics, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Department of Ophthalmology, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
PLoS One. 2014 Feb 11;9(2):e88588. doi: 10.1371/journal.pone.0088588. eCollection 2014.
Congenital toxoplasmosis is a public health problem in Brazil. This study aimed to determine risk factors associated with congenital toxoplasmosis in Minas Gerais which is the second largest Brazilian State based on number of inhabitants, and its territorial extension is larger than that of France.
Population-based case-control study to assess the association between congenital toxoplasmosis and maternal exposure to infection risk factors. The study included mothers/children participating in the Minas Gerais Newborn Screening Program. The cases consisted of 175 mothers of infected children, and the controls consisted of 278 mothers of children without suspected infection. The associations were assessed through binomial logistic regression with p ≤ 0.05.
The variables associated with lower probability of toxoplasmosis were: older mother age (OR = 0.89; CI95% = 0.85-0.93), higher level of education (OR = 0.85; CI95% = 0.78-0.92), access to potable water (OR = 0.21; CI95% = 0.08-0.51), and home with flush toilet (OR = 0.18; CI95% = 0.04-078). The variables associated with higher probability of infection were: cats in the neighborhood (OR = 2.27; CI95% = 1.27-4.06), owning or visiting homes with domestic cats (OR = 1.90; CI95% = 1.09-3.31), handling the soil (OR = 2.29; CI95% = 1.32-3.96), and eating fresh meat not previously frozen (OR = 3.97; CI95% = 2.17-7.25). After stratification according region of residence (rural or urban/peri-urban), home with flush toilet and consumption of treated water were protective against the disease only in the rural stratum.
In Minas Gerais, congenital toxoplasmosis has been associated with poor socioeconomic conditions. Considering maternal exposure to sources of Toxoplasma gondii, the predominating risk factors were those related to the ingestion of oocysts. It is expected that these results will contribute to development of a program for prevention of congenital toxoplasmosis adapted to the reality of the population of Minas Gerais. The differences between populations living in rural and urban areas regarding the main risk factors for toxoplasmosis point to the need of considering regional specificities in planning strategies to control congenital toxoplasmosis.
先天性弓形虫病是巴西的一个公共卫生问题。本研究旨在确定与米纳斯吉拉斯州先天性弓形虫病相关的危险因素，该州是巴西第二大州，居民数量众多，地域面积大于法国。
基于人群的病例对照研究，以评估先天性弓形虫病与母亲暴露于感染危险因素之间的关联。该研究纳入了参与米纳斯吉拉斯州新生儿筛查项目的母亲/儿童。病例组由175名感染儿童的母亲组成，对照组由278名无疑似感染儿童的母亲组成。通过二项逻辑回归评估关联，p≤0.05。
与弓形虫病发生概率较低相关的变量有：母亲年龄较大（OR = 0.89；95%CI = 0.85 - 0.93）、教育程度较高（OR = 0.85；95%CI = 0.78 - 0.92）、可获得饮用水（OR = 0.21；95%CI = 0.08 - 0.51）以及家中有冲水马桶（OR = 0.18；95%CI = 0.04 - 0.78）。与感染概率较高相关的变量有：附近有猫（OR = 2.27；95%CI = 1.27 - 4.06）、拥有或拜访有家猫的家庭（OR = 1.90；95%CI = 1.09 - 3.31）、接触土壤（OR = 2.29；95%CI = 1.32 - 3.96）以及食用未预先冷冻的新鲜肉类（OR = 3.97；95%CI = 2.17 - 7.25）。根据居住地区（农村或城市/城郊）分层后，家中有冲水马桶和饮用处理过的水仅在农村阶层对该病有保护作用。
在米纳斯吉拉斯州，先天性弓形虫病与社会经济条件差有关。考虑到母亲接触弓形虫的来源，主要危险因素是与摄入卵囊相关的因素。预计这些结果将有助于制定一项适合米纳斯吉拉斯州人群实际情况的先天性弓形虫病预防计划。农村和城市地区人群在弓形虫病主要危险因素方面的差异表明，在制定控制先天性弓形虫病的策略时需要考虑地区特殊性。
