Unrecognized Ingestion of Toxoplasma gondii Oocysts Leads to Congenital Toxoplasmosis and Causes Epidemics in North America
Unrecognized Ingestion of Toxoplasma gondii Oocysts Leads to Congenital Toxoplasmosis and Causes Epidemics in North America
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DOI：
10.1093/cid/cir667
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发表时间：
2011-12-01
影响因子：
11.8
通讯作者：
McLeod, Rima
中科院分区：
文献类型：
--
作者：
Boyer, Kenneth;Hill, Dolores;McLeod, Rima
背景先天性弓形虫病在北美是一种严重的、改变生命的疾病。如果先天性弓形虫病婴儿的母亲可以通过风险识别，这将为教育孕妇了解风险提供强有力的支持，以消除这种疾病。相反，如果并非所有风险都是可识别的，则建议使用不可检测的风险。一项新的检测子孢子抗体的试验表明，卵囊是4种北美流行病中弓形虫感染的主要来源，也是全国芝加哥先天性弓形虫病协作研究（NCCCTS）中儿童母亲弓形虫感染的主要来源。这种新的测试提供了机会，以确定是否风险因素或人口统计学特征可以识别感染卵囊的母亲。急性感染的母亲和他们的先天性感染的婴儿进行了评估，包括面对面的访谈有关的风险和评价围产期产妇血清样本。59（78%）的76名母亲的先天性感染的婴儿在NCCCTS有原发感染卵囊。只有49%的母亲确定了子孢子获得的重要风险因素。社会经济地位、家乡大小、母亲临床表现和种族不是可靠的预测因素。在北美，未被发现的食物和水被卵囊污染经常导致人类感染。感染者往往没有意识到风险。人口统计学特征不能识别卵囊感染。因此，虽然教育计划描述卫生措施可能是有益的，但它们不足以防止与先天性弓形虫病相关的痛苦和经济后果。只有接种疫苗或对孕妇和新生儿进行系统的血清学检测，然后进行治疗，才能预防北美大多数先天性弓形虫病。
Background. Congenital toxoplasmosis presents as severe, life-altering disease in North America. If mothers of infants with congenital toxoplasmosis could be identified by risks, it would provide strong support for educating pregnant women about risks, to eliminate this disease. Conversely, if not all risks are identifiable, undetectable risks are suggested. A new test detecting antibodies to sporozoites demonstrated that oocysts were the predominant source of Toxoplasma gondii infection in 4 North American epidemics and in mothers of children in the National Collaborative Chicago-based Congenital Toxoplasmosis Study (NCCCTS). This novel test offered the opportunity to determine whether risk factors or demographic characteristics could identify mothers infected with oocysts.Methods. Acutely infected mothers and their congenitally infected infants were evaluated, including in-person interviews concerning risks and evaluation of perinatal maternal serum samples.Results. Fifty-nine (78%) of 76 mothers of congenitally infected infants in NCCCTS had primary infection with oocysts. Only 49% of these mothers identified significant risk factors for sporozoite acquisition. Socioeconomic status, hometown size, maternal clinical presentations, and ethnicity were not reliable predictors.Conclusions. Undetected contamination of food and water by oocysts frequently causes human infections in North America. Risks are often unrecognized by those infected. Demographic characteristics did not identify oocyst infections. Thus, although education programs describing hygienic measures may be beneficial, they will not suffice to prevent the suffering and economic consequences associated with congenital toxoplasmosis. Only a vaccine or implementation of systematic serologic testing of pregnant women and newborns, followed by treatment, will prevent most congenital toxoplasmosis in North America.