Surtos de toxoplasmose humana e a forma infectante do agente. Achados de revisão sistemática

MEIRELES, Luciana Regina; EKMAN, Claudio Cesar Jaguaribe; ANDRADE JR, Heitor Franco de; LUNA, Expedito José de Albuquerque

doi:10.1590/S0036-46652015000500001

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Parasitology • Rev. Inst. Med. trop. S. Paulo 57 (5) • Sep-Oct 2015 • https://doi.org/10.1590/S0036-46652015000500001 copiar

Surtos de toxoplasmose humana e a forma infectante do agente. Achados de revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Toxoplasmose, infecção zoonótica altamente prevalente no mundo, é transmitida pela ingestão de oocistos em água e solo ou cistos teciduais em carne crua ou mal cozida. Um debate em andamento é se há diferenças nas características clínicas e epidemiológicas de surtos devido a uma ou outra forma infectante do agente. Realizamos revisão sistemática a partir de 437 relatos de surtos da doença, selecionando 38 artigos completos que descreveram a forma infectante do Toxoplasma com dados clínicos e epidemiológicos. Não houve seleção por gênero ou faixa etária nos surtos, descritos mais frequentemente nas Américas. Quantidade maior de indivíduos foi afetada quando oocistos, associados com solo ou água contaminados com fezes de gato, foram considerados a fonte de transmissão. O início dos sintomas ocorreu mais precocemente quando a infecção foi atribuída a cistos na carne (11,4 ± 6,7 dias) com distribuição temporal nítida de casos, embora um aspecto mais amplo e prolongado de novos casos foi observado quando oocistos na água foram a fonte de infecção (20 ± 7 dias, p < 0.001). Essas informações podem ser úteis no desenvolvimento e implantação de estratégias de controle.

Year	Geographical Transmisdistribution sion forms	Water	Meat	Vegetable	Soil	Confirmed cases	% Symptomatic	Risk population	% Infected	I.P (days)	Dissemination	Articles references
1966	South America	Cysts	0	1	0	0	110	87	10.000	1,1	NI	Focal	Magaldi et al.³¹31 . Magaldi C, Elkis H, Pattoli D, Coscina AL. Epidemic of toxoplasmosis at a university in São-José-dos Campos, S.P. Brazil. 1. Clinical and serologic data. Rev Latinoam Microbiol Parasitol (Mex). 1969;11:5-13.
1968	North America	Cysts	0	1	0	0	5	100	29	17	7	Focal	Kean et al.²⁸28 . Kean BH, Kimball AC, Christenson WN. An epidemic of acute toxoplasmosis. JAMA. 1969;208:1002-4.
1974	North America	Cysts	0	1	0	0	4	50	19	42	10	Focal	Center for Disease Control⁷7 . Center for Disease Control, Department of Health, Education and Welfare. ToxoplasmosisPennsylvania. MMWR.1975;24:85-6.
1975	North America	Cysts	0	1	0	0	6	83	7	83	12	Focal	Masur et al.³²32 . Masur H, Jones TC, Lempert JA, Cherubini TD. Outbreak of toxoplasmosis in a family and documentation of acquired retinochoroiditis. Am J Med.1978;64:396-402.
1976	North America	Oocysts	0	0	0	1	10	70	30	33	30	Focal	Stagno et al.⁴²42 . Stagno S, Dykes AC, Amos CS, Head RA, Juranek DD, Walls K. An outbreak of toxoplasmosis linked to cats. Pediatrics. 1980;65:706-12.
1977	Europe	Cysts	0	1	0	0	3	66	NI	NI	8	Focal	Fertig et al.²³23 . Fertig A, Selwyn S, Tibble MJK. Tetracycline treatment in a food borne outbreak of toxoplasmosis. Br Med J. 1977;1(6068):1064.
1977	North America	Oocysts	0	0	0	1	37	95	88	42	15	Focal	Teutsch et al.⁴⁴44 . Teutsch SM, Juranek DD, Sulzer A. Epidemic toxoplasmosis associated with infected cats. N Engl J Med. 1979;300:695-9.
1978	North America Tachyzoites	0	0	0	0	10	NA	24	42	38	Focal	Sacks et al.³⁸38 . Sacks JJ, Delgado DG, Lobel HO, Parker RL. Toxoplasmosis infection associated with eating undercooked venison. Am J Epidemiol. 1983;118:832-8.
1979	Central America	Oocysts	1	0	0	0	31	91	98	32	20	Wide		Benenson et al.²2 . Benenson MW, Takafuji ET, Lemon SM. Oocyst-transmitted toxoplasmosis associated with ingestion of contaminated water. N Engl J Med. 1982;307:666-9.
1979	Oceania	Cysts	0	1	0	0	5	40	6	83	NI	Focal	de Silva et al.¹³13 . De Silva LM, Mulcahy DL, Kamath KR. A family outbreak of toxoplasmosis: a serendipitous finding. J Infect. 1984;8:163-7.
1979	North America	Oocysts	0	0	0	1	9	44	13	69	NA	Focal	Shenep et al.⁴⁰40 . Shenep JL, Barenkamp SJ, Brammeier SA, Gardner TD. An outbreak of toxoplasmosis on an Illinois farm. Pediatr Infect Dis.1984;3:518-22.
1980	North America	Cysts	0	1	0	0	3	100	NA	NA	15	Focal	Sacks et al.³⁹39 . Sacks JJ, Roberto RR, Brooks NF. Toxoplasmosis infection associated with raw goat's milk. JAMA. 1982;248:1728-32.
1981	North America	Oocysts	0	0	0	1	6	33	9	67	NI	Focal	Luft e Remington (Outbreak 2)²⁹29 . Luft BJ, Remington JS. Acute Toxoplasma infection among family members of patients with acute lymphadenopathic toxoplasmosis. Arch Intern Med.1984;144:53-6.
1981	South America	Oocysts	0	0	0	1	5	40	6	83	NI	Focal	Luft e Remington (Outbreak 3)²⁹29 . Luft BJ, Remington JS. Acute Toxoplasma infection among family members of patients with acute lymphadenopathic toxoplasmosis. Arch Intern Med.1984;144:53-6.
1981	North America	Cysts	0	1	0	0	1	100	4	25	NI	Focal	Luft e Remington (Outbreak 5)²⁹29 . Luft BJ, Remington JS. Acute Toxoplasma infection among family members of patients with acute lymphadenopathic toxoplasmosis. Arch Intern Med.1984;144:53-6.
1982	North America	Oocysts	0	0	0	1	2	50	6	33	NI	Focal	Luft e Remington (Outbreak 1)²⁹29 . Luft BJ, Remington JS. Acute Toxoplasma infection among family members of patients with acute lymphadenopathic toxoplasmosis. Arch Intern Med.1984;144:53-6.
1982	North America	Oocysts	0	0	0	1	1	100	5	20	NI	Focal	Luft e Remington (Outbreak 4)²⁹29 . Luft BJ, Remington JS. Acute Toxoplasma infection among family members of patients with acute lymphadenopathic toxoplasmosis. Arch Intern Med.1984;144:53-6.
1983	South America Tachyzoites	0	0	0	0	3	66	5	60	30	Focal	Chiari et al.⁸8 . Chiari CA, Neves DP. Toxoplasmose humana adquirida através da ingestão de leite de cabra. Mem Inst Oswaldo Cruz. 1984;79:337-40.
1986	Europe	Cysts	0	1	0	0	3	66	4	75	NI	Focal		Humphreys et al.²⁶26 . Humphreys H, Hillary IB, Kiernan T. Toxoplasmosis: a family outbreak. Ir Med J. 1986;79:191.
1987	North America	Cysts	0	1	0	0	4	NA	22	36	90	Focal	McDonald et al.³³33 . McDonald JC, Gyorkos TW, Alberton B, MacLean JD, Richer G, Juranek D. An outbreak of toxoplasmosis in pregnant women in northern Quebec. J Infect Dis. 1990;161:76974.
1988	Europe	Tachyzoites	0	0	0	0	2	100	4	50	NA	Focal	Skinner et al.⁴¹41 . Skinner LJ, Timperley AC, Wightman D, Chatterton JMW, Ho-Yen DO. Simultaneous diagnosis of toxoplasmosis in goats and goatowner's family. Scand J Infect Dis. 1990;22:359-61.
1993	South America	Cysts	0	1	0	0	17	100	NI	NI	11	Focal	Bonametti et al.³3 . Bonametti AM, Passos JN, da Silva EM, Bortoliero AL. Outbreak of acute toxoplasmosis transmitted thru the ingestion of ovine raw meat. Rev Soc Bras Med Trop. 1996;30:215.
1994	Asia	Cysts	0	1	0	0	3	100	6	50	NI	Focal	Choi et al. (Outbreak 1)⁹9 . Choi WY, Nam HW, Kwak NH, Huh W, Kim YR, Kang MW, et al. Foodborne outbreaks of human toxoplasmosis. J Infect Dis. 1997;175:1280-2.
1994	Oceania	Cysts	0	1	0	0	12	75	38	32	11	Focal	Robson et al.³⁷37 . Robson JMB, Wood RN, Sullivan JJ, Nicolaides NJ, Lewis BR. A probable foodborne outbreak of toxoplasmosis. Communicable Diseases Intelligence. 1995;19:517-22.
1995	North America	Oocysts	1	0	0	0	100	82	321.585	0,03	NI	Wide	Bowie et al.⁴4 . Bowie WR, King AS, Werker DH, Isaac-Renton JL, Bell A, Eng SB, et al. Outbreak of toxoplasmosis associated with municipal drinking water. The BC Toxoplasma Investigation Team. Lancet. 1997;350:173-7.
1995	Asia	Cysts	0	1	0	0	5	100	11	45	7	Focal	Choi et al. (Outbreak 2)⁹9 . Choi WY, Nam HW, Kwak NH, Huh W, Kim YR, Kang MW, et al. Foodborne outbreaks of human toxoplasmosis. J Infect Dis. 1997;175:1280-2.
1999	South America	Oocysts	1	0	0	0	113	NI	NI	NI	NI	Focal	Gattás et al.²⁴24 . Gattás VL, Nunes EM, Soares ALB, Pires MA, Pinto PLS, de Andrade HF. Acute toxoplasmosis outbreak at Campus of the University of Sao Paulo related to food or water oocyst contamination . Annals of the International Conference on Emerging Infectious Diseases. Atlanta: Georgia; 2000. p. 135.
2001	South America	Oocysts	1	0	0	0	176	88	2.884	6,1	NI	Wide	de Moura et al.¹²12 . de Moura L, Bahia-Oliveira LM, Wada MY, Jones JL, Tuboi SH, Carmo EH, et al. Waterborne toxoplasmosis, Brazil, from field to gene. Emerg Infect Dis. 2006;12:3269.
2001	Asia	Oocysts	1	0	0	0	178	71	NI	NI	NI	Wide	Palanisamy et al.³⁵35 . Palanisamy M, Madhavan B, Balasundaram M, Andavar R, Venkatapathy N. Outbreak of ocular toxoplasmosis in Coimbatore, India. Indian J Ophthalmol. 2006;54:129-31.
2002	Asia	Oocysts	0	0	0	1	171	100	1797	9,5	NI	Focal	Doganci et al.¹⁵15 . Doganci L, Tanyuksel M, Araz ER, Besirbellioglu BA, Erdem U, Ozoguz CA, et al. A probable outbreak of toxoplasmosis among boarding school students in Turkey. Clin Microbiol Infect. 2006;12:672-4.
2003	South America	Oocysts	1	0	0	1	11	100	33	33,33	NI	Focal	Demar et al.¹⁴14 . Demar M, Ajzenberg D, Maubon D, Djossou F, Panchoe D, Punwasi W, et al. Fatal outbreak of human toxoplasmosis along the Maroni River: epidemiological, clinical, and parasitological aspects. Clin Infect Dis. 2007;45:e88-95.
2004	Asia	Oocysts	1	0	0	0	248	100	NI	NI	NI	Wide	Balasundaram et al.¹1 . Balasundaram MB, Andavar R, Palaniswamy M, Venkatapathy N. Outbreak of acquired ocular toxoplasmosis involving 248 patients. Arch Ophthalmol. 2010;128:28-32.
2004	South America	Oocysts	0	0	0	1	40	85	186	21	NI	Wide	Carmo et al.⁶6 . Carmo EL, Póvoa MM, Monteiro NS, Marinho RR, Nascimento JM, Freitas SN, et al. Surto de Toxoplasmose humana no Distrito de Monte Dourado, Município de Almeirim, Pará, Brasil. Rev Pan-Amaz Saude. 2010;1:61-6.
2005	South America	Cysts	0	1	0	0	10	100	16	62,5	30	Focal	de Almeida et al.¹¹11 . de Almeida MAB, de Alencar LR, do Carmo GMI, de Araújo WN, Garcia MHO, Reis AKV, et al. Surto intra familiar de toxoplasmose, Santa Vitória do Palmar-RS, Julho de 2005. Boletim Eletrônico Epidemiológico. 2006. Available from: http://portalsaude. saude.gov.br/images/pdf/2014/julho/18/Ano06-n03-surto-familiar-toxoplasmose-rscompleto.pdf http://portalsaude. saude.gov.br/images/...
2005	South America	Oocysts	1	0	0	0	9	100	800	1,2	NI	Focal	Madeira et al.³⁰30 . Madeira A, Búrigo MJ. Surto de toxoplasmose no município de Agronômica em Santa Catarina. Estudos e Avaliação [Internet]. Florianópolis: Secretaria de Estado de Saúde, s.d. [cited 2012 Sept 14]. Available from: http://www.dive.sc.gov.br/conteudos/ articulacao_tecnica/toxoplasmose-boletim-epidemiológico.pdf http://www.dive.sc.gov.br/conteudos/ art...
2006	South America	Cysts	0	1	0	0	6	100	NI	NI	6	Focal	Eduardo et al.²¹21 . Eduardo MBP, Katsuya EM, Ramos SRTS, Pavanello ORP, Brito SN, Madalosso G. Investigação do surto de toxoplasmose associado ao consumo de prato à base de carne. crua ("steak tartar"), nos municípios de São Paulo e Guarujá, SP, Novembro de 2006. BEPA. 2007;4(41). [cited 2012 Set 14]. Available at: http://www.cve.saude. sp.gov.br/agencia/bepa41_toxoplas.htm http://www.cve.saude. sp.gov.br/agencia/...
2006	South America	Cysts	0	1	0	0	61	97	315	19	8	Focal	Renoiner et al.³⁶36 . Renoiner EIM, Siqueira AA, Garcia MH, Alves RM, Cardoso ME, Ferreira ABPL, et al. Surto de toxoplasmose adquirida, Anápolis-GO, fevereiro de 2006. Boletim Eletrônico Epidemiológico 2007. Available from: http://portalsaude.saude.gov.br/ images/pdf/2014/julho/16/Ano07-n08-toxoplasmose-adquirida-go-completo.pdf http://portalsaude.saude.gov.br/ images/...
2009	South America	Oocysts	0	0	1	0	11	72	45	35	15	Focal	Ekman et al.²²22 . Ekman CCJ, Chiossi MF, Meireles LR, Andrade Júnior HF, Figueiredo WM, Marciano MA, et al. Case-control study of an outbreak of acute toxoplasmosis in an industrial plant in the state of São Paulo, Brazil. Rev Inst Med Trop Sao Paulo. 2012;54:239-44.

Gender as % of male reported predominance	55.26% [38.3 - 71.4] (21/38)	44.44% [21.5 - 69.2] (8/18)	64.70% [38.3 - 85.8] (11/17)	66.67% [9.4 - 99.2] (2/3)	NS
% of less than 15 year age group predominance	15.78% [6.0 - 31.3] (6/38)	22.22% [6.4 - 47.63] (4/18)	5.89% [0.2 - 28.7] (1/17)	33.33% [0.8 - 90.6] (1/3)	NS
% of more than 25 year age group predominance	44.73% [28.6 - 61.7] (17/38)	33.33% [13.3 - 59.0] (6/18)	58.82% [32.9 - 81.6] (10/17)	33.33% [0.8 - 90.6] (1/3)	NS
% of water attributed reports	21.05% [9.6 - 37.3] (8/38)	44.44% [21.5 - 69.2] (8/18)	0% [0 -19.5] (0/17)	0% [0 - 70.7] (0/3)	-
% of meal attributed reports	44.73% [28.6 - 61.7] (17/38)	0.00% [0.0 - 18.5] (0/18)	100.00% [80.5 - 100] (17/17)	0% [0 - 70.7] (0/3)	-
% of vegetables attributed reports	5.26% [0.6 - 17.7] (2/38)	11.11% [1.4 - 34.7] (2/18)	0% [0 -19.5] (0/17)	0 % [0.00 - 70.8] (0/3)	NS
% of soil contact attributed reports	26.31% [13.4 - 43.1] (10/38)	55.55% [30.8 - 78.5] (10/18)	0% [0-19.5] (0/17)	0% [0 - 70.8] (0/3)	-
% reports with acute disease cases	92.10% [78.6 - 98.3] (35/38)	94.44% [72.7 - 99.9] (17/18)	88.23% [63.6 - 98.5] (15/17)	100.00% [29.2 - 100] (3/3)	NS
% reports with other than acute disease cases	9.67% [2.0 - 25.8] (3/31)	6.67% [0.2 - 32] (1/15)	14.28% [1.8 - 42.8] (2/14)	0% [0 - 84.2] (0/2)	NS
% reports attributing outbreak to a limited clustered source	81.57% [65.7 - 92.3] (31/38)	66.67% [41 - 86.7] (12/18)	94.11% [71.3 - 99.9] (16/17)	NT	p < 0.05*

Numbers of confirmed cases	37.7 ± 62,3 (38)	64.3 ± 79.0 (18)	15.2 ± 28.1 (17)	5.0 ± 4.4 (3)	p < 0.05
Proportion of infected cases in population at risk	39.8 ± 24,4 (30)	32.3 ± 25.9 (14)	45.5 ± 23.7 (13)	50.7 ± 9 (3)	NS
Proportion of reported symptomatic cases	81.5 ± 21.5 (35)	77.7 ± 23.2 (17)	85.3 ± 20.0 (16)	83 ± 21.5 (2)	NS
Numbers of persons at risk in the outbreak	7532.6 ± 3944 (30)	16069 ± 54414 (14)	75.2 ± 152.6 (13)	11 ± 11.2 (3)	NS
Incubation period in days	20.2 ± 19.9 (17)	20.0 ± 7.1 (4)	11.4 ± 6.7 (11)	34 ± 5.79 (2)	p < 0.001

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[1] Correspondence to: Luciana Regina Meireles, Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Protozoologia. Av. Dr. Enéas de Carvalho Aguiar 470/1º andar, 05403-000 São Paulo, SP, Brasil. Tel/Fax: +55+11+30617010. E-mail:lrmeirel@usp.br