Cieľ práce: Zistenie séroprevalencie toxoplazmózy u pacientov vyšetrovaných v sieti spoločnosti Unilabs Slovensko, s. r. o., za obdobie 10 rokov (2011–2020). Materiál a metódy: V sledovanom období bolo vyšetrených cieleným sérologickým skríningom na toxoplazmózu 142 088 pacientov z celého Slovenska. V každej vzorke séra sa dokazovali IgG a IgM protilátky elektro-chemiluminiscenčnými testami. Celkovo bolo za sledované obdobie vykonaných 469 824 týchto vyšetrení v troch centrálnych laboratóriách spoločnosti Alpha medical, (terajší Unilabs Slovensko, s. r. o.): v Bratislave, Ružomberku-Likavke a v Stropkove. Výsledky: Séroprevalencia toxoplazmózy má u vyšetrovaných pacientov v horizonte sledovaných 10 rokov mierne stúpajúcu tendenciu (v prípade IgM protilátok), v triede IgG je trend ustálený, neklesá, ani nestúpa. Stúpajúci trend pozitívnych IgM protilátok sa ukazuje nielen vo všeobecnosti, ale aj u tehotných žien. Pri prepočtoch IgG séroprevalencie na 100 000 obyvateľov za celé Slovensko sa ukázal za sledovaných 10 rokov rastúci trend. Záver: Z výsledkov nášho výskumu vyplýva, že toxoplazmóza u nás ani zďaleka nie je na ústupe, práve naopak, vzniká dôvodné podozrenie, že pomaly stúpa jej incidencia, a to zvlášť u tehotných žien, čo je z hľadiska verejného zdravia hodné ďalšieho a podrobnejšieho skúmania.

Objective: Determination of the seroprevalence of toxoplasmosis in patients tested in the network Unilabs Slovakia Ltd over 10 years (2011–2020). Material and Methods: In the study period, 142,088 patients from all over Slovakia underwent targeted serological screening for toxoplasmosis. Serum samples were tested for IgG and IgM antibodies by electrochemiluminescence assays. A total of 469,824 of tests were performed during the study period in three central laboratories of the Alpha Medical company (now Unilabs Slovakia Ltd) located in Bratislava, Ružomberok-Likavka, and Stropkov. Results: The seroprevalence of toxoplasmosis has shown a slightly upward trend (for IgM antibodies), remaining stable for IgG class antibodies, neither declining nor rising. An upward trend in positive IgM antibodies appeared not only in general, but also in pregnant women. When calculated per 100,000 population, the IgG seroprevalence has shown an upward 10-year trend for the whole of Slovakia. Conclusion: The results of this study have evidenced that toxoplasmosis is far from declining in Slovakia; just on the contrary, it can be reasonably assumed that its incidence is slowly rising, especially among pregnant women, which, from the point of view of public health, is worthy of further and more detailed investigation.

• MeSH
• komplikace těhotenství MeSH
• lidé MeSH
• séroepidemiologické studie * MeSH
• toxoplazmóza * epidemiologie   mikrobiologie   MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Toxoplasma gondii infection in pregnant women could lead to significant changes during the pregnancy, affect the outcomes of pregnancy and the timing of labour. Small‐for‐gestational‐age (SGA) newborns are defined by birthweight below the 10th percentile for gestational age. We tested an association between latent toxoplasmosis in pregnant women and deliveries of SGA babies. MATERIAL AND METHODS: For testing, we included 1,647 women who gave birth to a singleton baby at ≥ 37 weeks of gestation. The complement-fixation test (CFT) and enzyme-linked immunosorbent assay (ELISA) tests for IgG and IgM were used. The latent form of toxoplasmosis was defined as a CFT titre of 1:8 or higher, together with index positivity IgG ELISA > 1.1 and negative IgM. RESULTS: There were 406 (24.7 %) women positive, and 1,241 (75.3 %) women negative for latent toxoplasmosis. Of all deliveries. 190 were SGA‐positive and 1,457 were SGA‐negative. Our study found a statistically significant association between latent toxoplasmosis and SGA foetuses born at term. The Pearson chi-square model was statistically significant (χ2(1) = 7.365, p = .007). The odds ratio was 1.567. CONCLUSION: Pregnant women with latent toxoplasmosis giving birth at ≥ 37 weeks of gestation have a 1.567 times higher risk of delivering an SGA baby (Tab. 2, Fig. 1, Ref. 30).

BACKGROUND: Therapeutic regimens for the treatment of toxoplasmosis are not standardized. Treatment strategy mainly at the end of the second and the beginning of the third trimester, especially in cases of negative prenatal diagnosis, is the least uniform. In some situations, the choice of treatment may be ambiguous, and adverse drug reactions of the therapy should be taken into consideration. METHODS: Adverse drug reactions of anti-toxoplasma therapy with spiramycin (n = 77) versus pyrimethamine/sulfadiazine (n = 35) were compared in 112 pregnant women. RESULTS: Up to 36.6% of women reported adverse reactions to the treatment overall (n = 41). Out of those 38.9% (n = 30) were treated with spiramycin and 31.4% (n = 11) with pyrimethamine/sulfadiazine. Toxic allergic reactions were the only indication for discontinuation of treatment in 8.9% of patients (n = 10), where 9.1% (n = 7) were reported in spiramycin and 8.6% (n = 3) in pyrimethamine/sulfadiazine cohort. Neurotoxic complications (acral paraesthesia) were significantly more frequent during the therapy with spiramycine in 19.5% (n = 15) compared to no cases in pyrimethamine/sulfadiazine group (p = .003). Other adverse drug reactions, such as gastrointestinal discomfort, nephrotoxicity, vaginal discomfort were reported, but the differences between the cohorts were not significant. CONCLUSIONS: The superiority of one of the therapeutic regimens was not statistically demonstrated, since the differences in overall toxicity or incidence of toxic allergic reactions between the cohorts were not confirmed (p = .53 and p = 1.00, respectively). However, although the isolated neurotoxicity of spiramycin was the only significant adverse reaction demonstrated in this study, pyrimethamine/sulfadiazine therapy should be preferred, because it is known to be more effective and with limited adverse reactions.

• MeSH
• alergie * farmakoterapie   MeSH
• kombinovaná farmakoterapie MeSH
• kongenitální toxoplazmóza * farmakoterapie   MeSH
• lidé MeSH
• nežádoucí účinky léčiv * MeSH
• plod MeSH
• pyrimethamin škodlivé účinky   MeSH
• spiramycin * škodlivé účinky   MeSH
• sulfadiazin škodlivé účinky   MeSH
• těhotenství MeSH
• toxoplazmóza * farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• TORCH infekce,
• MeSH
• časové faktory MeSH
• cytomegalovirové infekce embryologie   MeSH
• dítě MeSH
• infekční komplikace v těhotenství * diagnóza   epidemiologie   patologie   prevence a kontrola   MeSH
• lidé MeSH
• prenatální diagnóza metody   MeSH
• prenatální poškození * etiologie   mortalita   MeSH
• preventabilní nemoci MeSH
• sexuálně přenosné nemoci embryologie   MeSH
• toxoplazmóza embryologie   MeSH
• vakcinace klasifikace   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• ženské pohlaví MeSH

Kongenitální toxoplazmóza je sice méně častou, ale o to závažnější součástí neonatologické problematiky. Jedná se o onemocnění preventabilní, přesto stále častěji manifestované v symptomatické formě, významně postihující zejména CNS a smysly. Prognóza se odvíjí zejména od gestačního stáří plodu v době nákazy matky, včasnosti záchytu infekce a doby zahájení prenatální či postnatální terapie. Neonatolog v tomto řetězci zastupuje velmi významné místo, a to hlavně pro možnost časné diagnostiky tohoto onemocnění, které se nezřídka poprvé manifestuje v prvních dnech či týdnech po porodu. V práci jsou uvedeny současné poznatky o prevenci, diagnostice, klinice i terapii kongenitální toxoplazmózy, s akcentem na roli neonatologa v tomto procesu.

Congenital toxoplasmosis is a less common, but even more serious part of neonatology. It is a preventable disease, yet increasingly manifested in a symptomatic form, significantly affecting especially the CNS and senses. The prognosis is based mainly on the gestational age of the fetus at the time of maternal infection, early diagnosis and the time of initiation of prenatal or postnatal therapy. The neonatologist represents a very important place in this chain, especially for the possibility of early diagnosis of this disease, which often manifests itself for the first time in the first days or weeks after birth. The work discusses current knowledge about the prevention, diagnosis, clinical findings and treatment of congenital toxoplasmosis, with an emphasis on the role of neonatologists in this process.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• antimalarika terapeutické užití   MeSH
• infekční komplikace v těhotenství MeSH
• kombinovaná farmakoterapie MeSH
• kongenitální toxoplazmóza * diagnóza   farmakoterapie   MeSH
• lidé MeSH
• novorozenec MeSH
• postnatální péče MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• přehledy MeSH

Congenital toxoplasmosis is reportable disease in Europe. To prevent it antibody serological tests were introduced in several European countries as a part of screening programmes. Immunoglobulin G (IgG) avidity index testing is one of these tests for diagnosing acute infection with Toxoplasma gondii (Nicolle et Manceaux, 1908) in pregnant women. However, a low or moderate IgG avidity index can give inconclusive results for predicting woman's status. From June 2012 until the end of 2014, 17,990 women were included in the national screening program to prevent congenital toxoplasmosis. One hundred and twenty-six women were consecutively included in the study because they had low or moderate IgG avidity. Every woman with possible acute toxoplasmosis was followed up every month till delivery. Fifty-eight of 126 (46%) women got infected in months before current pregnancy, 39 women (31%) were infected early in pregnancy. Twenty-nine pregnant women of 126 (23%) got infected in the second/third trimester of pregnancy. New cut off for IgG avidity index was 0.11. With this cut off, we were able to exclude T. gondii acute infection in the first trimester with very good diagnostic accuracy (area under the curve (AUC) = 0.95, 95% confidence Interval (CI) 0.91-0.99, sensitivity 0.95, specificity 0.86). If an IgG avidity index above 0.11 is measured in a woman's serum and she is in the first trimester of pregnancy, then a odds ratio (OR) for acute infection with T. gondii is below 1 (OR 0.11, 95% CI 0.05-0.25, P < 0.0001). If we measure IgG avidity index that is ≥ 0.11 in the first trimester of pregnancy, we can exclude infection with T. gondii with good diagnostic accuracy in our cohort of women. With a new cut off we could reduce number of invasive procedures such as amniocentesis and put less pregnant women in distress.

• MeSH
• afinita protilátek MeSH
• imunoglobulin G MeSH
• kongenitální toxoplazmóza * diagnóza   MeSH
• lidé MeSH
• protilátky protozoální MeSH
• první trimestr těhotenství MeSH
• těhotenství MeSH
• Toxoplasma * MeSH
• toxoplazmóza * diagnóza   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• herpes simplex diagnóza   MeSH
• infekční komplikace v těhotenství * diagnóza   terapie   MeSH
• lidé MeSH
• těhotenství MeSH
• toxoplazmóza diagnóza   komplikace   MeSH
• zarděnky diagnóza   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• rozhovory MeSH

Parvovirus B19 infection in pregnancy may have a poor outcome for the fetus. Ocular anomalies, brain damage with hydrocephalus and central nervous system (CNS) scarring, cleft lip and hypospadias, as well myocarditis and congenital heart disease have been reported. We present a case of a preterm female neonate born with ascites, hydrothorax and congenital diaphragmatic eventration (CDE), with a prenatal diagnosis of congenital diaphragmatic hernia (CDH). The neonate was born prematurely at 32 weeks gestation with caesarean section due to a previous caesarean delivery. She was immediately intubated in the delivery room, transferred in the Neonatal Intensive Care Unit (NICU) and supported with high frequency oscillatory ventilation (HFOV). The diagnosis of CDH was sonographically estimated from the 20th week of gestation and surgical correction was decided. During surgery CDE was diagnosed instead of CDH and despite postoperatively care the neonate developed disseminated intravascular coagulation and finally died in the 40th hour of life. Along with the identification of parvovirus B19 in the pleural fluid by PCR, the biopsy of the diaphragm revealed connective tissue, full of vasculature and absence muscle tissue. Although only cytomegalovirus, rubella, and toxoplasmosis were considered to be associated with CDE, parvovirus B19 might also be related to this congenital diaphragmatic malformation. In CDE, the function of the lungs can be compromised as a consequence of the compression applied by the abdominal organs. The neonatologists should include this condition in their differential diagnosis for a more direct and effective management.

• MeSH
• bránice abnormality   MeSH
• císařský řez MeSH
• erythema infectiosum * MeSH
• eventrace bránice * diagnóza   MeSH
• lidé MeSH
• lidský parvovirus B19 * MeSH
• novorozenec MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Toxoplasma gondii, one of the most common parasites, causes toxoplasmosis, one of the most frequent zoonotic diseases worldwide. T. gondii infects about one-third of the world's population. T. gondii infection is generally considered a major risk for spontaneous abortion, prematurity and low birth weight in the animal sphere. Less commonly, a toxoplasma serological profile is correlated with the particular data of delivery. Acute T. gondii infection during pregnancy often leads to spontaneous abortion and/or a severe injury of the eyes, brain, and other structures of the foetus. Latent T. gondii infection of pregnant women could lead to less obvious but important changes during pregnancy, including the end product of pregnancy and the timing of labour. This study aimed to contribute to the current knowledge by comparing serological T. gondii profiles of pregnant women with prematurity and low birth weights of newborns. MATERIAL AND METHODS: A retrospective study design was adopted. The study participants included a cohort of 1733 pregnant women who consecutively gave birth to their children and underwent regular antenatal biochemical screening between the 14th and 16th weeks of pregnancy. Prematurity was defined as the liveborn preterm delivery in gestational age of pregnancy <37 weeks. Low birth weight was defined as weight at birth of ≤2499 grams. The complement-fixation test (CFT) provided serological profiles for toxoplasmosis that expresses the overall levels of toxoplasma immunoglobulins of all classes. Enzyme-linked immunosorbent assay (ELISA) tests for IgG and IgM were used simultaneously. IgM positivity helped to differentiate acute from the latent stage of toxoplasmosis. Birth data, especially the week of delivery and fetal weight, were evaluated accordingly. RESULTS: Of the 1733 pregnant women, 25% were diagnosed as latent toxoplasma positive, and 75% as toxoplasma negative. There were 87 premature deliveries versus 1646 timely births. We observed 88 low birth weights and 1645 normal fetal weights. We found a statistically significant association between latent toxoplasmosis and prematurity, χ2(1) = 5.471, p = .019 and between latent toxoplasmosis and low birth weight of newborns, χ2(1) = 7.663, p = .006. There was a 1.707 times higher risk of prematurity for toxoplasma-positive women, while the risk for low birth weight was 1.861 times higher. The strength of both tests of association was mild. We tested the correlation between the levels of CFT titres and week of delivery and weight of newborns. No association was found between the level of latent toxoplasmosis and the week of delivery and fetal weight. CONCLUSION: Latent toxoplasmosis was associated with premature birth rate and lower birth weight of newborns. The odds of premature delivery was 1.7 and low birth weight 1.9 times higher in women with latent toxoplasmosis compared to toxoplasma negative women. Even though the strength of the association in our large sample is relatively mild, the combination of latent toxoplasmosis with other adverse factors could cause serious harm. Whole CFT and specific IgG levels of latent toxoplasmosis are not linked to the severity of prematurity or low birth weight in newborns.

• MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• nemoci nedonošenců epidemiologie   MeSH
• nemoci novorozenců epidemiologie   MeSH
• novorozenec s nízkou porodní hmotností metabolismus   MeSH
• novorozenec MeSH
• parazitární komplikace těhotenství epidemiologie   MeSH
• předčasný porod etiologie   patofyziologie   MeSH
• prevalence MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• séroepidemiologické studie MeSH
• sérologické testy MeSH
• těhotenství MeSH
• těhotné ženy MeSH
• Toxoplasma patogenita   MeSH
• toxoplazmóza embryologie   epidemiologie   MeSH
• Check Tag
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• nekrotizující enterokolitida terapie   MeSH
• novorozenec nedonošený MeSH
• novorozenecká sepse etiologie   terapie   MeSH
• příčina smrti MeSH
• radiografie MeSH
• rizikové těhotenství MeSH
• Staphylococcus epidermidis patogenita   MeSH
• toxoplazmóza diagnóza   terapie   MeSH
• uživatelé drog MeSH
• vrozená syfilis * diagnóza   terapie   MeSH
• Check Tag
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH