Lea Sandoval

Seroepidemiology of human toxoplasmosis in Chile

A series of already published and unpublished seroepidemiological surveys for toxoplasmosis, carried out in Chile in 1982-1994, is reviewed, expanded and analyzed. The surveys included 76,317 apparently healthy individuals of different ages (0.57% of the countrys total population), from 309 urban and rural-periurban localities. Urban groups were integrated by blood donors, delivering mothers and middle grade schoolchildren, while rural-periurban individuals corresponded to unselected family groups. Blood samples were collected in filter paper. The presence of antibodies to Toxoplasma gondii was determined by the indirect hemagglutination test (IHAT), titers > or = 16 were considered positive. The test resulted positive in 28,124 (36.9%) of the surveyed people. Two hundred and six (0.3%) individuals presented IHAT titers > or = 1000, probably corresponding to acute or reactivated infections. A progressive increase of positive IHAT from northern to southern regions of the country was noted, phenomenon probably related to geographical conditions and to a higher production and consumption of different types of meat in the latter regions. It is postulated that ingestion of T gondii cysts by humans is epidemiologically as important as ingestion of oocysts. The result presented stress the epidemiological importance of toxoplasmosis in humans, and warn about eventual implications in immunocompromised patients and in transplacental transmission, organ transplants and transfusions.

Hidatidosis humana en Chile. Seroprevalencia y estimación del número de personas infectadas

Chile is located in the southwestern border of South America. The country is 4,329 km long and 96-342 wide. From north to south it is divided into five marked different biogeographical zones: deserts, steppes, bushes, forests (cattle raising) and austral (sheep raising). Population (June1999) 15,017,760 (14.6% rural). Human hydatidosis is endemic in Chile. According to Ministry of Health information about 320 cases are registered each year. In order to find out the likely prevalence of human hydatidosis in Chile,a series of serosurveys was carried out in 1988-1997 throughout the total country. By using the indirect hemagglutination reaction and ELISA for hydatidosis (tests with good sensibility and specificity) 60,790 unselected apparently healthy persons: 41,399 from urban areas (16,428 blood donors, from 13,894 delivering mothers and 11,077 middle grade school children) and 19,361 from rural areas - from randomly selected family groupings-were studied. A total individuals 82 (136/100,000) resulted positive: 36 (87/100,000) urban and 46 (241/100,000) rural, being the prevalence higher in rural areas, particularly in the southern austral zone (mean 1068/100,00). These figures agree with those observed in clinical epidemiological studies. In conformity with the present results, in the whole country 17,002 individuals should have hydatidosis: 10,318 urban and 6,784 rural. All these possible infected people, not necessarily should present pathology in the future, as it has been observed in autopsies from unselected individuals, performed at the Medico-Legal Service in Santiago, in whom 71.3% of diagnosed hydatosis with hydatid cysts in many different locations, was an autopsy finding

Infecciones por protozoos y helmintos intestinales en pre-escolares y escolares de la Comuna de Colina, Santiago, Chile. 2003

* Unidad de Parasitologia Basico-Clinica, Instituto de Ciencias Biomedicas (ICBM), Facultad deMedicina, Universidad de Chile.** Laboratorio de Referencia de Parasitologia, Instituto de Salud Publica de Chile.*** Servicio de Gastroenterologia, Hospital Clinico Jose Joaquin Aguirre, Universidad de Chile.****Departamento de Parasitologia, Instituto de Biologia, UNICAMP, Campinas, Sao Paulo, Brasil.Email: rmercado@machi.med.uchile.cl

Utilidad diagnóstica de ELISA IgG, IgM, IgA y Elisa avidez de IgG en toxoplasmosis reciente y crónica

Toxoplasmosis, a world-wide zoonotic infection, is generally asymptomatic and benign in immunocompetent individuals, but it can be serious in immunodeficiencies particularly in patients with acquired immunodeficiency syndrome and in children infected in utero. So, it is important to dispose methods which permit discriminate between recent and chronic infections. In order to contribute to improve the diagnosis of toxoplasmosis ELISA IgG, IgM, IgA and ELISA IgG avidity were performed in 15 and 24 sera from patients suspected of having acute and chronic infection respectively, according dye test (DT) titres. ELISA IgG was positive in both groups, ELISA IgM was positive in 78.6 and 58.3% respectively, while ELISA IgA was positive in 85.7 and 33.3% of recent and chronic group respectively. In those sera with low IgG avidity (18.8%) we found specific IgM in 71.5 and 4.2% and IgA in 78.6 and 0.0% of recent and chronic groups respectively. Parallelling, 208 sera samples were classified according to the results of DT, indirect hemagglutination and complement fixation tests in the following groups: acute (97), intermediate (36), chronic (35) and negative (40). The results were: acute (96.9-64.9-55.6 and 65.9%); intermediate (97.2-63.8-44.4 and 47.2%); chronic (45.7-42.8-5.7 and 34.3%) for IgG, IgM, IgA and low IgG avidity respectively. The use of both acute markers, IgA and low IgG avidity in the diagnosis of toxoplasmosis is discussed.

Analysis of Toxoplasma gondii surface antigen 2 gene (SAG2). Relevance of genotype I in clinical toxoplasmosis

Toxoplasma gondii is one of the most successful protozoan parasites given its ability to manipulate the immune system and establish a chronic infection. It is a parasite with a significant impact on human health, mainly in immunocompromised patients. In Europe and North America, only a few clonal genotypes (I, II and III) seem to be responsible for the vast majority of Toxoplasma infections. Surface antigen 2 gene (SAG2) has been extensively used for genotyping T. gondii isolates. The analysis of this locus reveals that in Northern hemisphere, human disease causing isolates are mainly type II, whereas T. gondii isolated from different animals are both type II and III. Since the immune response depends on parasite genotype, it seems relevant to characterize parasites producing human toxoplasmosis in different geographical areas. The growing information about the prevalent T. gondii genotypes in South America mostly refers to domestic animals. This is the first report of genetic characterization of T. gondii isolates from clinical samples in Chile, South America. All the samples analyzed corresponded to SAG2 type I isolates, and they differ from classic SAG2 type I by genetic polymorphisms. This study contributes to the scarce available information on T. gondii at South America, and reinforces an emerging concept suggesting that SAG2 type I, rather than II, parasites are a frequent cause of clinical toxoplasmosis in this continent.

Enfermedad de Chagas crónica en Chile. Experiencia de intervención educativa

* Carrera de Medicina. Facultad de Medicina. Universidad de Chile.** Laboratorio de Parasitologia Basico-Clinico. Programa de Biologia Celular y Molecular. ICBM. Facultad deMedicina. Universidad de Chile.*** Hospital Clinico. Universidad de Chile.**** Departamento de Educacion en Ciencias de la Salud. Facultad de Medicina. Universidad de Chile.***** Escuela de Tecnologia Medica. Facultad de Medicina. Universidad de Chile.****** Carrera de Psicologia. Universidad de Ciencias de la Informatica.******* Hospital de Combarbala. Servicio de Salud Coquimbo. IV Region. Chile.

Inmunodiagnóstico de la triquinosis humana

An indirect hemagglutination test (IHAT) and an ELISA test for trichinosis using as antigen a larvae soluble fraction from Trichinella spiralis was carried out for the detection of IgG, IgM and IgA specific antibodies in 113 serum samples from patients confirmed or suspected to have trichinosis by strong clinical and epidemiological evidences (Group I). The same tests were also performed on 110 serum samples corresponding to patients without strong evidences of having trichinosis (Group II). In Group I the corresponding sensitivities for RHAI, ELISA IgG, ELISA IgM, ELISA IgA were: 82.3-85.8-88.5 and 88.5% respectively. Seventeen patients were tested again a week after the first analysis (10 of them corresponded to negative ones), increasing the positivity: 23.5-100.0;35.3-100.0;41.2-100.0 and 41.2-100.0% for RHAI, ELISA IgG, ELISA IgM and ELISA IgA, respectively. Other two patients were followed-up for 5 years. IHAT and ELISA IgG remained positive, whereas ELISA IgM and ELISA IgA were constantly negative betweeen 17 and 32 months in one case, and between 48 and 60 months in the other (this last one had presented a severe clinic disease). In the group II, four patients were positive with IHAT, however only one for ELISA IgA, the latter also presented ELISA IgM near the cut off. The use of ELISA IgG, ELSIA IgM and ELISA IgA in the immunodiagnosis of trichinosis is discussed.