Recently acquired Toxoplasma gondii infection, Brazil.The city of Erechim, Brazil, has a 17% prevalence of ocular ocular /oc·u·lar/ (ok´u-lar) 1. of, pertaining to, or affecting the eye. 2. eyepiece. oc·u·lar adj. 1. Of or relating to the eye or the sense of sight. toxoplasmosis Toxoplasmosis Definition Toxoplasmosis is an infectious disease caused by the one-celled protozoan parasite Toxoplasma gondii. Although most individuals do not experience any symptoms, the disease can be very serious, and even fatal, in , and type 1 Toxoplasma gondii Tox·o·plas·ma gon·di·i n. A sporozoan species that is an intracellular parasite in a variety of vertebrates and is the causative agent of toxoplasmosis. predominates. To examine risk factors for acute T. gondii infection in this area, we administered a questionnaire to recently infected in·fect tr.v. in·fect·ed, in·fect·ing, in·fects 1. To contaminate with a pathogenic microorganism or agent. 2. To communicate a pathogen or disease to. 3. To invade and produce infection in. persons (n = 131) and seronegative seronegative /se·ro·neg·a·tive/ (-neg´ah-tiv) showing negative results on serological examination; showing a lack of antibody. se·ro·neg·a·tive adj. controls (n = 110). Eating undercooked meat; having a garden; working in the garden or yard more than once per week; eating rare meat; eating cured, dried, or smoked meat For the general process, see . Smoked meat is a method of preparing fish and meat which originates in prehistory. Its purpose is to preserve these protein rich foods, which would otherwise spoil quickly, for long periods of possibly lean times. ; eating frozen lamb; and being male increased risk for T. gondii infection in univariate analysis. Risk factors independently associated with acute T. gondii infection in multivariate analysis multivariate analysis, n a statistical approach used to evaluate multiple variables. multivariate analysis, n a set of techniques used when variation in several variables has to be studied simultaneously. were working in the garden (odds ratio [OR] 2.35, 95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. [CI] 1.27-4.33) and eating frozen lamb (OR 2.06, 95% CI 1.15-3.67). Among women (n = 86), having had children markedly increased the risk for T gondii infection (OR 14.94, 95% CI 3.68-60.73). ********** In recent years, because of the large number of postnatal postnatal /post·na·tal/ (-na´t'l) occurring after birth, with reference to the newborn. post·na·tal adj. Of or occurring after birth, especially in the period immediately after birth. Toxoplasma gondii infections, researchers estimate that most ocular disease from 7]. gondii is caused by infection after birth (1-3). In Erechim, a city in southern Brazil, a representative population-based household survey showed that 17.7% of >1,000 persons examined had ocular toxoplasmosis (4). This high rate is believed to be due to acute infection after birth because the rate of infection in young children in this area is low (4-6). Erechim has a population of 96,310 and is located in northern Rio Grande do Sul Rio Grande do Sul (rē`  grän`dĭ th s (population 9,619,416), the
southernmost state of Brazil, which borders Uruguay and Argentina. The
area was mostly settled by Italian, German, and Polish immigrants in the
early 20th century. Of the 3 primary restriction fragment Noun 1. restriction fragment - the fragment of DNA that is produced by cleaving DNA with a restriction enzymefragment - a piece broken off or cut off of something else; "a fragment of rock" polymorphism polymorphism, of minerals, property of crystallizing in two or more distinct forms. Calcium carbonate is dimorphous (two forms), crystallizing as calcite or aragonite. Titanium dioxide is trimorphous; its three forms are brookite, anatase (or octahedrite), and rutile. (SAG (1) A momentary drop in voltage from the power source. Contrast with spike. (2) (SAG) (SQL Access Group) See CLI. 2) genetic types of T. gondii, investigators have primarily found the type 1 organism in southern Brazil (7) and have identified it from chickens (8,9). Type 1 T. gondii is uncommon in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. and may be more virulent vir·u·lent adj. 1. Extremely infectious, malignant, or poisonous. Used of a disease or toxin. 2. Capable of causing disease by breaking down protective mechanisms of the host. Used of a pathogen. 3. for ocular disease (10,11). However, with worldwide food and animal distribution it could become more common in the United States and other countries. Although ocular toxoplasmosis has been a problem in southern Brazil for many years, no controlled studies have determined the sources of infection. Therefore, in 2003 and 2004, we conducted a case-control study case-control study, n an investigation employing an epidemiologic approach in which previously existing incidents of a medical condition are used in lieu of gathering new information from a randomized population. at the principal ophthalmology ophthalmology (ŏf'thălmŏl`əjē), branch of medicine specializing in the anatomy, function and diseases of the eye. Ophthalmologists specialize in the medical and surgical treatment of eye disorders, vision measurements for clinic in Erechim to evaluate the risk factors responsible for T. gondii infection so that prevention messages could be tailored to the factors identified. Methods The study was conducted by ophthalmologists at Clinica Silveira and the Federal University at Silo silo, watertight and airtight structure for making and storing silage. Silos vary in form from a covered pit, such as was used by the early Romans, to the modern storage tower, dating from the 19th cent. Paulo, Brazil, in collaboration with researchers from the University of California, Los Angeles UCLA comprises the College of Letters and Science (the primary undergraduate college), seven professional schools, and five professional Health Science schools. Since 2001, UCLA has enrolled over 33,000 total students, and that number is steadily rising. , California, and the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation ), Atlanta, Georgia. The questionnaire was adapted from those used in previous T. gondii case-control studies (12,13), with modification and input from the study researchers. The questionnaire took [approximately equal to] 25 minutes to complete and inquired about demographic variables and a comprehensive set of risk factors related to meat, vegetables, food preparation, soil contact, drinking water drinking water supply of water available to animals for drinking supplied via nipples, in troughs, dams, ponds and larger natural water sources; an insufficient supply leads to dehydration; it can be the source of infection, e.g. leptospirosis, salmonellosis, or of poisoning, e.g. , and animal exposure (especially cat and cat feces feces or excrement or stools Solid bodily waste discharged from the colon through the anus during defecation. Normal feces are 75% water. The rest is about 30% dead bacteria, 30% indigestible food matter, 10–20% cholesterol and other fats, exposure). Information about the number of pregnancies and children was collected from women participating in the survey. Questions involving habitual Regular or customary; usual. A habitual drunkard, for example, is an individual who regularly becomes intoxicated as opposed to a person who drinks infrequently. behavior focused on the most recent 12 months. The questionnaire was self-administered at Clinica Silveira, the principal ophthalmology clinic in Erechim, with parental assistance for children <16 years of age. The study was reviewed and approved by the human subjects review committee at the Federal University of Sao Paulo and approved for analysis at CDC. Oral consent was obtained for completion of the questionnaire. All participants with ocular disease received care and follow-up at Clinica Silveira. Case-patients with recent T. gondii infection were defined as visitors to the clinic from June 2003 to June 2004 with positive test results for both T. gondii-specific immunoglobulin G immunoglobulin G n. Abbr. IgG The most abundant class of antibodies found in blood serum and lymph and active against bacteria, fungi, viruses, and foreign particles. Immunoglobulin G antibodies trigger action of the complement system. (IgG) and IgM. For each patient, an attempt was made to identify a control as the next patient with negative T. gondii antibody test results. Antibody testing was performed at the Fleury Laboratory by using the Abbott AxSYM The Abbott Axsym is an immunochemical automated analyser made by Abbott Laboratories. It is used for serology tests and therapeutic drug monitoring, and uses antibodies to alter the deflection of polarised light. system (Abbott Diagnostics, Abbott Park, IL, USA). Data were first examined with univariate analysis; then factors with p value [less than or equal to] 0.05 for association with recent T. gondii infection (and sufficient sample size) were entered into logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. models for the sample as a whole (NI = 241), for women [greater than or equal to] 18 years of age (n = 86), and children <18 years of age (n = 106). Men [greater than or equal to] 18 years of age were not examined as a subgroup sub·group n. 1. A distinct group within a group; a subdivision of a group. 2. A subordinate group. 3. Mathematics A group that is a subset of a group. tr.v. in logistic models logistic models, n.pl statistical models that describe the relationship between a qualitative dependent variable (that is, one that can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. because the sample size was too small (n = 49). In odds ratio (OR) calculations with a zero value in [greater than or equal to] 1 cells, a correction of 0.5 was added to every cell to avoid undefined results (logit method). Attributable risks attributable risk Epidemiology Any factor which ↑ the risk of suffering a particular condition. See Relative risk, Risk factor. Cf Nonattributable risk Statistics The rate of a disorder in exposed subjects that is attributable to the exposure derived from were calculated from the logistic regression results for factors that significantly (p [less than or equal to] 0.05) increased risk for T. gondii infection by using the following formula: attributable risk = proportion of cases exposed for each factor x ([OR - 1]/OR). Data analysis was conducted with SAS (1) (SAS Institute Inc., Cary, NC, www.sas.com) A software company that specializes in data warehousing and decision support software based on the SAS System. Founded in 1976, SAS is one of the world's largest privately held software companies. See SAS System. software (14). Results Of 140 persons who had positive Toxoplasma Toxoplasma /Toxo·plas·ma/ (tok?so-plaz´mah) a genus of sporozoa that are intracellular parasites of many organs and tissues of birds and mammals, including humans. T. gon´dii is the etiologic agent of toxoplasmosis. IgG and IgM test results, 131 (93.6%) agreed to participate and completed questionnaires. Of 121 persons who had negative Toxoplasma IgG and IgM test results, 110 (90.9%) agreed to participate and completed questionnaires. The demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. of patients and controls are presented in Table 1. Controls were more likely to be in the 16- to 20- and 21- to 30-year age ranges and female and less likely to be in the [less than or equal to] 5-, 31-40-, and [greater than or equal to] 41-year age groups. In univariate analysis among the group as a whole, patients were significantly more likely than controls to eat rare meat (this question referred to meat in general); eat cured, dried, or smoked meat given by a friend or relative (purchased cured, dried, or smoked meat was not significantly associated with case status); have a garden; work in the yard or garden; eat frozen lamb; and be male. Patients were less likely to eat raw beef, eat raw ground beef, eat raw ground chicken, and be born in Erechim or upper Uruguay (Table 2). Among women [greater than or equal to] 18 years of age, having had [greater than or equal to] 1 child (OR 14.68, 95% confidence interval [CI] 4.10-52.50, p<0.0001) (or [greater than or equal to] 1 pregnancy, colinear co·lin·e·ar adj. 1. Containing elements that correspond to one another and that are arranged in the same linear sequence. 2. Collinear. co·lin with number of children) was strongly associated with risk for T. gondii infection (Table 3). Women infected with T. gondii were also more likely than those not infected to have lived in their present home >12 months, work with animals (all types), work in the garden, and have [greater than or equal to] 1 cat or kitten kitten newborn or young cat or ferret. kitten mortality complex a general term applied to a syndrome involving death of young kittens, particularly in breeding establishments. living at home. They were less likely to be infected if they ate raw ground beef, raw chicken, rare or raw ground chicken, and fed their cat dried food. In addition, the trend in risk for recent T. gondii infection increased from having no children (4 [17.4%] of 23), to 1 child (11[68.8%] of 16), to 1 child (11 [68.8%] of 16), to [greater than or equal to] 2 children (23 [79.3%] of 29) (p<0.0001). Among children <18 years of age, in univariate analysis those with recent T. gondii infection were more likely than those without infection to have a cat that catches its own food; feed the cat raw food; work in the yard more than once per week; eat cured, dried, or smoked meat given by a friend or relative; eat frozen lamb; eat rare meat; eat rare pork; and be male. They were less likely to be born in Erechim or upper Uruguay or wear gloves while working in the yard (Table 4). In multivariate analysis for the complete group, persons recently infected with T. gondii were significantly more likely than those who were not infected to work in the garden (OR 2.35, 95% CI 1.27-4.33, p = 0.006) and eat frozen lamb (OR 2.06, 95% CI 1.15-3.67, p = 0.02) but less likely to be born in Erechim or upper Uruguay (OR 0.19, 95% CI 0.09-0.39, p<0.0001) (Table 5). In multivariate analysis, for women [greater than or equal to] 18 years of age, having had [greater than or equal to] 1 child compared to having no children markedly increased risk for recent T. gondii infection (OR 14.94, 95% CI 3.68 60.73, p<0.0002) (Table 5). For children <18 years of age, being born in Erechim or upper Uruguay was associated with a reduced risk for recent T. gondii infection compared to those born elsewhere (OR 0.04, 95% CI 0.01-0.22, p = 0.0002), and male sex (OR 5.70, 95% CI 1.95-16.66, p = 0.002) was associated with an increased risk for T. gondii infection (Table 5). The attributable risks for the factors that significantly increased the risk for recent T. gondii infection in logistic regression for the group as a whole (from Table 5) were working in the garden (0.25) and eating frozen lamb (0.15). Among women [greater than or equal to] 18 years of age, having had [greater than or equal to] 1 child was associated with a high attributable risk (0.84). Among children <18 years of age, male sex was associated with an attributable risk of 0.64. Discussion In the study group overall (Table 2), we found that a number of meat- and soil-related factors were associated with recent T. gondii infection, which included eating cured, dried, or smoked meat given by a friend or relative; eating rare meat; eating frozen lamb; and having a garden and working in the yard or garden (soil contact). The presence of meat-related factors emphasizes the importance of cooking meat well (>67[degrees]C) and not assuming that all home freezing methods will kill T. gondii cysts. Having a garden or working in the yard increases the chances of oocyst oocyst /oo·cyst/ (-sist) the encysted or encapsulated ookinete in the wall of a mosquito's stomach; also, the analogous stage in the development of any sporozoan. o·o·cyst n. exposure through soil contact. Men were at increased risk for recent T. gondii infection, which could also be related to increased soil contact. To minimize T. gondii exposure, gloves should be worn while gardening, and hands should be washed thoroughly afterward af·ter·ward also af·ter·wards adv. At a later time; subsequently. Adv. 1. afterward - happening at a time subsequent to a reference time; "he apologized subsequently"; "he's going to the store but he'll be back here with soap and water. Although sample size limitations precluded us from including all the variables in multivariate analysis, working in the garden remained significant in multivariate analysis. Although the number of persons who ate raw meat was small, eating raw ground chicken was associated with a decreased risk for T. gondii infection. Chickens grown commercially are probably not involved in the transmission of T. gondii because modern methods reduce soil exposure, chickens are usually frozen for storage before purchase, and they are thoroughly cooked (15). Eating chicken could be associated with a decrease in risk because those who eat chicken may be less likely to eat other meats that are associated with a greater risk. However, free-range chickens in Brazil can be infected with T. gondii (9), and eating fresh, undercooked meat from free-range chickens could pose a risk for infection. In addition, eating raw beef or raw ground beef decreased the risk for T. gondii infection in univariate analysis, although the sample size was small for this variable as well. Beef is rarely contaminated contaminated, v 1. made radioactive by the addition of small quantities of radioactive material. 2. made contaminated by adding infective or radiographic materials. 3. an infective surface or object. with T. gondii and is not believed to be a consequential con·se·quen·tial adj. 1. Following as an effect, result, or conclusion; consequent. 2. Having important consequences; significant: source of infection (15), but the role of beef in transmission to humans has not been completely determined. Eating raw ground beef that is contaminated with pork because the grinding machine grinding machine Machine tool that uses a rotating abrasive grinding wheel to change the shape or dimensions of a hard, usually metallic, workpiece. Grinding is the most accurate of all the basic machining processes. was not cleaned after grinding grinding, process by which surface material is removed from an object, usually metal, by the abrasive action of a rotating wheel or a moving belt that contains abrasive grains. pork could increase the risk for T. gondii infection. Eating rare meat (all types combined) was a risk factor for T. gondii infection. Pork and lamb are the most likely meats to be contaminated with T. gondii (15). Although these data are not specifically from Erechim, researchers in southern Brazil have recently reported that 8.7% of 149 fresh pork sausage sausage, food consisting of finely chopped meat mixed with seasonings and, often, other ingredients, all encased in a thin membrane. Although sausages were made by the ancient Greeks and Romans, they were usually plain and unspiced; in the Middle Ages people began to samples were positive for T. gondii by bioassay Bioassay A method for the quantitation of the effects on a biological system by its exposure to a substance, as well as the quantitation of the concentration of a substance by some observable effect on a biological system. in mice in the state of Parana (16), and 17% of 286 finishing pigs tested positive for T. gondii antibodies with the modified agglutination test agglutination test n. Any of various tests in which blood serum causes agglutination of bacteria or blood cells of a foreign type, used to determine infection and to identify pathogens and blood types. in the state of Sao Paulo (17). Dubey et al. determined that tissue cysts survive in pork for <3 minutes if heated to 64[degrees]C (18), so cooking meat (especially pork or lamb) below this temperature could lead to infection. The strongest factor in analysis of the group overall was the reduced risk for T. gondii infection among persons born in Erechim or upper Uruguay compared to persons born elsewhere. This reduction in risk was also significant in multivariate analysis and in children and is likely due to referral of patients with ocular disease from outside the area. Risk for T. gondii infection was also reduced among women born in Erechim or upper Uruguay, but the reduction was not significant (data not shown). For women [greater than or equal to] 18 years of age, having had [greater than or equal to] 1 child was strongly associated with recent T. gondii infection in both univariate and multivariate analysis (Tables 3 and 5). Having had [greater than or equal to] 1 pregnancy also showed a strong association with recent T. gondii infection in univariate analysis, but we did not examine it in multivariate analysis because it is highly correlated cor·re·late v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates v.tr. 1. To put or bring into causal, complementary, parallel, or reciprocal relation. 2. with the number of children. Pregnancy and number of children were risk factors for T. gondii infection in other studies, including several from Brazil (19-22). Avelino et al. (20) suggest that the greater vulnerability of pregnant women to T. gondii infection is probably due to alterations in immune mechanisms associated with gestation GESTATION, med. jur. The time during which a female, who has conceived, carries the embryo or foetus in her uterus. By the common consent of mankind, the term of gestation is considered to be ten lunar months, or forty weeks, equal to nine calendar months and a week. . In some settings, pregnancy could affect culinary cu·li·nar·y adj. Of or relating to a kitchen or to cookery. [Latin cul  n habits. In
our study, the number of children and past pregnancies increased risk
for recent T. gondii infection. Another possible explanation for this
finding is that children bring, or track, contaminated soil into the
house, increasing risk for infection.Among children <18 years of age, in univariate analysis many of the meat- and soil-related risk factors were associated with an increased risk for infection that was seen in the group as a whole (Table 4). In addition, feeding cats raw food and having cats that catch their own food were associated with increased risk. To prevent cats from becoming infected with T. gondii, they should be fed only dry, canned, or well-cooked food and kept indoors when possible to discourage hunting. In multivariate analysis of the risk factors for children, male sex was the principal factor that significantly increased risk for infection, although eating rare meat and frozen lamb approached significance. One of the strengths of our study is that serologically defined acute T. gondii infection was required for the case definition. Most T. gondii IgM- and IgG-positive persons are infected for [less than or equal to] 1 year, so their more recent behavior correlates with the time of their infection. Our study also has a number of limitations. The Clinica Silveira is known for expertise in ocular toxoplasmosis and draws patients with toxoplasmosis-related eye disease from the surrounding area. This fact is the likely reason why patients with acute T. gondii infection were more likely to come from outside the Erechim area than from Erechim. Although the sample size was adequate to identify numerous risk factors for T. gondii infection, it was not large enough to allow analysis for all subgroups (for example, multivariate analysis of adult men). Some associations in our study may have been due to confounders that we did not consider in the analysis (especially in univariate analysis); however, we inquired about a comprehensive set of variables, including those previously known to be associated with T. gondii infection, and performed multivariate analysis. In addition, our study was limited to 1 area of Brazil, and the results cannot necessarily be applied to other areas of the country. In conclusion, our study identified a number of risk factors for T. gondii infection among persons with ocular disease. Because T. gondii infection often leads to ocular disease in this region of Brazil, avoiding infection can improve ocular health. Proper meat and soil- and water-related hygiene could reduce the risk for infection with T. gondii, especially with preventive education efforts based on risk factors identified in this case-control study. The association of T. gondii infection in women with the number of children they have had (and their pregnancies) requires further study to fully elucidate e·lu·ci·date v. e·lu·ci·dat·ed, e·lu·ci·dat·ing, e·lu·ci·dates v.tr. To make clear or plain, especially by explanation; clarify. v.intr. To give an explanation that serves to clarify. the factors that contribute to this increase in risk. In the future, type 1 T. gondii could spread to other areas of the world and increase the risk for ocular disease in those regions. Dr Jones has worked at CDC for 15 years, first in the area of HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and most recently in parasitic diseases A parasitic disease is an infectious disease caused or transmitted by a parasite. Many parasites do not cause disease per se. Parasitic diseases can affect practically all living organisms, from plants to man. The study of parasitic diseases is called by parasitology. . His current research focuses on toxoplasmosis. References (1.) Holland GN. Reconsidering the pathogenesis pathogenesis /patho·gen·e·sis/ (path?ah-jen´e-sis) the development of morbid conditions or of disease; more specifically the cellular events and reactions and other pathologic mechanisms occurring in the development of disease. of ocular toxoplasmosis. Am J Ophthalmol. 1999;128:502-5. (2.) Gilbert RE, Stanford MR. Is ocular toxoplasmosis caused by prenatal prenatal /pre·na·tal/ (-na´tal) preceding birth. pre·na·tal adj. Preceding birth. Also called antenatal. prenatal preceding birth. or postnatal infection? Br J Ophthalmol. 2000;84:244-6. (3.) Holland GN. LX Edward Jackson Edward Jackson or Ed Jackson are the names of several people:
The process of re-determining the value of property or land for tax purposes. Notes: Property is usually reassessed on an annual basis. You may request a "reassessment" if you disagree with your assessment. . Part 1: epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause and course of disease. Am J Ophthalmol. 2003;136:973-88. (4.) Glasner PD, Silveira C, Kruszon-Moran D, Martins MC, Burnier M Jr, Silveira S, et al. An unusually high prevalence of ocular toxoplasmosis in southern Brazil. Am J Ophthalmol. 1992;114:136-44. (5.) Nussenblatt RB, Belfort R Jr. Ocular toxoplasmosis. An old disease revisited. JAMA JAMA abbr. Journal of the American Medical Association . 1994;271:304-7. (6.) Silveira C, Belfort R Jr, Muccioli C, Abreu MT, Martins MC, Victora C, et al. A follow-up study of Toxoplasma gondii infection in southern Brazil. Am J Ophthalmol. 2001;131:351-4. (7.) Vallochi AL, Muccioli C, Martins MC, Silveira C, Belfort R, Rizzo LV. The genotype genotype (jēn`ətīp'): see genetics. genotype Genetic makeup of an organism. The genotype determines the hereditary potentials and limitations of an individual. of Toxoplasma gondii strains causing ocular toxoplasmosis in humans in Brazil. Am J Ophthalmol. 2005;139:350-1. (8.) Dubey JR Graham DH, Blackston CR, Lehmann T, Gennari SM, Ragozo AM, et al. Biological and genetic characterization A rather long and fancy word for analyzing a system or process and measuring its "characteristics." For example, a Web characterization would yield the number of current sites on the Web, types of sites, annual growth, etc. of Toxoplasma gondii isolates from chickens (Gallus Gallus (Caius Vibius Trebonianus Gallus) (găl`əs), d. 253 or 254, Roman emperor after 251. He fought in the eastern campaign that proved fatal to Decius. domesticus) from Sao Paulo, Brazil: unexpected findings. Int J Parasitol. 2002;32:99-105. (9.) Dubey JP, Navarro IT, Graham DH, Dahl dahl n. 1. See pigeon pea. 2. or dal A thick creamy East Indian stew made with lentils or other legumes, onions, and various spices. E, Freire RL, Prudencio LB, et al. Characterization of Toxoplasma gondii isolates from free-range chickens from Parana, Brazil. Vet Parasitol. 2003;117:229-34. (10.) Grigg ME, Ganatra J, Boothroyd JC, Margolis TP. Unusual abundance of atypical atypical /atyp·i·cal/ (-i-k'l) irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. a·typ·i·cal adj. strains associated with human ocular toxoplasmosis. J Infect infect /in·fect/ (in-fekt´) 1. to invade and produce infection in. 2. to transmit a pathogen or disease to. in·fect v. 1. Dis. 2001;184:633-9. (11) Darde ML. Genetic analysis of the diversity in Toxoplasma gondii. Ann 1st Super Sanita. 2004;40:5743. (12.) Cook AJ, Gilbert RE, Buffolano W. Sources of Toxoplasma infection in pregnant women: European multicentre case-control study. European Research Network on Congenital Toxoplasmosis congenital toxoplasmosis A transplacental infection with the protozoan Toxoplasma gondii affecting ±1⁄3 of fetuses of ♀ with acute acquired toxoplasmosis, most severe if the infection occurs in 1st . BMJ BMJ n abbr (= British Medical Journal) → vom BMA herausgegebene Zeitschrift . 2000;321:142-7. (13.) Bowie WR, King AS, Werker DH, Isaac-Renton JL, Bell A, Eng SB, et al. Outbreak of toxoplasmosis associated with municipal drinking water. Lancet lancet /lan·cet/ (lan´set) a small, pointed, two-edged surgical knife. lan·cet n. . 1997;350:173-7. (14.) SAS version 8.02. Cary (NC): SAS Institute SAS Institute Inc., headquartered in Cary, North Carolina, USA, has been a major producer of software since it was founded in 1976 by Anthony Barr, James Goodnight, John Sall and Jane Helwig. Inc.; 2001. (15.) Dubey JP. Toxoplasmosis. J Am Vet Med Assoc. 1994;205:1593-8. (16.) Dias RAF, Navarro IT, Ruffolo BB, Bugni FM, de Castro MV, Freire RL. Toxoplasma gondii in fresh pork sausage and seroprevalence seroprevalence Immunology The proportion of a population that is seropositive–ie, has been exposed to a particular pathogen or immunogen; the seropositivity of a population is calculated as the number of individuals who produce a particular antibody divided in butchers from factories in Londrina, Parana State, Brazil. Rev lnst Med Trop Sao Paulo. 2005;47:185-9. (17.) de A Dos Santos Santos (sän`t  s), city (1996 pop. 412,288), São Paulo state, SE Brazil, on the island of São Vicente in the Atlantic just off the mainland. CB, de Carvalho AC, Ragozo AM, Soares RM,
Amaku M, Yai LE, et al. First isolation and characterization of
Toxoplasma gondii from finishing pigs from Sao Paulo State, Brazil. Vet
Parasitol. 2005; 131:207-11.(18.) Dubey JP, Kotula AW, Sharar A, Andrews CD, Lindsay DS. Effect of high temperature on infectivity infectivity ability of an agent to infect. of Toxoplasma gondii tissue cysts in pork. J Parasitol. 1990;76:201-4. (19.) Avelino MM, Junior DC, de Parada JB, de Castro AM. Risk factors for Toxoplasma gondii infection in women of childbearing child·bear·ing n. Pregnancy and parturition. child  bear ing adj. age.
Braz J Infect Dis. 2004;8:164-74.(20.) Avelino MM, Campos Campos (käm`p s), city (1996 pop. 391,299), Rio de Janeiro state, SE Brazil, on the Paraíba River near its mouth. D Jr, de Parada JCB JCBNoun trademark, Brit a large machine used in building, that has a shovel on the front and a digger arm on the back [initials of Joseph Cyril Bamford, its manufacturer] JCB® n abbr , Castro AM. Pregnancy as a risk factor for acute toxoplasmosis seroconversion seroconversion /se·ro·con·ver·sion/ (-con-ver´zhun) the change of a seronegative test from negative to positive, indicating the development of antibodies in response to immunization or infection. . Eur J Obstet Gyn Reprod Biol. 2003; 108:19-24. (21.) Nissapathorn V, Noor Azmi MA, Cho SM, Fong MY, Init I, Rohela M, et al. Toxoplasmosis: prevalence and risk factors. J Obstet Gynaecol. 2003;23:618-24. (22.) Jara M, Hsu HW, Eaton RB, Demaria A Jr. Epidemiology of congenital toxoplasmosis identified by population-based newborn screening newborn screening Neonatology The analysis of a neonate's blood for metabolic or other disorders to prevent mental retardation, disability or death in Massachusetts. Pediatr Infect Dis J. 2001;20:1132-5. Jeffrey L. Jones, * Cristina Muccioli, ([dagger]) Rubens Belfort, Jr, ([dagger]) Gary N. Holland, ([double dagger double dagger n. A reference mark (  ) used in printing and writing. Also called diesis.Noun 1. ]) Jacquelin M. Roberts, * and Claudio Silveira ([section]) * Centers for Disease Control and Prevention, Atlanta, Georgia, USA; ([dagger])Federal University of Sao Paulo Paulista School of Medicine, Sao Paulo, Sao Paulo, Brazil; ([double dagger]) David Geffen School of Medicine at UCLA UCLA School of Medicine or David Geffen School of Medicine at UCLA is an accredited allopathic medical school located in Los Angeles, California, United States. The school was named in honor of media mogul David Geffen who donated $200 million in unrestricted funds to the , Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850. , California, USA; and ([section]) Clinica Silveira, Erechim, Rio Grande do Sul, Brazil Address for correspondence: Jeffrey L. Jones, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F22, Atlanta, GA 30341-3724, USA; fax: 770-488-7761; email: jlj1@cdc.gov
Table 1. Demographics of Toxoplasma gondii patients and
controls, Erechim, Brazil, 2003-2004, N=241
Patients, no. Controls, no.
Factor (%) (n = 131 *) (%) (n = 110 *)
Age (y)
[less than or equal to] 5 14 (10.7) 1 (0.9)
6-10 16 (12.2) 16 (14.6)
11-15 19 (14.5) 14 (12.7)
16-20 12 (9.2) 31 (28.2)
21-30 21 (16.0) 31 (28.2)
31-40 28 (21.4) 11 (10.0)
[greater than or equal to] 41 21 (16.0) 6 (5.5)
Sex
Male 72 (55.0) 42 (38.2)
Female 59 (45.0) 68 (61.8)
Race
White 127 (97.0) 105 (95.5)
Other 4 (3.1) 5 (4.5)
Ethnicity
German, 117 (94.4) 102 (96.2)
Polish, or Italian
Other 7 (5.7) 4 (3.8)
[chi square] p
Factor value
Age (y) <0.0001
[less than or equal to] 5
6-10
11-15
16-20
21-30
31-40
[greater than or equal to] 41
Sex 0.01
Male
Female
Race 0.54
White
Other
Ethnicity 0.51
German,
Polish, or Italian
Other
* Numbers within each category may not add to total n because of
nonresponse.
Table 2. Factors associated with risk for acute Toxoplasma gondii
infection, Erechim, Brazil, 2003-2004, N=241 (univariate factors
shown with p [less than or equal to] 0.05) *
No. with factor/
Factor no. patients ([dagger]) (%)
Have a garden (excludes those living on 59/69 (85.5)
farms)
Born in Erechim or upper Uruguay 78/130 (60.0)
Work in garden 57/130 (43.9)
Eat cured, dried, or smoked meat given 60/130 (46.2)
by friend or relative
Eat rare meat 73/131 (55.7)
Of those that eat raw meat, eat raw beef 18/31 (58.1)
Of those that eat raw meat, eat raw 11/31 (35.5)
ground beef
Of those that eat raw meat, eat raw 2/30 (6.7)
ground chicken
Eat frozen lamb 37/131 (28.2)
Male sex 72/131 (55.0)
Work in yard >1 x/wk 65/90 (72.2)
No. with factor/
Factor no. controls ([dagger]) (%)
Have a garden (excludes those living on 41/61 (67.2)
farms)
Born in Erechim or upper Uruguay 98/110 (89.1)
Work in garden 30/110 (27.3)
Eat cured, dried, or smoked meat given 33/110 (30.0)
by friend or relative
Eat rare meat 47/110 (42.7)
Of those that eat raw meat, eat raw beef 14/16 (87.5)
Of those that eat raw meat, eat raw 12/16 (75.0)
ground beef
Of those that eat raw meat, eat raw 5/15 (33.3)
ground chicken
Eat frozen lamb 19/110 (17.3)
Male sex 42/110 (38.2)
Work in yard >1 x/wk 35/71 (49.3)
Factor OR (95% CI)
Have a garden (excludes those living on 2.88 (1.22-6.78)
farms)
Born in Erechim or upper Uruguay 0.18 (0.09-0.37)
Work in garden 2.08 (1.21-3.59)
Eat cured, dried, or smoked meat given 2.00 (1.17-3.41)
by friend or relative
Eat rare meat 1.69 (1.01-2.81)
Of those that eat raw meat, eat raw beef 0.20 (0.04-1.02)
Of those that eat raw meat, eat raw 0.18 (0.05-0.71)
ground beef
Of those that eat raw meat, eat raw 0.14 (0.02-0.86)
ground chicken
Eat frozen lamb 1.89 (1.01-3.52)
Male sex 1.98 (1.18-3.31)
Work in yard >1 x/wk 2.67 (1.39-5.15)
Factor p value
Have a garden (excludes those living on 0.01
farms)
Born in Erechim or upper Uruguay <0.0001
Work in garden 0.008
Eat cured, dried, or smoked meat given 0.01
by friend or relative
Eat rare meat 0.045
Of those that eat raw meat, eat raw beef 0.042 ([double dagger])
Of those that eat raw meat, eat raw 0.01
ground beef
Of those that eat raw meat, eat raw 0.02
ground chicken
Eat frozen lamb 0.045
Male sex 0.01
Work in yard >1 x/wk 0.003
* OR, odds ratio; CI, confidence interval.
([dagger]) Totals vary because some questions applied to a subset of
participants and because response rates varied.
([double dagger]) Exact method, OR 0.20, 95% CI 0.02-1.14, p = 0.078.
Table 3. Factors associated with risk for acute Toxoplasma gondii
infection in women [greater than or equal to] 18 years of age, Erechim,
Brazil, 2003-2004, N=86 (univariate factors shown with p [less than or
equal to] 0.05) *
No. with factor/
Factor no. patients ([dagger]) (%)
Lived in present home >12 mo 46/46 (100)
Work with animals 16/46 (34.8)
Work in garden in past 12 mo 26/46 (56.5)
Eat rare ground chicken 1/23 (4.4)
Eat raw ground beef 4/12 (33.3)
Eat raw chicken 2/12 (16.7)
Eat raw ground chicken 0/12
[greater than or equal to] 1 cat living 20/46 (43.5)
at home
[greater than or equal to] 1 kitten 9/46 (19.6)
living at home
Feed cat dried food 29/46 (63.0)
[greater than or equal to] 1 pregnancy 34/37 (91.9)
[greater than or equal to] 1 child 34/38 (89.5)
No. with factor/
Factor no. controls ([dagger]) (%)
Lived in present home >12 mo 35/40 (87.5)
Work with animals 6/40 (15.0)
Work in garden in past 12 mo 14/40 (35.0)
Eat rare ground chicken 4/15 (26.7)
Eat raw ground beef 6/7 (85.7)
Eat raw chicken 4/6 (66.7)
Eat raw ground chicken 4/6 (66.7)
[greater than or equal to] 1 cat living 9/40 (22.5)
at home
[greater than or equal to] 1 kitten 2/39 (5.1)
living at home
Feed cat dried food 33/40 (82.5)
[greater than or equal to] 1 pregnancy 10/28 (35.7)
[greater than or equal to] 1 child 11/30 (367)
Factor OR (95% CI)
Lived in present home >12 mo 14.41 (logit) (0.77-269.25)
Work with animals 3.02 (1.05-8.71)
Work in garden in past 12 mo 2.41 (1.01-5.78)
Eat rare ground chicken 0.13 (0.01-1.26)
Eat raw ground beef 0.08 (0.01-0.95)
Eat raw chicken 0.10 (0.01-0.98)
Eat raw ground chicken 0.02 (logit) (0.00-0.58)
[greater than or equal to] 1 cat living 2.65 (1.03-6.81)
at home
[greater than or equal to] 1 kitten 4.50 (0.91-22.26)
living at home
Feed cat dried food 0.36 (0.13-0.995)
[greater than or equal to] 1 pregnancy 20.40 (4.98-83.64)
[greater than or equal to] 1 child 14.68 (4.10-52.50)
Factor p value
Lived in present home >12 mo 0.01
Work with animals 0.04
Work in garden in past 12 mo 0.05
Eat rare ground chicken 0.05
Eat raw ground beef 0.03
Eat raw chicken 0.04
Eat raw ground chicken 0.001
[greater than or equal to] 1 cat living 0.04
at home
[greater than or equal to] 1 kitten 0.05
living at home
Feed cat dried food 0.05
[greater than or equal to] 1 pregnancy <0.0001
[greater than or equal to] 1 child <0.0001
* OR, odds ratio; CI, confidence interval.
([dagger]) Totals vary because some questions applied to a subset of
participants and because response rates varied.
Table 4. Factors associated with risk for acute Toxoplasma gondii
infection among children <18 years of age, Erechim, Brazil, 2003-2004,
N=106 (univariate factors with p [less than or equal to] 0.05) *
No. with factor/
Factor no. patients ([dagger]) (%)
Born in Erechim or upper Uruguay 32/58 (55.2)
Cat at least occasionally catches own 25/26 (96.2)
food
Feed cat raw food 15/26 (57.7)
Work in yard >1 x/wk 35/43 (81.4)
Wear gloves when working in yard 0/49
Eat cured, dried, or smoked meat given 20/58 (34.5)
by friend or relative
Eat frozen lamb 12/58 (20.7)
Eat rare meat 33/58 (56.9)
Of those that eat rare meat, eat rare 10/32 (31.3)
pork
Male sex 45/58 (77.6)
No. with factor/
Factor no. controls ([dagger]) (%)
Born in Erechim or upper Uruguay 46/48 (95.8)
Cat at least occasionally catches own 16/21 (76.2)
food
Feed cat raw food 6/21 (28.6)
Work in yard >1 x/wk 18/32 (56.3)
Wear gloves when working in yard 6/35 (17.1)
Eat cured, dried, or smoked meat given 7/48 (14.6)
by friend or relative
Eat frozen lamb 3/48 (6.3)
Eat rare meat 17/48 (35.4)
Of those that eat rare meat, eat rare 0/17
pork
Male sex 20/48 (41.7)
Factor OR (95% CI)
Born in Erechim or upper Uruguay 0.05 (0.01-0.24)
Cat at least occasionally catches own 7.81 (0.83-73.15)
food
Feed cat raw food 3.41 (1.00-11.61)
Work in yard >1 x/wk 3.40 (1.21-9.61)
Wear gloves when working in yard 0.05 (logit) (0.00-0.84)
Eat cured, dried, or smoked meat given 3.08 (1.17-8.11)
by friend or relative
Eat frozen lamb 3.91 (1.03-14.80)
Eat rare meat 2.41 (1.10-5.29)
Of those that eat rare meat, eat rare 16.33 (logit) (0.89-298.33)
pork
Male sex 4.84 (2.09-11.26)
Factor p value
Born in Erechim or upper Uruguay <0.0001
Cat at least occasionally catches own 0.04
food
Feed cat raw food 0.04
Work in yard >1 x/wk 0.02
Wear gloves when working in yard 0.003
Eat cured, dried, or smoked meat given 0.02
by friend or relative
Eat frozen lamb 0.03
Eat rare meat 0.03
Of those that eat rare meat, eat rare 0.01
pork
Male sex 0.0002
* OR, odds ratio; CI, confidence interval.
([dagger]) Totals vary because some questions applied to a subset of
participants and because response rates varied.
Table 5. Factors associated with risk for acute Toxoplasma gondii
infection in multivariate analysis, Erechim, Brazil, 2003-2004
Factor OR (95% CI) * p value
All persons (N = 241), factors
representing [greater than or equal
to] 100 cases and p [less than or
equal to] 0.05 in univariate
analysis
Born in Erechim or upper Uruguay 0.19 (0.09-0.39) <0.0001
Work in garden 2.35 (1.27-4.33) 0.006
Eat cured, dried, or smoked meat
given by friend or relative 1.58 (0.86-2.91) 0.14
Eat rare meat 1.35 (0.76-2.41) 0.31
Eat frozen lamb 2.06 (1.15-3.67) 0.02
Male sex 1.21 (0.59-2.49) 0.60
Women [greater than or equal to] 18 y
(n = 86), factors representing
[greater than or equal to] 30 cases
and p [less than or equal to] 0.05
in univariate analysis ([dagger])
[greater than or equal to] 1 child 14.94 (3.68-60.73) 0.0002
Work with animals 1.74 (0.24-12.86) 0.59
[greater than or equal to] 1 cat
living at home 0.63 (0.05-7.35) 0.71
[greater than or equal to] 1 kitten
living at home 2.95 (0.21-41.03 0.42
Feed cat dried food 0.86 (0.04-19.10) 0.93
Work in the garden in past 12 mo 1.09 (0.29-4.05) 0.90
Children <18 y (n = 106), factors
representing [greater than or equal
to] 50 cases and p [less than or
equal to] 0.05 in univariate
analysis
Born in Erechim or upper Uruguay 0.04 (0.01-0.22) 0.0002
Eat cured, dried, or smoked meat
given by a friend or relative 1.75 (0.51-6.02) 0.37
Eat frozen lamb 4.52 (0.85-23.97) 0.08
Eat rare meat 2.52 (0.93-6.81) 0.07
Male sex 5.70 (1.95-16.66) 0.002
* Referent is absence of factor. OR, odds ratio; CI, confidence
interval.
([dagger]) The factor "lived in present home >12 mo" had a p value of
0.01 in univariate analysis, but 95% CI calculated with log it crossed
1; therefore, it was not included.
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