{"id":2159,"date":"2020-09-07T13:52:38","date_gmt":"2020-09-07T11:52:38","guid":{"rendered":"https:\/\/www.newslab.sk\/prevencia-toxoplazmozy-v-tehotnosti-na-slovensku\/"},"modified":"2020-09-07T13:55:48","modified_gmt":"2020-09-07T11:55:48","slug":"prevention-of-toxoplasmosis-in-pregnancy-in-slovakia","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/prevention-of-toxoplasmosis-in-pregnancy-in-slovakia\/","title":{"rendered":"Prevention of toxoplasmosis in pregnancy in Slovakia"},"content":{"rendered":"

*<\/strong>All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.<\/strong><\/span><\/p>\n

 <\/p>\n

\u00davod
\n<\/strong>
\nVroden\u00e1 toxoplazm\u00f3za predstavuje v\u00e1\u017eny zdravotn\u00edcky probl\u00e9m na celom svete, preto v mnoh\u00fdch krajin\u00e1ch maj\u00fa za \u00fa\u010delom v\u010dasn\u00e9ho odhalenia infekcie, resp. redukcie n\u00e1sledkov kongenit\u00e1lnej toxoplazm\u00f3zy zaveden\u00fd rutinn\u00fd s\u00e9rologick\u00fd skr\u00edning matiek a det\u00ed vr\u00e1tane \u0161pecifickej terapie(1). Program strat\u00e9gie a prevencie kongenit\u00e1lnej toxoplazm\u00f3zy je \u00faspe\u0161ne aplikovan\u00fd vo viacer\u00fdch krajin\u00e1ch(1,2). Slovensko sa zaradilo k t\u00fdmto krajin\u00e1m v roku 2006, ke\u010f vo\u0161iel do platnosti program prevencie kongenit\u00e1lnej toxoplazm\u00f3zy, ktor\u00fd je zakotven\u00fd v Odbornom usmernen\u00ed MZ SR o diagnostike toxoplazm\u00f3zy(3). Pod\u013ea tohto programu je ka\u017ed\u00e1 tehotn\u00e1 \u017eena s\u00e9rologicky vy\u0161etrovan\u00e1 na za\u010diatku tehotenstva a negat\u00edvne \u017eeny opakovane minim\u00e1lne raz v ka\u017edom nasleduj\u00facom trimestri. V pr\u00e1ci uv\u00e1dzame v\u00fdsledky vy\u0161etren\u00ed tehotn\u00fdch \u017eien na toxoplazm\u00f3zu od roku 1998, pod\u013ea vtedy platnej legislat\u00edvy.<\/p>\n

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Materi\u00e1l a met\u00f3dy
\n<\/strong>
\nV rokoch 1998 a\u017e 2016 sme vy\u0161etrili cielen\u00fdm s\u00e9rologick\u00fdm skr\u00edningom na toxoplazm\u00f3zu 69 138 tehotn\u00fdch \u017eien z Bratislavy: v rokoch 1998 \u2013 2006 8 637 tehotn\u00fdch \u017eien a v rokoch platnosti prevent\u00edvneho programu (2007 \u2013 2016) 60 501 \u017eien. Ka\u017ed\u00fa vzorku s\u00e9ra sme vy\u0161etrili reakciou v\u00e4zby komplementu (RVK) a d\u00f4kazom IgG a IgM protil\u00e1tok imunoenz\u00fdmov\u00fdmi alebo elektrochemiluminiscen\u010dn\u00fdmi testami. V indikovan\u00fdch pr\u00edpadoch sme testovali IgA protil\u00e1tky a aviditu IgG protil\u00e1tok. V plodovej vode sme zis\u0165ovali toxoplazmov\u00fa DNA technikou PCR. Pri susp. neonat\u00e1lnej toxoplazm\u00f3ze sme pou\u017eili komparat\u00edvny blot IgG a IgM.<\/p>\n

 <\/p>\n

V\u00fdsledky<\/strong><\/p>\n

V rokoch 1998 \u2013 2006 sme v Bratislave vy\u0161etrili 8 637 tehotn\u00fdch \u017eien, v dobe platnosti skr\u00edningu v rokoch 2007 \u2013 2016 po\u010det vy\u0161etren\u00ed tehotn\u00fdch \u017eien vzr\u00e1stol sedemkr\u00e1t na po\u010det 60 501. PrimoinfekciuT. gondii sme dok\u00e1zali za hodnoten\u00e9 obdobie u 99 (0,14 %) tehotn\u00fdch \u017eien (tabu\u013eka 1). V 1. trimestri sa infikovalo 94 \u017eien, v tre\u0165om p\u00e4\u0165 \u017eien. 85 \u017eien (83,8 %) po aplik\u00e1cii rovamyc\u00ednu porodilo zdrav\u00e9 die\u0165a, kongenit\u00e1lnu toxoplazm\u00f3zu sme s\u00e9rologicky diagnostikovali u \u0161iestich novorodencov, u v\u0161etk\u00fdch piatich infikovan\u00fdch v tre\u0165om trimestri. V\u0161etk\u00fdch p\u00e4\u0165 det\u00ed sa narodilo bez sympt\u00f3mov toxoplazmovej infekcie, ka\u017ed\u00e9 die\u0165a podst\u00fapilo \u0161pecifick\u00fa toxoplazmov\u00fa lie\u010dbu a s\u00fa po rokoch po pravideln\u00fdch kontrol\u00e1ch zdrav\u00ed. Jeden novorodenec so Sabinovou tri\u00e1dou sa narodil matke, ktor\u00e1 nebola po\u010das tehotenstva vy\u0161etrovan\u00e1 na toxoplazm\u00f3zu, dvaja novorodenci sa narodili s chorioretinit\u00eddou a kalcifik\u00e1tmi na mozgu. \u0160tyri \u017eeny porodili m\u0155tvy plod, v\u0161etk\u00fdm bol aplikovan\u00fd rovamyc\u00edn, a sedem \u017eien podst\u00fapilo interrupciu. Lie\u010dba u nich podan\u00e1 nebola. Ani v jednom pr\u00edpade nebolo vykonan\u00e9 patologick\u00e9 vy\u0161etrenie plodu. Efektivitu s\u00e9rologick\u00e9ho skr\u00edningu dokumentujeme \u0161tatisticky v\u00fdznamne vy\u0161\u0161\u00edm po\u010dtom naroden\u00fdch zdrav\u00fdch det\u00ed matiek po zaveden\u00ed prenat\u00e1lneho skr\u00edningu do praxe v rokoch 2007 \u2013 2016 (78; 86,7 %, \u03c72=3,4, P=0,05) v porovnan\u00ed s po\u010dtom naroden\u00fdch zdrav\u00fdch det\u00ed v rokoch 1998 \u2013 2006, pred platnos\u0165ou povinn\u00e9ho s\u00e9rologick\u00e9ho skr\u00edningu na toxoplazm\u00f3zu 7 (77,8 %).<\/p>\n

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Diskusia<\/strong><\/p>\n

Sk\u00fasenosti z kraj\u00edn ukazuj\u00fa, \u017ee uplat\u0148ovanie a dodr\u017eiavanie samotn\u00fdch profylaktick\u00fdch prevent\u00edvnych opatren\u00ed riziko kongenit\u00e1lnej toxoplazm\u00f3zy v\u00fdznamne zni\u017euj\u00fa, nie v\u0161ak vylu\u010duj\u00fa. D\u00f4le\u017eit\u00fd je teda \u010fal\u0161\u00ed krok, zameran\u00fd na zistenie prim\u00e1rnej infekcie u tehotnej \u017eeny, \u010do vy\u017eaduje s\u00e9rologick\u00fd skr\u00edning. Napriek tomu n\u00e1zory na prenat\u00e1lny s\u00e9rologick\u00fd skr\u00edning nie s\u00fa v jednotliv\u00fdch krajin\u00e1ch z\u010faleka jednotn\u00e9. \u201eCost benefit\u201c prenat\u00e1lneho skr\u00edningu je spochyb\u0148ovan\u00fd na z\u00e1klade n\u00edzkej s\u00e9roprevalencie u tehotn\u00fdch \u017eien, ako aj n\u00edzkej frekvencie
\nsymptomatickej vrodenej toxoplazm\u00f3zy(4,5). Na druhej strane, Peyron et al. (2007) s\u00edce vyhodnotili, \u017ee u 79 % toxoplazmov\u00fdch infekci\u00ed matiek nedo\u0161lo ku kongenit\u00e1lnej infekcii a vroden\u00e9 chyby sa vyskytli u menej ako 1 % novorodencov, ale autori pripisuj\u00fa n\u00edzku chorobnos\u0165 a \u00famrtnos\u0165 pr\u00e1ve v\u010dasnej diagnostike a lie\u010dbe infekcie matky(5). V Eur\u00f3pe m\u00e1 p\u00e4\u0165 kraj\u00edn (Rak\u00fasko, Belgicko, Franc\u00fazsko, Slovensko a Slovinsko) povinn\u00fd skr\u00edning tehotn\u00fdch \u017eien a akt\u00edvnu surveillance pr\u00edpadov kongenit\u00e1lnej toxoplazm\u00f3zy, \u0161tyri krajiny maj\u00fa dobrovo\u013en\u00fd skr\u00edning (Bulharsko, \u010cesko, Ma\u010farsko, Nemecko) a osem kraj\u00edn doh\u013ead nad vrodenou toxoplazm\u00f3zou nevykon\u00e1va(6). Pretrv\u00e1vaj\u00facim probl\u00e9mom u n\u00e1s s\u00fa opakovan\u00e9 vy\u0161etrenia s\u00e9rologicky negat\u00edvnych \u017eien. Za hodnoten\u00e9 obdobie bolo dva a viackr\u00e1t vy\u0161etren\u00fdch iba 17,7 % neinfikovan\u00fdch \u017eien. Spravidla sa negat\u00edvny v\u00fdsledok pova\u017euje za dobr\u00fd a v skr\u00edningu sa \u010falej nepokra\u010duje. Ekonomick\u00e9 v\u00fdhrady s\u00fa argumentom proti s\u00e9rologick\u00e9mu skr\u00edningu, ale zistenie v\u010dasnej primoinfekcie matky a infekcia plodu sa d\u00e1 odhali\u0165 iba s\u00e9rologick\u00fdm vy\u0161etren\u00edm. Rie\u0161en\u00edm v bud\u00facnosti by mohla by\u0165 vakc\u00edna proti infekcii Toxoplasma gondii, ktor\u00e1 by sa mohla uplatni\u0165 pri diagnostike, lie\u010dbe a pr\u00edpadne prevencii vrodenej toxoplazm\u00f3zy(7).<\/p>\n

 <\/p>\n

Z\u00e1ver<\/strong><\/p>\n

Prevencia toxoplazm\u00f3zy uplat\u0148ovan\u00edm povinn\u00e9ho s\u00e9rologick\u00e9ho\u00a0 skr\u00edningu na Slovensku napriek nedostatkom m\u00e1 v\u00fdznamn\u00fd pr\u00ednos v rast\u00facom po\u010dte odhalen\u00fdch toxoplazmov\u00fdch primoinfekci\u00ed v tehotenstve. V\u0161etky deti pri s\u00e9rologicky odhalenej primoinfekcii v tehotenstve a lie\u010dbe matky sa narodili zdrav\u00e9.<\/p>\n

Po\u010fakovanie:<\/strong> \u0160t\u00fadia bola podporen\u00e1 projektom KEG \u010d. 013TTU-4\/2019.<\/p>\n

 <\/p>\n

Literat\u00fara<\/strong>
\n1. Asp\u00f6ck H, Pollak A. Prevention of prenatal toxoplasmosis by serological screening of pregnant women in Austria. Scand J Infect Dis Suppl 1992; 84: 32-38.
\n2. Janitschke K. Toxoplasmose-Vorsorge bei Schwangeren und Neugeborenen in Deutschland. Mitt. \u00d6sterr. Ges. Tropenmed. Parasitol 1996; 18: 19-24.
\n3. Odborn\u00e9 usmernenie MzSR o diagnostike toxoplazm\u00f3zy. 2006, \u010diastka 52, ro\u010d. 54.
\n4. The SYROCOT (Systematic Review on Congential Toxoplasmosis) study group, Thi\u00e9baut R, Leproust S, Ch\u00eane G, Gilbert R. Effectiveness of prenatal treatment for congenital toxoplasmosis: a meta-analysis of individual patients\u2018 data. Lancet 2007; 369(9556): 115-122.
\n5. Peyron F, L\u2019ollivier C, Mandelbrot L, et al. Maternal and Congenital Toxoplasmosis: Diagnosis and Treatment Recommendations of a French Multidisciplinary Working Group. Pathogens 2019; 8(1): 24.
\n6. Surveillance report. Congenital toxoplasmosis \u2013 Annual Epidemiological Report for 2016. European Centre for Disease Prevention and Control. Stockholm: ECDC; 2019.
\n7. Assolini JP, Concato VM, Gon\u00e7alves MD et al. Nanomedicine advances in toxoplasmosis: diagnostic, treatment, and vaccine applications. Parasitol Res 2017; 116(6): 1603-1615.<\/p>\n","protected":false},"excerpt":{"rendered":"

*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.   \u00davod Vroden\u00e1 toxoplazm\u00f3za predstavuje v\u00e1\u017eny zdravotn\u00edcky probl\u00e9m na celom svete, preto v mnoh\u00fdch krajin\u00e1ch maj\u00fa za \u00fa\u010delom v\u010dasn\u00e9ho odhalenia infekcie, resp. redukcie n\u00e1sledkov kongenit\u00e1lnej toxoplazm\u00f3zy zaveden\u00fd rutinn\u00fd s\u00e9rologick\u00fd skr\u00edning<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[1596],"tags":[1647,1648,1424,1646],"class_list":["post-2159","post","type-post","status-publish","format-standard","hentry","category-parazitologia-en","tag-prenatal-screening","tag-prevent","tag-toxoplasma-gondii-en","tag-toxoplasmosis","typ_clanku-original-work"],"acf":{"abstrakt":"

Since 2006, the Slovak Republic is one of five European countries with compulsory serological screening for toxoplasmosis in pregnancy. Serological testing starts in the first trimester. In seronegative women, it is repeated at least once in the following trimester. Between 2007 and 2016, we examined 60,501 pregnant women and found primary Toxoplasma infection in 90 (0.15%). Of these, 85 became infected in the first trimester, five previously negative women got infected in the third trimester. We found a congenital infection in five children. Since the application of prenatal screening, we found a significantly higher number of healthy children than before the application of prenatal screening (86.7%, \u03c72 = 3.4, P = 0.05).<\/p>\n

Keywords:<\/strong> Toxoplasma gondii, toxoplasmosis, prenatal screening, prevent<\/p>\n","casopis":[{"ID":2132,"post_author":"7","post_date":"2020-09-04 08:09:57","post_date_gmt":"2020-09-04 06:09:57","post_content":"SUPPLEMENT\r\n\r\nPri pr\u00edle\u017eitosti odbornej konferencie\r\n\r\nI. Aktu\u00e1lne probl\u00e9my hum\u00e1nnej parazitol\u00f3gie<\/strong>\r\n