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Doctoral Thesis
DOI
https://doi.org/10.11606/T.17.2020.tde-05102020-103415
Document
Author
Full name
Rafael Estevão De Angelis
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2020
Supervisor
Committee
Furtado, João Marcello Fórtes (President)
Jorge, Eliane Chaves
Messias, André Márcio Vieira
Rodrigues, Fernando Bellissimo
Title in Portuguese
Frequência de anticorpos anti-Toxoplasma gondii e de lesões oculares causadas pelo parasita, e fatores de risco associados à toxoplasmose ocular em Cássia dos Coqueiros, São Paulo
Keywords in Portuguese
Acuidade visual
Epidemiologia
Retinocoroidite
Toxoplasma gondii
Toxoplasmose ocular
Uveíte posterior
Abstract in Portuguese
Determinar a frequência e os fatores de risco para a sorologia positiva para toxoplasmose e da presença de lesões oculares atribuíveis ao parasita, e suas características, na cidade de Cássia dos Coqueiros-SP. Casuística e Métodos: Todos os habitantes maiores de 18 anos foram convidados para a coleta de amostra de sangue e realização de sorologia para toxoplasmose. Posteriormente, estes participantes foram convidados a responderem um questionário sobre fatores de risco para a doença e, em outro momento, submeterem-se ao exame oftalmológico. As lesões presumidas de toxoplasmose ocular encontradas foram registradas em vídeo e analisadas por três oftalmologistas mascarados. Foram consideradas como lesões de toxoplasmose ocular aquelas em que houve concordância entre os avaliadores e a sorologia do participante era positiva. Os achados sorológicos e oftalmológicos foram relacionados às respostas obtidas no questionário. Resultados: Foram colhidas amostras de sangue de 1150 participantes, 984 foram avaliadas e 624 (63,4%) apresentaram anticorpos anti-Toxoplasma gondii. Submeteram-se ao exame oftalmológico 721 participantes, 490 (68,0%) com presença de anticorpos anti-Toxoplasma gondii. Após a avaliação das lesões registradas em vídeo (Kappa = 0,37; p<0,001), foram encontrados 48 olhos (3,3%), de 42 participantes (5,8%), com lesões de toxoplasmose. Lesões inconclusivas, ou cujo participante apresentava sorologia negativa, foram excluídas. Na maioria dos olhos acometidos a lesão era única (58,3%) e periférica (77,1%), sendo unilateral em 85,7% dos participantes. Lesões maiores que 1 DD relacionaram-se com a idade mais avançada (p=0,047). Nenhum participante apresentou lesão ativa. O consumo de carne crua ou mal passada (Odds ratio - OR: 2,61; Índice de confiança - IC: 1,40 - 4,84; p=0,002), presença de felinos no domicílio (OR: 1,36; IC: 1,03 - 1,81; p=0,03), menor escolaridade (menos de quatro anos de estudo: OR: 4,40; IC: 2,44 - 7,96; p<0,01), pertencer ao estrato social agrupado baixo (OR: 1,44; IC: 1,09 - 1,88), e a idade avançada (OR: 3,89; IC: 2,27 - 6,66; p<0,01) relacionaram-se com sorologia positiva para anticorpos anti-Toxoplasma gondii. A presença de lesão ocular relacionou-se com o estrato social agrupado baixo (OR: 2,89; IC: 1,2 a 6,97; p=0,018). Não houve diferença entre a acuidade visual dos participantes com ou sem lesão ocular (olho direito p=0,66 e olho esquerdo p=0,87). Conclusões: A frequência de sorologia positiva para anticorpos anti-Toxoplasma gondii na cidade de Cássia dos Coqueiros-SP é alta em relação a outras regiões do mundo, mas está dentro da variação encontrada no Brasil. O mesmo ocorre com as lesões de toxoplasmose ocular. Observou-se que o estrato social agrupado baixo é um possível fator de risco comum entre a contaminação pelo parasita e a manifestação da doença ocular. A localidade majoritariamente periférica justifica a ausência de relação com a diminuição da acuidade visual nos olhos afetados.
Title in English
Frequency of anti-Toxoplasma gondii antibodies and ocular lesions caused by the parasite, and risk factors associated with ocular toxoplasmosis in Cássia dos Coqueiros, São Paulo
Keywords in English
Epidemiology
Ocular toxoplasmosis
Posterior uveitis
Retinochoroiditis
Toxoplasma gondii
Abstract in English
To determine the frequency and risk factors of positive serology for toxoplasmosis, and the presence of eye lesions attributable to the parasite, and the characteristics of this lesions, in the city of Cássia dos Coqueiros - SP. Casuistic and Methods: All inhabitants over 18 were invited to collect a blood sample and perform serology for toxoplasmosis. Subsequently, we invited these participants to answer a questionnaire about risk factors for the disease and, later, to undergo an eye examination. The presumed lesions of ocular toxoplasmosis found were recorded on video and analyzed by three masked ophthalmologists. Ocular toxoplasmosis lesions were those in which there was an agreement between the evaluators, and the participant's serology was positive. The serological and ophthalmological findings were related to the answers obtained in the questionnaire. Results: Blood samples were collected from 1150 participants. We evaluated 984, and 624 (63.4%) presented anti-Toxoplasma gondii antibodies. We evaluated an ophthalmological examination in 721 participants, 490 (68.0%), with anti-Toxoplasma gondii antibodies. After assessing the lesions recorded on video (Kappa = 0.37; p<0.001), 48 eyes (3.3%), from 42 participants (5.8%), were found with toxoplasmosis lesions. Inconclusive lesions, or whose participant had negative serology, were excluded. In most of the affected eyes, the lesion was unique (58.3%) and peripheral (77.1%), being unilateral in 85.7% of the participants. Lesions larger than 1 DD were related to older age (p = 0.047). No participant had an active lesion. Nobody presented active infection lesion. The consumption of raw or undercooked meat (OR: 2.61; CI: 1.40 - 4.84; p=0.002), presence of felines in the household (OR: 1,36; IC: 1,03 - 1,81; p=0,03), lower education level (less than four years of study: OR: 4.40; CI: 2, 44 - 7.96; p<0.01), belong to the low clustered social stratum (OR: 1,44; IC: 1,09 - 1,88), and advanced age (OR: 3,89; IC: 2,27 - 6,66; p<0,01) were related to the presence of positive serology for anti-Toxoplasma gondii antibodies. The presence of ocular lesion was associated with lower social stratum (OR: 2.89; CI: 1.2 to 6.97; p=0.018). There was no difference between the visual acuity of the participants with or without ocular lesions (right eye p=0.66 and left eye p=0.87). Conclusions: The frequency of positive serology for anti-Toxoplasma gondii antibodies in the city of Cássia dos Coqueiros - SP is high compared to other regions of the world, but it is within the range found in Brazil. The same occurs with the ocular lesions of toxoplasmosis. Belonging to the low clustered social stratum was found to be a possible common risk factor between contamination by the parasite and the manifestation of eye disease. The most peripheral location justifies the lack of relationship with the decrease in visual acuity in the affected eyes.
 
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Publishing Date
2020-10-19
 
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