Case-control study of an outbreak of acute toxoplasmosis in an industrial plant in the state of São Paulo, Brazil

Foodborne diseases represent operational risks in industrial restaurants. We described an outbreak of nine clustered cases of acute illness resembling acute toxoplasmosis in an industrial plant with 2300 employees. These patients and another 36 similar asymptomatic employees were diagnosed with anti-T. gondii IgG titer and avidity by ELISA. We excluded 14 patients based on high IgG avidity and chronic toxoplasmosis: 13 from controls and one from acute disease other than T. gondii infection. We also identified another three asymptomatic employees with T.gondii acute infection and also anti-T. gondii IgM positive as remaining acute cases. Case control study was conducted by interview in 11 acute infections and 20 negative controls. The ingestion of green vegetables, but not meat or water, was observed to be associated with the incidence of acute disease. These data reinforce the importance of sanitation control in industrial restaurants and also demonstrate the need for improvement in quality control regarding vegetables at risk for T. gondii oocyst contamination. We emphasized the accurate diagnosis of indexed cases and the detection of asymptomatic infections to determine the extent of the toxoplasmosis outbreak.

HUMAN TOXOPLASMOSIS OUTBREAKS AND THE AGENT INFECTING FORM. FINDINGS FROM A SYSTEMATIC REVIEW

SUMMARY Toxoplasmosis, a worldwide highly prevalent zoonotic infection, is transmitted either by the oocysts, from water and soil, or the tissue cysts, in raw or undercooked infected meat, of Toxoplasma gondii. An ongoing debate is whether there are differences between the clinical and epidemiological characteristics of the outbreaks due to one or the other infective form of the agent. We performed a systematic review, recovering 437 reported outbreaks of which 38 were selected. They were complete reports containing ascribed Toxoplasma infecting form, and clinical and demographic data. There was no gender or age group selection in the outbreaks, which were described more often in the Americas. A large number of individuals were affected when oocysts, associated with soil and water contaminated with cat feces, were considered the transmission source. Onset of symptoms occurred early when the infection was ascribed to meat tissue cysts (11.4 ± 6.7 days) with sharpened temporal distribution of cases, while a broader and prolonged appearance of new cases was observed when oocysts in water were the source of the infection (20 ± 7 days, p < 0.001). Such information may be useful in the design and implementation of control strategies.

Gestos e posturas do enfermeiro durante a orientação a familiares de paciente s internados em Unidade de Terapia Intensiva (UTI)

Trata-se de um estudo como caracterização dos gestos e posturas utilizados pelo enfermeiro durante a orientação sistematizada de familiares dos pacientes internados em UTI. Os dados foram coletados através de filmagem das interações entre a enfermeira e o familiar. Na análise foram identificadas as diversas categorias dos gestos propostos por Ekman e Friesen. Entre os resultados destacou-se com maior frequência a presença dos gestos ilustrativos, o que foi positivo, pois eles contribuiram para enfatizar a fala da enfermeira e facilitar a compreensão do familiar.

Distribuição dos Hydrozoa até agora conhecidos nas costas do Brasil

This work was done with the aim of computing all the species of Hydrozoa (Siphonophora excluded) that have been collected on the Brazilian coast, or in the pelagial, near the coast (some of the "Meteor" Stations). Nutting's (1900, 1904, 1915) and Mayer's (1910) monographs were taken as starting points and later papers and the Zoological Record used to check posterior findings. As a whole, 116 different valid names, among species and forms, have been mentioned from the Brazilian coast, distributed among 60 genera. Of the 116 species, 82 are represented by hydropolyps, 30 by hydromedusae (11 of which belong to the Trachylina and therefore lack a polypoid generation) and finally, by 4 species of which are known both polypoid and medusoid generations. The subdivision of the coast has been made at random, on account of the scarcity of the findings, except for the best known district, that goes from the latitude of Vitoria (State of Espirito Santo, at about 20ºlat.S.) to the bay of Santos (State of São Paulo, about 24ºlat.S.). The latitude of Cabo Frio (23ºlat.S.) was considered as a possible natural barrier, and the results of the global counting of the distribution of the hydropolyps North and South of 23ºlat.S. is the following: 29 species are known only North of Cabo Frio, 26 only from the same latitude (see direction of the coast, along parallel 23ºS.) or further South and 28 species are known both North and South of the coast (of these, 5 species are "cosmopolitan"). Therefore it seems quite possible that Cabo Frio really is a barrier to the distribution of 55 species. 26 species are endemic to the Brazilian coast, of these, only 5 are found both North and South of the Cape, while-14 are found only North and 7 only South. No studies can be done, on the bathymetric distribution in relation to the latitude. These results must be considered as provisory since more extensive researches will probably alter these figures. However, I believe that they are significative as a mean index of the condition of the hydrozoan fauna of the Brazilian coast. A tentative working hypothesis is presented as to the possible factors that confer such a zoogeographic importance to the region of Cabo Frio, a fact that has been foreseen by Ekman (1935, p. 73). Geographic position, currents, latitude and nature of the sea bottom between the continent and the oceanic island of Trindade have been taken in consideration, and all of them seem to be possible eficient factors of separation. Furthermore, according to the data obtained by the "Meteor" Expedition in July 2, 1926, at station 164 (23º8'lat.S. - 42º5'long.W.) and station 165 (23º35'lat.S. - 40º52'long.W.) and by what is known by hearsay and local experience of the region (exact continued study is urgently needed), it seems possible that, off from the sharp curve that the coast has at Cabo Frio, there may be an irregularity of the general scheme of the current and local upwelling may be present that would explain the local low temperature, low salinity and high density of the superficial layers as well as the abundance of fishes; these factors might contribute towards the establishement of a zoogeographical barrier. Further work is needed and nothing more than an hypothesis can be presented for the moment.