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Infectio

Print version ISSN 0123-9392

Infect. vol.21 no.2 Bogotá Apr./June 2017

http://dx.doi.org/10.22354/in.v21i2.661 

EDITORIAL

Guías basadas en evidencia para toxoplasmosis durante el embarazo

Evidence based guideline for toxoplasmosis during pregnancy

Jorge E. Gomez-Marín1,*1 

Editor in Chief Infectio

1* Editor in Chief Infectio Grupo GEPAMOL. Universidad del Quindio, Colombia

Colombia was the first country in the world in to develop one evidence based guideline for toxoplasmosis. The project was presented in 2010, begun in 2011 and it was published in Spanish in Infectio in December 20121. This guideline was part of the evidence based guidelines for infectious and hemorrhagic complication of the pregnancy developed by the ministry of Health and Colciencias: http://gpc.minsalud.gov.co/gpc_sites/Repositorio/Conv_500/GPC_embarazo/gpc_embarazo.aspx.

In the past, political decision to implement, or not, national programs for toxoplasmosis were based on epidemiological and clinical studies (e.g. France, Danemark or Austria that decide to implement or England that decide not implementation). Some informal recommendations were previously made in Argentina, Spain and during an international meeting in Colombia in 20072. Today, the application of evidence based clinical recommendations, in each health system, need a standardized formulation. This should be made with external evaluation and socioeconomical analysis of the impact of the implementation of guidelines, to attain independent and scientifically valid evaluation for cost benefit equilibrated health decisions, that will guarantees the viability of the health system. The Colombian guidelines accomplished each step with a rigorous and systematic methodology. The Colombian guidelines is one step forward to the American Academy of Pediatrics (AAP) technical report3 because included recommendations and economical evaluation of the impact of its application. Moreover, the Ministry of Health of Colombia develop a tool to estimate the economic impact in different scenario of health expenses: http://mps1.minproteccionsocial.gov.co/HAIP/AIP_CPN.

The Colombian Association of Infectious Diseases (ACIN) have assumed the costs of english translation of this guideline that is published in the present number of Infectio. We think that the Colombian effort to elaborate this guideline can be very useful to other countries and can be a basis for local adaptations. Although have passed three years after its diffusion in Spanish, they still valid in its great part. In fact, recent publications have given additional support to the most important recommendation: the monthly screening based on IgM anti-Toxoplasma during pregnancy for seronegatives women4. This aspect was widely analyzed in the AAP technical report3.

I have been witness that before the implementation of the guidelines in my region, there were one to three cases each year of hydranencepahly, but there were no more cases after the implementation of the recommendation. Only in present year I has had one case of one girl of an indigenous group that for cultural reasons do not assisted to the prenatal control. I hope this observation correspond to truly application of the guidelines and that no more severe cases I will see in the future.

References

1. Alberto Cortés J, Enrique Gómez J, Ignacio Silva P, et al. Guía de atención integral para la prevención, detección temprana y tratamiento de las complicaciones del embarazo, parto y puerperio: sección toxoplasmosis en el embarazo. Infectio. 2012;16(4):230-246. doi:10.1016/S0123-9392(12)70018-8. [ Links ]

2. Gomez-Marin J. III International Congress on Congenital Toxoplasmosis. Infectio. 2012;11(1S):3. http://www.revistainfectio.org/index.php/infectio/article/view/161/217. Accessed February 5, 2017. [ Links ]

3. Maldonado YA, Read JS. Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States. Pediatrics. 2017;139(2):e20163860. doi:10.1542/peds.2016-3860. [ Links ]

4. Wallon M, Peyron F, Cornu C, et al. Congenital Toxoplasma Infection: Monthly Prenatal Screening Decreases Transmission Rate and Improves Clinical Outcome at Age 3 Years. Clin Infect Dis. 2013;56(9):1223-1231. doi:10.1093/cid/cit032. [ Links ]

1Cómo citar este artículo: Gomez-Marín JE. Evidence based guideline for toxoplasmosis during pregnancy. Infectio 2017. http://dx.doi.org/10.22354/in.v21i2.661

Recibido: 05 de Febrero de 2016; Aprobado: 05 de Febrero de 2017

Autor para correspondencia. Correo electrónico: gepamol2@uniquindio.edu.co

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons