Artisan fresh cheese from raw cow's milk as a possible route of transmission in a toxoplasmosis outbreak, in Brazil

Abstract

Background: The objective of this study was to report an outbreak of human toxoplasmosis occurring in the municipality of Montes Claros de Goiás, Goiás, Brazil, from December 2015 to August 2016. Seven acute cases in June 2016 triggered the subsequent search. Methods: A total of 251 individuals were selected through an active search, of which 114 (45.4%) agreed to participate in the research and blood collection. For serological diagnosis were used enzyme-linked immunosorbent assay (ELISA) for IgG and IgM and avidity tests. Results: Of the 114 serum samples evaluated, 12.3% (14/114) showed antibodies against Toxoplasma gondii, with a profile indicative of acute infection. Samples of artisan fresh cheese, public water, vegetables and irrigation water were collected.Toxoplasma gondii DNA fragments were amplified using the polymerase chain reaction from two samples of artisan fresh cheese and a sample of irrigation water from the vegetable garden. A control case study was carried out, and the variable cow's artisan fresh cheese consumption was statistically significant (p = .01). Conclusions: The results showed that cheese analysed and/or irrigated water of vegetable represented an important route of transmission for the disease. This is the first reported outbreak possibly caused by cow's artisan fresh cheese. It is difficult to prove that these routes were the cause of the outbreak; however, the findings allow us to infer that the individuals involved in the outbreak were in contact with these risk factors. K E Y W O R D Sepidemiology, food, foodborne disease, surveillance, Toxoplasma gondii

Outbreaks of clinical toxoplasmosis in humans: five decades of personal experience, perspectives and lessons learned

“…Another outbreak in Montes Claros de Goiás in the state of Goiás was epidemiologically linked to consumption of fresh cheese from raw cow's milk [24]. Symptoms noted are summarized in Table 1.…”

Contamination of Soil, Water, Fresh Produce, and Bivalve Mollusks with Toxoplasma gondii Oocysts: A Systematic Review

“…Indeed, only 13 of the selected articles studied the association between oocyst detection in environmental matrices with human T. gondii infection and toxoplasmosis (outbreaks, endemic, or sporadic cases), most of them from North and South America. Five of these studies focused on soil [ 56 , 60 , 70 , 77 , 80 ], with three of them reporting positive samples; 10 were in water [ 51 , 60 , 70 , 87 , 88 , 89 , 91 , 92 , 104 , 105 ], with eight reporting positive samples; and three were on fresh produce [ 60 , 88 , 92 ], with one reporting positive samples and the other reporting negative samples, but suggesting that the occurrence of toxoplasmosis was connected with vegetable consumption in a restaurant [ 60 ] ( Table 1 , Table 2 , Table 3 and Table 4 ).…”

“…The public health importance of different contaminated water sources is determined by their uses. In relation to this, one article reported 9.0% (9/100) recreational water samples to be oocyst positive [ 78 ], while the detection rates were between 16.7% (9/54) [ 95 ] and 50.0% (1/2) [ 88 ] in irrigation/washing water, and 2.3% (1/44) [ 97 ] and 100% (8/8) [ 51 ] in potable water. The origin of these samples was not specified in all cases; the recreational water corresponded to lakes and pools, the irrigation/washing water was from a river, and in one study, the potable water corresponded to water kept in tanks/towers from houses, in fountains, and from the water and sewage company.…”

“…The number of samples collected was extremely variable: from three irrigation, municipal, and/or cistern water samples [ 60 , 88 , 111 ] to 1427 public water supply samples [ 109 ]. In addition, the sample volume ranged from 0.01 L [ 61 ] to up to 2500 L [ 100 ].…”

Epidemiology of a toxoplasmosis outbreak in a research institution in northern Paraná, Brazil

“…In Brazil, outbreak notification and epidemiological investigation is a compulsory activity of health surveillance (Reingold, 1998). Since 1967, when the first outbreak of toxoplasmosis was registered in Bragança Paulista, São Paulo, Brazil, more than 35 reports have been published worldwide, with most of them in Brazil (da Costa et al, 2020; Pinto‐Ferreira, Caldart, et al, 2019; Pinto‐Ferreira, Mitsuka‐Breganó, et al, 2019). The main transmission routes were water (Moura et al, 2006), vegetables (Brasil, 2012), fruits (Dutra et al, 2011), undercooked meats (Masur, Jones, Lempert, & Cherubini, 1978), raw meats (Pomares, 2011) and unpasteurized goat's milk (Chiari & Neves, 1984).…”