Research Article
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A public health problem in pregnant women: acute toxoplasma infection - a retrospective study of 12 years of data from a training and research hospital in Izmir

Year 2024, Volume: 9 Issue: 1, 8 - 13, 25.03.2024

Kazım Kıratlı Mustafa Şengül

https://doi.org/10.22391/fppc.1379747

Abstract

Introduction: The aim of this study is to identify the prevalence of acute toxoplasmosis in pregnant patients who are monitored in our hospital and to provide insight into screening and management options by assessing maternal and fetal outcomes.
Methods: Pregnants between the ages of 18-49, who were followed up in the Gynecology and Obstetrics Polyclinic/Clinic and Infectious Diseases Polyclinic/Clinic of a Training and Research Hospital between January 1, 2010 and December 31, 2021, were included in this study. T. gondii IgM, IgG and avidity tests which were performed for pregnant women were evaluated retrospectively.
Results: The study consisted of 7480 pregnants. Three hundred eighty-six (%5.16) of the pregnant women tested positive. Anti-T. gondii IgM seropositivity was found to be most common in the 18-28 age group (7.82%), and this frequency gradually decreased as age progressed. Two of the 122 patients whose polymerase chain reaction for T. gondii was examined from amniotic fluid at the outer center had congenital toxoplasmosis, and these pregnancies were terminated.
Conclusions: Pregnant women continue to have a considerable risk of developing acute toxoplasmosis. For this infestation, which still remains on the agenda as a public health problem, every individual who is planning a pregnancy and has not had a serological test before should be screened before pregnancy. Pregnant women should continue to be informed and educated about this parasite, in our opinion.

Keywords

Avidity Infestation Pregnancy Toxoplasma

Ethical Statement

The research was approved by the Izmir Katip Celebi University (İKCU) Ethics Committee (İKCU Non-Invasive Clinical Research Ethics Committee Decision Form: 0024/20.01.2022).

References

  • 1. WHO Estimates of the Global Burden of Foodborne Diseases (2015). Available from URL: www.euro.who.int/_data/assets/pdf_file/0011 Accessed: February 18, 2022.
  • 2. Centers for Disease Control and Prevention. Toxoplasmosis (Toxoplasma gondii) (2022). Available from URL: http://www.cdc.gov/dpdx/toxoplasmosis/ index.html Accessed: June 24, 2022
  • 3. Li K, Wang M, Zhang H, Lei Z, Zhang L, Luo H, et al. Epidemiology of Toxoplasma gondii infection in native Tibetans in Tibet, China. Acta Parasitol. 2017;26;62(3):529-32. https://doi.org/10.1515/ap-2017-0063
  • 4. Pinto B, Mattei R, Moscato GA, Cristofano M, Giraldi M, Scarpato R, et al. Toxoplasma infection in individuals in central Italy: does a gender-linked risk exist? Eur J Clin Microbiol Infect Dis. 2017;36(4):739-46. https://doi.org/10.1007/s10096-016-2857-8
  • 5. McLeod R, Cohen W, Dovgin S, Finkelstein L, Boyer KM. Human Toxoplasma infection. In Weiss LM and Kim K (eds), (2020). Toxoplasma gondii: The Model Apicomplexan – Perspectives and Methods, 3rd Edn. London: Academic Press, pp. 117–227.
  • 6. Xia J, Yolken RH. Strain hypothesis of Toxoplasma gondii infection on the outcome of human diseases. Acta Physiol (Oxf). 2015;213(4):828-45. https://doi.org/10.1111/apha.12458
  • 7. Paquet C, Yudin MH, Society of Obstetricians and Gynaecologists of Canada. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can. 2013;35(1):78-81. https://doi.org/10.1016/s1701-2163(15)31053-7
  • 8. Kaye A. Toxoplasmosis: diagnosis, treatment, and prevention in congenitally exposed infants. J Pediatr Health Care. 2011;25(6):355-64. https://doi.org/10.1016/j.pedhc.2010.04.008
  • 9. Peyron F, Wallon M, Kieffer F and Garweg J. Toxoplasmosis. InWilson CB, Nizet V, Maldonado YA, Remington JS and Klein JO (eds), (2016). Infectious Diseases of the Fetus and the Newborn Infant, 8th Edn. Philadelphia, PA, USA: Elsevier. pp. 949–1042.
  • 10. Bollani L, Auriti C, Achille C, Garofoli F, De Rose DU, Meroni V, et al. Congenital Toxoplasmosis: The State of the Art. Front Pediatr. 2022;6;10:894573. https://doi.org/10.3389/fped.2022.894573
  • 11. Bollani L, Strocchio L, Stronati M. Congenital toxoplasmosis. Early Human Development. 2013;89:70-2. https://doi.org/10.1016/S0378-3782(13)70107-5
  • 12. Wallon M, Peyron F. Congenital toxoplasmosis: a plea for a neglected disease. Pathogens. 2018;23;7(1):25. https://doi.org/10.3390/pathogens7010025
  • 13. Picone O, Fuchs F, Benoist G, Binquet C, Kieffer F, Wallon M, et al. Toxoplasmosis screening during pregnancy in France: opinion of an expert panel for the CNGOF. J Gynecol Obstet Hum Reprod. 2020;49(7):101814. https://doi.org/10.1016/j.jogoh.2020.101814
  • 14. Binquet C, Lejeune C, Seror V, Peyron F, Bertaux AC, Scemama O, et al. The cost effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis. PLoS One. 2019;18;14(9):e0221709. https://doi.org/10.1371/journal.pone.0221709
  • 15. Saso A, Bamford A, Grewal K, Noori M, Hatcher J, D'Arco F, et al. Fifteen-minute consultation: management of the infant born to a mother with toxoplasmosis in pregnancy. Arch Dis Child Educ Pract Ed. 2020;105(5):262-9. https://doi.org/10.1136/archdischild-2018-316603
  • 16. Liu Q, Wang ZD, Huang SY, Zhu XQ. Diagnosis of toxoplasmosis and typing of Toxoplasma gondii. Parasit vectors. 2015; 28;8:292. https://doi.org/10.1186/s13071-015-0902-6
  • 17. Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol. 2004;42(3):941-5. https://doi.org/10.1128/jcm.42.3.941-945.2004
  • 18. Beder D, Taşbent FE. General Features and Laboratory Diagnosis of Toxoplasma gondii Infection. Turkiye Parazitol Derg. 2020;44(2):94-101. https://doi.org/10.4274/tpd.galenos.2020.6634
  • 19. Sepúlveda-Arias JC, Gómez-Marin JE, Bobić B, Naranjo-Galvis CA, Djurković-Djaković O. Toxoplasmosis as a travel risk. Travel medicine and infectious disease. 2014;12(6 Pt A):592-601. https://doi.org/10.1016/j.tmaid.2014.05.007
  • 20. Dhombres F, Friszer S, Maurice P, Gonzales M, Kieffer F, Garel C, et al. Prognosis of fetal parenchymal cerebral lesions without ventriculomegaly in congenital toxoplasmosis infection. Fetal Diagn Ther. 2017;41(1):8-14. https://doi.org/10.1159/000445113
  • 21. Peyron F, L'ollivier C, Mandelbrot L, Wallon M, Piarroux R, Kieffer F, et al. Maternal and congenital toxoplasmosis: diagnosis and treatment recommendations of a French multidisciplinary working group. Pathogens. 2019; 18;8(1):24. https://doi.org/10.3390/pathogens8010024
  • 22. Dunay IR, Gajurel K, Dhakal R, Liesenfeld O, Montoya JG. Treatment of toxoplasmosis: historical perspective, animal models, and current clinical practice. Clin Microbiol Rev. 2018; 12;31(4):e00057-17. https://doi.org/10.1128/cmr.00057-17
  • 23. Rostami A, Riahi SM, Contopoulos-Ioannidis DG, Gamble HR, Fakhri Y, Shiadeh MN, et al. Acute Toxoplasma infection in pregnant women worldwide: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2019;14;13(10):e0007807. https://doi.org/10.1371/journal.pntd.0007807
  • 24. Borkakoty B, Biswas D, Jakharia A, Mahanta J. Seroprevalence of Toxoplasma gondii among pregnant women in Northeast India. J Assoc Physicians India. 2016;64(10):24-8. PMID: 27766799
  • 25. Malatyalı E, Yıldız İ, Tileklioğlu E, Ertabaklar H, Ertuğ S. Retrospective Analysis of T.gondii Serology Results from Adnan Menderes University Faculty of Medicine Parasitology Laboratory from 2007 to 2017. Turkiye Parazitol Derg. 2019;28;43(1):1-4. https://doi.org/10.4274/tpd.galenos.2018.6098
  • 26. Selek MB, Bektöre B, Baylan O, Özyurt M. Serological Investigation of Toxoplasma gondii on Pregnant Women and Toxoplasmosis Suspected Patients Between 2012-2014 Years on a Tertiary Training Hospital. Turkiye Parazitol Derg. 2015;39(3):200-4. https://doi.org/10.5152/tpd.2015.3961
  • 27. Prusa AR, Kasper DC, Pollak A, Gleiss A, Waldhoer T, Hayde M. The Austrian toxoplasmosis register, 1992-2008. Clin Infect Dis. 2015;15;60(2):e4-e10. https://doi.org/10.1093/cid/ciu724
  • 28. SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group, Thiébaut R, Leproust S, Chêne G, Gilbert R. Effectiveness of prenatal treatment for congenital toxoplasmosis: a meta-analysis of individual patients’ data. Lancet. 2007;13;369(9556):115-22. https://doi.org/10.1016/s0140-6736(07)60072-5
  • 29. Olariu TR, Press C, Talucod J, Olson K, Montoya JG. Congenital toxoplasmosis in the United States: clinical and serologic findings in infants born to mothers treated during pregnancy. Parasite. 2019;26:13. https://doi.org/10.1051/parasite/2019013
  • 30. Hotop A, Hlobil H, Gross U. Efficacy of rapid treatment initiation following primary Toxoplasma gondii infection during pregnancy. Clin Infect Dis. 2012;54(11):1545-52. https://doi.org/10.1093/cid/cis234
  • 31. İnceboz T, Korkmaz M, Dirim Erdoğan D, İnceboz Ü. Acute Toxoplasmosis During Pregnancy: A Hard Call. Turkiye Parazitol Derg. 2021;45(3):223-6. https://doi.org/10.4274/tpd.galenos.2021.43043
  • 32. Cortina-Borja M, Tan HK, Wallon M, Paul M, Prusa A, Buffolano W, et al. Prenatal treatment for serious neurological sequelae of congenital toxoplasmosis: an observational prospective cohort study. PLoS Med. 2010;12;7(10):e1000351. https://doi.org/10.1371/journal.pmed.1000351
  • 33. Hutson SL, Wheeler KM, McLone D, Frim D, Penn R, Swisher CN, et al. Patterns of hydrocephalus caused by congenital Toxoplasma gondii infection associate with parasite genetics. Clinical Infectious Diseases. 2015;61, 1831-4. https://doi.org/10.1093/cid/civ720
  • 34. Codaccioni C, Picone O, Lambert V, Maurice P, Pomar L, Winer N, et al. Ultrasound features of fetal toxoplasmosis: a contemporary multicenter survey in 88 fetuses. Prenatal Diagnosis. 2020;40(13):1741-52. https://doi.org/10.1002/pd.5756

Gebelerde bir halk sağlığı sorunu: akut toksoplazma enfeksiyonu-İzmir'deki bir eğitim ve araştırma hastanesinin 12 yıllık verilerinin retrospektif çalışması

Year 2024, Volume: 9 Issue: 1, 8 - 13, 25.03.2024

Kazım Kıratlı Mustafa Şengül

https://doi.org/10.22391/fppc.1379747

Abstract

Giriş: Bu çalışmanın amacı hastanemizde takip edilen gebe hastalarda akut toksoplazmoz prevalansını belirlemek, anne ve fetus sonuçlarını değerlendirerek tarama ve yönetim seçeneklerine ışık tutmaktır.
Yöntem: Bu çalışmaya 1 Ocak 2010 ile 31 Aralık 2021 tarihleri arasında bir Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Polikliniği/Kliniği ve Enfeksiyon Hastalıkları Polikliniği/Kliniğinde takip edilen 18-49 yaş arası gebeler dahil edildi. Gebelere yapılan T. gondii IgM, IgG ve avidite testleri geriye dönük olarak değerlendirildi.
Bulgular: Çalışma 7480 gebe içermektedir. Gebelerin 386'sının (%5,16) testi pozitif çıktı. Anti-T. gondii IgM seropozitifliğinin en sık 18-28 yaş grubunda (%7,82) görüldüğü ve yaş ilerledikçe bu sıklığın giderek azaldığı görüldü. Amniyotik sıvıdan, dış merkezde T. gondii için polimeraz zincir reaksiyonu bakılan 122 hastanın ikisinde konjenital toksoplazmoz tanısı konuldu ve bu gebelikler sonlandırıldı.
Sonuç: Gebe kadınlarda akut toksoplazmoz gelişme riski önemli ölçüde devam etmektedir. Halen bir halk sağlığı sorunu olarak gündemde olan bu infestasyon için gebelik planlayan ve daha önce serolojik test yaptırmamış her bireyin gebelik öncesinde tarama yaptırması gerekmektedir. Bizce gebe kadınların bu parazit hakkında bilgilendirilmesi ve eğitilmesi devam etmelidir.

Keywords

Avidite İnfestasyon Gebelik Toksoplazma

References

  • 1. WHO Estimates of the Global Burden of Foodborne Diseases (2015). Available from URL: www.euro.who.int/_data/assets/pdf_file/0011 Accessed: February 18, 2022.
  • 2. Centers for Disease Control and Prevention. Toxoplasmosis (Toxoplasma gondii) (2022). Available from URL: http://www.cdc.gov/dpdx/toxoplasmosis/ index.html Accessed: June 24, 2022
  • 3. Li K, Wang M, Zhang H, Lei Z, Zhang L, Luo H, et al. Epidemiology of Toxoplasma gondii infection in native Tibetans in Tibet, China. Acta Parasitol. 2017;26;62(3):529-32. https://doi.org/10.1515/ap-2017-0063
  • 4. Pinto B, Mattei R, Moscato GA, Cristofano M, Giraldi M, Scarpato R, et al. Toxoplasma infection in individuals in central Italy: does a gender-linked risk exist? Eur J Clin Microbiol Infect Dis. 2017;36(4):739-46. https://doi.org/10.1007/s10096-016-2857-8
  • 5. McLeod R, Cohen W, Dovgin S, Finkelstein L, Boyer KM. Human Toxoplasma infection. In Weiss LM and Kim K (eds), (2020). Toxoplasma gondii: The Model Apicomplexan – Perspectives and Methods, 3rd Edn. London: Academic Press, pp. 117–227.
  • 6. Xia J, Yolken RH. Strain hypothesis of Toxoplasma gondii infection on the outcome of human diseases. Acta Physiol (Oxf). 2015;213(4):828-45. https://doi.org/10.1111/apha.12458
  • 7. Paquet C, Yudin MH, Society of Obstetricians and Gynaecologists of Canada. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can. 2013;35(1):78-81. https://doi.org/10.1016/s1701-2163(15)31053-7
  • 8. Kaye A. Toxoplasmosis: diagnosis, treatment, and prevention in congenitally exposed infants. J Pediatr Health Care. 2011;25(6):355-64. https://doi.org/10.1016/j.pedhc.2010.04.008
  • 9. Peyron F, Wallon M, Kieffer F and Garweg J. Toxoplasmosis. InWilson CB, Nizet V, Maldonado YA, Remington JS and Klein JO (eds), (2016). Infectious Diseases of the Fetus and the Newborn Infant, 8th Edn. Philadelphia, PA, USA: Elsevier. pp. 949–1042.
  • 10. Bollani L, Auriti C, Achille C, Garofoli F, De Rose DU, Meroni V, et al. Congenital Toxoplasmosis: The State of the Art. Front Pediatr. 2022;6;10:894573. https://doi.org/10.3389/fped.2022.894573
  • 11. Bollani L, Strocchio L, Stronati M. Congenital toxoplasmosis. Early Human Development. 2013;89:70-2. https://doi.org/10.1016/S0378-3782(13)70107-5
  • 12. Wallon M, Peyron F. Congenital toxoplasmosis: a plea for a neglected disease. Pathogens. 2018;23;7(1):25. https://doi.org/10.3390/pathogens7010025
  • 13. Picone O, Fuchs F, Benoist G, Binquet C, Kieffer F, Wallon M, et al. Toxoplasmosis screening during pregnancy in France: opinion of an expert panel for the CNGOF. J Gynecol Obstet Hum Reprod. 2020;49(7):101814. https://doi.org/10.1016/j.jogoh.2020.101814
  • 14. Binquet C, Lejeune C, Seror V, Peyron F, Bertaux AC, Scemama O, et al. The cost effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis. PLoS One. 2019;18;14(9):e0221709. https://doi.org/10.1371/journal.pone.0221709
  • 15. Saso A, Bamford A, Grewal K, Noori M, Hatcher J, D'Arco F, et al. Fifteen-minute consultation: management of the infant born to a mother with toxoplasmosis in pregnancy. Arch Dis Child Educ Pract Ed. 2020;105(5):262-9. https://doi.org/10.1136/archdischild-2018-316603
  • 16. Liu Q, Wang ZD, Huang SY, Zhu XQ. Diagnosis of toxoplasmosis and typing of Toxoplasma gondii. Parasit vectors. 2015; 28;8:292. https://doi.org/10.1186/s13071-015-0902-6
  • 17. Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol. 2004;42(3):941-5. https://doi.org/10.1128/jcm.42.3.941-945.2004
  • 18. Beder D, Taşbent FE. General Features and Laboratory Diagnosis of Toxoplasma gondii Infection. Turkiye Parazitol Derg. 2020;44(2):94-101. https://doi.org/10.4274/tpd.galenos.2020.6634
  • 19. Sepúlveda-Arias JC, Gómez-Marin JE, Bobić B, Naranjo-Galvis CA, Djurković-Djaković O. Toxoplasmosis as a travel risk. Travel medicine and infectious disease. 2014;12(6 Pt A):592-601. https://doi.org/10.1016/j.tmaid.2014.05.007
  • 20. Dhombres F, Friszer S, Maurice P, Gonzales M, Kieffer F, Garel C, et al. Prognosis of fetal parenchymal cerebral lesions without ventriculomegaly in congenital toxoplasmosis infection. Fetal Diagn Ther. 2017;41(1):8-14. https://doi.org/10.1159/000445113
  • 21. Peyron F, L'ollivier C, Mandelbrot L, Wallon M, Piarroux R, Kieffer F, et al. Maternal and congenital toxoplasmosis: diagnosis and treatment recommendations of a French multidisciplinary working group. Pathogens. 2019; 18;8(1):24. https://doi.org/10.3390/pathogens8010024
  • 22. Dunay IR, Gajurel K, Dhakal R, Liesenfeld O, Montoya JG. Treatment of toxoplasmosis: historical perspective, animal models, and current clinical practice. Clin Microbiol Rev. 2018; 12;31(4):e00057-17. https://doi.org/10.1128/cmr.00057-17
  • 23. Rostami A, Riahi SM, Contopoulos-Ioannidis DG, Gamble HR, Fakhri Y, Shiadeh MN, et al. Acute Toxoplasma infection in pregnant women worldwide: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2019;14;13(10):e0007807. https://doi.org/10.1371/journal.pntd.0007807
  • 24. Borkakoty B, Biswas D, Jakharia A, Mahanta J. Seroprevalence of Toxoplasma gondii among pregnant women in Northeast India. J Assoc Physicians India. 2016;64(10):24-8. PMID: 27766799
  • 25. Malatyalı E, Yıldız İ, Tileklioğlu E, Ertabaklar H, Ertuğ S. Retrospective Analysis of T.gondii Serology Results from Adnan Menderes University Faculty of Medicine Parasitology Laboratory from 2007 to 2017. Turkiye Parazitol Derg. 2019;28;43(1):1-4. https://doi.org/10.4274/tpd.galenos.2018.6098
  • 26. Selek MB, Bektöre B, Baylan O, Özyurt M. Serological Investigation of Toxoplasma gondii on Pregnant Women and Toxoplasmosis Suspected Patients Between 2012-2014 Years on a Tertiary Training Hospital. Turkiye Parazitol Derg. 2015;39(3):200-4. https://doi.org/10.5152/tpd.2015.3961
  • 27. Prusa AR, Kasper DC, Pollak A, Gleiss A, Waldhoer T, Hayde M. The Austrian toxoplasmosis register, 1992-2008. Clin Infect Dis. 2015;15;60(2):e4-e10. https://doi.org/10.1093/cid/ciu724
  • 28. SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group, Thiébaut R, Leproust S, Chêne G, Gilbert R. Effectiveness of prenatal treatment for congenital toxoplasmosis: a meta-analysis of individual patients’ data. Lancet. 2007;13;369(9556):115-22. https://doi.org/10.1016/s0140-6736(07)60072-5
  • 29. Olariu TR, Press C, Talucod J, Olson K, Montoya JG. Congenital toxoplasmosis in the United States: clinical and serologic findings in infants born to mothers treated during pregnancy. Parasite. 2019;26:13. https://doi.org/10.1051/parasite/2019013
  • 30. Hotop A, Hlobil H, Gross U. Efficacy of rapid treatment initiation following primary Toxoplasma gondii infection during pregnancy. Clin Infect Dis. 2012;54(11):1545-52. https://doi.org/10.1093/cid/cis234
  • 31. İnceboz T, Korkmaz M, Dirim Erdoğan D, İnceboz Ü. Acute Toxoplasmosis During Pregnancy: A Hard Call. Turkiye Parazitol Derg. 2021;45(3):223-6. https://doi.org/10.4274/tpd.galenos.2021.43043
  • 32. Cortina-Borja M, Tan HK, Wallon M, Paul M, Prusa A, Buffolano W, et al. Prenatal treatment for serious neurological sequelae of congenital toxoplasmosis: an observational prospective cohort study. PLoS Med. 2010;12;7(10):e1000351. https://doi.org/10.1371/journal.pmed.1000351
  • 33. Hutson SL, Wheeler KM, McLone D, Frim D, Penn R, Swisher CN, et al. Patterns of hydrocephalus caused by congenital Toxoplasma gondii infection associate with parasite genetics. Clinical Infectious Diseases. 2015;61, 1831-4. https://doi.org/10.1093/cid/civ720
  • 34. Codaccioni C, Picone O, Lambert V, Maurice P, Pomar L, Winer N, et al. Ultrasound features of fetal toxoplasmosis: a contemporary multicenter survey in 88 fetuses. Prenatal Diagnosis. 2020;40(13):1741-52. https://doi.org/10.1002/pd.5756
There are 34 citations in total.

Details

Primary Language English
Subjects Infectious Diseases
Journal Section Original Research
Authors

Kazım Kıratlı 0000-0001-8317-955X

Mustafa Şengül 0000-0002-9129-4336

Publication Date March 25, 2024
Submission Date October 22, 2023
Acceptance Date February 20, 2024
Published in Issue Year 2024Volume: 9 Issue: 1

Cite

APA Kıratlı, K., & Şengül, M. (2024). A public health problem in pregnant women: acute toxoplasma infection - a retrospective study of 12 years of data from a training and research hospital in Izmir. Family Practice and Palliative Care, 9(1), 8-13. https://doi.org/10.22391/fppc.1379747
AMA Kıratlı K, Şengül M. A public health problem in pregnant women: acute toxoplasma infection - a retrospective study of 12 years of data from a training and research hospital in Izmir. Fam Pract Palliat Care. March 2024;9(1):8-13. doi:10.22391/fppc.1379747
Chicago Kıratlı, Kazım, and Mustafa Şengül. “A Public Health Problem in Pregnant Women: Acute Toxoplasma Infection - a Retrospective Study of 12 Years of Data from a Training and Research Hospital in Izmir”. Family Practice and Palliative Care 9, no. 1 (March 2024): 8-13. https://doi.org/10.22391/fppc.1379747.
EndNote Kıratlı K, Şengül M (March 1, 2024) A public health problem in pregnant women: acute toxoplasma infection - a retrospective study of 12 years of data from a training and research hospital in Izmir. Family Practice and Palliative Care 9 1 8–13.
IEEE K. Kıratlı and M. Şengül, “A public health problem in pregnant women: acute toxoplasma infection - a retrospective study of 12 years of data from a training and research hospital in Izmir”, Fam Pract Palliat Care, vol. 9, no. 1, pp. 8–13, 2024, doi: 10.22391/fppc.1379747.
ISNAD Kıratlı, Kazım - Şengül, Mustafa. “A Public Health Problem in Pregnant Women: Acute Toxoplasma Infection - a Retrospective Study of 12 Years of Data from a Training and Research Hospital in Izmir”. Family Practice and Palliative Care 9/1 (March 2024), 8-13. https://doi.org/10.22391/fppc.1379747.
JAMA Kıratlı K, Şengül M. A public health problem in pregnant women: acute toxoplasma infection - a retrospective study of 12 years of data from a training and research hospital in Izmir. Fam Pract Palliat Care. 2024;9:8–13.
MLA Kıratlı, Kazım and Mustafa Şengül. “A Public Health Problem in Pregnant Women: Acute Toxoplasma Infection - a Retrospective Study of 12 Years of Data from a Training and Research Hospital in Izmir”. Family Practice and Palliative Care, vol. 9, no. 1, 2024, pp. 8-13, doi:10.22391/fppc.1379747.
Vancouver Kıratlı K, Şengül M. A public health problem in pregnant women: acute toxoplasma infection - a retrospective study of 12 years of data from a training and research hospital in Izmir. Fam Pract Palliat Care. 2024;9(1):8-13.
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