1. Date of download: 7/11/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved. A, Distribution of parasite serotypes in the United States with locations mapped according to birthplace. (Climate regions, following designations of the Pacific Northwest National Laboratory and Oak Ridge National Library. 143 Map adapted from http://apps1.eere.energy.gov/buildings/publications/pdfs/building_america/ba_climateguide_7_1.pdf.) B, Serotypes and US regions. US regions were derived from the 10 standard federal regions as established by the Office of Management and Budget: East (regions I, II, and III); Southeast (region IV); South (region VI); Central (regions V, VII, and VIII); West (region IX); and Pacific Northwest (region X). The serotypes II, IIa, II = I/III, I/IIIa, I/III, and NE-II serotypes are defined elsewhere. 56 Pie graphs: Percentage = (Number of persons born in climate or geographic region with parasite serotype/Total number of persons with parasite serotype) × 100. C, NE-II serotype had greater proportions of persons residing in rural locales. Lower socioeconomic status was associated with NE-II serotype. Hispanic ethnicity was associated with NE-II serotype. SES indicates socioeconomic status calculated by the Hollingshead 4-factor socioeconomic score. SES of 4 persons with II and one person with NE-II serotype were not calculated because data were not available. SES of 4 persons with the II serotype and 1 person with the NE-II serotype was not calculated because data were not available. Rural: hometown population size, 1900 at the time of first visit to National Collaborative Chicago- based Congenital Toxoplasmosis Study (NCCCTS). D, Prematurity was associated with NE-II serotype, but not exclusively. Severe disease at birth was associated with NE-II serotype, but not exclusively. There were severely involved children diagnosed at birth with II and NE-II serotypes. Rx indicates persons in the NCCCTS cohort who were diagnosed in the perinatal period and treated during the first year of life. 24, 25, 27, 30, 35, 37, 39, 41, 51, 83, 84, 98 No Rx indicates persons in the NCCCTS cohort who missed being treated in the first year of life and were referred to the NCCCTS after that time. 28, 41, 129 All indicates persons in the Rx plus No Rx cohorts. S, severe; S/MN, severe/moderate neurologic disease, as defined in Reference 27. E, NeighborNet phylogenetic network of Toxoplasma gondii isolates. Isolates from animals in the United States are in red letters. RH88, PTG, CTG, TgCgCa1 (also known as Cougar1, COUGAR), MAS, and TgCatBr5 are used as reference strains. Numeric number in parentheses following each isolate’s identification number is the number of strains with the identical genotype from the same states. (A, B, reproduced with permission from McLeod et al 56 ; C, D, data from McLeod et al 56 ; E, reproduced with permission from Dubey and Se. 144 ) Legend : From: Toxoplasmosis in the Fetus and Newborn Infant Neonatology: Clinical Practice and Procedures, 2015 From: Toxoplasmosis in the Fetus and Newborn Infant Neonatology: Clinical Practice and Procedures, 2015