Prevalence and genotyping ofToxoplasma gondii among Saudi pregnant women in Saudi Arabia

Cross-sectional community-based study to assess the awareness of toxoplasmosis in Saudi Arabia

A few reports have been published and documented low level of awareness on toxoplasmosis among Saudi women. Herein, a cross sectional community based study was undertaken to evaluate basic knowledge on toxoplasmosis among residents in the Eastern province (Sharqiyah). Thisstudy was conducted between December 2022 and January 2023 on 334 females from different ages and educational backgrounds. Analysis of their responses revealed that only (24.9%) had heard about the disease. However, (69.8%) properly identified cats as the source of Toxoplasma gondii (T. gondii), but a smaller percentage (47.7%) knew that they might become infected through handling cat feces, and a few (26.3%) believed that bad hand hygiene can result in T. gondii infection. A few males (n = 26) have also participated, for the first time in Saudi Arabia, and displayed also low level of knowledge on toxoplasmosis. We do recommend establishing educational programs for females, in various Saudi provinces, to raise awareness on toxoplasmosis.

Seroprevalence and risk factors for Toxoplasma gondii infection among pregnant women at Debre Markos Referral Hospital, northwest Ethiopia

BACKGROUND

To assess the seroprevalence and risk factors of Toxoplasma gondii infection in pregnant women at the Debre Markos Referral Hospital, northwest Ethiopia.

METHODS

A facility-based cross-sectional study was undertaken among pregnant women from March 2020 to May 2021. Sociodemographic and clinical data were collected from randomly selected participants. Five millilitres of blood was collected and an enzyme-linked immunosorbent assay kit was used to test for T. gondii immunoglobulin G (IgG) antibodies. A logistic regression model was computed to identify the risk factors. The adjusted odds ratio (aOR) was estimated along with the 95% confidence interval (CI). A statistically significant association was defined as p<0.05.

RESULTS

T. gondii IgG antibody positivity was found in 38.8% (n=132) of 340 pregnant women. Contact with cats (AOR 2.5 [95% CI 1.5 to 4.2]), eating raw/undercooked meat (AOR 5.7 [95% CI 3.2 to 10.3]), consuming unwashed vegetables (AOR 4.1 [95% CI 2.1 to 8.0]), a history of abortion (AOR 1.9 [95% CI 1.1 to 3.3]) and drinking water sources (AOR 2.5 [95% CI 1.2 to 5.2]) demonstrated a statistically significant association with T. gondii infection.

CONCLUSIONS

Toxoplasmosis was found to be fairly common in pregnant mothers. Proper cat excreta disposal, not eating raw/undercooked meat, maintaining hand cleanliness and following environmental sanitation protocols could be important to decrease T. gondii infection.

Seroprevalence of toxoplasmosis at referral hospitals in the northwestern region, Saudi Arabia

BACKGROUND

Toxoplasmosis is induced by Toxoplasma gondii, which affects 30 percent of the global population and is responsible for deaths related to foodborne pathogens. This study aimed to describe the seroprevalence of T. gondii infections in patients attending referral hospitals in the northwestern region of Saudi Arabia.

MATERIALS AND METHODS

The serology test results for T. gondii antibodies of 797 patients were retrospectively analyzed using the hospitals' database. The enzyme-linked immunosorbent assay was used to detect anti-T. gondii antibodies (IgG and/or IgM).

RESULTS

Overall, the prevalence of anti-T. gondii antibodies was 8.3%. Higher (9.9%) prevalence of positive results among patients aged 30 years and above was observed. Statistically, the various age groups (P = 0.031) were found to be significant. Female was noted to have increased (8.1%) seroprevalence, and the incidence of infection occurred largely among participants living in rural areas (8.2%).

CONCLUSIONS

Toxoplasmosis remains a public health concern. The seroprevalence of T. gondii antibodies was relatively low in the study area. IgG antibodies to T. gondii were mainly detected. Increasing awareness on the mode of transmission, source of infection, and disease prevention through health education and dissemination is vital to reduce or eliminate toxoplasmosis.

Seroprevalence of Infections with TORCH Agents in Romania: A Systematic Review

Maternal-fetal infectious pathology-notably the TORCH panel (Toxoplasma gondii, rubella, Cytomegalovirus, and herpes simplex viruses)-critically impacts maternal and neonatal health. This review collates data on the seroprevalence of IgG and IgM antibodies against TORCH agents in Romanian women, aiming to discern regional and population differences and identify risk factors. Twenty studies were included in the review, revealing variable seroprevalence rates across the country. Regions such as Moldavia and Banat showed higher anti-T. gondii IgG seroprevalence rates than Bihor, with notable declines in Banat. Rural, older, and multiparous women showed elevated T. gondii IgG rates. Anti-rubella vaccine introduction significantly reduced the prevalence of anti-rubella IgG antibodies, but recent vaccination coverage decreases raise concerns. CMV and HSV seroprevalence varied geographically, with rural areas generally showing higher CMV rates and HSV influenced by factors like education level and number of sexual partners. Concurrent seroprevalence of multiple TORCH components in some cases underscores potential common risk factors. This study highlights the importance of continuous monitoring and preventive measures such as vaccinations and awareness campaigns to mitigate the health impact on the pregnant population.

Toxoplasma and Risk of Spontaneous Abortion: A Meta-Analysis in A Population of Iranian Women

Toxoplasma gondii is found as an intracellular protozoan parasite in the Apicomplexa phylum that can be transmitted to the fetus and causes miscarriage, infection, and asymptomatic neonatal disease. In the present study, we characterized the seroprevalence rate of anti-Toxoplasma gondii antibodies in a population of Iranian women with a recent a spontaneous abortion. We examined our national and international databases including Irandoc, Magiran, SID, Medlib, Scopus, PubMed, and the Science Direct. The search strategy was carried out by using keywords and MeSH terms. The statistical analysis was performed by STATA 14.2. By using the random effects model and the fixed effects model the statistical analysis was performed while the heterogeneity was ≥75 and ≤50%, respectively. We used the chi-squared test and I2 index to calculate heterogeneity among studies, and for evaluating publication bias, Funnel plots and Egger tests were used. The seroprevalence positive rate of IgG among women who had experienced abortion was observed 32% [95% confidence interval (CI): 20-45%] based on the random-effects model. The seroprevalence positive rate of IgM based on the fixed-effect model and positive IgG rate based on the random-effect model was evaluated 4% (95% CI: 3-6%) and 32% (9% CI: 3-42%) among women immediately after an abortion, respectively. According to the finding of our study, toxoplasmosis can be one of the most significant causes of abortion.

Molecular Characterization of Toxoplasma gondii in Cats and Its Zoonotic Potential for Public Health Significance

Toxoplasmosis is a globally distributed disease of warm-blooded animals. It is caused by the opportunistic parasite Toxoplasma gondii (T. gondii). One-third of the global human population is believed to be infected with T. gondii. Cats serve as final host of T. gondii and are the main source of contamination of soil and water. This study aimed to detect genotypes of T. gondii in cats. Fecal samples (n = 400) were collected from districts of South Punjab (Khanewal and Sahiwal), and were processed by polymerase chain reaction (PCR) followed by sequencing and phylogenetic analysis. The obtained oligonucleotide sequences (T. gondii) were submitted to the GenBank database, and the evolutionary tree was constructed using MEGA-X software. Seven fecal samples (3.5%) from cats were positive. Five out of thirteen fecal samples (38.46%) found to be positive for T. gondii with microscopy were confirmed by PCR. After phylogenetic analysis with 3 clonal types and atypical strains, isolates of T. gondii in current study were more closely linked to a typical strain (AF249696). Besides genotyping from cats, seroprevalence from humans and ruminants is still considered to be the best and easiest way to identify the Toxoplasma. Blood samples were collected from sheep and goats (n = 2000 each), and human blood samples (n = 400) were collected from the same vicinity. Seroprevalence was determined using a commercial enzyme-linked immunosorbent assay (ELISA) kit. In Khanewal, the blood samples of 292 goats (29.2%) and 265 sheep (26.5%), and 6 fecal samples from cats (3%) were positive. Out of 200 human blood samples, 52 were positive, with a seroprevalence of 26%. In the Sahiwal district, the blood samples from 49 humans, 235 sheep and 348 goats were positive, with seroprevalence of 24.5%, 23.5% and 34.8%, respectively. The present study revealed the current circulating genotype of T. gondii from cats in the districts Khanewal and Sahiwal and the seroprevalence of the organism in small ruminants and humans living in the same vicinity. Further genotype analyses of the organism from ruminants and humans are needed.

Immunological, Histopathological, Molecular Identification and Genotyping of Toxoplasma gondii in Small Ruminants in Egypt

&lt;b&gt;Background and Objective:&lt;/b&gt; Toxoplasmosis is an infective zoonotic disease caused by protozoan &lt;i&gt;Toxoplasma gondii &lt;/i&gt;(&lt;i&gt;T. gondii&lt;/i&gt;).&lt;i&gt; &lt;/i&gt;Molecular identification of &lt;i&gt;T. gondii&lt;/i&gt; followed by studying the hereditary variety range of &lt;i&gt;T. gondii &lt;/i&gt;isolates in Egypt was investigated. &lt;b&gt;Materials and Methods:&lt;/b&gt; Blood samples were acquired from 138 live ewes and 212 she-goats from 5 governorates of Egypt, also the blood and its related tissue samples (uterus, diaphragm, heart and thigh muscles from each animal) were collected from slaughtered 180 ewes and 206 she-goats from Cairo and Giza abattoirs. &lt;b&gt;Results:&lt;/b&gt; Using ELISA, the total seropositivity of live ewes and she-goats was 26.8 and 21.2%, respectively, while it was 16.6 and 33% in slaughtered ewes and she-goats, respectively. &lt;i&gt;T. gondii&lt;/i&gt; tissue cysts with the associated characteristic histopathological changes were detected in different organs. Twenty-eight &lt;i&gt;T. gondii&lt;/i&gt; isolates were confirmed using PCR, while among 24 milk samples from seropositive live ewes and she-goats, only 12.5 and 6.25%, were positive using PCR, respectively. Genotyping using multiple nested PCR (n-PCR) combined with restriction enzyme analysis (RFLP) of the surface antigen 2 (SAG2) gene confirmed 26 isolates (92.8%) as type II and 2 (7.1%) as type III. &lt;b&gt;Conclusion:&lt;/b&gt; Type II and III are the most common &lt;i&gt;T. gondii&lt;/i&gt; genotypes in Egyptian small ruminants with additional importance for public health in Egypt. Further studies are needed on the role of milk in the transmission of toxoplasmosis.

A pilot study on screening for gestational/congenital toxoplasmosis of pregnant women at delivery in the Eastern Province of Saudi Arabia

BACKGROUND

Globally, congenital toxoplasmosis remains a significant cause of morbidity and mortality, and outbreaks of T. gondii infection represent a major public health threat, especially in developing countries. Evidence in the literature indicates that only a few studies have been conducted on the incidence of maternal and congenital toxoplasmosis in Saudi Arabia. This prospective study aims to measure the overall incidence of congenital toxoplasmosis, both patent and 'silent' infection, among pregnant women in the Eastern Province of Saudi Arabia. The study would attempt to relate the cord blood results with the time of seroconversion in the mother, underlining the importance of early intervention in such cases.

METHODS

Five hundred paired maternal/cord blood samples were tested for anti-Toxoplasma IgG or IgM antibodies. Samples were collected during delivery from mother and newborn (cord blood) from November 2011 to May 2012. Only positive for anti-Toxoplasma IgG or/and IgM cord blood was processed for real-time PCR for confirmation. The age of mothers ranged from 16 to 45 years.

RESULTS

The sample subjects were tested during child delivery for specific IgG and IgM antibodies against Toxoplasmosis, of which 21.0% (n = 105) mother/baby pairs were found serologically positive for anti-Toxoplasma IgG antibodies. The rate of maternal seropositivity for anti-Toxoplasma IgM antibodies was found among 4 participants (0.8%), who were also seropositive for anti-Toxoplasma IgG antibodies. None of the children tested positive for anti-Toxoplasma IgM antibodies, even those born to mothers with IgM positive. All 105 cord blood tests in the study sample were confirmed negative by real-time PCR. The seroprevalence of Toxoplasma IgG antibodies increased with maternal age, parity, and was significantly higher in women who gave birth to children with congenital anomalies (p = 0.008).

CONCLUSION

The findings of the current study indicate a dire need to develop and implement preventive programs against Toxoplasma gondii infection, as well as a health education program on how to avoid toxoplasmosis for all seronegative women during pregnancy.

Prevalence of toxoplasmosis, rubella, cytomegalovirus, and herpes (TORCH) infections among women attending the antenatal care clinic, maternity hospital in Abha, Southwestern Saudi Arabia

Objectives:

To investigate the presence of toxoplasmosis, rubella, cytomegalovirus, and herpes (TORCH) infections in women attending at the antenatal care clinic in Abha, Kingdom of Saudi Arabia (KSA).

Methods:

A total of 190 blood samples were collected from Abha maternity hospital in Aseer region, KSA, from February 2018 to May 2019 and screened with the TORCH panel (toxoplasmagondii [IgG/IgM], cytomegalovirus [CMV] [IgG/IgM], rubella [IgG/IgM], and herpes simplex type 1 and 2 [IgG/IgM]).

Results:

The mean age was 31.42±6.514 years and gestational age was 32.48±6.168 weeks. Serum IgG was positive for Toxoplasma gondii (T. gondii) (27.4%), herpes simplex type 1 (HSV-1) (94.7%), herpes simplex type 2 (HSV-2) (0.5%), CMV (100%), and rubella (88.9%). Serum IgM was positive only for CMV (9.5%). Though, there was an association between abortions from previous pregnancies (26.5%), intrauterine death (5.8%), premature labor (3.2%), microcephaly (1.6%), other congenital diseases (1.6%) and low birth weight (0.5%) with current IgG positivity for TORCH infections, the results were not statistically significant.

Conclusion:

Seropositivity for IgG antibodies correlate with TORCH-associated pregnancy complications in Abha, KSA; however, IgM positive CMV pregnant cases warrant further systematic investigation to understand the implications of CMV on outcomes during pregnancy.

Anti-toxoplasma Antibody Prevalence and Cost-effectiveness in Pregnant Women at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Background: Toxoplasma gondii (T. gondii) is one of the most prevalent infectious parasites in humans worldwide. The diagnosis of toxoplasmosis is based on serological screening through the detection of anti-toxoplasmosis antibodies: IgG, which indicates previous exposure and the presence of active immunity, and IgM, which indicates a recent infection. We aimed to determine the prevalence of anti-toxoplasma antibodies in pregnant women at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, and explore the cost-effectiveness of anti-toxoplasma screening.

Method: This was an analytic retrospective study of women who underwent serology testing for anti-toxoplasmosis antibodies at KAUH in 2013-2018. Data were collected from hospital documentation and IBM Statistical Package for Social Sciences (SPSS Inc., Chicago, IL) version 22 was used for analysis.

Result: Of the 9,098 pregnant women seen at KAUH, 2,754 had undergone the test, and 38 had a positive result, i.e., a seroprevalence rate of 1.4%. Most women were Saudis (57.9%), and almost all were multiparous. Of those with a positive result, 36.8% were in the third trimester. Most births were by spontaneous vaginal delivery (65.8%). Twelve (31.6%) of the women with toxoplasmosis experienced obstetric complications. The estimated total cost of screening the pregnancies was US $919,646.00

Conclusion: The prevalence of pregnant women with a positive anti-toxoplasmosis test result was low, and we believe there is no net benefit from screening all pregnant women for toxoplasmosis. Primary prevention should be through health education, and we recommend screening only women with high-risk pregnancies.

Seroprevalence of Toxoplasma gondii among pregnant women attending antenatal clinics at Hawassa University comprehensive specialized and Yirgalem General Hospitals, in Southern Ethiopia

BACKGROUND

Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. It is acquired by consumption of raw or undercooked meat containing tissue cyst, food or water contaminated with oocyst and congenital infection through the placenta leading to serious congenital abnormalities in the fetus like miscarriage, stillbirth, intrauterine death and neurologic defects. Therefore; this study was aimed to determine the prevalence of toxoplasmosis infection and its possible risk factors associated with pregnant women attending antenatal clinics in Hawassa and Yiregalem Hospitals, Southern Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted from December 2016 to May 2017. The study was done in antenatal care clinics of Hawassa and Yiregalem Hospitals in Southern, Ethiopia. Five hundred pregnant women were interviewed with a pretested structured questionnaire to collect risk factors and socio-demographic data. Blood samples were collected and serum was separated and tested for anti- Toxoplasma gondii antibodies using ELISA (Enzyme-linked Immunosorbent Assay). Data were analyzed using SPSS version 20 statistical software. The risk factors were tested for significance using Bivariate and multivariate analysis. P-value < 0.05 was considered statistically significant.

RESULTS

The weighted prevalence of this study was 81.8% for the anti- Toxoplasma gondii antibody. Almost all participants (99.6%) had no information about the disease. A significant association was observed between seroprevalence and contact with domestic cats (OR = 1.206, 95% CI (1.627-2.206, P = 0.043), consumption of raw meat (OR = 0.848, 95% CI: 1.517-2.941, P = 0.019) and unpasteurized milk (OR = 0.871, 95% CI 1.531-2.221, P = 0.032). A significant association was not observed between seroprevalence and age, history of abortion, and blood transfusion.

CONCLUSIONS

The findings of this study demonstrated a relatively higher prevalence of seropositivity than studies reported from other countries. Existence of domestic cats at home, consumption of undercooked meat and unpasteurized milk were identified as risk factors for T. gondii infection. Therefore, a health education program to increase the mother's knowledge about toxoplasmosis towards avoiding eating undercooked meat, contact with cats and consumption of unpasteurized milk during pregnancy is recommended. Furthermore, our results suggested that the implementation of newborn screening and follow-up testing can lead to reducing of toxoplasmosis associated complications.

Serological and molecular screening of umbilical cord blood for Toxoplasma gondii infection

BACKGROUND

Human umbilical cord blood has proven to be a successful alternate source of hematopoietic stem cells for pediatric patients with major hematologic disorders. Toxoplasma gondii is a global opportunistic protozoan which cause fatal complications in immunocompromised individuals.

AIM

Our goal is to study the prevalence of toxoplasmosis in umbilical cord blood (UCB) and to assess the sensitivity of ELISA and PCR for Toxoplasma infection screening.

MATERIAL AND METHODS

One hundred cord blood samples were collected immediately after delivery. Anti-Toxoplasma IgG and IgM antibodies were determined using ELISA method; Toxoplasma DNA was detected using nested PCR technique. Total nucleated cells (TNC) and HB were also determined. Demographic data and risk factors data related to the transmission of toxoplasmosis, were collected from mothers.

RESULTS

Among 100 cord blood samples, 36 (36%) were positive for anti-Toxoplasma IgG antibodies and 6 (6%) were positive for anti-Toxoplasma IgM antibodies. The nested PCR showed 11 (11%) samples containing Toxoplasma DNA from which, 6 (55%) samples were IgM positive. There was no significant association between the risk of Toxoplasma transmission and cord blood positivity for toxoplasmosis.

CONCLUSION

Owing to the prevalence of toxoplasmosis, its rapid progression and its fatal outcome in immunocompromised patients, cord blood screening for toxoplasmosis with nested PCR should be incorporated into cord blood bank screening protocols.

Seroprevalence of Toxoplasma gondii and its associated risk factors among women of reproductive age in Saudi Arabia: a systematic review and meta-analysis

Toxoplasma gondii (T. gondii), which infects many warm-blooded animals including humans, causes toxoplasmosis, a globally widespread condition. To date, no research has explored the overall T. gondii infection seroprevalence among women in Saudi Arabia, nor have the risk factors associated with the infection been examined in the Saudi Arabian context. The present systematic review and meta-analysis therefore aimed to investigate toxoplasmosis seroprevalence based on previous study samples of Saudi women of reproductive age, and to establish the potentially risk factors in this national context. PubMed, Science Direct, and Scopus were searched for studies on T. gondii seroprevalence among women in mainland Saudi Arabia published between January 2000 and December 2017. Seroprevalence with 95% CI was presented for each study, and point estimates and their 95% CIs of pooled seroprevalence were then calculated. Twenty papers were eligible for inclusion, with samples totaling 13,597 females of childbearing age (ie, between 15 and 49 years) covering various regions of Saudi Arabia. The pooled estimation for T. gondii prevalence using a random-effect model was calculated as 27.8% (95% CI =20.6%–36.3%). A significant association was observed between age and T. gondii seroprevalence. This review represents the first comprehensive and systematic evaluation of T. gondii infection seroprevalence among Saudi Arabian women, and reports a high prevalence of Toxoplasma infection. Further research is required to support the development of more cost-effective preventive strategies.

Toxoplasma gondii Type I, predominant genotype isolated from sheep in South of Iran

Aim:

This study was performed to determine the genetic diversity of Toxoplasma gondii in sheep using nested-polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in Southern Iran.

Materials and Methods:

The tissue samples of diaphragm and heart from 125 sheep were collected from the main slaughterhouses of Jahrom district in South of Fars province, Iran, between Aprils and June 2013. The DNA were extracted and analyzed by nested-PCR using specific primers for SAG2 and GRA6 loci. RFLP was used to classify strains into one of the three major lineages of T. gondii.

Results:

T. gondii Type I was predominant in this area. The data obtained from both loci demonstrated that the frequency of each genotype was 72% Type I, 2.4% Type III, 7.2% mixed Type I and II, 16.8% mixed Type I and III, 0.8% mixed Type II and III, and 0.8% mixed Type I, II and III.

Conclusions:

Although the previously published data indicated that Type II is the predominant T. gondii genotype in sheep in the other parts of the world, this study showed that genotype I is the dominant genotype of T. gondii in the southern Iran; however, other genotypes were detected. High diversity of T. gondii genotypes including mix genotypes in lambs is of importance for the public health. These studies depict a new mapping of T. gondii genotypes pattern which could be very helpful in toxoplasmosis control and prevention.