Some observations on the epidemiology of toxoplasmosis in Canada

Human infectious diseases and the changing climate in the Arctic

Climatic factors, especially temperature, precipitation, and humidity play an important role in disease transmission. As the Arctic changes at an unprecedented rate due to climate change, understanding how climatic factors and climate change affect infectious disease rates is important for minimizing human and economic costs. The purpose of this systematic review was to compile recent studies in the field and compare the results to a previously published review. English language searches were conducted in PubMed, ScienceDirect, Scopus, and PLOS One. Russian language searches were conducted in the Scientific Electronic Library "eLibrary.ru". This systematic review yielded 22 articles (51%) published in English and 21 articles (49%) published in Russian since 2012. Articles about zoonotic and vector-borne diseases accounted for 67% (n = 29) of the review. Tick-borne diseases, tularemia, anthrax, and vibriosis were the most researched diseases likely to be impacted by climatic factors in the Arctic. Increased temperature and precipitation are predicted to have the greatest impact on infectious diseases in the Arctic.

East-West Divide: temperature and land cover drive spatial variation of Toxoplasma gondii infection in Eurasian otters (Lutra lutra) from England and Wales

Toxoplasma gondii, a zoonotic parasite of global importance, infects all endothermic vertebrates, with extensive health implications. The prevalence of this parasite is seldom monitored in wildlife. Here, a semi-aquatic species, the Eurasian otter (Lutra lutra) was used as a model to assess the potential effect of climate, land cover and biotic factors on T. gondii seroprevalence in British wildlife. The Sabin–Feldman cytoplasm-modifying dye test identified T. gondii antibodies in 25·5% of blood samples from otters found dead, mainly as road kill, in England and Wales, between 2004 and 2010. Otters in the east of England were more likely to be infected with T. gondii than those in western regions. Land cover and temperature are key determinants of T. gondii infection risk, with more infection in arable areas and lower infection where temperatures are higher. The probability of T. gondii infection increased with host age, reflecting cumulative exposure with time, but there was no association between T. gondii seroprevalence and cause of host death.

Association of climatic factors with infectious diseases in the Arctic and subarctic region--a systematic review

Background

The Arctic and subarctic area are likely to be highly affected by climate change, with possible impacts on human health due to effects on food security and infectious diseases.

Objectives

To investigate the evidence for an association between climatic factors and infectious diseases, and to identify the most climate-sensitive diseases and vulnerable populations in the Arctic and subarctic region.

Methods

A systematic review was conducted. A search was made in PubMed, with the last update in May 2013. Inclusion criteria included human cases of infectious disease as outcome, climate or weather factor as exposure, and Arctic or subarctic areas as study origin. Narrative reviews, case reports, and projection studies were excluded. Abstracts and selected full texts were read and evaluated by two independent readers. A data collection sheet and an adjusted version of the SIGN methodology checklist were used to assess the quality grade of each article.

Results

In total, 1953 abstracts were initially found, of which finally 29 articles were included. Almost half of the studies were carried out in Canada (n=14), the rest from Sweden (n=6), Finland (n=4), Norway (n=2), Russia (n=2), and Alaska, US (n=1). Articles were analyzed by disease group: food- and waterborne diseases, vector-borne diseases, airborne viral- and airborne bacterial diseases. Strong evidence was found in our review for an association between climatic factors and food- and waterborne diseases. The scientific evidence for a link between climate and specific vector- and rodent-borne diseases was weak due to that only a few diseases being addressed in more than one publication, although several articles were of very high quality. Air temperature and humidity seem to be important climatic factors to investigate further for viral- and bacterial airborne diseases, but from our results no conclusion about a causal relationship could be drawn.

Conclusions

More studies of high quality are needed to investigate the adverse health impacts of weather and climatic factors in the Arctic and subarctic region. No studies from Greenland or Iceland were found, and only a few from Siberia and Alaska. Disease and syndromic surveillance should be part of climate change adaptation measures in the Arctic and subarctic regions, with monitoring of extreme weather events known to pose a risk for certain infectious diseases implemented at the community level.

Are some cases of psychosis caused by microbial agents? A review of the evidence

The infectious theory of psychosis, prominent early in the twentieth century, has recently received renewed scientific support. Evidence has accumulated that schizophrenia and bipolar disorder are complex diseases in which many predisposing genes interact with one or more environmental agents to cause symptoms. The protozoan Toxoplasma gondii and cytomegalovirus are discussed as examples of infectious agents that have been linked to schizophrenia and in which genes and infectious agents interact. Such infections may occur early in life and are thus consistent with neurodevelopmental as well as genetic theories of psychosis. The outstanding questions regarding infectious theories concern timing and causality. Attempts are underway to address the former by examining sera of individuals prior to the onset of illness and to address the latter by using antiinfective medications to treat individuals with psychosis. The identification of infectious agents associated with the etiopathogenesis of schizophrenia might lead to new methods for the diagnosis, treatment and prevention of this disorder.

Antibodies to Toxoplasma gondii in patients with schizophrenia: a meta-analysis

Recent studies have linked infectious agents to schizophrenia. The largest number of studies has involved the analysis of Toxoplasma gondii; these studies were subjected to a meta-analysis. Published articles and abstracts were identified by searches of MEDLINE, Ovid, and Google Scholar; by a search of Chinese publications; through letters to researchers; and by visiting China. Published and unpublished controlled studies that used serological methods for measuring T. gondii antibodies to assess inpatients and/or outpatients diagnosed with schizophrenia were selected for analysis, and source documents were translated as needed. Forty-two studies carried out in 17 countries over 5 decades were identified; 23 of these (6 unpublished) met selection criteria. The combined odds ratio (OR) was 2.73 (95% confidence interval, 2.10 to 3.60; chi-square with 1 df 263; P < .000001). Seven studies that included only patients with first-episode schizophrenia (OR 2.54) did not differ significantly from 16 studies that included patients in all clinical phases (OR 2.79). The results suggest that individuals with schizophrenia have an increased prevalence of antibodies to T. gondii. This association is consistent with other epidemiological studies as well as with animal studies. Although the OR of 2.73 is modest, it exceeds that for genetic or other environmental factors identified to date and suggests that Toxoplasma is in some way associated with a large number of cases of schizophrenia. If an etiological association can be proven, it would have implications for the design of measures for the prevention and treatment of this disease.

Prevalence of Toxoplasma gondii antibodies in red deer (Cervus elaphus) and other wild ruminants from Spain

Serum samples from 441 red deer (Cervus elaphus) and 161 other wild ruminant species, collected between 1993 and 2005 from six regions of Spain were tested for antibodies against Toxoplasma gondii by the modified agglutination test (MAT). Antibodies to T. gondii (MAT 1:25 or higher) were detected in 15.6% of red deer. Statistically significant differences were observed among sampling sites with seroprevalence in red deer from Catalonia (42.2%) being significantly higher compared with other Spanish regions (8.7%) (P < 0.05). Statistically significant differences were not observed between T. gondii seroprevalence and sex, age or management of hunting estates (open versus fenced). Seroprevalence of T.gondii infection in other ruminants species was 24% of 79 fallow deer (Dama dama), 21.8% of 33 in roe deer (Capreolus capreolus), 33.3% of three Spanish ibex (Capra pyrenaica), 20% of 10 chamois (Rupicapra pyrenaica), 10% of 10 barbary sheep (Ammotragus lervia), and 14.8% of 27 mouflon (Ovis ammon) in areas not including Catalonia, where no samples from these species were available. Serological results indicated a widespread exposure to T. gondii among wildlife in Spain and suggest that consumption of raw or inadequately cooked meat, as well as handling carcasses of wild game, should be taken into account as a source of infection for humans.

Seasonal variations in acute toxoplasmosis in pregnant women in Slovenia

Between December 1999 and December 2004, 40 081 pregnant women were examined for toxoplasmosis with Toxo-IgG, Toxo-IgM enzyme immunoassay. Women with positive results were then retested with the Toxo-IgG avidity assay for recent toxoplasmosis. Recent acute toxoplasmosis in pregnant women was found to be significantly more frequent (p < 0.01) during winter than summer. The incidence of acute toxoplasmosis during winter-spring was also significantly more frequent (p < 0.025) than summer-autumn. This phenomenon should be taken into account when formulating preventive measures for toxoplasmosis, especially for pregnant women.

The seroepidemiology of toxoplasmosis in the lower Fraser Valley of British Columbia

OBJECTIVE

To determine the seroprevalence of toxoplasmosis in vegetarian and nonvegetarian members of different ethnic communities in the lower Fraser Valley of British Columbia.

DESIGN

Serum samples were collected from 2027 participants drawn from various ethnic groups and tested by elisa for the presence of immunoglobulin (Ig) G and IgM antibodies to Toxoplasma gondii. Coded questionnaires requesting information relevant to the study were completed by each participant. The study population comprised 1334 females and 693 males; ages ranged from 17 to 102 years.

MAIN RESULTS

Four hundred and nineteen (20.7%) individuals were IgG positive with titres ranging from 1:100 to 1:3200. IgM antibodies were detected in only four individuals. The seroprevalence rose with increase in age but there was no significant difference between males and females. A positive correlation was shown between ingestion of meat and between consumption of unpasteurized milk and antibodies to T gondii. Eighty per cent of females between the ages of 17 and 40, of all ethnic origins, were seronegative. Seropositivity did not differ between cat owners and non-cat owners.

CONCLUSIONS

Women of childbearing age are at risk of acquiring toxoplasmosis during pregnancy and of transmitting the infection transplacentally. Consumption of undercooked meat and unpasteurized milk may result in the acquisition of toxoplasmosis. Data suggest that acquisition of toxoplasmosis is more likely via environmental oocysts or cysts in food source animals than by direct contact with cats.

A seroepidemiological survey of toxoplasmosis in Scotland and England

The Sabin-Feldman dye test was used to detect the presence of Toxoplasma antibodies in two groups of blood donors in central Scotland, one group from a rural area and one from an urban area, and in patients attending a medical outpatients clinic and females attending an antenatal clinic serving a mixed urban and rural area in the midlands of England. Results obtained from these four groups showed that 7.6, 7.8, 35.7 and 14.9% respectively had antibody titres of 1: greater than or equal to 10. A group of travelling people, defined in the Local Government and Planning (Scotland) Act, 1982, as '...persons of nomadic habit of life, whatever their race or origin...', from Scotland were also surveyed and 28% of this group had antibodies of 1: greater than or equal to 10. Individuals in this latter group were reported to have minimal contact with cats because of their lifestyles. The prevalences of the travelling people were analysed by age group and showed no correlation with age, but other groups did show an increasing prevalence with age. The significance of these results is discussed.

Congenital toxoplasmosis: epidemiologic features and control

Toxoplasmosis is caused by the parasite Toxoplasma gondii. It is acquired from undercooked meat or from food or fomites contaminated by cat feces. The disease can be transmitted to the fetus only during maternal parasitemia, which is associated with primary infection. Extrapolation from current data suggests that there are 140 to 1400 cases of congenital toxoplasmosis per year in Canada and that 70 to 280 of the infants are severely affected at birth; many of the others suffer sequelae later in life. Serologic diagnosis of primary infection in the mother is quite sensitive and specific. Diagnosis in the infant is more difficult and may take several months. Prenatal treatment of the woman and postnatal treatment of the infant are hampered by the lack of proven efficacy as well as ethical and compliance problems. Preventive serologic screening and prophylaxis have the same drawbacks. Educating young women to avoid infection is an inexpensive, low-risk intervention that would be the preferred preventive strategy if it could be shown to be effective. Immunization may prove to be the most cost-effective method of preventing congenital toxoplasmosis if a safe and effective vaccine is developed.

Toxoplasmosis update and public health implications

Toxoplasma gondii has a coccidian life cycle in the intestine of domestic and wild felids that includes a series of asexual and sexual stages and an oocyst stage that is shed in the feces. Oocysts complete their development outside the body, eventually becoming infective for about 350 species of vertebrates including cats and man. The effects of climate on oocyst survival and the physical and biological means of oocyst dispersal are discussed. Infectivity and pathogenicity for livestock species vary. Acute disease results from rapidly multiplying tachyzoites that may be transmitted by carnivorism, transfusion, vertical transmission and other routes. Patent infections may persist for the life of a host as bradyzoites within tissue cysts. Bradyzoites initiate acute infection in other hosts after carnivorism or organ transplantation or in the same host after immunosuppression. Also discussed are: (a) prevalence of T. gondii in livestock as determined by digestion and serological techniques, (b) identification in humans as accomplished by isolation, serological and skin test techniques and (c) identification in cats as accomplished primarily by fecal examinations for oocysts infective for mice. Source of human infections, major outbreaks, treatment, effects on mental health and methods for preventing toxoplasmosis in man and livestock are listed.

Screening for toxoplasmosis in pregnancy

The prevalence of antibody against Toxoplasma gondi in a population of 715 pregnant women has been evaluated by two methods: indirect haemagglutination antibody (IHA) and indirect fluorescent antibody (IFA) test and all positive sera were checked by the dye test. Five hundred of the study population were questioned on diet and on animal contact to elucidate a possible relation to the prevalence of antibody. Results are expressed in international units (IU) of antibody against T gondi. Of the 715 sera, 171 were positive by IHA and 173 by IFA. One hundred and sixty-seven sera were positive by both tests, ninety-eight (58%) correlating exactly, as to the concentration of antibody. The ten sera which were not positive by both tests all had detectable antibody at the minimum concentration only (12 IU). The dye test confirmed all sera positive by both tests with the exception of three. It also confirmed one of four sera positive by IHA antibody alone and two of six positive by IFA alone. All sera that proved dye test-negative had low antibody concentrations (12 IU) by IHA or IFA. The IHA test, which is commercially available in kit form, would be suitable for use as a screening test during pregnancy. The estimated annual rate of antibody acquisition over the age range 16-40 years is 1.2% per annum with the highest rate in the 36-40 age group (2.5% per annum) and the lowest in the 26-30 age group (0.4% per annum). The clinical history was not significantly different between those with and those without antibody against T gondi but significantly more women in the 36-40 age group had a history of animal contact than those in the 26-30 age group. No conclusive evidence of recent or current infection was found.

The prevalence and epidemiology of toxoplasmosis in Ontario

The results of testing 7060 human serum specimens obtained in the Province of Ontario, Canada, were analysed for the presence of antibodies to Toxoplasma gondii. Of these samples 38% were serologically positive at a titre of 1/16 or greater. The age-specific rates climbed from 2.7% in infants between 6 months and 1 year of age, to about 50% in individuals aged 25 years or over. Variations in prevalence were noted between different areas within the province and evidence is put forward to show that an inverse relation exists between urban size and toxoplasma prevalence. Seasonal and annual variations were not shown to be significant. On the basis of a very small sample of specimens, cat ownership not appear to cause a significant increase in the risk of acquiring this infection.