Portugal and Angola: similarities and differences in Toxoplasma gondii seroprevalence and risk factors in pregnant women

Anti-Toxoplasma gondii Antibodies in European Residents: A Systematic Review and Meta-Analysis of Studies Published between 2000 and 2020

Toxoplasmosis has a major impact on animal and public health. Information regarding the seroprevalence of human Toxoplasma gondii infections from a European perspective has not yet been compiled to date. Thus, the present review summarized available resident data from the period 2000-2020. The overall seroprevalence of anti-T. gondii IgG was 32.1%, with great variability between countries (n = 30). The subgroup analysis identified different pooled prevalence data depending on the geographic area (p < 0.0001), target population (p = 0.0147), and serological diagnosis assays used (p = 0.0059). A high heterogeneity (I2 = 100%, p < 0.001; Q = 3.5e+05, d.f. = 135, p < 0.001) and degree of publication bias (Egger's test = 6.14, p < 0.001) were observed among the 134 studies considered. The occurrence of anti-T. gondii IgM, which was reported in 64.7% of studies, reached a pooled seroprevalence of 0.6%. In addition, among the eight main risk factors identified, "contact with soil", "consumption of undercooked beef", and "intake of unwashed vegetables" were the most significantly associated with infections. The fact that one-third of the European population has been exposed to T. gondii justifies extra efforts to harmonize surveillance systems and develop additional risk-factor analyses based on detailed source attribution assessment.

Seroprevalence and Risk Factors of Toxoplasma gondii Infection Among High-Risk Populations in Jiangsu Province, Eastern China

Toxoplasma gondii, an opportunistic protozoan, infects one-third of people worldwide and could lead to serious outcomes in immunodeficient or immunocompromised populations. The present study aimed to investigate the prevalence and risk factors for T. gondii infection among high-risk populations in Jiangsu Province, eastern China. We conducted a cross-sectional survey among 4 categories of populations in 13 prefectures including HIV/AIDS patients, livestock breeding/processing (B/P) staff, pregnant women, and cancer patients. We detected specific immunoglobulin G and M (IgG and IgM) levels for each participant using enzyme-linked immunosorbent assay (ELISA) and asked to complete a questionnaire for each participant that covered sociodemographic information as well as the basic knowledge of attitudes toward and the practices for the prevention of toxoplasmosis. A total of 5231 participants distributed across 13 prefecture-level cities was surveyed, including 2455 males and 2776 females. Total seropositivity rate in each population category was as follows: 9.08% (HIV/AIDS patients), 11.65% (livestock B/P staff), 5.50% (pregnant women), and 12.89% (cancer patients). We detected IgM positivity in HIV/AIDS patients (0.47%, 6/1289), livestock B/P staff (0.08%, 1/1330), and cancer patients (0.46%, 6/1303) but not in pregnant women. Further, we detected IgM+IgG positivity only in cancer patients (0.31%, 4/1303). The seropositivity rate for pregnant women was significantly lower, while cancer patients were significantly higher. Higher educational levels were associated with lower seropositivity rates for T. gondii infection. High seropositivity rates were associated with long period of HIV infection among HIV/AIDS patients, frequent contact with livestock among livestock breeding/processing staff and male older patients among cancer patients, respectively. Analysis of practices across all participants showed that frequent contact with pets in everyday life or using the same cutting board for both raw and cooked foods leads to higher seropositivity rates. Therefore, we obtained the seroprevalence and risk factors of toxoplasmosis among high-risk populations in Jiangsu Province which could provide evidence for the implementation of control measures in the near future.

T. gondii Infection in Urban and Rural Areas in the Amazon: Where Is the Risk for Toxoplasmosis?

Toxoplasmosis, an infection caused by Toxoplasma gondii, which is found worldwide, can affect human and animal health in different ways. This study aimed to estimate the infection prevalence in humans and to determine risk factors related to urban and rural areas in a municipality in the Brazilian Amazon where an outbreak had been registered. Blood samples for serological analysis were obtained, and interviews were performed to fill out an epidemiological questionnaire. A total of 1140 individuals were included, of which 70.6% (804/1140; 95% CI: 67.9–73.2%) were positive for IgG anti-T. gondii antibodies. In rural areas, the prevalence was 62.6% (95% CI: 58.9–66.3%), while in urban areas, it was 81.9% (95% CI: 78.4–85.4%). The risk of becoming infected in urban areas was 2.7 times higher (95% CI = 2.0–3.6%) than that in rural areas. When comparing the prevalence in the age group from 1 to 10 years in both areas, the rate was 28.6% (42/147; 95% CI: 21.3–35.9%) for rural areas and 69.4% (61/88; CI 95%: 59.7–79.0%) for urban areas. Therefore, it is concluded that parasite exposure starts in the first years of life in urban areas and that disordered urban area expansion may cause an increase in exposure to the different strains of T. gondii present in the Amazon.

Serological prevalence of toxoplasmosis in pregnant women in Luanda (Angola): Geospatial distribution and its association with socio-demographic and clinical-obstetric determinants

We report a study on toxoplasmosis in pregnant women in Luanda, Angola, determining the seroprevalence, geospatial distribution and its association with socio-economic features, dietary habits and hygiene and health conditions. Anti-Toxoplasma gondii IgG and IgM were quantified in serum samples of women attended at the Lucrecia Paim Maternity Hospital between May 2016 and August 2017. The IgG avidity test and qPCR assay were used for dating the primary infection. Data were collected by questionnaire after written consent, and spatial distribution was assessed through a Kernel Density Function. The potential risk factors associated with Toxoplasma infection were evaluated using bivariate and multivariate binomial logistic regression analysis. Anti-T. gondii antibodies were quantified in 878 pregnant women, and 346 (39.4%) samples were IgG positive, 2 (0.2%) positive for IgM and IgG, and 530 (60.4%) negative for both immunoglobulins. The longitudinal study showed that none of the seronegative women seroconverted during the survey. Regarding other infections, 226 (25.7%) were positive for hepatitis B, while 118 (13.4%) were HIV-positive. The seroprevalence of toxoplasmosis was similar in most municipalities: 43.8% in Cazenga (28 of 64); 42.5% in Viana (88 of 207); 42.3% in Cacuaco (22 of 52); and 41.1% in Luanda ((179 of 435). In contrast, the seroprevalence in municipality of Belas was lower (25.8%; 31 of 120) and bivariate and multivariate analysis has shown a lower risk for toxoplasmosis in this area (OR 0.479, CI: 0.305–0.737; OR 0.471, CI: 0.299–0.728). The multivariate analysis has shown a significant increased risk for toxoplasmosis in women in the last trimester of pregnancy (OR 1.457, CI: 1.011–2.102), suffering spontaneous abortion (OR 1.863, CI: 1.014–3.465) and having pets at home (OR 1.658, CI: 1.212–2.269). Also, women who tested positive for hepatitis B (OR 1.375, CI: 1.008–1.874) and HIV (OR 1.833, CI: 1.233–2.730) had a significant increased risk for T. gondii infection. In conclusion, our study showed that a large number of pregnant women are not immunized for toxoplasmosis and identified the risk factors for this infection in Luanda. It is crucial to establish the diagnosis of primary maternal infection as well as the diagnosis of congenital toxoplasmosis. Our results underlined the need for diagnostic and clinical follow-up of toxoplasmosis, HIV and hepatitis B during pregnancy.

Toxoplasma gondii infection in pregnant women: a cross-sectional study in Matehuala City, Mexico

OBJECTIVES

This study aimed to determine the seroprevalence of Toxoplasma gondii (T. gondii) infection in pregnant women in Matehuala City, Mexico; and the associated risk factors.

DESIGN

A cross-sectional study.

SETTING

Matehuala City, Mexico.

PARTICIPANTS

311 pregnant women.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sera of women were analysed for anti-T. gondii IgG and IgM antibodies by commercially available immunoassays. Bivariate and multivariate analyses were used to assess the association between T. gondii seroprevalence and the characteristics of the pregnant women.

RESULTS

Thirteen (4.2%) of the 311 pregnant women studied were positive for anti-T. gondii IgG antibodies. No anti-T. gondii IgM antibodies were found in anti-T. gondii IgG seropositive women. No association between seropositivity and history of blood transfusion, transplantation, caesarean sections, deliveries, miscarriages or number of pregnancies was found. Logistic regression analysis of sociodemographic, behavioural and housing variables showed that availability of potable water at street represented a risk factor for T. gondii infection (age-adjusted OR=2.18; 95% CI: 1.05 to 4.53; p=0.03), whereas being born in Mexico was a protective factor for infection (age-adjusted OR=0.01; 95% CI: 0.001 to 0.35; p=0.008).

CONCLUSIONS

In this first study on the seroepidemiology of T. gondii infection in pregnant women in Matehuala, we conclude that the seroprevalence of T. gondii infection is low and similar to those reported in pregnant women in other Mexican cities. However, the seroprevalence found is lower than those reported in pregnant women in other countries in the Americas and Europe. Two risk factors associated with T. gondii infection were identified. Results of the present study may help for the optimal planning of preventive measures against toxoplasmosis in pregnant women.

Seroprevalence and Risk Factors of Toxoplasma gondii Infection in Pregnant Women from Western Romania

Seroprevalence and risk factors of Toxoplasma gondii infection were assessed among pregnant women in Western Romania. T. gondii seroprevalence was evaluated in 208 pregnant women by demonstration of serum antibodies using the commercial Vitros anti-Toxoplasma immunoglobulin G (IgG) and IgM assays. A questionnaire was administered to obtain information regarding the risk factors associated with T. gondii seropositivity. Chi-squared tests, Fisher exact test, and Stata 9.2 (Statacorp, Texas) were used to evaluate differences between T. gondii positive and negative women. T. gondii antibodies were demonstrated in 116 (55.8%) of 208 pregnant women. Lower level of education and working with meat were found to be risk factors for T. gondii seropositivity. Pet owners (cats and/or dogs) had a higher T. gondii seroprevalence than those who did not report having any pet (p = 0.032). Women with ≥4 live births were more frequently T. gondii seropositive than those without previous births (p < 0.002). Women with histories of spontaneous abortions were more frequently T. gondii seropositive than those without such a history (p = 0.036). Our results indicate a high prevalence of T. gondii antibodies in pregnant women in Romania. Risk factors for T. gondii past infection were being in the older age group, working with meat, having pets, a lower level of education, higher gravidity, and history of spontaneous abortions. This survey provided the first data regarding risk factors for T. gondii infection in pregnant women from Western Romania.

Toxoplasmosis in pregnancy: a neglected bane but a serious threat in Nigeria

Toxoplasmosis is a global health threat in which occurrence in pregnant women poses grave consequences to fetal wellbeing. Studies on prenatal Toxoplasma gondii infection are generally limited in sub-Saharan African countries, including Nigeria. The risk of transmission of toxoplasmosis is very high in Nigeria due to the favourable climatic conditions and prevailing behavioural and socio-economic factors that could aid transmission. Currently, there are no systematic and organized procedures for diagnosis and treatment of maternal toxoplasmosis in Nigeria. These conditions forecast possible unabated transmission in many areas and exponential impact on associated adverse events of the disease during pregnancy. This paper highlights the importance of early diagnosis and treatment during pregnancy which may forestall subsequent development of infection in children delivered by infected mothers. Inclusion of toxoplasmosis control policy in the routine antenatal care of pregnant women is therefore strongly recommended.