Toxoplasmosis-related knowledge and practices among pregnant women in the United States

Seroprevalence and Associated Risk Factors of Toxoplasma gondii in Patients Diagnosed with Schizophrenia: A Case-Control Cross Sectional Study

The protozoan parasite, Toxoplasma gondii, has been linked to several psychiatric disorders, including schizophrenia. The aim of this study was to assess the prevalence of T. gondii IgG antibodies and risk factors associated with seroprevalence in patients diagnosed with schizophrenia. This seroepidemiological study assessed 196 participants, divided into two groups. The study group consisted of 98 schizophrenic patients and was matched with 98 healthy blood donors. A questionnaire was used to gather information regarding potential risk factors associated with T. gondii seroprevalence. Results revealed a higher seroprevalence of T. gondii IgG antibodies in schizophrenic patients (69.39%, 68/98) when compared to healthy controls (51.02%, 50/98) (OR: 2.18; 95% CI: 1.21-3.9; p = 0.01). Patients with schizophrenia who consumed raw or undercooked meat (80.65%, 25/31) (OR: 3.75; 95% CI: 1.25-11.21, p = 0.02) and those with a lower educational level (77.59%, 45/58) (OR: 3.5; 95% CI: 1.59-7.54, p = 0.002) presented increased T. gondii seropositivity rates versus their control counterparts. Our findings indicate a high T. gondii IgG seroprevalence in patients diagnosed with schizophrenia compared to healthy blood donors. Factors associated with T. gondii seroprevalence were consumption of raw or uncooked meat and a lower educational attainment. This study provided the first data regarding the potential risk factors for toxoplasmosis in Romanian patients diagnosed with schizophrenia and may serve as a foundation for future research and the development of preventive strategies.

Congenital infectious encephalopathies from the intrapartum period to postnatal life

Congenital infections are a common but often underrecognized cause of fetal brain abnormalities, as well as fetal-neonatal morbidity and mortality, that should be considered by all healthcare professionals providing neurological care to fetuses and newborns. Maternal infection with various pathogens (cytomegalovirus, Toxoplasmosis, Rubella virus, Parvovirus B19, lymphocytic choriomeningitis virus, syphilis, Zika virus, varicella zoster virus) during pregnancy can be transmitted to the developing fetus, which can cause multisystem dysfunction and destructive or malformative central nervous system lesions. These can be recognized on fetal and neonatal imaging, including ultrasound and MRI. Imaging and clinical features often overlap, but some distinguishing features can help identify specific pathogens and guide subsequent testing strategies. Some pathogens can be specifically treated, and others can be managed with targeted interventions or symptomatic therapy based on expected complications. Neurological and neurodevelopmental complications related to congenital infections vary widely and are likely driven by a combination of pathophysiologic factors, alone or in combination. These include direct invasion of the fetal central nervous system by pathogens, inflammation of the maternal-placental-fetal triad in response to infection, and long-term effects of immunogenic and epigenetic changes in the fetus in response to maternal-fetal infection. Congenital infections and their neurodevelopmental impacts should be seen as an issue of public health policy, given that infection and the associated complications disproportionately affect woman and children from low- and middle-income countries and those with lower socio-economic status in high-income countries. Congenital infections may be preventable and treatable, which can improve long-term neurodevelopmental outcomes in children.

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.

Seroprevalencia y factores de riesgo asociados a toxoplasmosis gestacional en el Nororiente Colombiano

Highlights: La toxoplasmosis gestacional podría constituir una grave problemática en ascenso en la población atendida en zona fronteriza nororiental de Colombia. La incrementada reactividad IgM específica a T.gondii en mujeres gestantes representa una alarma para la generación de estrategias de impacto en la prevención de esta problemática, como población priorizada. La seronegatividad frente a T.gondii, aún predominante en población gestante evaluada en región nororiental de Colombia, constituye un factor de riesgo relevante de toxoplasmosis gestacional, reflejado en alta susceptibilidad. La considerable exposición a factores de riesgo de toxoplasmosis en el embarazo implica una clara oportunidad de mejora de la calidad del control prenatal, mediante atención integral. Introducción:La toxoplasmosis es una zoonosis prevalente en un tercio de la población mundial, que afecta negativamente la salud materno-fetal causando daños de grado variable al feto. Objetivo: Se propuso evaluar el estado serológico IgG e IgM anti-Toxoplasma gondii y factores de riesgo relacionados, en mujeres gestantes de primer trimestre en Cúcuta, Colombia, en el año 2018. Materiales y métodos: Estudio transversal y correlacional en 111 mujeres participando voluntariamente, a quienes se testeó para IgM e IgG específicas por inmunoensayo LIA. Resultados: Se halló 19,8% y 35,1% de seropositividad total para IgM e IgG, respectivamente, 11,7% lo fue únicamente para IgM y 53,2% corresponde a la frecuencia de seronegatividad global para T.gondii; Se identificaron factores de riesgo (IC=95%) como consumo de carne mal cocida (54,1% de los casos, OR=1,8, p=0,120), de agua del grifo (48,6%, OR=1,4, p=0,421), de leche cruda de cabra o de vaca (39,6%, OR=0,78, p=0,553), además de convivencia con gatos (23,4%), éste último asociado significativamente a seropositividad al parásito (OR=2,8, p=0,025). Discusión y Conclusiones: Nuestros hallazgos revelan un posible riesgo de primo-infección en más de la mitad de la población gestante dada su seronegatividad frente al parásito, pero también una frecuencia considerable de casos con sospecha de infección muy reciente, lo que además de asociarse a un factor de riesgo previamente reconocido, deja entrever otros aspectos de riesgo en torno a la alimentación que deben impactarse mediante estrategias de prevención durante el control prenatal, sugiriendo la necesidad de fortalecer la vigilancia en torno al evento. Como citar este artículo: Cárdenas Sierra Denny Miley, Domínguez Julio Camila, Blanco Oliveros María Ximena, Soto Javier Andrés, Tórres Morales Elizabeth. Seroprevalencia y factores de riesgo asociados a toxoplasmosis gestacional en el Nororiente Colombiano. Revista Cuidarte. 2023;14(1):e2287. http://dx.doi.org/10.15649/cuidarte.2287

Building Programs to Eradicate Toxoplasmosis Part II: Education

Purpose of Review

Review work to create and evaluate educational materials that could serve as a primary prevention strategy to help both providers and patients in Panama, Colombia, and the USA reduce disease burden of Toxoplasma infections.

Recent Findings

Educational programs had not been evaluated for efficacy in Panama, USA, or Colombia.

Summary

Educational programs for high school students, pregnant women, medical students and professionals, scientists, and lay personnel were created. In most settings, short-term effects were evaluated. In Panama, Colombia, and USA, all materials showed short-term utility in transmitting information to learners. These educational materials can serve as a component of larger public health programs to lower disease burden from congenital toxoplasmosis. Future priorities include conducting robust longitudinal studies of whether education correlates with reduced adverse disease outcomes, modifying educational materials as new information regarding region-specific risk factors is discovered, and ensuring materials are widely accessible.

Serological survey of Toxoplasma gondii infection in cats in Khon Kaen, Northeast Thailand

Background and Aim: Toxoplasmosis is a zoonosis caused by Toxoplasma gondii. Cats are known to be the definitive hosts that can excrete these environmentally resistant oocysts. Other mammals, avians, and even humans can serve as the intermediate host. T. gondii infection is often asymptomatic in healthy individuals; however, it could result in serious health problems in immunocompromised and pregnant individuals. This study investigated the occurrence of T. gondii infection in cats in Khao Suan Kwang and Mueang Khon Kaen. Materials and Methods: In total, 100 serum samples from cats, that is, 62 owned cats (31 males and 31 females) and 38 adopted stray cats (21 males and 17 females), were examined for antibodies against T. gondii through rapid immunochromatographic tests (ICT). Owners were asked to sign a consent form and answer the questionnaires before sample collection. Demographic information about the cats and their owners was also recorded. Results: The overall seroprevalence of cats positive for T. gondii antibodies was found to be 5%. Notably, the Toxoplasma antibody prevalence was significantly higher in the adopted stray cats (10.53% [4/38]) that roamed the zoo than in the owned cats (1.61% [1/62]) (p > 0.05). No significant difference was observed between male (8.33%) and female (1.92%) cats. The cat owners' questionnaire revealed that more than half had never heard of toxoplasmosis before (67.7%), whereas 30.6% knew nothing about the disease transmission routes. Conclusion: This study presented a low seroprevalence of antibodies to T. gondii in owned cats from the Mueang Khon Kaen District, whereas high seroprevalence was detected in the adopted stray cats from Khao Suan Kwang. Adopted stray cats can have a higher potential for T. gondii infection; thus, they could be a source of toxoplasmosis transmission to humans. Therefore, it is essential to control the number of stray cats, and a screening test for antitoxoplasmosis could be recommended before adoption. Although the total seroprevalence was noted to be low, the zoonotic disease was present. Therefore, raising the community's awareness and knowledge might reduce the disease transmission from animals to humans.

Epidemiological investigation and reinfection evaluation of Toxoplasma gondii in chickens in Shandong Province, China

Toxoplasma gondii infects almost all warm-blooded animals, and toxoplasmosis is a common zoonotic parasitic disease worldwide. A nested PCR with high specificity and sensitivity was developed in this study based on the data collected on the infection rate of toxoplasmosis in chickens in Shandong province, and the effect of low temperature on the infectivity of tachyzoites was investigated. The sampling data showed that the total prevalence of T. gondii in Shandong province was 12.3%, and the positive rate varied in different regions, ranging from 6.7% to 21%. Chickens were infected with T. gondii under laboratory conditions, and positive chicken hearts were stored under various cold conditions to infect mice for reinfection evaluation. The results demonstrated that the parasites maintained high infectivity in mice even after 6 h of storage at -20 °C ambient temperature, indicating that short-term cryopreservation is not effective in reducing the risk of T. gondii transmission. These results form the basis for assessing the risk of toxoplasmosis contamination in consumed chicken products and provide information on the prevention of parasite transmission from animals to humans.

Hygiene measures as primary prevention of toxoplasmosis during pregnancy: A systematic review

Background Hygiene measures are recommended to prevent toxoplasmosis during pregnancy, although screening for seroconversion in pregnant women currently are debated and practices vary among countries. Objectives The purpose of this systematic literature review was to assess the effectiveness of hygiene measures during pregnancy to prevent toxoplasmosis infection. Search Strategy We followed the standard MOOSE and PRISMA criteria when conducting this systematic review and reporting the results. Selection criteria A systematic literature search was conducted for studies focused on congenital toxoplasmosis prevention, toxoplasmosis prevention during pregnancy, toxoplasmosis prevention and hygiene measures, which were published between 1970 and August 2020, using the databases of PubMed, Scope Med, EMBASE, and the Cochrane library. Data collection and analysis Our literature search identified 3964 articles, 3757 were excluded after review of title or abstract and 67 studies were considered relevant to the subject. We reviewed risk factors for toxoplasmosis infection during pregnancy and for congenital toxoplasmosis, preventive measures for toxoplasmosis during pregnancy, including: dietary recommendations, pet care measures, environmental measures, knowledge of risk factors and ways to control toxoplasmosis infection, knowledge of risk factors for infection by health professionals, knowledge of primary prevention measures by pregnant women. Conclusion: Hygiene measures are effective and applicable primary prevention to reduce toxoplasmosis and avoid congenital toxoplasmosis and its consequences. Funding No.

'Don't Worry, Honey: It's Cooked': Addressing Food Risk during Pregnancy on Facebook Italian Posts

During pregnancy, women exposed to microbiological risks are more susceptible to contracting specific pathogens, which can lead to serious diseases both in the mother and the foetus. Food-borne diseases can be avoided to a large extent by following good practices of food manipulation and cooking. Safe eating behaviours are influenced by knowledge and perception of food risks and are constructed, among others, online. Pregnant women often use Web 2.0 to obtain and share pregnancy-related information as a strategy of collective coping with emotions through conversations. This paper explores how knowledge and perceptions of food risks during pregnancy are shared among users on Italian Facebook pages and groups. The corpus, including 648,399 items (i.e., posts), was analysed: (a) first, by means of the Reinert method, to verify to what extent issues concerning food risks are debated; and (b) second, through a manual content analysis, to observe how food risks are addressed in terms of contents and social sharing of emotions. The main results show that food risk is not among the most discussed topics, and the least known and debated food risks are the most widespread (e.g., campylobacteriosis). Sometimes, food risks, when addressed, were minimised or denied, and the belief to be ‘less at risk’ than peers for such risk (i.e., optimistic bias) was observed. The results underline the importance, for health institutions, of building a tailored communication strategy on food risks during pregnancy to promote correct food behaviours by exploiting social networks.

Food Safety Knowledge and Practices of Pregnant Women and Postpartum Mothers in Slovenia

Food safety during pregnancy and postpartum is important for preventing foodborne diseases, while pregnant women are considered vulnerable due to their immunomodulatory condition. The current study aimed to investigate the self-reported food safety knowledge and practices of pregnant women and postpartum mothers in Slovenia using an online questionnaire and to compare the results with nonpregnant women as a control group. The study was conducted with 426 women, of whom 145 were pregnant, 191 were not pregnant, and 90 were postpartum. The online questionnaire consisted of questions related to food safety risk perception, hand hygiene, food purchase, food storage, food preparation and handling of infant formula and breast milk. The results showed that women generally have basic knowledge of proper food handling and are aware of food safety, but some specific gaps were identified in food handling at home, especially concerning microbiological risks. However, the results showed that pregnant women performed better than the postpartum group, and both groups performed significantly better than the nonpregnant group. The media was most frequently cited as a source of food safety information, especially by the pregnant group. Trained health workers should also inform women on how to ensure food safety in the home environment.

Toxoplasma gondii Infection in Swine: Implications for Public Health

Toxoplasmosis, due to Toxoplasma gondii, is a parasitic disease with global importance. Among livestock, chronic T. gondii infection has been reported in higher rates in pigs and small ruminants, but with subclinical infections in case commonly encountered in pigs. Seroprevalence in the global pig population ranges according to the age or species of pigs, geographical distribution, production programs, and systems. Generally, T. gondii infections are noticed in low prevalence rates in conventional pig farms with high hygiene standards. In contrast, higher prevalence is common on free-ranging farms, outdoor or backyard small pig fams, as well as in farmed or hunted wild boars. The T. gondii average worldwide seroprevalence in pigs is reported to be 13% in Europe, 21% in Africa, 25% in North America, 21% in Asia, and 23% in South America. Human toxoplasmosis outbreaks have been correlated with the consumption of raw or undercooked meat, especially from infected pigs or wild boars, as well as of contaminated drinking water. The risk of infection in processed pork products is lower compared with fresh pork, as meat processing can reduce or inactivate T. gondii tissue cysts. Hence, the prevalence of T. gondii in the pig population may be a useful indicator of the risk of human toxoplasmosis associated with the consumption of pork products. The lack of obligatory screening methods at farm level for the detection of antibodies in farmed animals or the viable T. gondii in carcasses at slaughterhouse level increases the risk of contaminated pork or meat products. For this reason, the application of biosecurity and surveillance programs at farm level is very important to prevent a T. gondii infection.

An analytical study on the awareness and practice relating toxoplasmosis among pregnant women in Casablanca, Morocco

BACKGROUND

Although toxoplasmosis is asymptomatic in most cases among pregnant women, it may cause newborn abortions and birth defects if the infection occurs during pregnancy. Therefore, raising awareness and promoting good practices of pregnant women towards toxoplasmosis disease is essential to avoid infection during pregnancy. The aim of this cross-sectional study is to assess toxoplasmosis awareness and its risk-related behavior pregnant women who attended public health centers in one of the biggest Moroccan cities: Casablanca.

METHODS

A structured questionnaire was used to collect data including socio-demographics data, awareness of etiology, modes of transmission and preventive practices towards toxoplasmosis.

RESULTS

This study survey showed that among 390 pregnant women interviewed, 41.2% reported having heard or read information regarding toxoplasmosis. Only 8.1% of them knew that toxoplasmosis is a parasitic disease caused by Toxoplasma gondii, and 13.7% of those who gave a correct answer were aware that the host of toxoplasmosis is cats. There is a significant statistical association between age, level of education and profession of pregnant women and toxoplasmosis awareness. Despite of the majority of the interviewed pregnant women had had effective preventive practices towards toxoplasmosis, 17.4% of pregnant women were convinced that Toxoplasmosis can transmit to the fetus and 14.3% stated it is asymptomatic in most cases.

CONCLUSION

This study highlights the low level of knowledge and awareness of toxoplasmosis among pregnant women in Casablanca/Morocco. Therefore, a special education program targeting all women during their reproductive age is necessary.

Seroprevalence of ToRCH Pathogens in Southeast Asia

ToRCH is the acronym for several pathogens associated with pregnancy complications and sequelae in the unborn or newborn child. Particularly primary infections during pregnancy are associated with increased risk. Seroprevalence data of ToRCH infections are important, especially in countries with weak disease surveillance systems, to estimate immunity and vaccination levels, as well as exposure rates and thus the risk of infection during pregnancy. A systematic literature search spanning a 30-year time period was conducted to identify serosurveys on ToRCH pathogens in Southeast Asia. The 96 identified studies showed that some pathogens were well studied, while only limited data were available for others. Studies from the better-developed countries of the region were more abundant. Moreover, seroprevalence data were often limited to a certain geographical region within the country or to certain cohorts, there was an evident lack of recent serosurveys, and the study quality was often not adequate. Well-designed and area-wide serosurveys of ToRCH pathogens are clearly warranted. If combined with risk factor analysis, these studies may guide the development and implementation of effective measures for infection prevention, especially during pregnancy. In addition, educational programs for health care workers and for pregnant women during antenatal care are urgently needed.

Evaluating uncertainty and variability associated with Toxoplasma gondii survival during cooking and low temperature storage of fresh cut meats

Toxoplasmosis is an infection caused by the protozoan parasite, Toxoplasma gondii. It has been reported as the fourth leading cause of hospitalization and second leading cause of death among 31 major foodborne pathogens in the United States. Humans are infected through consumption of raw or undercooked meat containing T. gondii tissue cysts or ingestion of food, soil, or water contaminated by T. gondii oocysts. People often lack knowledge about how to prevent T. gondii infection, especially the risks associated with eating or handling raw or undercooked meat. Current available data on cooking or low temperature storage for whole cuts of meat are not sufficient to validate inactivation of T. gondii. The objectives of the present study were to estimate the relationship of time and temperature with the survival rate of T. gondii during cooking and low temperature storage of fresh cut meats. We used different statistical sampling techniques such as bootstrap resampling and Gibbs sampling to establish those relationships. Monte Carlo simulation was used to estimate the safe temperature for cooking and storing meats. The results showed no detection of T. gondii in fresh meats when the internal temperature reached above 64 °C (147.2 °F) and below -18 °C (0 °F). The tissue cysts can remain viable at least up to 30 days at 4 °C (39 °F) and about 3.3% cysts survived at 62.8 °C (145 °F). This study can provide helpful information in improving the risk models to further mitigate the public health burden of toxoplasmosis.

Control of human toxoplasmosis

Toxoplasmosis is caused by Toxoplasma gondii, an apicomplexan parasite that is able to infect any nucleated cell in any warm-blooded animal. Toxoplasma gondii infects around 2 billion people and, whilst only a small percentage of infected people will suffer serious disease, the prevalence of the parasite makes it one of the most damaging zoonotic diseases in the world. Toxoplasmosis is a disease with multiple manifestations: it can cause a fatal encephalitis in immunosuppressed people; if first contracted during pregnancy, it can cause miscarriage or congenital defects in the neonate; and it can cause serious ocular disease, even in immunocompetent people. The disease has a complex epidemiology, being transmitted by ingestion of oocysts that are shed in the faeces of definitive feline hosts and contaminate water, soil and crops, or by consumption of intracellular cysts in undercooked meat from intermediate hosts. In this review we examine current and future approaches to control toxoplasmosis, which encompass a variety of measures that target different components of the life cycle of T. gondii. These include: education programs about the parasite and avoidance of contact with infectious stages; biosecurity and sanitation to ensure food and water safety; chemo- and immunotherapeutics to control active infections and disease; prophylactic options to prevent acquisition of infection by livestock and cyst formation in meat; and vaccines to prevent shedding of oocysts by definitive feline hosts.

Toxoplasmosis and knowledge: what do the Italian women know about?

Toxoplasmosis is a worldwide zoonotic infectious disease caused by Toxoplasma gondii. This infection is estimated to affect about a third of the world's population. The aim of this study was to evaluate the knowledge of Italian women about toxoplasmosis and its forms of transmission, clinical manifestations, diagnosis and prevention through two different modalities (e-research and traditional research). In a cross-sectional study, 808 Italian women were interviewed, using a self-administered questionnaire, through two different modalities: an e-research or web survey and a traditional paper research and 84% reported to have heard about toxoplasmosis, but from most of the sample, it resulted that the knowledge of the protozoan disease was superficial and incomplete.The assessment of the dimensionality related to the toxoplasmosis knowledge's instrument showed that the scale is composed by two stable and reliable factors which explain 58.6% of the variance: (a) the basic knowledge (α = 0.83), which explains the 45.2% of the variance and (b) the specialist knowledge (α = 0.71), which explains the 13.4% of the variance. The variance and the multiple linear regression data analysis showed significant predictors of correct basic knowledge of toxoplasmosis: the highest age, the highest degree of study, to have previously contracted illness or to know someone who had contracted it, to be working or to be housewives. In conclusion, this study showed limited awareness of toxoplasmosis and suggested the implementation of effective education and learning programs. The results also showed that online data collection, in academic research, might be a valid alternative to more traditional (paper-and-pencil) surveys.

Toxoplasmosis screening during pregnancy in France: Opinion of an expert panel for the CNGOF

Prenatal screening to prevent congenital toxoplasmosis as performed in France for several decades has been questioned in view of the decreasing incidence of this infection and the cost of testing. The French College of Obstetrics and Gynecology mandated a multidisciplinary panel of experts to perform a reassessment of the screening program in accordance with international good practice. In France, about 70% of pregnant women are not immune to T. gondii, and 0.2-0.25% become infected during pregnancy. The risk of maternal-fetal transmission of infection is on average 25-29% and depends greatly on the gestational age at seroconversion. In case of fetal transmission, the outcome is livebirth in 95% of cases, with latent congenital toxoplasmosis in 90% of cases and symptomatic forms in 10% of cases, of which 1/3 are severe and 2/3 moderate. Biological techniques have satisfactory performance regarding serologies for the diagnosis of maternal infections and PCR on amniotic fluid for the prenatal diagnosis of congenital toxoplasmosis. Primary prevention of toxoplasmosis is based on hygiene measures that are relatively simple, but poorly implemented. In case of maternal seroconversion, there is a strong case for prenatal prophylactic treatment as soon as possible (ideally within 3 weeks of seroconversion), spiramycin before 14 weeks of gestation (WG), and with a tendency to superiority of the pyrimethamine/sulfadiazine association over spiramycin beyond 14 W G, in order to reduce the risk of symptomatic congenital toxoplasmosis. In case of congenital toxoplasmosis, prompt initiation of treatment reduces the occurrence of cerebral signs and symptoms, as well as retinal lesions. Several medico-economic evaluations of the French toxoplasmosis screening program have been conducted including an individual cost-effectiveness approach with decision analysis which concluded on the profitability of prenatal screening as carried out in France (monthly surveillance of seronegative women, prenatal treatment in case of seroconversion, termination of pregnancy in severe forms). Though most international societies do not recommend systematic screening for mainly financial reasons, if congenital toxoplasmosis appears benign in France today, it is probably thanks to screening and the possibility of early treatment of fetuses and/or newborns. Thus, the panel recommends continuing for now the program in France for prevention of congenital toxoplasmosis.

Comparison of consumer knowledge about Campylobacter, Salmonella and Toxoplasma and their transmissibility via meat: results of a consumer study in Germany

BACKGROUND

Campylobacter is the most commonly reported causative agent of foodborne bacterial infection in Germany, and contaminated chicken meat is an important source of this zoonotic agent. The aim of this study was to determine the knowledge of consumers in Germany about Campylobacter, Salmonella and Toxoplasma and their transmissibility via meat. In addition, we investigated the level of knowledge between selected consumer groups and whether the results coincided with those of international studies.

METHODS

We conducted a cross-sectional survey of 1008 consumers in Germany via an online panel to record, analyse and evaluate the state of knowledge about Campylobacter, Salmonella and Toxoplasma. The participants were selected according to age, gender and federal states to be representative of the German population.

RESULTS

Overall, 68.3% of the respondents had never heard of Campylobacter, 20.2% had heard of Campylobacter but did not know how to protect themselves, and only 11.5% knew how to protect themselves from Campylobacter infections. Slightly more than half (52.2%) of the respondents who had at least heard of Campylobacter knew that Campylobacter was transmissible via meat. Knowledge increased significantly with age. Participants over 60 years old knew about Campylobacter almost three times as often as the 16- to 19-year-old comparison group (OR = 2.982). Consumers who had at least a secondary school certificate were almost twice as likely to know about Campylobacter as those who had no school certificate or a lower secondary school certificate (OR = 1.899). Participants who were not actors in the food chain were significantly less frequently informed about Campylobacter than were those who were actors in the food chain. Consumer knowledge of Toxoplasma was better than that of Campylobacter. Consumers have the most knowledge about Salmonella.

CONCLUSIONS

Consumers in Germany are predominantly poorly informed about Campylobacter and the transmission route via meat. General knowledge of Toxoplasma is better than that of Campylobacter. Among the three pathogens, consumers are best informed about Salmonella. This finding highlights the importance of making existing information materials more accessible to consumers in the future to increase their knowledge, with the objective of reducing the incidence of Campylobacter infections.

Knowledge and attitudes about toxoplasmosis among female university students in Egypt

Aim This study aimed to assess toxoplasmosis-related knowledge, attitudes and preventive practices among female undergraduate students in Beni-Suef University, Egypt. Subjects and methods A cross-sectional design with a multi-stage random sample of female Beni-Suef university students were recruited in this survey over a period of 8 weeks' duration using a self-administrated questionnaire. Results Among 1079 female students, only 35 (3.2%) had good knowledge. Female students of the Health Care faculty and students from rural areas had a significantly higher rate of good knowledge. The results also illustrated that most of the studied sample (63%) had a negative attitude. Nearly one-third of participants were convinced that toxoplasmosis shows symptoms and only (25.6%) agreed about the occurrence of toxoplasmosis infection during pregnancy. A significant positive correlation was found between the total knowledge score and the total attitude score of female students, indicating that students with better knowledge had more positive attitudes. Of the participants, 67.1% always ate fast food, while 70.7%, 72% and 78.2% of female students reported hand washing after gardening, cleaning areas where cats were and cooking with meat, respectively. Conclusion Knowledge regarding toxoplasmosis was deficient among female students attending Beni-Suef University, and they had a negative attitude regarding toxoplasmosis. There was also a positive correlation between students' knowledge and their attitude toward toxoplasmosis infection. Many students avoided risk behaviors in the correct way, without realizing what they avoided. There is a critical need for efficient educational programs to raise the population's awareness regarding toxoplasmosis.

Toxoplasmosis knowledge and preventive behavior among pregnant women in the city of Imperatriz, Maranhão, Brazil

The aim of this study was to assess toxoplasmosis knowledge and preventive behavior, and relate these to socioeconomic, pre-natal and environmental issues among pregnant women served by the Family Health Strategy in the municipality of Imperatriz, Maranhão, Brazil. This is a cross-sectional study performed by applying a structured and pre-tested questionnaire to a sample of 239 pregnant women. Only 23.4% of the pregnant women had good knowledge of the disease, primarily in the area of prevention, and 58.9% adopted suitable preventive behaviors. The results obtained show a significant association of various toxoplasmosis risk factors, such as drinking untreated water (OR = 2.1245; IC95% = 1.20-3.73; p = 0.0128), contact with cats (OR = 7.6875; IC95% = 4.22-13.97; p < 0,0001), cleaning cat feces (OR = 6.8738; IC95% = 3.02-15.60; p < 0.0001), eating raw meat (OR = 5.7405; IC95% = 3.21-10.24 and handling sand/cat litter OR = 10.7376; IC95% = 4.64-24.85; p < 0.0001). This shows a need for continued education on toxoplasmosis for the pregnant women seen by the Imperatriz FHS, and for more comprehensive preventive measures, with public health and education policies that take into consideration economic, social, environmental and cultural issues.

High burden and low awareness of toxoplasmosis in the United States

Toxoplasmosis, a disease with diverse clinical manifestations, caused by infection with the Apicomplexan parasite, Toxoplasma gondii (T. gondii), is a major source of morbidity and mortality in the United States. Although toxoplasmosis prevalence and mortality have declined over the past two decades, the CDC considers this disease a neglected parasitic infection requiring public health action. Here, we overview the literature to bring attention to the prevalence of the disease in the United States, and high economic burden associated with the disease. The conclusions to be drawn are clear: there is low awareness and underestimation of the disease burden amongst healthcare professionals; a high economic burden associated with the disease; relapse rates to treatment represent additional mortality and morbidity and further costs for the healthcare system; and better treatments are necessary to combat this public health threat.

Knowledge and Attitude Regarding Toxoplasmosis among Jazan University Female Students

Background

In Saudi Arabia, the prevalence of toxoplasmosis is high. However, to date, few studies have evaluated the degree of knowledge on toxoplasmosis among females in Saudi Arabia.

Objectives

The objective of this study was to assess the knowledge, attitude and preventive behavior regarding toxoplasmosis among female students at Jazan University, Jazan, southwest Saudi Arabia.

Materials and Methods

This cross-sectional study was conducted on a random sample of 440 female students at Jazan University using a semi-structured, self-administered questionnaire. Data with numerical/qualitative variables were expressed as frequency and percentage. Chi-square test was used to analyze categorical variables. P < 0.05 was used to indicate statistical significance.

Results

This study found that more than three-quarters (79.1%) of the students had insufficient knowledge about toxoplasmosis. Students from healthcare faculties had higher knowledge scores (28.5%) than students from arts and humanities (20.6%) and science (18.9%) faculties; however, the differences were not statistically significant (P = 0.77). The majority of the studied sample (92.3%) was found to eat fast food on a regular basis. About 42%, 54% and 4% of the respondents reported that they never, occasionally and always ate improperly washed vegetables, respectively.

Conclusions

This study found that a substantial proportion of Jazan University's female students have insufficient knowledge on toxoplasmosis. Health educational programs are necessary to increase the awareness and knowledge about toxoplasmosis and its clinical manifestations.

A multicenter survey on toxoplasmosis knowledge among pregnant women in Poland (the TOWER study)

Background

The seroprevalence of Toxoplasma gondii ranges widely in different areas of the world and different populations. Although toxoplasmosis is typically benign and asymptomatic, it induces major complications in immunocompromised individuals and during pregnancy. Prevention of maternal primary infection constitutes the major tool for avoiding congenital T. gondii infections and toxoplasmosis complications. The preventive measures depend on the women’s knowledge about toxoplasmosis. The aim of the study was to assess the knowledge on toxoplasmosis among pregnant women in Poland.

Methods

The study was conducted between October 2016 and January 2017 in 3 Polish cities. During a visit in a hospital outpatient clinic, pregnant women aged > 16 years fulfilled a previously validated questionnaire. The questions concerned personal data (age, parity, educational level, place of residence), toxoplasmosis knowledge (etiology, routes of transmission, symptoms, sequelae), and sources consulted to collect information.

Results

Overall, 465 pregnant women participated in the survey; 439 (94.4%) were aware of toxoplasmosis. Toxoplasmosis was perceived as a zoonotic disease by 77.4%, as a parasitic disease by 41.7%, as a disease transmitted through poor hand hygiene by 8.6%, as a childhood illness by 4%, and as a congenital disease by 0.4%. Regarding the transmission route, 84.5% of women pointed at a domestic cat, 46.7% at eating raw or undercooked meat. The total of 84.3% did not know toxoplasmosis symptoms, and 12.0% stated that they did not present the symptoms. In multivariate analysis, younger age (OR, 2.74; 95% CI, 1.67–4.49; p <  0.001), city residence (OR, 13.45; 95% CI, 3.12–57.89; p <  0.003), and higher education level (OR, 6.81; 95% CI, 3.69–12.59; p <  0.001) were significantly associated with better knowledge of toxoplasmosis, and the number of children (OR, 0.32; 95% CI, 0.22–0.48; p <  0.001) – with higher knowledge of the symptoms.

Conclusions

Among pregnant women in Poland, the basic knowledge on toxoplasmosis is very high (94.4%). Younger age, city residence, higher education level, and the number of children turned out significantly associated with better knowledge of T. gondii and toxoplasmosis symptoms.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2031-7) contains supplementary material, which is available to authorized users.

Global initiative for congenital toxoplasmosis: an observational and international comparative clinical analysis

Globally, congenital toxoplasmosis remains a significant cause of morbidity and mortality, and outbreaks of infection with T. gondii represent a significant, emerging public health burden, especially in the developing world. This parasite is a threat to public health. Disease often is not recognized and is inadequately managed. Herein, we analyze the status of congenital toxoplasmosis in Morocco, Colombia, the United States, and France. We identify the unique challenges faced by each nation in the implementation of optimal approaches to congenital toxoplasmosis as a public health problem. We suggest that developed and developing countries use a multipronged approach, modeling their public health management protocols after those in France. We conclude that education, screening, appropriate treatment, and the development of novel modalities will be required to intervene successfully in caring for individuals with this infection. Gestational screening has been demonstrated to be cost-effective, morbidity-sparing, and life-saving. Recognition of the value and promise of public health interventions to prevent human suffering from this emerging infection will facilitate better patient and societal outcomes.

A review on inactivation methods of Toxoplasma gondii in foods

Toxoplasmosis is an infection caused by Toxoplasma gondii, a widespread zoonotic protozoan which poses a great threat to human health and economic well-being worldwide. It is usually acquired by ingestion of water contaminated with oocysts from the feces of infected cats or by the ingestion of raw or undercooked foodstuff containing tissue cysts. The oocyst can contaminate irrigation water and fresh edible produce. It is estimated that approximately one-third of the human population worldwide harbor this parasite. Infection with T. gondii is an important cause of diseases of the central nervous system and the eye in immunocompromised and immunocompetent individuals. The purpose of this study was to evaluate the efficacy and applicability of thermal (heating, cooking, freezing and low temperature), non-thermal (high pressure processing, ionizing irradiation and curing) and chemical and biochemical (disinfection, essential oils and biochemical methods such as enzymes, nanoparticles, antibiotics and immune response) treatments for the inactivation, inhabitation or to kill T. gondii in foodstuff intended for public consumption and under experimental conditions.

Toxoplasma gondii Lineages Circulating in Slaughtered Industrial Pigs and Potential Risk for Consumers

Toxoplasma gondii is a cosmopolitan zoonotic protozoan parasite, and the consumption of raw or undercooked pig meat is one of the most important sources of T. gondii infection. Three predominant lineages, types I, II, and III, are widespread in Europe. Although still poorly understood, a relationship between each type and the severity of illness represents a public health issue. To gain further knowledge of the genotypes in circulation and of the potential risk for consumers, one heart sample and one diaphragm sample (206 total) were taken from each of 103 pig carcasses at an abattoir in Italy. Then, we used 529-bp repetitive element PCR and a B1 real-time PCR high-resolution melting assay coupled with sequencing to detect and genotype T. gondii isolates. T. gondii DNA was detected in 14 pigs (13.6%, 95% confidence interval = 7 to 20.2%), and types I (3.9%), II (5.8%), and III (3.9%) were identified. We found that heart tissue had a significantly higher PCR positivity rate for T. gondii than did diaphragm tissue. This is Europe's largest study on genotyping of T. gondii from pigs, and it demonstrates that all three main lineages are present in carcasses of industrially reared pigs in Italy. There is a potential risk to consumers of infection with any or all of the three lineages, and the related clinical consequences should be taken into account. This study suggests that monitoring of T. gondii types in meat is essential, especially in meat that is traditionally eaten raw or that is minimally processed.

Food Safety Instruction Improves Knowledge and Behavior Risk and Protection Factors for Foodborne Illnesses in Pregnant Populations

Objective This study compared knowledge and food-handling behavior after pathogen-specific (experimental treatment) versus basic food safety instruction (active control) presented during nutrition education classes for low-income English- and Spanish-language pregnant women. Methods Subjects (n = 550) were randomly assigned to treatment groups in two different locations in the United States. Food safety instruction was part of an 8-lesson curriculum. Food safety knowledge and behavior were measured pre/post intervention. Descriptive data were analyzed by Chi-Square or ANOVA; changes after intervention were analyzed by regression analysis. Results Knowledge improved after intervention in the pathogen-specific treatment group compared to active control, especially among Spanish-language women. Behavior change after intervention for the pathogen-specific treatment group improved for thermometer usage, refrigeration and consumption of foods at high risk for safety; however, all other improvements in behavior were accounted for by intervention regardless of treatment group. As expected, higher pre-instruction behavioral competency limited potential gain in behavior post-instruction due to a ceiling effect. This effect was more dominant among English-language women. Improvements were also linked to formal education completed, a partner at home, and other children in the home. Conclusions for Practice This study demonstrated that pathogen-specific food safety instruction leads to enhance knowledge and food handling behaviors that may improve the public health of pregnant women and their unborn children, especially among Spanish-language women. More importantly, food safety instruction, even at the most basic level, benefited pregnant women's food safety knowledge and food-handling behavior after intervention.

Toxoplasma gondii in the Food Supply

Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. Infections are usually either asymptomatic or develop mild symptoms that are self-limited, but infections in immunosuppressed persons can be severe. Infections in pregnant women can cause serious health problems in the child such as mental retardation and blindness. Infection with T. gondii in immunocompetent adults can lead to impaired eyesight. Toxoplasmosis has ranked very highly in two studies of death and disability attributable to foodborne pathogens. The consumption of raw or undercooked meat containing T. gondii tissue cysts and the consumption of raw vegetables or water contaminated with T. gondii oocysts from cat feces is most frequently associated with human illness. The risk of acquiring a Toxoplasma infection via food varies with cultural and eating habits in different human populations.

Seroprevalence of Toxoplasma gondii among HIV Patients in Jahrom, Southern Iran

Toxoplasma gondii is an important opportunistic agent especially in immunocompromised hosts and can cause significant morbidity and mortality. Hence, detection and monitoring of anti-Toxoplasma antibodies are of a great interest in HIV-infected patients. A study on the prevalence of toxoplasmosis and associated risk factors was carried out among HIV-infected patients in Jahrom, southern Iran. The prevalence of anti-Toxoplasma IgG antibodies was 21.1% in HIV-infected patients by ELISA. PCR was performed on all of the samples, and 1 of the blood samples was positively detected. Among the HIV patients, anti-Toxoplasma IgG antibodies were significantly higher in age group of 30-39 years old (P=0.05). The seroprevalence of toxoplasmosis in patients with CD4⁺<100 cells/μl was 33.3% that was significantly higher than the other groups (P=0.042) with or without IgG antibodies. The CD4⁺ count mean of seropositive patients was lower than that of seronegative patients. The seroprevalence of toxoplasmosis in patients with highly active antiretroviral therapy was significantly less than patients without therapy (P=0.02). In conclusion, this study showed low seroprevalence of latent toxoplasmosis among HIV-infected patients in the region and confirmed the need for intensifying prevention efforts among this high-risk population and also the risk of toxoplasmosis reactivation which could be important among this population.

Toxoplasmosis seroprevalence in relation to knowledge and practice among pregnant women in Dhahran, Saudi Arabia

The epidemiological importance of the different routes of Toxoplasma gondii transmission is not known and depends largely on population behaviour and knowledge. This study was conducted to assess toxoplasmosis seropositivity and the related knowledge and preventive practices that are necessary for the prevention of the disease among pregnant women. All pregnant women attending antenatal clinic were tested for T. gondii immunoglobulins followed by a survey questionnaire that tested their knowledge and preventive practice. Statistical comparisons were made between the seropositive and negative ones. We determined a low to moderate seroprevalence of toxoplasmosis among pregnant women in Dhahran, Saudi Arabia as compared to many other parts of the world. The overall positivity rates of IgG and IgM against T. gondii among 400 pregnant women were 28.5 and 3%, respectively. 75.5% of the participants had never heard about toxoplasmosis and the associated risk factors. Lack of knowledge was associated with the higher risk of infection (OR = 4.04, p < 0.001). Keeping pet cats was not common and poorly associated with infections (OR = 1.15, p ≥ 0.64). Consumption of undercooked meat was reported frequently and only slight risk was associated with sheep/goat meat (OR = 1.39, p = 0.15). Eating outside the home at restaurants was reported for the first time to be related to a higher risk of infection (OR = 2.69, p < 0.001). Several possible risk factors were suggested through odds ratios calculation and overall knowledge of toxoplasmosis by pregnant women was poor. It is therefore vital to provide a formal education about toxoplasmosis risk factors to women of childbearing age.

Listeriosis and Toxoplasmosis in Pregnancy: Essentials for Healthcare Providers

Listeriosis and toxoplasmosis are foodborne illnesses that can have long-term consequences when contracted during pregnancy. Listeriosis is implicated in stillbirth, preterm labor, newborn sepsis, and meningitis, among other complications. Toxoplasmosis is associated with blindness, cognitive delays, seizures, and hearing loss, among other significant disabilities. Healthcare providers who understand the fundamentals of Listeria and Toxoplasma infection will have the tools to identify symptoms and high-risk behaviors, educate women to make safer decisions, and provide anticipatory guidance if a pregnant woman would become infected with either of these foodborne illnesses.

Toxoplasmosis, Parvovirus, and Cytomegalovirus in Pregnancy

There are several infections in adults that warrant special consideration in pregnant women given the potential fetal consequences. Among these are toxoplasmosis, parvovirus B19, and cytomegalovirus. These infections have an important impact on the developing fetus, depending on the timing of infection. This article reviews the modes of transmission as well as maternal and neonatal effects of each of these infections. In addition, the article outlines recommended testing, fetal surveillance, and treatment where indicated.

Toxoplasmosis-Related Knowledge and Preventive Practices among Undergraduate Female Students in Jordan

Foodborne toxoplasmosis is a leading cause of foodborne deaths and hospitalization worldwide. The level of exposure to Toxoplasma gondii is influenced by culture and eating habits. There is a scarcity of data about women's knowledge and perception of this disease. The aim of this study was to determine toxoplasmosis knowledge and preventive practices of young childbearing age women in Jordan. A descriptive cross-sectional study recruited a random sample of 1,390 undergraduate university female students and was stratified based on place of residency. About half of students (51.1%) reported having "ever" heard or read about toxoplasmosis, and almost all students (98.6%) had never been tested for toxoplasmosis. Overall, there was a lack of awareness about toxoplasmosis, its risk factors, symptoms, and timing of infection, and preventive practices. High percentages of females reported a high level of hygienic practices related to hand washing after gardening, changing cat litter, and handling raw meat. However, 16.7% of students reported eating raw meat, 26.5% usually eat traditional herbs, and 17.2% drink untreated spring water. This study establishes a baseline for the awareness levels about toxoplasmosis among young women in Jordan. These findings highlight the urgent need for toxoplasmosis awareness and preventive education for childbearing females. An effective education and outreach program should cover important topics concerning risk factors, high-risk foods, and preventive measures against toxoplasmosis.

Seroprevalence of Toxoplasma gondii in the Iranian general population: a systematic review and meta-analysis

Toxoplasma gondii is one of the most common protozoan parasites with widespread distribution globally. It is the causative agent of Toxoplasma infection, which is prevalent in human and other warm-blooded vertebrates. While T. gondii infection in healthy people is usually asymptomatic, it can lead to serious pathological effects in congenital cases and immunodeficient patients. We sought to identify the seroprevalence rate of Toxoplasma infection in the Iranian general population to develop a comprehensive description of the disease condition in Iran for future use. Electronic databases (PubMed, Google Scholar, Science Direct, and Scopus) and Persian language databases (Magiran, Scientific Information Database [SID], Iran Medex, and Iran Doc) were searched. Furthermore, graduate student dissertations and proceedings of national parasitology congresses were searched manually. Our search resulted in a total of 35 reports published from 1978 to 2012.These include 22 published articles, 1 unpublished study, 8 proceedings from the Iranian conference of parasitology, and 4 graduate student dissertations, resulting in 52,294 individuals and 23,385 IgG seropositive cases. The random errors method was used for this meta-analysis. The result shows that the overall seroprevalence rate of toxoplasmos is among the general population in Iran was 39.3% (95% CI=33.0%-45.7%). There was no significant difference in the seroprevalence rate between male and female patients. A significant linear trend of increasing overall prevalence by age was noted (P<0.0001). In addition, the data indicates that there are high seroprevalence in groups who have direct contact with cats, consume uncooked meat and raw fruits or vegetables, in farmers and Housewife, individuals who have a low level of education, and live in rural areas. To the best of our knowledge, this is the first systematic review of T. gondii infection seroprevalence in Iran, which shows a high prevalence of Toxoplasma infection (more than one third). We highly recommend further study for the purposes of aiding patient management and developing more efficient diagnostic tests and effective prevention approaches.

What information do Dutch midwives give clients about toxoplasmosis, listeriosis and cytomegalovirus prevention? An exploratory study of videotaped consultations

OBJECTIVE

To assess information provided by midwives about methods to prevent toxoplasmosis, listeriosis and cytomegalovirus, and whether the amount of provided information varied according to clients' and midwives' characteristics.

METHODS

Intake consultations with 229 clients in four midwifery practices were videotaped between August 2010 and April 2011. Videotaped intake consultations, where infectious disease prevention were discussed, were evaluated, using a specifically designed nine-item scoring tool. Midwives and clients filled in a questionnaire about their background characteristics. Multilevel linear regression analysis was performed to establish associations between the amount of information provided and clients' and midwives' characteristics.

RESULTS

In total 172 consultations with fifteen midwives were suitable for analyses. Information about not eating raw or undercooked meat and not consuming unpasteurized dairy products was provided most often. Information about not sharing eating utensils with small children and thoroughly reheating all ready-to-eat foods were rarely provided. More information was provided when the client was a primigravidae or the consultation lasted longer than 50min.

CONCLUSION

Information on infectious disease prevention given to pregnant women by primary care midwives was insufficient; especially for cytomegalovirus prevention.

PRACTICE IMPLICATIONS

A guideline for professionals on preventable infectious diseases may be useful to inform pregnant women properly.

Knowledge and practice on Toxoplasma infection in pregnant women from Malaysia, Philippines, and Thailand

Toxoplasma gondii, is one of the infectious agents of congenital TORCH infections, causes severe clinical outcomes in fetus and newborns. Nevertheless this life-threatening parasitic disease is preventable by simple preventive measures related to lifestyle during pregnancy. We aim to study on the knowledge about toxoplasmosis and practices that prevents this infection among the pregnant women. Total of 2598 pregnant women from Malaysia, Philippines, and Thailand were randomly surveyed to determine the knowledge and their practices on Toxoplasma infection. The questionnaire covered respondents' general information and knowledge on plausible risks factors, symptoms, timing of infection, prevention knowledge, and preventive behavior regarding Toxoplasma infection. Majority of these pregnant women were in their age group of 20-29 years (50.9%), completed secondary level of education (51.7%), in their second trimester of pregnancies (38.1%), non-parous (36.6%), and had no history of abortion (90.4%). Based on this survey, only 11% of these pregnant women had read, heard, or seen information regarding toxoplasmosis and 3.5% of them were aware of being tested for the infection. A small percentage of these pregnant women knew that T. gondii were shed in the feces of infected cats (19.4%) and sometimes found in the raw or undercooked meat (11.0%). There was 16.1% of responding women knew that toxoplasmosis is caused by an infection. Demographic profiles such as age group, level of education, pregnancy term, and number of children of the pregnant women showed significant association with their responses toward prevention knowledge and preventive behavior related questions (P < 0.05). Thus, it is suggested that health education on toxoplasmosis and primary behavioral practices should be consistently offered to reproductive age women in general and pregnant women in particular. This information could help to reduce vertical transmission of Toxoplasma infection during pregnancy.

Neglected parasitic infections in the United States: toxoplasmosis

Toxoplasma gondii is a leading cause of severe foodborne illness in the United States. Population-based studies have found T. gondii infection to be more prevalent in racial/ethnic minority and socioeconomically disadvantaged groups. Soil contaminated with cat feces, undercooked meat, and congenital transmission are the principal sources of infection. Toxoplasmosis-associated illnesses include congenital neurologic and ocular disease; acquired illness in immunocompetent persons, most notably ocular disease; and encephalitis or disseminated disease in immunosuppressed persons. The association of T. gondii infection with risk for mental illness is intriguing and requires further research. Reduction of T. gondii in meat, improvements in hygiene and food preparation practices, and reduction of environmental contamination can prevent toxoplasmosis, but more research is needed on how to implement these measures. In addition, screening and treatment may help prevent toxoplasmosis or reduce the severity of disease in some settings.

Awareness of and knowledge about mother-to-child infections in Japanese pregnant women

To reduce the incidence of infants with congenital infections, women should be aware of and know prevention measures against maternal infection with mother-to-child infections during pregnancy. Our objective was to assess the awareness of and knowledge about mother-to-child infections in Japanese pregnant women. A survey of 343 Japanese pregnant women was completed. Awareness of 13 pathogens capable of mother-to-child transmission was surveyed. Knowledge about the transmission route, the most susceptible time of infection that may cause severe fetal disease during pregnancy, and methods to prevent maternal infection were investigated for four major pathogens (cytomegalovirus, rubella virus, Toxoplasma gondii, and parvovirus B19) and results were compared between these pathogens. The proportion of women aware of pathogens concerning TORCH syndrome was the following: rubella virus 76%, Treponema pallidum 69%, Toxoplasma gondii 58%, parvovirus B19 28%, herpes simplex virus 27%, and cytomegalovirus 18%. Only 8% knew how cytomegalovirus is transmitted, and only 12% knew how parvovirus B19 is transmitted; both were significantly lower than those who knew transmission routes for rubella virus or Toxoplasma gondii. The proportion of women who knew the most susceptible time for severe fetal infection by maternal acquisition of cytomegalovirus, Toxoplasma gondii, or parvovirus B19 was significantly lower than that for rubella virus. The vast majority of surveyed women were not aware of methods to prevent maternal infection with cytomegalovirus or parvovirus B19. In conclusion, current awareness of and knowledge about cytomegalovirus and parvovirus B19 infection are low in Japanese pregnant women.

Toxoplasmosis preventive behavior and related knowledge among Saudi pregnant women: an exploratory study

INTRODUCTION

Many cases of congenital toxoplasmosis can be prevented provided that pregnant women following hygienic measures to avert risk of infection and to reduce severity of the condition if primary prevention failed.

OBJECTIVES

This descriptive exploratory study aimed to assess the risk behavior and knowledge related to toxoplasmoisis among Saudi pregnant women attending primary health care centers (PHCs) in Al Hassa, Saudi Arabia and to determine socio-demographic characteristics related to risk behavior and knowledge.

METHODS

All Saudi pregnant women attending antenatal care at randomly selected six urban and four rural PHCs were approached. Those agreed to participate were interviewed using a pre-tested structured questionnaire collecting data regarding socio-demographic, obstetric history, toxoplasmosis risk behaviors and related knowledge.

RESULTS

Of the included pregnant women, 234 (26.8%) have fulfilled the criteria for toxoplasmosis preventive behavior recommended by Centers for Disease Prevention and Control to prevent congenital toxoplasmosis, while 48.9% reported at least one risk behavior and 24.3% reported ? two risk behaviors. Logistic regression model revealed that pregnant women aged 20 to < 30 years and those with previous history of unfavorable pregnancy outcome were more likely to follow toxoplasmosis preventive behavior. Toxoplasmosis-related knowledge showed that many women had identified the role of cats in disease transmission while failed to identify other risk factors including consumption of undercooked meats, unwashed fruits and vegetables, and contacting with soil. Predictors for pregnant women to be knowledgeable towards toxoplasmosis included those aged 30 to <40 years (OR=1.53), with ? secondary education (OR=1.96), had previous unfavorable pregnancy outcomes (OR=1.88) and investigated for toxoplasmosis (OR=2.08) as reveled by multivariate regression model.

CONCLUSION

Pregnant women in Al Hasas, Saudi Arabia, are substantially vulnerable to toxoplasmosis infection as they are lacking the necessary preventive behavior. A sizable portion have no sufficient knowledge for primary prevention of congenital toxoplasmosis, health education at primary care is necessary to avert the potential toxoplasmosis related complications especially in the neonates.

Observational study to assess pregnant women's knowledge and behaviour to prevent toxoplasmosis, listeriosis and cytomegalovirus

Background

Toxoplasmosis, listeriosis and cytomegalovirus (CMV) can negatively affect pregnancy outcomes, but can be prevented by simple precautions of pregnant women. Literature suggests that pregnant women are not always adequately informed by their care provider about preventable infectious diseases and most pregnant women have a low level of knowledge regarding these topics. There is not much information about the actual risk behaviour of pregnant women. The purpose of this study was to assess knowledge and risk behaviour related to toxoplasmosis, listeriosis and CMV infection prevention in pregnant women.

Methods

A cross-sectional survey among pregnant women from twenty midwifery practices across the Netherlands that participated in the DELIVER study, between October 2010 and December 2010. The questionnaire items covered respondents’ knowledge of preventive practices in general, risk behaviour, and sources of received information.

Results

Of the 1,097 respondents (response 66.0%), 75.3% had heard, read or seen information about toxoplasmosis, 61.7% about listeriosis and 12.5% about CMV. The majority reported having heard about these infections from their care providers or read about these in printed media or on the Internet. Respondents showed limited knowledge about preventive practices for toxoplasmosis, listeriosis or CMV infection. Regarding toxoplasmosis, risk behaviour was more prevalent among respondents who had a high level of education, had the Dutch nationality, did not take folic acid during their first trimester, and had ever worked in a children day-care setting. Regarding listeriosis, risk behaviour was more prevalent among respondents who where in their third trimester. Regarding CMV infections, risk behaviour was less prevalent among respondents who were in their third trimester of pregnancy.

Conclusion

Of the respondents, a substantial part did not have knowledge about preventive practices to avoid listeriosis, toxoplasmosis and CMV infections during pregnancy. Many pregnant women are appropriately avoiding risk behaviour, without knowing what they are avoiding. Advising pregnant women about behaviours and life-style habits to prevent infectious diseases remains important and information about preventive practices need to be complete and adequate. However, it may be less important to give pregnant women specific infectious diseases information. More attention towards CMV is necessary.

Toxoplasma gondii infection in women of childbearing age of Isfahan, Iran: A population-based study

Background:

We conducted an epidemiological survey on seroprevalence of toxoplasma infection in women of childbearing age in Isfahan Province.

Materials and Methods:

In a cross-sectional study in 2010, 217 women in the age range of 10–50 years were randomly selected. The blood samples examined for the presence of IgG anti-Toxoplasma gondii antibody by a commercial ELISA kit (Dia-Pro, Milan, Italy). Chi-square and Fisher's exact tests were employed to examine the antibody status in different age, marriage, education, and residence groups.

Results:

The overall prevalence was 47.5% (103/217). The peak age of infection acquisition was in the range 30–40 years in rural areas and 20–30 years in urban districts. There was no significant association between residence, education, and marriage groups on the one hand and chance of T. gondii infection on the other hand.

Conclusions:

The findings of the study suggest a moderate prevalence of T. gondii infection, but a high prevalence in ages of high reproductive activities.

Toxoplasma gondii seroprevalence in Mali

The protozoan parasite Toxoplasma gondii is globally distributed, with considerable local variation in prevalence based on behavioral and environmental factors. To assess prevalence and estimate risk in Mali, we conducted a survey of 760 serum samples previously collected for malaria studies. A modified agglutination test detected antibodies in ∼27% of the adult population, with no significant differences between men and women, or between urban and rural study sites. In the village of Kolle, seroprevalence rose from 0% in infants (<1 yr, but after weaning of maternal immunoglobulin G) to 0.8% (1-5 yr), 2.7% (6-10), 11.3% (11-15), and 26.8% (>15); differences between the <10-, 11-15-, and >15-yr age groups were highly significant (P ≤ 0.01). We also observed an increase in anti- T. gondii antibody titers with age. Modeling the observed age distribution suggests a seroconversion rate of ∼1%/yr, indicating that congenital toxoplasmosis may be an under-appreciated public health concern in Mali.

Foodborne toxoplasmosis

Toxoplasmosis can be due to congenital infection or acquired infection after birth and is one of the leading illnesses associated with foodborne hospitalizations and deaths. Undercooked meat, especially pork, lamb, and wild game meat, and soil contaminated with cat feces on raw fruits and vegetables are the major sources of foodborne transmission for humans. The new trend in the production of free-range organically raised meat could increase the risk of Toxoplasma gondii contamination of meat. Foodborne transmission can be prevented by production practices that reduce T. gondii in meat, adequate cooking of meat, washing of raw fruits and vegetables, prevention of cross contamination in the kitchen, and measures that decrease spread of viable oocysts into the environment.