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Rosado D, Intriago B, Loor E, Alcívar F, Avila J, Sotomayor M, Villacres L, Faytong-Haro M. Associations between Toxoplasma gondii seropositivity and psychopathological manifestations in schizophrenic patients: A single-center study from Ecuador. PLoS One 2024; 19:e0297523. [PMID: 38394236 PMCID: PMC10890741 DOI: 10.1371/journal.pone.0297523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Schizophrenia, a complex neuropsychiatric disorder, is believed to be influenced by various factors including environmental exposures. A potential environmental factor is the infection by the obligate intracellular parasitic protozoan, Toxoplasma gondii which affects neurotransmitter levels, which could potentially exacerbate, trigger symptoms of schizophrenia or make them worst. OBJECTIVE To investigate the association between Toxoplasma gondii seropositivity and psychopathological presentation in persons with schizophrenia in Ecuador. METHODS This study was conducted at the Neuroscience Institute of Guayaquil, Ecuador. Among 368 inpatients, 104 were selected based on specific inclusion and exclusion criteria. Descriptive statistics captured patient characteristics and mental health outcomes. Logistic regression models estimated the effect of toxoplasmosis on various mental health outcomes, controlling for demographic and health-related variables. RESULTS 86.5% of participants were seropositive for toxoplasmosis. Toxoplasma-seropositive schizophrenic patients had a lower risk of depression but a significantly higher risk of disorientation. The most prevalent mental health outcomes were Language Impairments (70.2%) and Bizarre Behavior (76.0%). CONCLUSION Our findings suggest that Toxoplasma gondii seropositivity may have specific effects on mental functions in schizophrenic patients, particularly reducing the risk of depression but increasing the risk of disorientation. Further studies are required to clarify these associations and the potential underlying mechanisms.
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Affiliation(s)
- Diego Rosado
- School of Health, Universidad de Especialidades Espíritu Santo, Guayas, Samborondón, Ecuador
| | - Belen Intriago
- School of Health, Universidad de Especialidades Espíritu Santo, Guayas, Samborondón, Ecuador
| | - Evelyn Loor
- School of Health, Universidad de Especialidades Espíritu Santo, Guayas, Samborondón, Ecuador
| | - Flor Alcívar
- School of Health, Universidad de Especialidades Espíritu Santo, Guayas, Samborondón, Ecuador
| | - Jorge Avila
- Internal Medicine, Elizabeth’s Medical Center, Tufts University, St, Hospital, Boston, MA, United States of America
| | - Mario Sotomayor
- Gastroenterology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Larissa Villacres
- School of Health, Universidad de Especialidades Espíritu Santo, Guayas, Samborondón, Ecuador
| | - Marco Faytong-Haro
- Universidad Estatal de Milagro, Cdla. Universitaria “Dr. Rómulo Minchala Murillo”, Guayas, Milagro, Ecuador
- Laboratorio para Investigación para el Desarrollo del Ecuador, Guayas, Guayaquil, Ecuador
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Guimarães AL, Richer Araujo Coelho D, Scoriels L, Mambrini J, Ribeiro do Valle Antonelli L, Henriques P, Teixeira-Carvalho A, Assis Martins Filho O, Mineo J, Bahia-Oliveira L, Panizzutti R. Effects of Toxoplasma gondii infection on cognition, symptoms, and response to digital cognitive training in schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:104. [PMID: 36434103 PMCID: PMC9700796 DOI: 10.1038/s41537-022-00292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/28/2022] [Indexed: 11/27/2022]
Abstract
Studies indicate that neuroscience-informed digital cognitive training can remediate cognitive impairments in schizophrenia, but the factors contributing to these deficits and response to treatment remain unclear. Toxoplasma gondii is a neuroinvasive parasite linked to cognitive decline that also presents a higher prevalence in schizophrenia. Here, we compared the cognition and symptom severity of IgG seropositive (TOXO+; n = 25) and seronegative (TOXO-; n = 35) patients who participated in a randomized controlled trial of digital cognitive training. At baseline, TOXO+ subjects presented lower global cognition than TOXO- (F = 3.78, p = 0.05). Specifically, TOXO+ subjects showed worse verbal memory and learning (F = 4.48, p = 0.03), social cognition (F = 5.71, p = 0.02), and higher antibody concentrations were associated with increased negative (r = 0.42, p = 0.04) and total (r = 0.40, p = 0.04) schizophrenia symptoms. After training, the TOXO+ group showed higher adherence to the intervention (X2 = 9.31, p = 0.03), but there were no differences in changes in cognition and symptoms between groups. These findings highlight the association between seropositivity to T. gondii and deteriorated cognition and symptoms in schizophrenia. Further research is needed to assess the specific efficacy of digital cognitive training on this population.
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Affiliation(s)
- Anna Luiza Guimarães
- grid.8536.80000 0001 2294 473XInstituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil ,grid.8536.80000 0001 2294 473XInstituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - David Richer Araujo Coelho
- grid.8536.80000 0001 2294 473XDepartamento de Imunoparasitologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Linda Scoriels
- grid.8536.80000 0001 2294 473XInstituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil ,grid.8536.80000 0001 2294 473XInstituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Mambrini
- grid.418068.30000 0001 0723 0931Instituto René Rachou, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Priscilla Henriques
- grid.418068.30000 0001 0723 0931Instituto René Rachou, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Andréa Teixeira-Carvalho
- grid.418068.30000 0001 0723 0931Instituto René Rachou, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - José Mineo
- grid.411284.a0000 0004 4647 6936Universidade Federal de Uberlândia, Uberlândia, Brazil
| | - Lilian Bahia-Oliveira
- grid.8536.80000 0001 2294 473XDepartamento de Imunoparasitologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Panizzutti
- grid.8536.80000 0001 2294 473XInstituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil ,grid.8536.80000 0001 2294 473XInstituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Ademe M, Kebede T, Teferra S, Alemayehu M, Girma F, Abebe T. Is latent Toxoplasma gondii infection associated with the occurrence of schizophrenia? A case-control study. PLoS One 2022; 17:e0270377. [PMID: 35737701 PMCID: PMC9223392 DOI: 10.1371/journal.pone.0270377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Neurotropic pathogens such as Toxoplasma gondii (T. gondii) which result in chronic infections in the brain are associated with mental illnesses. In view of this, a growing body of literature has revealed the possible interaction of schizophrenia and T. gondii infection.
Method
A case-control study was conducted from February 2018 to January 2019 among 47 Schizophrenia patients and 47 age and sex-matched controls. Data was collected using a structured questionnaire. Serum was used for serological analysis of anti-T. gondii IgG and IgM antibodies through chemiluminescent immunoassay. Proportions and mean with standard deviations (SD) were used as descriptive measures and variables with p-values <0.05 were considered as statistically significant and independently associated with schizophrenia.
Result
The mean ages of schizophrenia patients and controls were 29.64 ± 5.8 yrs and 30.98 ± 7.3 yrs, respectively. We found that 81.9% (77/94) of the study subjects had a positive anti-T. gondii IgG antibody. While the difference is statistically insignificant, schizophrenic patients have a marginally higher seroprevalence of toxoplasmosis than controls (87.2% vs 80.9%; p = 0.398). Schizophrenia cases who live in homes with soil floors have a significantly higher T. gondii infection as compared to those who live in homes with cement/ceramic floors (90.9% vs 33.3%; p = 0.004). Furthermore, there was a significantly lower T. gondii infection among schizophrenic cases who were taking antipsychotic medication for more than three yrs (79.3% vs 100.0%, p = 0.039). On the other hand, among all study subjects who have T. gondii infection, subjects who are addicted to khat and alcohol were about seven times more likely to develop schizophrenia (71.4% vs 47.7%, OR = 7.13, p = 0.024).
Conclusion
Our data is not sufficient to show a significant positive correlation between T. gondii infection and schizophrenia. For study subjects with T. gondii infection, addiction to khat and alcohol is one of the risk factors for schizophrenia.
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Affiliation(s)
- Muluneh Ademe
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Tadesse Kebede
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melkam Alemayehu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Friehiwot Girma
- Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Burkhardt E, Berger M, Yolken RH, Lin A, Yuen HP, Wood SJ, Francey SM, Thompson A, McGorry PD, Nelson B, Yung AR, Amminger GP. Toxoplasma gondii, Herpesviridae and long-term risk of transition to first-episode psychosis in an ultra high-risk sample. Schizophr Res 2021; 233:24-30. [PMID: 34225023 DOI: 10.1016/j.schres.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/11/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ultra high-risk (UHR) criteria were introduced to identify people at imminent risk of developing psychosis. To improve prognostic accuracy, additional clinical and biological risk factors have been researched. Associations between psychotic disorders and infections with Toxoplasma gondii and Herpesviridae have been found. It is unknown if exposure to those pathogens increases the risk of transition to psychosis in UHR cohorts. METHODS We conducted a long-term follow-up of 96 people meeting UHR criteria, previously seen at the Personal Assessment and Crisis Evaluation (PACE) clinic, a specialized service in Melbourne, Australia. Transition to psychosis was assessed using the Comprehensive Assessment of the At-Risk Mental State (CAARMS) and state public mental health records. The relationship between IgG antibodies to Herpesviridae (HSV-1, HSV-2, CMV, EBV, VZV) and Toxoplasma gondii and risk for transition was examined with Cox regression models. RESULTS Mean follow-up duration was 6.46 (±3.65) years. Participants who transitioned to psychosis (n = 14) had significantly higher antibody titers for Toxoplasma gondii compared to those who did not develop psychosis (p = 0.03). After adjusting for age, gender and year of baseline assessment, seropositivity for Toxoplasma gondii was associated with a 3.6-fold increase in transition hazard in multivariate Cox regression models (HR = 3.6; p = 0.036). No significant association was found between serostatus for Herpesviridae and risk of transition. CONCLUSIONS Exposure to Toxoplasma gondii may contribute to the manifestation of positive psychotic symptoms and increase the risk of transitioning to psychosis in UHR individuals.
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Affiliation(s)
- E Burkhardt
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - M Berger
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - R H Yolken
- John Hopkins University School of Medicine, Stanley Division of Developmental Neurovirology, Baltimore, USA
| | - A Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - H P Yuen
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S J Wood
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S M Francey
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A Thompson
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - P D McGorry
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - B Nelson
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A R Yung
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; School of Health Sciences, University of Manchester, UK
| | - G P Amminger
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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5
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Ansari-Lari M, Zendehboodi Z, Masoudian M, Mohammadi F. Additive effect of glutathione S-transferase T1 active genotype and infection with Toxoplasma gondii for increasing the risk of schizophrenia. Nord J Psychiatry 2021; 75:275-280. [PMID: 33191823 DOI: 10.1080/08039488.2020.1843711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine if Toxoplasma gondii (T. gondii) infection may play a role in the development of schizophrenia in genetically susceptible persons with regard to genes encoding glutathione S-transferase T1 (GSTT1) and M1 (GSTM1). METHODS A total of 78 cases with psychiatric diagnosis of schizophrenia were compared with 91 healthy controls. For detection of IgG antibodies, enzyme-linked immunosorbent assay was used. Genotyping of GSTM1 and GSTT1 was performed by multiplex PCR. Chi-square and logistic regression were used for statistical analyses. RESULTS A higher frequency of the GSTT1 active gene in schizophrenic patients was observed. When risk categories based on the combination of T. gondii status and GSTs polymorphisms were compared, risk of schizophrenia increased in T. gondii positive/GSTT1 absent subjects (OR = 4.75, p = 0.05) compared with T. gondii negative/GSTT1 absent group. When T. gondii positive subjects had the GSTT1 active genotype, the risk increased linearly (OR = 10.20, p < 0.001). Odds ratio in T. gondii positive groups were almost the same in combination with the GSTM1 active genotype (OR = 4.45, p = 0.003) or null genotype (OR = 4.37, p = 0.006). CONCLUSIONS Our results showed an additive effect for T. gondii and GSTT1 active genotype as risk factors for schizophrenia in Iranian population. This is a small pilot study and replicating the study with larger groups of patients in multinational investigation to clarify these findings is recommended.
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Affiliation(s)
- Maryam Ansari-Lari
- Department of Food Hygiene and Public Heath, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Zahra Zendehboodi
- Department of Biology, College of Sciences, Shiraz University, Shiraz, Iran
| | - Malihe Masoudian
- Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Fahimeh Mohammadi
- Graduated from the School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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Manuel L, Santos-Gomes G, Noormahomed EV. Human toxoplasmosis in Mozambique: gaps in knowledge and research opportunities. Parasit Vectors 2020; 13:571. [PMID: 33176884 PMCID: PMC7659051 DOI: 10.1186/s13071-020-04441-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/30/2020] [Indexed: 01/01/2023] Open
Abstract
Toxoplasmosis is a parasitic zoonotic disease caused by Toxoplasma gondii that afflicts humans worldwide and wild and domestic warm-blooded animals. In immunocompetent individuals, the acute phase of infection presents transient low or mild symptoms that remain unnoticed. In immunocompromised patients, T. gondii is a life-threatening opportunistic infection, which can result from the reactivation of latent infection or primary infection. Moreover, congenital toxoplasmosis, which results from the transplacental passage of tachyzoites into the fetus during a pregnant primary infection, can lead to miscarriage, stillbirth, or ocular and neurologic disease, and neurocognitive deficits in the newborns. Thus, the present review aims to address the current knowledge of T. gondii infection and toxoplasmosis in Africa and especially in Mozambique, stressing the importance of identifying risk factors and promote awareness among the health care providers and population, assessing the gaps in knowledge and define research priorities. In Mozambique, and in general in southern African countries, clinical disease and epidemiological data have not yet been entirely addressed in addition to the implications of T. gondii infection in immunocompetent individuals, in pregnant women, and its relation with neuropsychiatric disorders. The main gaps in knowledge in Mozambique include lack of awareness of the disease, lack of diagnostic methods in health facilities, lack of genetic data, and lack of control strategies.![]()
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Affiliation(s)
- Leonardo Manuel
- Faculty of Health Sciences, Universidade Lurio, Nampula, Mozambique
| | - Gabriela Santos-Gomes
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Emilia V Noormahomed
- Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique. .,Department of Medicine, Infectious Disease Division, University of California, San Diego, USA. .,Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique.
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Toxoplasma gondii: AnUnderestimated Threat? Trends Parasitol 2020; 36:959-969. [PMID: 33012669 DOI: 10.1016/j.pt.2020.08.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023]
Abstract
Traditionally, the protozoan parasite Toxoplasma gondii has been thought of as relevant to public health primarily within the context of congenital toxoplasmosis or postnatally acquired disease in immunocompromised patients. However, latent T.gondii infection has been increasingly associated with a wide variety of neuropsychiatric disorders and, more recently, causal frameworks for these epidemiological associations have been proposed. We present assimilated evidence on the associations between T.gondii and various human neuropsychiatric disorders and outline how these may be explained within a unifying causal framework. We argue that the occult effects of latent T.gondii infection likely outweigh the recognised overt morbidity caused by toxoplasmosis, substantially raising the public health importance of this parasite.
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Ibrahim Ali M, Abdel Gawad Mousa Ismail M, Abd-Elftah Abd-Allah G, Abdel-Latif M, Mohamed Shaapan R, Salah H, Sayed Abdel Gawad S, Abu-Sarea EY. Toxoplasmosis in Schizophrenic Patients: Immune-diagnosis and Serum Dopamine Level. Pak J Biol Sci 2020; 23:1131-1137. [PMID: 32981244 DOI: 10.3923/pjbs.2020.1131.1137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Toxoplasma gondii is an obligate intracellular protozoan parasite widely distributed all over the world. It has been associated with various psychiatric conditions as schizophrenia. This study aiming to evaluate the association between T. gondii infection and schizophrenia and to estimate the effect of T. gondii infection on the serum dopamine level among schizophrenic patients. MATERIALS AND METHODS A case-control study was conducted over 45 schizophrenic patients and 44 normal controls. Serum IgM and IgG anti-T. gondii antibodies were detected by a commercial ELISA Kit. The immunoblotting method was performed for the detection of IgG anti-Toxoplasma dopamine was detected by the human dopamine ELISA kit. RESULTS Anti-T. gondii IgM was negative in all the 90 studied individuals. However, anti-T. gondii IgG was positive in 25 schizophrenic patients (55.6%) and 13 normal healthy controls (28.9%). Immunoblotting showed stronger specific reaction to proteins with molecular weights 50 and 60 kDa by +ve IgG schizophrenic patients. The serum dopamine level among schizophrenic patients was increased as compared to healthy controls (47.22 and 25.79%, respectively; p <0.001). In addition, the dopamine levels in +ve IgG were higher than those of -ve IgG schizophrenic patients. CONCLUSION These results suggest that chronic T. gondii infection causes high dopamine levels that may lead to schizophrenia. About 55% of schizophrenic patients showed positive IgG reactions to Toxoplasma within this population, the dopamine levels were higher than seronegative population and revealed both 50 and 60 kDa proteins band specific to Toxoplasma.
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Romanov DV, Brazhnikov AI, Andreyuk DS, Zakharova NV, Bravve LV, Kovaleva VA, Abbazova EV, Goncharov DB, Titova IV, Domonova EA, Kostyuk GP. Schizophrenia and toxoplasmosis: association with catatonic symptoms. CONSORTIUM PSYCHIATRICUM 2020; 1:22-29. [PMID: 38680390 PMCID: PMC11047268 DOI: 10.17650/2712-7672-2020-1-1-22-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 05/01/2024] Open
Abstract
Introduction The association between schizophrenia and toxoplasmosis has been demonstrated in a number of studies: the prevalence of schizophrenia is significantly higher in toxoplasmosis positive subjects than in those with T. gondii negative status. However, the clinical significance of this association remains poorly understood. Objectives To identify clinical phenomena that are typical for toxoplasmosis-associated (T. gondii seropositive) schizophrenia compared to Toxoplasma-seronegative schizophrenia. Methods A retrospective database analysis of serum samples from 105 inpatients with schizophrenia (ICD-10code: F20; including 55 male patients; mean age of 27.4 6.4 years) was carried out. The clinical examination involved a structured interview including ICD-10 and E. Bleulers criteria for schizophrenia and psychometric tests(Positive and Negative Scales of PANSS). Serum antibodies (IgG) to T. gondii were identified using ELISA. The statistical significance of any differences were evaluated using the non-parametric Mann-Whitney (U) and X2 tests. Results The proportion of seropositive patients in the sample was 16.2%. Comparing schizophrenia patients, who were seropositive or seronegative for toxoplasmosis, there were no statistically significant differences for the mean total PANSS score, mean PANSS-P, PANSS-N or PANSS-G scores. For the majority of PANSS items, differences were also statistically insignificant, except for G5 and G6mannerism and posturing. Seropositive patients had a higher score for this item than seronegative patients: 3.5 versus 2.1 points (U=389.5; р=0.001). Depression, on the contrary,was less pronounced in seropositive than seronegative patients: 1.4 versus 2.4 points (U=509.5; р=0.023). In addition,in seropositive patients, the frequency of symptoms such as mutism according to ICD-10 criteria for schizophrenia was significantly higher (23.5% versus 3.4%, X2=9.27, р=0.013), and the whole group of catatonic symptoms according to the E. Bleulers criteria for schizophrenia was higher (52.9% versus 28.4%, X2=3.916, p = 0.048). Conclusion The association between a positive toxoplasmosis status in patients with schizophrenia and catatonic symptoms has been revealed for the first time and should be verified in larger studies.
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Affiliation(s)
- Dmitry V. Romanov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- Mental Health Research Centre
| | | | - Denis S. Andreyuk
- Mental-health clinic No. 1 named after N.A. Aleхeev
- M.V. Lomonosov Moscow State University, Faculty of Economics
| | | | | | - Vasilisa A. Kovaleva
- N.F. Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia
| | - Evgeniya V. Abbazova
- N.F. Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia
| | - Dmitriy B. Goncharov
- N.F. Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia
| | - Irina V. Titova
- N.F. Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia
| | - Elvira A. Domonova
- N.F. Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia
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Kano SI, Hodgkinson CA, Jones-Brando L, Eastwood S, Ishizuka K, Niwa M, Choi EY, Chang DJ, Chen Y, Velivela SD, Leister F, Wood J, Chowdari K, Ducci F, Caycedo DA, Heinz E, Newman ER, Cascella N, Mortensen PB, Zandi PP, Dickerson F, Nimgaonkar V, Goldman D, Harrison PJ, Yolken RH, Sawa A. Host-parasite interaction associated with major mental illness. Mol Psychiatry 2020; 25:194-205. [PMID: 30127472 PMCID: PMC6382596 DOI: 10.1038/s41380-018-0217-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/16/2018] [Accepted: 06/20/2018] [Indexed: 11/23/2022]
Abstract
Clinical studies frequently report that patients with major mental illness such as schizophrenia and bipolar disorder have co-morbid physical conditions, suggesting that systemic alterations affecting both brain and peripheral tissues might underlie the disorders. Numerous studies have reported elevated levels of anti-Toxoplasma gondii (T. gondii) antibodies in patients with major mental illnesses, but the underlying mechanism was unclear. Using multidisciplinary epidemiological, cell biological, and gene expression profiling approaches, we report here multiple lines of evidence suggesting that a major mental illness-related susceptibility factor, Disrupted in schizophrenia (DISC1), is involved in host immune responses against T. gondii infection. Specifically, our cell biology and gene expression studies have revealed that DISC1 Leu607Phe variation, which changes DISC1 interaction with activating transcription factor 4 (ATF4), modifies gene expression patterns upon T. gondii infection. Our epidemiological data have also shown that DISC1 607 Phe/Phe genotype was associated with higher T. gondii antibody levels in sera. Although further studies are required, our study provides mechanistic insight into one of the few well-replicated serological observations in major mental illness.
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Affiliation(s)
- Shin-Ichi Kano
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Colin A Hodgkinson
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Lorraine Jones-Brando
- Stanley Division of Developmental Neurovirology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Sharon Eastwood
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
| | - Koko Ishizuka
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Minae Niwa
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Eric Y Choi
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Daniel J Chang
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Yian Chen
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Swetha D Velivela
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Flora Leister
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joel Wood
- Departments of Psychiatry and Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Kodavali Chowdari
- Departments of Psychiatry and Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Francesca Ducci
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Daniel A Caycedo
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Elizabeth Heinz
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Emily R Newman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Nicola Cascella
- Departments of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Preben B Mortensen
- National Centre for Register-Based Research, University of Aarhus, Aarhus, 8000, Denmark
| | - Peter P Zandi
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Faith Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, 21204, USA
| | - Vishwajit Nimgaonkar
- Departments of Psychiatry and Human Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - David Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
| | - Robert H Yolken
- Stanley Division of Developmental Neurovirology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Akira Sawa
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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11
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Pierson J, Yeruva RR, El-Mallakh RS. Can in utero Zika virus exposure be a risk factor for schizophrenia in the offspring? World J Biol Psychiatry 2020; 21:2-11. [PMID: 30051738 DOI: 10.1080/15622975.2018.1500027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives: Schizophrenia is a severe psychiatric illness that has been purported to be causally related to in utero infection of neurotropic organisms. For obvious ethical reasons, this hypothesis has never been tested prospectively in humans. However, with the recent introduction of Zika virus into the New World offers the opportunity to test the hypothesis of infection in schizophrenia.Methods: This is a directed review examining the hypothesis. The literature relevant to Zika virus transmission in the New World, its biology and neurotropy is reviewed.Results: Zika virus has been associated with a wide variety of neural tube and neuroanatomical abnormalities. In its original range, Zika is only infrequently associated with congenital anomalies, but in the New World, where the majority of the population has not developed immunity, infections are associated with a wide range of neurologic abnormalities.Conclusions: The current outbreak of Zika virus in the Western Hemisphere, offers the opportunity to prospectively examine the congenital infection hypothesis of the pathogenesis of schizophrenia.
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Affiliation(s)
- Johnathan Pierson
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA
| | - Rajashekar Reddy Yeruva
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA
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12
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Flegr J, Horáček J. Negative Effects of Latent Toxoplasmosis on Mental Health. Front Psychiatry 2019; 10:1012. [PMID: 32132937 PMCID: PMC7040223 DOI: 10.3389/fpsyt.2019.01012] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022] Open
Abstract
Infection by the parasite Toxoplasma, which affects about 33% of world population, is associated with an increased risk of several mental health disorders, the most strongly with schizophrenia. It is unknown whether schizophrenia is associated with this infection the most strongly, or whether this association has just been the most intensively studied for historical reasons. We used the data from 6,367 subjects tested for toxoplasmosis who took part in an internet survey to search for associations of these infections with 24 mental health disorders and evidence of otherwise impaired mental health. The typical symptom associated with toxoplasmosis was anxiety, and the typical toxoplasmosis-associated disorders were autism (OR = 4.78), schizophrenia (OR = 3.33), attention deficit hyperactivity disorder (OR = 2.50), obsessive compulsive disorder (OR = 1.86), antisocial personality disorder (OR = 1.63), learning disabilities (OR = 1.59), and anxiety disorder (OR = 1.48). Toxoplasmosis could play a substantial role in the etiopathogenesis of mental health disorders and its association with schizophrenia is the second strongest association, after autism.
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Affiliation(s)
- Jaroslav Flegr
- Division of Biology, Faculty of Science, Charles University in Prague, Prague, Czechia.,Applied Neurosciences and Brain Imagination, National Institute of Mental Health, Klecany, Czechia
| | - Jiří Horáček
- Applied Neurosciences and Brain Imagination, National Institute of Mental Health, Klecany, Czechia
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13
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Latent toxoplasmosis and olfactory functions of Rh positive and Rh negative subjects. PLoS One 2018; 13:e0209773. [PMID: 30589911 PMCID: PMC6307871 DOI: 10.1371/journal.pone.0209773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022] Open
Abstract
Backgrounds The prevalence of toxoplasmosis is higher in schizophrenics than in the general population. It has been suggested that certain symptoms of schizophrenia, including changes in olfactory functions, are in fact symptoms of toxoplasmosis that can be easily detected in schizophrenics only due to the increased prevalence of toxoplasmosis in this population. Schizophrenics have impaired identification of odors and lower sensitivity of odor detection, however, no information about these parameters of non-schizophrenic Toxoplasma-infected subjects is available. Methods Here we searched for differences in olfactory functions between 62 infected and 61 noninfected non-schizophrenic subjects using the case-controls experimental design. Results The infected men scored better than the non-infected controls in the standard odor-identification test. The infected women rated all smells as more intensive while the infected men rated nearly all smells as less intensive. Infected women rated the pleasantness of the smell of the cat urine as higher than the non-infected women and the opposite was true for the men–in contrast, higher pleasantness of odor in infected men and lower in infected women were observed and described in the 2011 study. Toxoplasmosis, Rh, and toxoplasmosis-Rh interaction were not associated with the rated pleasantness of the smell of other stimuli. However, our sample contained only 17 Rh negative men and 30 Rh negative women. Therefore, all results concerning the main effects of Rh factor and the interaction with Rh factor must be considered only preliminary. Conclusions Our results suggest that latent toxoplasmosis is associated with changes in the olfactory functions in humans; however, the observed changes differ from those observed in schizophrenics.
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14
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Liu HC, Hung GCL, Yang SY, Liao YT, Pan CH, Chen CC, Kuo CJ. Antipsychotic drugs and risk of newly diagnosed tuberculosis in schizophrenia. Psychiatry Clin Neurosci 2018; 72:789-800. [PMID: 29987915 DOI: 10.1111/pcn.12736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/18/2018] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Abstract
AIM Patients with schizophrenia have a higher incidence of tuberculosis than do people in the general population. Information is limited regarding the association between antipsychotic agents and the risk of tuberculosis in patients with schizophrenia. This exploratory study assessed the risk of tuberculosis among patients with schizophrenia on antipsychotic therapy. METHODS Among a nationwide schizophrenia cohort derived from the National Health Insurance Research Database in Taiwan (n = 32 399), we identified 284 patients who had developed newly diagnosed tuberculosis after their first psychiatric admission. Ten or fewer matched controls were selected randomly from the cohort for each patient based on risk-set sampling. We categorized exposure to antipsychotic medications by type and defined daily dose. Using multivariate methods, we explored individual antipsychotic agents for the risk of tuberculosis and employed a propensity-scoring method in sensitivity analyses to validate any associations. RESULTS Among the antipsychotic agents studied and after adjustment for covariates, current use of clozapine was the only antipsychotic agent associated with a 63% increased risk of tuberculosis (adjusted risk ratio = 1.63, P = 0.014). In addition, the association did not show a clear dose-dependent relationship. Clozapine combined with other antipsychotic agents showed a potential synergistic risk for tuberculosis (adjusted risk ratio = 2.30, P = 0.044). CONCLUSION This exploratory study suggests the potential risk of clozapine on the risk of tuberculosis, especially for those on clozapine in combination with other antipsychotics. Future studies are needed to verify the association.
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Affiliation(s)
- Hsing-Cheng Liu
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Galen Chin-Lun Hung
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Shu-Yu Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Tang Liao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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15
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Is there a relation between the manipulative activity of Toxoplasma and personalized medicine? Expert Rev Anti Infect Ther 2017; 16:1-3. [DOI: 10.1080/14787210.2018.1417838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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16
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Abdulai-Saiku S, Tong WH, Vyas A. Sexual Transmission of Cyst-Forming Coccidian Parasites with Complex Life Cycles. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0133-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Campos-Carli SMD, Vieira ÉLM, Rocha NP, Oliveira KD, Guimarães FC, Barbosa IG, Barros JLVMD, Okusaga O, Martins-Filho OA, Salgado JV, Teixeira AL. Toxoplasma gondii infection and chronic schizophrenia: is there any association? ARCH CLIN PSYCHIAT 2017. [DOI: 10.1590/0101-60830000000140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | | | - Natalia Pessoa Rocha
- Federal University of Minas Gerais, Brazil; The University of Texas Health Science Center at Houston, USA
| | | | | | | | | | | | | | - João Vinícius Salgado
- Federal University of Minas Gerais, Brazil; Hospital Foundation of the State of Minas Gerais, Brazil
| | - Antônio Lúcio Teixeira
- Federal University of Minas Gerais, Brazil; The University of Texas Health Science Center at Houston, USA
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18
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Flegr J. Does Toxoplasma infection increase sexual masochism and submissiveness? Yes and no. Commun Integr Biol 2017; 10:e1303590. [PMID: 29259726 PMCID: PMC5731508 DOI: 10.1080/19420889.2017.1303590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 12/19/2022] Open
Abstract
The parasite Toxoplasma needs to get from its intermediate hosts, e.g. rodents, to its definitive hosts, cats, by predation. To increase the probability of this occurrence, Toxoplasma manipulates the behavior of its hosts, for example, by the demethylation of promoters of certain genes in the host's amygdala. After this modification, the stimuli that normally activate fear-related circuits, e.g., the smell of a cat in mice, or smell of leopards in chimpanzees, start to additionally co-activate sexual arousal-related circuits in the infected animals. In humans, the increased attraction to masochistic sexual practices was recently observed in a study performed on 36,564 subjects. Here I show that lower rather than higher attraction to sexual masochism and submissiveness among infected subjects is detected if simple univariate tests instead of multivariate tests are applied to the same data. I show and discuss that when analyzing multiple effects of complex stimuli on complex biological systems we need to use multivariate techniques and very large data sets. We must also accept the fact that any single factor usually explains only a small fraction of variability in the focal variable.
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Affiliation(s)
- Jaroslav Flegr
- Division of Biology, Faculty of Science, Charles University, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Czechia
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19
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Toxoplasma gondii infection and schizophrenia: an inter-kingdom communication perspective. Curr Opin Infect Dis 2017; 29:311-8. [PMID: 27120002 DOI: 10.1097/qco.0000000000000265] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The apicomplexan protozoan Toxoplasma gondii has a striking predilection for infecting the central nervous system and has been suggested as a risk factor for schizophrenia. Here, we address some of the mechanisms by which T. gondii achieves this by manipulating signaling pathways of the host brain cells. RECENT FINDINGS Recent years have brought notable progress in the understanding of how the opportunistic parasite T. gondii establishes a successful infection in mammalian brain by secreting effector molecules that manipulate multiple cell functions. Many pathways involved in this inter-kingdom signaling, such as dopaminergic, GABAergic and kynurenine pathways, also have key roles in the development of schizophrenia. More understanding of T. gondii-brain cell interaction holds the key to unlocking the mystery of T. gondii-mediated schizophrenia pathogenesis. SUMMARY T. gondii usurps a variety of host signaling pathways to ensure physiological adaptation, evasion of host immune defense systems, and efficient replication. A detailed knowledge of T. gondii signaling molecules involved in this cross-kingdom communication with host brain cells will probably provide novel means of pharmacologically manipulating host cellular pathways to promote efficient elimination of the parasite and may permit the development of new schizophrenia-modifying therapeutics.
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20
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Ansari-Lari M, Farashbandi H, Mohammadi F. Association of Toxoplasma gondii infection with schizophrenia and its relationship with suicide attempts in these patients. Trop Med Int Health 2017; 22:1322-1327. [PMID: 28734096 DOI: 10.1111/tmi.12933] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate the association between schizophrenia and Toxoplasma gondii, and to assess the association of infection with suicide attempts and age of onset of schizophrenia in these patients. METHODS Case-control study Fars Province, southern Iran. Cases were individuals with psychiatric diagnosis of schizophrenia as per Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Controls were healthy blood donors, frequency-matched with patients according to age and sex. For the detection of IgG antibodies, enzyme-linked immunosorbent assay (ELISA) was used. Data about demographic information in all subjects and duration of illness and history of suicide attempts in patients with schizophrenia were collected using a brief questionnaire and hospital records. Chi-square test and multivariable logistic regression were used for statistical analyses. RESULTS Among 99 cases, 42 individuals (42%) were positive for T. gondii antibody, vs. 41 (27%) among 152 controls (OR = 2, 95% CI: 1.2-3.4, P = 0.012). We compared the suicide attempts in patients with schizophrenia based on their T. gondii serologic status. There was a lower rate of suicide attempts in seropositive male patients than seronegative ones (OR = 0.3, 95% CI: 0.1-0.97, P = 0.04). Age of onset of schizophrenia did not differ between T. gondii-infected and non-infected patients. CONCLUSIONS These findings may have implications for schizophrenia and suicide prevention programmes. However, clearly further studies are required to confirm them.
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Affiliation(s)
- Maryam Ansari-Lari
- Department of Food Hygiene and Public Heath, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Hassan Farashbandi
- Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Mohammadi
- Department of Food Hygiene and Public Heath, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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21
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Toxoplasma gondii and schizophrenia: a review of published RCTs. Parasitol Res 2017; 116:1793-1799. [PMID: 28508166 DOI: 10.1007/s00436-017-5478-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/02/2017] [Indexed: 12/19/2022]
Abstract
Over the last 60 years, accumulating evidence has suggested that acute, chronic, and maternal Toxoplasma gondii infections predispose to schizophrenia. More recent evidence suggests that chronically infected patients with schizophrenia present with more severe disease. After acute infection, parasites form walled cysts in the brain, leading to lifelong chronic infection and drug resistance to commonly used antiparasitics. Chronic infection is the most studied and closely linked with development and severity of schizophrenia. There are currently four published randomized controlled trials evaluating antiparasitic drugs, specifically azithromycin, trimethoprim, artemisinin, and artemether, in patients with schizophrenia. No trials have demonstrated a change in psychopathology with adjunctive treatment. Published trials have either selected drugs without evidence against chronic infection or used them at doses too low to reduce brain cyst burden. Furthermore, trials have failed to achieve sufficient power or account for confounders such as previous antipsychotic treatment, sex, age, or rhesus status on antiparasitic effect. There are currently no ongoing trials of anti-Toxoplasma therapy in schizophrenia despite ample evidence to justify further testing.
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22
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Toxoplasma-infected subjects report an Obsessive-Compulsive Disorder diagnosis more often and score higher in Obsessive-Compulsive Inventory. Eur Psychiatry 2016; 40:82-87. [PMID: 27992837 DOI: 10.1016/j.eurpsy.2016.09.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Latent toxoplasmosis, the life-long presence of dormant stages of Toxoplasma in immunoprivileged organs and of anamnestic IgG antibodies in blood, affects about 30% of humans. Infected subjects have an increased incidence of various disorders, including schizophrenia. Several studies, as well as the character of toxoplasmosis-associated disturbance of neurotransmitters, suggest that toxoplasmosis could also play an etiological role in Obsessive-Compulsive Disorder (OCD). METHODS The aim of the present cross-sectional study performed on a population of 7471 volunteers was to confirm the association between toxoplasmosis and OCD, and toxoplasmosis and psychological symptoms of OCD estimated by the standard Obsessive-Compulsive Inventory-Revised (OCI-R). RESULTS Incidence of OCD was 2.18% (n=39) in men and 2.28% (n=83) in women. Subjects with toxoplasmosis had about a 2.5 times higher odds of OCD and about a 2.7 times higher odds of learning disabilities. The incidence of 18 other neuropsychiatric disorders did not differ between Toxoplasma-infected and Toxoplasma-free subjects. The infected subjects, even the OCD-free subjects, scored higher on the OCI-R. LIMITATIONS Examined subjects provided the information about their toxoplasmosis and OCD statuses themselves, which could result in underrating the strength of observed associations. CONCLUSIONS The results confirmed earlier reports of the association between toxoplasmosis and OCD. They also support recent claims that latent toxoplasmosis is in fact a serious disease with many impacts on quality of life of patients.
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23
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Esshili A, Thabet S, Jemli A, Trifa F, Mechri A, Zaafrane F, Gaha L, Juckel G, Babba H, Bel Hadj Jrad B. Toxoplasma gondii infection in schizophrenia and associated clinical features. Psychiatry Res 2016; 245:327-332. [PMID: 27573055 DOI: 10.1016/j.psychres.2016.08.056] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/16/2016] [Accepted: 08/21/2016] [Indexed: 10/21/2022]
Abstract
The belief that latent toxoplasmosis is asymptomatic has been questioned, in particular due to the repeated highlighted link between the Toxoplasma gondii infection and an increased incidence of schizophrenia. However, to understand this relationship, the effect of infection with Toxoplasma gondii on the severity of schizophrenia has been poorly studied. Our work focused on comparing the prevalence of Toxoplasma infection between schizophrenic patients and healthy controls, as well as comparing the clinical features and the demographic characteristics between Toxoplasma-seronegative and Toxoplasma-seropositive patients with schizophrenia. The rate of IgG antibody in the schizophrenia patients was 74.8% compared 53.8% in controls. Patients with schizophrenia had a significantly higher mean of serum IgG antibodies to T. gondii compared to controls. The seropositive male patients had a higher age of disease onset, a higher BPRS score, a greater negative PANSS score and a lower GAF score than the seronegative male patients. These results suggest a higher severity of clinical symptoms in the male patients with schizophrenia. This study provides further evidence to the hypothesis that exposure to Toxoplasma may be a risk factor for schizophrenia. Moreover, toxoplasmosis in men with schizophrenia may lead to more severe negative and cognitive symptoms and a less favorable course of schizophrenia.
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Affiliation(s)
- Awatef Esshili
- Laboratoire de génétique, biodiversité et valorisation des bioressources (LGVB) LR11ES41, Institut supérieur de biotechnologie de Monastir, Université de Monastir, Tunisia; Department of Psychiatry and Psychotherapy, Ruhr University Bochum LWL University Hospital Bochum, Alexandrinenstr., 144791 Bochum, Germany
| | - Sihem Thabet
- Laboratoire de génétique, biodiversité et valorisation des bioressources (LGVB) LR11ES41, Institut supérieur de biotechnologie de Monastir, Université de Monastir, Tunisia
| | - Achraf Jemli
- Laboratoire de génétique, biodiversité et valorisation des bioressources (LGVB) LR11ES41, Institut supérieur de biotechnologie de Monastir, Université de Monastir, Tunisia
| | - Fatma Trifa
- Département de biostatistiques, Institut Supérieur de Biotechnologie de Monastir, 5000 Université de Monastir, Tunisia
| | - Anouar Mechri
- Laboratoire de vulnérabilité aux psychoses LR10ES05 et Service de psychiatrie Centre Hospitalier Universitaire FB, Monastir, Université de Monastir, 5000 Monastir, Tunisia
| | - Ferid Zaafrane
- Laboratoire de vulnérabilité aux psychoses LR10ES05 et Service de psychiatrie Centre Hospitalier Universitaire FB, Monastir, Université de Monastir, 5000 Monastir, Tunisia
| | - Lotfi Gaha
- Laboratoire de vulnérabilité aux psychoses LR10ES05 et Service de psychiatrie Centre Hospitalier Universitaire FB, Monastir, Université de Monastir, 5000 Monastir, Tunisia
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, Ruhr University Bochum LWL University Hospital Bochum, Alexandrinenstr., 144791 Bochum, Germany
| | - Hamouda Babba
- Laboratoire de Parasitologie-Mycologie Médicale et Moléculaire (LP3M), LR12ES08, Faculté de Pharmacie, Université de Monastir, Laboratoire B Centre de Maternité EPS. F, Bourguiba. Monastir, Tunisia
| | - Besma Bel Hadj Jrad
- Laboratoire de génétique, biodiversité et valorisation des bioressources (LGVB) LR11ES41, Institut supérieur de biotechnologie de Monastir, Université de Monastir, Tunisia.
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24
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Gargaté MJ, Ferreira I, Vilares A, Martins S, Cardoso C, Silva S, Nunes B, Gomes JP. Toxoplasma gondii seroprevalence in the Portuguese population: comparison of three cross-sectional studies spanning three decades. BMJ Open 2016; 6:e011648. [PMID: 27707823 PMCID: PMC5073473 DOI: 10.1136/bmjopen-2016-011648] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Toxoplasma gondii is an obligate intracellular protozoan infecting up to one-third of the world's population, constituting a life threat if transmitted from mother to child during pregnancy. In Portugal, there is a lack of knowledge of the current epidemiological situation, as the unique toxoplasmosis National Serological Survey was performed in 1979/1980. METHODS We studied the seroprevalence trends in the Portuguese general population over the past 3 decades, by assessing chronological spread cross-sectional studies, with special focus on women of childbearing age, by age group, region and gender. RESULTS The T. gondii overall seroprevalence decreased from 47% in 1979/1980 to 22% (95% CI 20% to 24%) in 2013. Generally, we observed that the prevalence of T. gondii IgG increased significantly with age and it decreased over time, both in the general population and in the childbearing women (18% prevalence in 2013). CONCLUSIONS The scenario observed for the latter indicates that more than 80% of childbearing women are susceptible to primary infection yielding a risk of congenital toxoplasmosis and respective sequelae. Since there is no vaccine to prevent human toxoplasmosis, the improvement of primary prevention constitutes a major tool to avoid infection in such susceptible groups.
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Affiliation(s)
- Maria João Gargaté
- National Reference Laboratory of Parasitic and Fungal Infections, National Institute of Health, Lisbon, Portugal
| | - Idalina Ferreira
- National Reference Laboratory of Parasitic and Fungal Infections, National Institute of Health, Lisbon, Portugal
| | - Anabela Vilares
- National Reference Laboratory of Parasitic and Fungal Infections, National Institute of Health, Lisbon, Portugal
| | - Susana Martins
- National Reference Laboratory of Parasitic and Fungal Infections, National Institute of Health, Lisbon, Portugal
| | - Carlos Cardoso
- Clinical laboratory Dr. Joaquim Chaves, Lisbon, Portugal
| | - Susana Silva
- Department of Epidemiology, National Institute of Health, Lisbon, Portugal
| | - Baltazar Nunes
- Department of Epidemiology, National Institute of Health, Lisbon, Portugal
| | - João Paulo Gomes
- Department of Infectious Diseases, National Institute of Health, Lisbon, Portugal
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25
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Elsheikha HM, Büsselberg D, Zhu XQ. The known and missing links between Toxoplasma gondii and schizophrenia. Metab Brain Dis 2016; 31:749-59. [PMID: 27041387 DOI: 10.1007/s11011-016-9822-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/20/2016] [Indexed: 12/14/2022]
Abstract
Toxoplasma gondii, an intracellular protozoan parasite, has a striking predilection for infecting the Central Nervous System and has been linked to an increased incidence of a number of psychiatric diseases. Several in vitro and in vivo studies have shown that T. gondii infection can affect the structure, bioenergetics and function of brain cells, and alters several host cell processes, including dopaminergic, tryptophan-kynurenine, GABAergic, AKT1, Jak/STAT, and vasopressinergic pathways. These mechanisms underlying the neuropathology of latent toxoplasmosis seem to operate also in schizophrenia, supporting the link between the two disorders. Better understanding of the intricate parasite-neuroglial communications holds the key to unlocking the mystery of T. gondii-mediated schizophrenia and offers substantial prospects for the development of disease-modifying therapies.
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Affiliation(s)
- Hany M Elsheikha
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Leicestershire, LE12 5RD, UK.
| | - Dietrich Büsselberg
- Weill Cornell Medical College in Qatar, Qatar Foundation - Education City, P.O. Box: 24144, Doha, Qatar
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, People's Republic of China
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Do differences in Toxoplasma prevalence influence global variation in secondary sex ratio? Preliminary ecological regression study. Parasitology 2016; 143:1193-203. [DOI: 10.1017/s0031182016000597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SUMMARYSex of the fetus is genetically determined such that an equal number of sons and daughters are born in large populations. However, the ratio of female to male births across human populations varies significantly. Many factors have been implicated in this. The theory that natural selection should favour female offspring under suboptimal environmental conditions implies that pathogens may affect secondary sex ratio (ratio of male to female births). Using regression models containing 13 potential confounding factors, we have found that variation of the secondary sex ratio can be predicted by seroprevalence of Toxoplasma across 94 populations distributed across African, American, Asian and European continents. Toxoplasma seroprevalence was the third strongest predictor of secondary sex ratio, β = −0·097, P < 0·01, after son preference, β = 0·261, P < 0·05, and fertility, β = −0·145, P < 0·001. Our preliminary results suggest that Toxoplasma gondii infection could be one of the most important environmental factors influencing the global variation of offspring sex ratio in humans. The effect of latent toxoplasmosis on public health could be much more serious than it is usually supposed to be.
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Tomasik J, Schultz TL, Kluge W, Yolken RH, Bahn S, Carruthers VB. Shared Immune and Repair Markers During Experimental Toxoplasma Chronic Brain Infection and Schizophrenia. Schizophr Bull 2016; 42:386-95. [PMID: 26392628 PMCID: PMC4753603 DOI: 10.1093/schbul/sbv134] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic neurologic infection with Toxoplasma gondii is relatively common in humans and is one of the strongest known risk factors for schizophrenia. Nevertheless, the exact neuropathological mechanisms linking T gondii infection and schizophrenia remain unclear. Here we utilize a mouse model of chronic T gondii infection to identify protein biomarkers that are altered in serum and brain samples at 2 time points during chronic infection. Furthermore, we compare the identified biomarkers to those differing between "postmortem" brain samples from 35 schizophrenia patients and 33 healthy controls. Our findings suggest that T gondii infection causes substantial and widespread immune activation indicative of neural damage and reactive tissue repair in the animal model that partly overlaps with changes observed in the brains of schizophrenia patients. The overlapping changes include increases in C-reactive protein (CRP), interleukin-1 beta (IL-1β), interferon gamma (IFNγ), plasminogen activator inhibitor 1 (PAI-1), tissue inhibitor of metalloproteinases 1 (TIMP-1), and vascular cell adhesion molecule 1 (VCAM-1). Potential roles of these factors in the pathogenesis of schizophrenia and toxoplasmosis are discussed. Identifying a defined set of markers shared within the pathophysiological landscape of these diseases could be a key step towards understanding their specific contributions to pathogenesis.
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Affiliation(s)
- Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK;,Department of Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Tracey L. Schultz
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI
| | - Wolfgang Kluge
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Robert H. Yolken
- Stanley Laboratory of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK;,Department of Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands;, Joint last authors/ these authors contributed equally to the study
| | - Vern B. Carruthers
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI;, Joint last authors/ these authors contributed equally to the study
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Flegr J, Hodný Z. Cat scratches, not bites, are associated with unipolar depression--cross-sectional study. Parasit Vectors 2016; 9:8. [PMID: 26728406 PMCID: PMC4700762 DOI: 10.1186/s13071-015-1290-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent study performed on 1.3 million patients showed a strong association between being bitten by a cat and probability of being diagnosed with depression. Authors suggested that infection with cat parasite Toxoplasma could be the reason for this association. METHOD A cross sectional internet study on a non-clinical population of 5,535 subjects was undertaken. RESULTS The subjects that reported having been bitten by a dog and a cat or scratched by a cat have higher Beck depression score. They were more likely to have visited psychiatrists, psychotherapists and neurologists in past two years, to have been previously diagnosed with depression (but not with bipolar disorder). Multivariate analysis of models with cat biting, cat scratching, toxoplasmosis, the number of cats at home, and the age of subjects as independent variables showed that only cat scratching had positive effect on depression (p = 0.004). Cat biting and toxoplasmosis had no effect on the depression, and the number of cats at home had a negative effect on depression (p = 0.021). CONCLUSIONS Absence of association between toxoplasmosis and depression and five times stronger association of depression with cat scratching than with cat biting suggests that the pathogen responsible for mood disorders in animals-injured subjects is probably not the protozoon Toxoplasma gondii but another organism; possibly the agent of cat-scratched disease - the bacteria Bartonella henselae.
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Affiliation(s)
- Jaroslav Flegr
- Department of Biology, Faculty of Science, Charles University in Prague, Viničná 7, 128 44, Prague, Czech Republic.
| | - Zdeněk Hodný
- Department of Genome Integrity, Institute of Molecular Genetics ASCR, v.v.i, Prague, Czech Republic.
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Flegr J. Neurological and Neuropsychiatric Consequences of Chronic Toxoplasma Infection. CURRENT CLINICAL MICROBIOLOGY REPORTS 2015. [DOI: 10.1007/s40588-015-0024-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sutterland AL, Fond G, Kuin A, Koeter MWJ, Lutter R, van Gool T, Yolken R, Szoke A, Leboyer M, de Haan L. Beyond the association. Toxoplasma gondii in schizophrenia, bipolar disorder, and addiction: systematic review and meta-analysis. Acta Psychiatr Scand 2015; 132:161-79. [PMID: 25877655 DOI: 10.1111/acps.12423] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To perform a meta-analysis on studies reporting prevalence of Toxoplasma gondii (T. gondii) infection in any psychiatric disorder compared with healthy controls. Our secondary objective was to analyze factors possibly moderating heterogeneity. METHOD A systematic search was performed to identify studies into T. gondii infection for all major psychiatric disorders versus healthy controls. Methodological quality, publication bias, and possible moderators were assessed. RESULTS A total of 2866 citations were retrieved and 50 studies finally included. Significant odds ratios (ORs) with IgG antibodies were found in schizophrenia (OR 1.81, P < 0.00001), bipolar disorder (OR 1.52, P = 0.02), obsessive-compulsive disorder (OR 3.4, P < 0.001), and addiction (OR 1.91, P < 0.00001), but not for major depression (OR 1.21, P = 0.28). Exploration of the association between T. gondii and schizophrenia yielded a significant effect of seropositivity before onset and serointensity, but not IgM antibodies or gender. The amplitude of the OR was influenced by region and general seroprevalence. Moderators together accounted for 56% of the observed variance in study effects. After controlling for publication bias, the adjusted OR (1.43) in schizophrenia remained significant. CONCLUSION These findings suggest that T. gondii infection is associated with several psychiatric disorders and that in schizophrenia reactivation of latent T. gondii infection may occur.
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Affiliation(s)
- A L Sutterland
- Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - G Fond
- AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Translationnelle, Université Paris Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France
| | - A Kuin
- Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - M W J Koeter
- Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - R Lutter
- Departments of Experimental Immunology and Respiratory Medicine, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - T van Gool
- Department of Parasitology, Academic Medical Centre (AMC), Amsterdam, the Netherlands
| | - R Yolken
- Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Szoke
- AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Translationnelle, Université Paris Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France
| | - M Leboyer
- AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Translationnelle, Université Paris Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France
| | - L de Haan
- Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands
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A game-theoretic approach to valuating toxoplasmosis vaccination strategies. Theor Popul Biol 2015; 105:33-8. [PMID: 26319752 DOI: 10.1016/j.tpb.2015.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 07/02/2015] [Accepted: 08/17/2015] [Indexed: 12/21/2022]
Abstract
The protozoan Toxoplasma gondii is a parasite often found in wild and domestic cats, and it is the cause of the disease toxoplasmosis. More than 60 million people in the United States carry the parasite, and the Centers for Disease Control have placed toxoplasmosis in their disease classification group Neglected Parasitic Infections as one of five parasitic diseases targeted as priorities for public health action. In recent years, there has been significant progress toward the development of a practical vaccine, so vaccination programs may soon be a viable approach to controlling the disease. Anticipating the availability of a toxoplasmosis vaccine, we are interested in determining when cat owners should vaccinate their own pets. We have created a mathematical model describing the conditions under which vaccination is advantageous. Our model can be used to predict the average vaccination level in the population. We find that there is a critical vaccine cost threshold above which no one will use the vaccine. A vaccine cost slightly below this threshold, however, results in high usage of the vaccine, and consequently in a significant reduction in population seroprevalence. Not surprisingly, we find that populations may achieve herd immunity only if the cost of vaccine is zero.
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Abstract
INTRODUCTION A number of different infections are associated with acute psychosis. However, relationships between infections and acute psychosis in patients with schizophrenia have not been extensively explored. Exposure to Toxoplasma gondii is a replicated risk factor for schizophrenia. Previous studies have focused on T. gondii IgG antibodies, which are a marker of lifetime exposure, whereas IgM antibodies are a marker of acute/recent exposure, persistent infection, or reinfection. We performed a meta-analysis of T. gondii IgM antibodies and acute psychosis, to further investigate whether infections may be associated with relapse in schizophrenia. METHODS We identified articles by systematic searches of PubMed, PsycINFO, and ISI databases. We included studies, in English, of serum T. gondii IgM antibodies in patients with acute psychosis and controls. RESULTS Sixteen independent samples (2353 patients and 1707 controls) met inclusion criteria. Data were pooled using a random effects model. There was a significant increase in risk of positive T. gondii IgM antibodies in acute psychosis compared with controls (7.6% vs 5.7%, OR = 1.68, 95% CI = 1.23-2.27, P = .001). The association was stronger for patients with chronic schizophrenia (8.7% vs 4.6%, OR = 2.54, 95% CI = 1.63-3.96, P < .001) than first-episode psychosis. In meta-regression analyses, age, sex, and publication year were unrelated to the association; however, there was a significant association with geographic region. DISCUSSION An increased seroprevalence of T. gondii IgM in patients with acute psychosis complements and extends previous findings, suggesting that infections may be relevant to the etiopathophysiology of relapse in some patients with schizophrenia.
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Affiliation(s)
- Joel M Monroe
- Department of Psychiatry and Health Behavior, Georgia Regents University, Augusta, GA
| | - Peter F Buckley
- Medical College of Georgia, Georgia Regents University, Augusta, GA
| | - Brian J Miller
- Department of Psychiatry and Health Behavior, Georgia Regents University, Augusta, GA;
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Abstract
The existence of an association between schizophrenia and an infection by the protozoan parasite Toxoplasma gondii has been suspected since the 1950s. Two significant phenomena first garnered the attention of the psychiatric community toward toxoplasmosis, the illness precipitated by an infection of the parasite. Transient symptoms of acute toxoplasmosis sometimes resemble the clinical picture of paranoid schizophrenia. Many studies have also found an increased seroprevalence of toxoplasmosis in clients of mental health institutions in comparison with members of control populations. We have had to wait until the first decade of our millennium for several independent research teams to make discoveries that would shed light on the possible mechanisms that link the Toxoplasma parasite to schizophrenia.
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Affiliation(s)
- Jaroslav Flegr
- Biology Section, Faculty of Science, Charles University, Prague, Czech Republic
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Eells JB, Varela-Stokes A, Guo-Ross SX, Kummari E, Smith HM, Cox AD, Lindsay DS. Chronic Toxoplasma gondii in Nurr1-null heterozygous mice exacerbates elevated open field activity. PLoS One 2015; 10:e0119280. [PMID: 25855987 PMCID: PMC4391871 DOI: 10.1371/journal.pone.0119280] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 01/20/2015] [Indexed: 12/19/2022] Open
Abstract
Latent infection with Toxoplasma gondii is common in humans (approximately 30% of the global population) and is a significant risk factor for schizophrenia. Since prevalence of T. gondii infection is far greater than prevalence of schizophrenia (0.5-1%), genetic risk factors are likely also necessary to contribute to schizophrenia. To test this concept in an animal model, Nurr1-null heterozygous (+/-) mice and wild-type (+/+) mice were evaluate using an emergence test, activity in an open field and with a novel object, response to bobcat urine and prepulse inhibition of the acoustic startle response (PPI) prior to and 6 weeks after infection with T. gondii. In the emergence test, T. gondii infection significantly decreased the amount of time spent in the cylinder. Toxoplasma gondii infection significantly elevated open field activity in both +/+ and +/- mice but this increase was significantly exacerbated in +/- mice. T. gondii infection reduced PPI in male +/- mice but this was not statistically significant. Aversion to bobcat urine was abolished by T. gondii infection in +/+ mice. In female +/- mice, aversion to bobcat urine remained after T. gondii infection while the male +/- mice showed no aversion to bobcat urine. Antibody titers of infected mice were a critical variable associated with changes in open field activity, such that an inverted U shaped relationship existed between antibody titers and the percent change in open field activity with a significant increase in activity at low and medium antibody titers but no effect at high antibody titers. These data demonstrate that the Nurr1 +/- genotype predisposes mice to T. gondii-induced alterations in behaviors that involve dopamine neurotransmission and are associated with symptoms of schizophrenia. We propose that these alterations in murine behavior were due to further exacerbation of the altered dopamine neurotransmission in Nurr1 +/- mice.
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Affiliation(s)
- Jeffrey B. Eells
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, United States of America
- * E-mail:
| | - Andrea Varela-Stokes
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, United States of America
| | - Shirley X. Guo-Ross
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, United States of America
| | - Evangel Kummari
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, United States of America
| | - Holly M. Smith
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, United States of America
| | - Arin D. Cox
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, United States of America
| | - David S. Lindsay
- Department of Biomedical Sciences & Pathobiology, Virginia–Maryland Regional College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, United States of America
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Flegr J, Markoš A. Masterpiece of epigenetic engineering - how Toxoplasma gondii reprogrammes host brains to change fear to sexual attraction. Mol Ecol 2015; 23:5934-6. [PMID: 25532868 DOI: 10.1111/mec.13006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/03/2014] [Accepted: 11/14/2014] [Indexed: 12/28/2022]
Abstract
The protozoan parasite Toxoplasma gondii is known to induce specific behavioural changes in its intermediate hosts, including humans, that are believed to increase the chance of its successful transmission to the definitive host, the cat. The most conspicuous change is the so-called fatal attraction phenomenon, the switch from the mice's and rats' natural fear of the smell of cats toward an attraction to this smell. The mechanism of this manipulation activity is unknown; however, many indices suggest that changes in the concentrations of dopamine and testosterone are involved. In this issue of Molecular Ecology, Hari Dass & Vyas (2014) present results of a study showing that, by hypomethylation of certain regulatory elements of key gene, Toxoplasma is able to reprogramme the brain's genetic machinery in such a way that cat odour activates and changes the wiring of the medial amygdala circuits responsible for sexual behaviour. This study delivers the first clear evidence of a parasite's ability to use sophisticated epigenetic engineering techniques for the manipulation of the phenotype of its infected host.
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Affiliation(s)
- Jaroslav Flegr
- Biology Section, Faculty of Science, Charles University, Prague, 204004, Czech Republic
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Bergen SE. Genetic Modifiers and Subtypes in Schizophrenia. Curr Behav Neurosci Rep 2014. [DOI: 10.1007/s40473-014-0025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Příplatová L, Šebánková B, Flegr J. Contrasting effect of prepulse signals on performance of Toxoplasma-infected and Toxoplasma-free subjects in an acoustic reaction times test. PLoS One 2014; 9:e112771. [PMID: 25384036 PMCID: PMC4226587 DOI: 10.1371/journal.pone.0112771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 10/16/2014] [Indexed: 11/20/2022] Open
Abstract
Background About 30% of people on Earth have latent toxoplasmosis. Infected subjects do not express any clinical symptoms, however, they carry dormant stages of parasite Toxoplasma for the rest of their life. This form of toxoplasmosis is mostly considered harmless, however, recent studies showed its specific effects on physiology, behaviour and its associations with various diseases, including psychiatric disorders such as schizophrenia. Individuals who suffer from schizophrenia have about 2.7 times higher prevalence of Toxoplasma-seropositivity than controls, which suggests that some traits characteristic of schizophrenic patients, including the sex difference in schizophrenia onset, decrease of grey matter density in specific brain areas and modification of prepulse inhibition of startle reaction could in fact be caused by toxoplasmosis for those patients who are Toxoplasma-seropositive. Methodology/Principal Findings We measured the effect of prepulse inhibition/facilitation of the startle reaction on reaction times. The students, 170 women and 66 men, were asked to react as quickly as possible to a startling acoustic signal by pressing a computer mouse button. Some of the startling signals were without the prepulse, some were 20 msec. preceded by a short (20 msec.) prepulse signal of lower intensity. Toxoplasma-seropositive subjects had longer reaction times than the controls. Acoustic prepulse shorted the reaction times in all subjects. This effect of prepulse on reaction times was stronger in male subjects and increased with the duration of infection, suggesting that it represented a cumulative effect of latent toxoplasmosis, rather than a fading out after effect of past acute toxoplasmosis. Conclusions Different sensitivity of Toxoplasma-seropositive and Toxoplasma-seronegative subjects on effect of prepulses on reaction times (the toxoplasmosis-prepulse interaction) suggested, but of course did not prove, that the alternations of prepulse inhibition of startle reaction observed in schizophrenia patients probably joined the list of schizophrenia symptoms that are in fact caused by latent toxoplasmosis.
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Affiliation(s)
- Lenka Příplatová
- Faculty of Science, Charles University, Dept. Philosophy and History of Science, Prague, Czech Republic
| | - Blanka Šebánková
- Faculty of Science, Charles University, Dept. Philosophy and History of Science, Prague, Czech Republic
| | - Jaroslav Flegr
- Faculty of Science, Charles University, Dept. Philosophy and History of Science, Prague, Czech Republic
- * E-mail:
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Flegr J, Klapilová K, Kaňková Š. Toxoplasmosis can be a sexually transmitted infection with serious clinical consequences. Not all routes of infection are created equal. Med Hypotheses 2014; 83:286-9. [DOI: 10.1016/j.mehy.2014.05.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/24/2014] [Indexed: 11/29/2022]
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Pearce BD, Kruszon-Moran D, Jones JL. The association of Toxoplasma gondii infection with neurocognitive deficits in a population-based analysis. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1001-10. [PMID: 24477344 PMCID: PMC4091920 DOI: 10.1007/s00127-014-0820-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/05/2014] [Indexed: 01/10/2023]
Abstract
PURPOSE To examine the relationship between infection with Toxoplasma gondii (toxo) and cognition. METHODS Multivariate logistic regression was used to test the association of toxo seropositivity with indices of cognitive function among over 4,200 adults in the third National Health and Nutrition Examination Survey. RESULTS Toxo-seropositive participants were more likely than seronegative participants to score in the worst quartile of the simple reaction time test (OR 1.3, 95 % CI 1.0, 1.6), symbol-digit substitution test (SDST, OR 1.5, 95 % CI 1.2, 1.9) and the serial-digit learning test (trials to criterion) (SDLTNT, OR 1.4, 95 % CI 1.1, 1.8) in models adjusted for age, race/ethnicity, gender and foreign birth. After further adjustment for all cofactors, the association between toxo seropositivity and these outcomes was no longer significant. However, seropositivity was associated with worse scores on the SDST (OR 2.9, 95 % CI 1.8, 4.8) among those in the lowest income category and the SDLTNT (OR 1.5, 95 % CI 1.1, 2.5) among those foreign born. CONCLUSIONS Toxo seropositivity may be associated with poor cognitive test scores in certain subgroups; however, causation cannot be established in this cross-sectional study.
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Affiliation(s)
- Brad D Pearce
- Department of Epidemiology, Emory University, Rollins School of Public Health, 1518-002-3BB, Atlanta, GA, 30322, USA,
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Gender identity disorder and schizophrenia: neurodevelopmental disorders with common causal mechanisms? SCHIZOPHRENIA RESEARCH AND TREATMENT 2014; 2014:463757. [PMID: 25548672 PMCID: PMC4274821 DOI: 10.1155/2014/463757] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/20/2014] [Indexed: 12/15/2022]
Abstract
Gender identity disorder (GID), recently renamed gender dysphoria (GD), is a rare condition characterized by an incongruity between gender identity and biological sex. Clinical evidence suggests that schizophrenia occurs in patients with GID at rates higher than in the general population and that patients with GID may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. Neurobiological research, including brain imaging and studies of finger length ratio and handedness, suggests that both these disorders are associated with altered cerebral sexual dimorphism and changes in cerebral lateralization. Various mechanisms, such as Toxoplasma infection, reduced levels of brain-derived neurotrophic factor (BDNF), early childhood adversity, and links with autism spectrum disorders, may account for some of this overlap. The implications of this association for further research are discussed.
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Feigenson KA, Kusnecov AW, Silverstein SM. Inflammation and the two-hit hypothesis of schizophrenia. Neurosci Biobehav Rev 2014; 38:72-93. [PMID: 24247023 PMCID: PMC3896922 DOI: 10.1016/j.neubiorev.2013.11.006] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/26/2013] [Accepted: 11/07/2013] [Indexed: 12/12/2022]
Abstract
The high societal and individual cost of schizophrenia necessitates finding better, more effective treatment, diagnosis, and prevention strategies. One of the obstacles in this endeavor is the diverse set of etiologies that comprises schizophrenia. A substantial body of evidence has grown over the last few decades to suggest that schizophrenia is a heterogeneous syndrome with overlapping symptoms and etiologies. At the same time, an increasing number of clinical, epidemiological, and experimental studies have shown links between schizophrenia and inflammatory conditions. In this review, we analyze the literature on inflammation and schizophrenia, with a particular focus on comorbidity, biomarkers, and environmental insults. We then identify several mechanisms by which inflammation could influence the development of schizophrenia via the two-hit hypothesis. Lastly, we note the relevance of these findings to clinical applications in the diagnosis, prevention, and treatment of schizophrenia.
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Affiliation(s)
- Keith A Feigenson
- Robert Wood Johnson Medical School at Rutgers, The State University of New Jersey, 675 Hoes Lane, Piscataway, NJ 08854, USA.
| | - Alex W Kusnecov
- Department of Psychology, Behavioral and Systems Neuroscience Program and Joint Graduate Program in Toxicology, Rutgers University, 52 Frelinghuysen Road, Piscataway, NJ 08854-8020, USA.
| | - Steven M Silverstein
- Robert Wood Johnson Medical School at Rutgers, The State University of New Jersey, 675 Hoes Lane, Piscataway, NJ 08854, USA; University Behavioral Health Care at Rutgers, The State University of New Jersey, 671 Hoes Lane, Piscataway, NJ 08855, USA.
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Flegr J. How and why Toxoplasma makes us crazy. Trends Parasitol 2013; 29:156-63. [PMID: 23433494 DOI: 10.1016/j.pt.2013.01.007] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Abstract
For a long time, a latent toxoplasmosis, the lifelong presence of dormant stages of Toxoplasma in various tissues, including the brain, was considered harmless for immunocompetent persons. Within the past 10 years, however, many independent studies have shown that this parasitic disease, with a worldwide prevalence of about 30%, could be indirectly responsible for hundreds of thousands of deaths due to its effects on the rate of traffic and workplace accidents, and also suicides. Moreover, latent toxoplasmosis is probably one of the most important risk factors for schizophrenia. At least some of these effects, possibly mediated by increased dopamine and decreased tryptophan, are products of manipulation activity by Toxoplasma aiming to increase the probability of transmission from intermediate to definitive host through predation.
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Affiliation(s)
- Jaroslav Flegr
- Faculty of Science, Charles University in Prague, Prague 128 44, Czech Republic.
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