Toxocara seroprevalence in patients with idiopathic Parkinson's disease: chance association or coincidence?

Case-Control Study to Assess the Association between Epilepsy and Toxocara Infection/Exposure

Although causes and etiology of epilepsy are mostly obscure, some zoonotic parasites, such as Toxocara species, have been proposed as a risk factor for this disease. Here, we conducted an age-matched case-control study to evaluate whether there is an association between epilepsy and the presence of serum antibodies to Toxocara in incident cases. We included 94 idiopathic epileptic patients as cases, and—from the same geographical region—88 people with no own history of epilepsy or neurological disease as control subjects. Epilepsy was confirmed by a physician using the International League Against Epilepsy (ILAE) definition. All participants were screened for the anti-Toxocara IgG serum antibody by enzyme-linked immunosorbent assay (ELISA). Univariate and mutltivariate statistical analyses were applied to calculate the crude and adjusted odds ratios (OR) and 95% confidence intervals (CIs). Anti-Toxocara serum antibody was detected in 37 epileptic patients and in 23 control subjects, giving respective seroprevalences of 39.3% (95% CI, 29.4–49.9%) and 26.1% (95% CI, 17.3–36.5%), respectively. Adjusted multivariate logistic regression analysis estimated an OR of 2.38 (95% CI, 1.25–4.63), indicating a significant association between epilepsy and Toxocara seropositivity. There was also a significant association between seropositivity to Toxocara and partial (OR, 2.60; 95% CI, 1.14–6.04) or generalized (OR, 2.17; 95% CI, 1.09–4.40%) seizures. Findings from the present study of incident epileptic cases support previous studies proposing that Toxocara infection/exposure is a risk factor for epilepsy. However, further well-designed population-based surveys and mechanistic/experimental studies in animal models are required to better understand the reason(s) for this association.

Excretory/secretory proteins of adult Toxocara canis induce changes in the expression of proteins involved in the NOD1-RIP2-NF-κB pathway and modulate cytokine production in mouse macrophages

Dog roundworm (Toxocara canis) is the major causative agent of toxocarosis, a parasitic disease of both veterinary and medical importance. Knowledge gaps in fundamental and applied aspects hinder the control of this important zoonotic disease. To have a better understanding of Toxocara infection and host immune responses, mouse macrophages were exposed to excretory/secretory (ES) proteins released by adult worms of T. canis in vitro. The messenger RNA transcription and protein expression of nucleotide-binding oligomerization domain-containing protein 1 (NOD1), receptor interacting protein 2 (RIP2) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) in macrophages were analysed using quantitative real-time PCR (qRT-PCR) and Western blot. The levels of tumour necrosis factor alpha (TNF-ɑ), interleukin-1 beta (IL-1β) and IL-6 released by the stimulated macrophages were analysed using enzyme-linked immunosorbent assay. It was found that 20 μg/mL ES proteins of adult T. canis induced the expression of NOD1, RIP2 and NF-κB in mouse macrophages at both transcriptional and translational levels after 9 h of incubation in vitro. Incubation with 20 μg/mL ES proteins also modulated the production of pro-inflammatory cytokines TNF-ɑ, IL-1β and IL-6 by the macrophages. Taken together, ES proteins of adult T. canis appeared to be able to affect the macrophage NOD1-RIP2-NF-κB signalling pathway, which might play a role in regulating the production of proinflammatory cytokines. Further investigation of these aspects should lead to a better understanding of immune recognition of and modulation by Toxocara canis in host animals.

Cerebral Toxocara canis larval infection presenting as delayed encephalopathy and nonconvulsive status epilepticus: a case report

Adult cerebral Toxocara canis larval infections are rare. Humans are infected by contacting soil that contains infectious eggs or by eating undercooked meat. We encountered a patient with cerebral T. canis infection who showed recurrent altered mentality with nonconvulsive status epilepticus (NCSE). A 71-year-old male was admitted with complaints of drowsy mentality and abnormal behavior. Magnetic resonance imaging revealed non-enhanced multiple gliosis and calcified lesions. Electroencephalography revealed NCSE, which was cured with valproate. However, he was readmitted because of recurrence of symptoms. On cerebrospinal fluid examination, T. canis antibodies were observed. Subsequently, he was treated with albendazole and corticosteroids. Although corticosteroid improved his symptoms, the therapy could not be continued because the patient developed septic shock. This is the first report of cerebral T. canis larval infection presenting as delayed encephalopathy and NCSE. In patients with unexplainable progressive encephalopathy, particularly when gliosis or calcified lesions are observed on neuroimaging, cerebral T. canis larval infection should be considered and treated promptly.

Global and regional seroprevalence estimates for human toxocariasis: A call for action

Human toxocariasis is a parasitic disease transmitted usually from dogs and/or cats that are infected with Toxocara species, and can be associated with a range of allergic, neurological and/or visual disorders. Recent epidemiological research has estimated that ~1.4 billion people worldwide, particularly in subtropical and tropical regions, are infected with, or exposed to Toxocara species, indicating that human toxocariasis is a neglected tropical disease. Here, we review recent research efforts, consider risk factors, discuss limitations in current seroprevalence estimates, and propose some future research directions towards improved awareness, surveillance, prevention and control of this neglected disease.

Toxocara-induced neural larva migrans (neurotoxocarosis) in rodent model hosts

Neural larva migrans (NLM), or neurotoxocarosis, induced by Toxocara canis or Toxocara cati results from migrating and persisting larvae in the central nervous system of paratenic hosts, including humans. As the diagnosis of NLM in humans is not straightforward, most knowledge on the disease is derived from only a few published clinical cases. To improve our understanding of human NLM, studies on the pathogenesis and clinical symptoms in laboratory animal model systems are indispensable, and rodents have been accepted as the most appropriate model organisms for NLM. As research has mostly focused on neuroinvasive T. canis-larvae, information regarding the pathogenesis of T. cati-induced NLM remains scarce. This review summarises the current state of knowledge on neuroinvasion by both T. canis and T. cati in different rodent model hosts, the resulting behavioural changes, and histopathological alterations during the course of NLM as well as the potential molecular pathogenic mechanisms.

Pathogenesis of cerebral toxocariasis and neurodegenerative diseases

Toxocara canis belongs to one of zoonotic parasites that commonly infects canines worldwide, and its eggs in host faeces may contaminate the food, water, soil and their fur as well as the larvae entrapped in the granuloma can infect paratenic hosts including mice and humans. Survivability of T. canis embryonated eggs under moist, cool conditions may be as long as 2-4 years or more. In paratenic hosts such as mice and humans, T. canis L3 larvae neither moult, grow, nor replicate and will wander through a number of internal organs in humans so as to cause Th2-dominant pathology in various internal organs as leading to neurotoxocariasis (NT), ocular toxocariasis (OT), or visceral larva migrans (VLM). Although the systemic immune response to T. canis has been widely reported, the immune response in the brain has received little attention. Differential cytokine expression and other brain injury-associated biomarkers or neurodegeneration-associated factors have been observed in infected versus uninfected outbred and inbred mice. Preliminary data have also suggested a possible link between significant memory impairment and cytokine production associated with T. canis infection in the hippocampus which has been long recognised as being responsible for learning and memory functions. Notably, it remains an enigma concerning cerebral invasion by T. canis larvae rarely induces a recognisable neurological syndrome or its involvement in neuropathological disorders in humans. Exploration of the relationship between host and parasite in the brain may elucidate the cryptic symptoms of human cerebral toxocariasis, with patients presenting with mental retardation, epilepsy, neurodegeneration and other central nervous system (CNS) disorders.

Human toxocariasis - A look at a neglected disease through an epidemiological 'prism'

Toxocariasis, a disease caused by infection with larvae of Toxocara canis, T. cati and/or congeners, represents clinical syndromes in humans including visceral and ocular larva migrans, neurotoxocariasis and covert/common toxocariasis. It is reported to be one of the most widespread public health and economically important zoonotic parasitic infections that humans share with dogs, wild canids, including foxes, and possibly other mammals. Humans become infected by accidental ingestion of embryonated Toxocara eggs, or larvae from tissues from domestic or wild paratenic hosts. Most infections are asymptomatic, and human disease may go unnoticed, as clinical investigation is often not pursued and/or diagnostic testing not conducted. Sometimes toxocariasis can be associated with complications, such as allergic and/or neurological disorders, possibly including cognitive or developmental delays in children. There is no anti-toxocariasis vaccine, and chemotherapy in humans varies, depending on symptoms and location of larvae, and may include the administration of albendazole or mebendazole, together with anti-inflammatory corticosteroids. Some recent studies indicate that toxocariasis is having an increased, adverse impact on human health in some, particularly underprivileged, tropical and subtropical communities around the world. Although tens of millions of people, especially children, are expected to be exposed to, or infected with Toxocara species, there is limited precise epidemiological data or information on the relationship between seropositivity and disease (toxocariasis) on a global scale. To gain an improved insight into this area, the present article reviews salient clinical aspects of human toxocariasis and the epidemiology of this disease, with particular reference to seroprevalence, and discusses future research and approaches/measures to understand and prevent/control this socioeconomically important, yet neglected zoonosis.

Toxoplasma gondii infection and risk of Parkinson and Alzheimer diseases: A systematic review and meta-analysis on observational studies

In the past decade, Toxoplasma gondii infection has been recognized as a potential risk for many psychiatric and neurological disorders. We performed this systematic review and meta-analysis to evaluate the association between Toxoplasma infection and Parkinson's and Alzheimer's diseases. PubMed, Web of science, Scopus and Embase databases were searched up to September 30, 2018 for studies that reported risk of Parkinson's and Alzheimer's diseases associated with Toxoplasma infection. We used a random effects meta-analysis model to generate the pooled odds ratio (OR) with 95% confidence intervals (CIs). Eleven studies, including seven studies for Parkinson's disease (428 patients and 540 controls) and four studies for Alzheimer's disease (301 patients and 313 controls), were included in the meta-analysis. We found that there was no statistically significant association between Toxoplasma infection, as determined by IgG serology, IgM serology, and PCR with increased risk of Parkinson's disease (OR, 1.14; 95% CI, 0.78-1.68), (OR, 1.61; 95% CI, 0.33-7.76) and (OR, 1.87; 95% CI, 0.43-8.05), respectively. The OR for association of Toxoplasma infection, based on IgG serology with Alzheimer's patients, compared to control group, was (OR, 1.38; 95% CI, 0.99-1.92), demonstrating a marginally significant association between Toxoplasma infection and Alzheimer's disease. Our findings do not support a general hypotheses regarding an associative relationship between Toxoplasma infection and Parkinson's disease, but do support a marginally significant association between Toxoplasma infection and Alzheimer's disease; this association should be investigated further through longitudinal and experimental studies.

Aquaporin 1 is located on the intestinal basolateral membrane in Toxocara canis and might play a role in drug uptake

Background

Aquaporins (AQPs) are a family of integral membrane channel proteins that facilitate the transport of water and other small solutes across cell membranes. AQPs appear to play crucial roles in parasite survival and represent possible drug targets for novel intervention strategy. In this work, we investigated the tissue distribution and biological roles of an aquaporin TcAQP1 in the neglected parasitic nematode Toxocara canis.

Methods

Recombinant C-terminal hydrophilic domain of AQP1 of T. canis (rTcAQP1c) and polyclonal antibody against rTcAQP1c were produced to analyse the tissue expression of native TcAQP1 in adult (female and male) worms using an immunohistochemical approach. RNA interference (RNAi), quantitative real-time PCR (qRT-PCR) and nematocidal assays were performed to investigate the functional roles of TcAQP1 in the adult stage of T. canis.

Results

Immunofluorescence analysis showed that TcAQP1 was localised predominantly in the epithelial linings of the reproductive tract and basolateral membrane of the intestine in the adult stage (female and male) of T. canis, indicating important roles in reproduction, nutrient absorption and/or osmoregulation. Treatment with silencing RNA for 24 h resulted in a significant reduction of Tc-aqp-1 mRNA level in adult T. canis, though no phenotypical change was observed. The efficient gene knockdown compromised the nematocidal activity of albendazole in vitro, suggesting the role of TcAQP1 in drug uptake.

Conclusions

The findings of this study provide important information about tissue expression and functional roles of TcAQP1 protein in adult T. canis. Understanding the biological functions of this protein in other developmental stages of T. canis and related parasitic nematodes would contribute to the discovery of novel diagnostic or anthelmintic targets.

The Association between Toxoplasma gondii Infection and Risk of Parkinson's Disease: A Systematic Review and Meta-Analysis

Background

Several studies have investigated the association between Toxoplasma gondii (T. gondii) infection and risk of Parkinson's disease (PD) with inconsistent results. Clarifying this relation might be useful for better understanding of the risk factors and the relevant mechanisms of PD, thus a meta-analysis was conducted to explore whether exposure to T. gondii is associated with an increased risk of PD.

Methods

We conducted this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A rigorous literature selection was performed by using the databases of PubMed, Embase, Web of Science, Cochrane Library, and ScienceDirect. Odds ratio (OR) and corresponding 95% confidential interval (CI) were pooled by using fixed-effects models. Sensitivity analysis, publication bias test, and methodological quality assessment of studies were also performed.

Results

Seven studies involving 1086 subjects were included in this meta-analysis. Pooled data by using fixed-effects models suggested both latent infection (OR, 1.17; 95% CI, 0.86 to 1.58; P=0.314) and acute infection (OR, 1.13; 95% CI, 0.30 to 4.35; P=0.855) were not associated with PD risk. Stable and robust estimates were confirmed by sensitivity analysis. No publication bias was found by visual inspection of the funnel plot, Begg's, and Egger's test.

Conclusions

This meta-analysis does not support any possible association between T. gondii infection and risk of PD. Researches are still warranted to further explore the underlying mechanisms of T. gondii in the pathogenesis of PD and their causal relationship.

Comparative bioinformatic analysis suggests that specific dauer-like signalling pathway components regulate Toxocara canis development and migration in the mammalian host

Background

Toxocara canis is quite closely related to Ascaris suum but its biology is more complex, involving a phase of arrested development (diapause or hypobiosis) in tissues as well as transplacental and transmammary transmission routes. In the present study, we explored and compared dauer-like signalling pathways of T. canis and A. suum to infer which components in these pathways might associate with, or regulate, this added complexity in T. canis.

Methods

Guided by information for Caenorhabditis elegans, we bioinformatically inferred and compared components of dauer-like signalling pathways in T. canis and A. suum using genomic and transcriptomic data sets. In these two ascaridoids, we also explored endogenous dafachronic acids (DAs), which are known to be critical in regulating larval developmental processes in C. elegans and other nematodes, by liquid chromatography-mass spectrometry (LC-MS).

Results

Orthologues of C. elegans dauer signalling genes were identified in T. canis (n = 55) and A. suum (n = 51), inferring the presence of a dauer-like signalling pathway in both species. Comparisons showed clear differences between C. elegans and these ascaridoids as well as between T. canis and A. suum, particularly in the transforming growth factor-β (TGF-β) and insulin-like signalling pathways. Specifically, in both A. suum and T. canis, there was a paucity of genes encoding SMAD transcription factor-related protein (daf-3, daf-5, daf-8 and daf-14) and insulin/insulin-like peptide (daf-28, ins-4, ins-6 and ins-7) homologues, suggesting an evolution and adaptation of the signalling pathway in these parasites. In T. canis, there were more orthologues coding for homologues of antagonist insulin-like peptides (Tc-ins-1 and Tc-ins-18), an insulin receptor substrate (Tc-ist-1) and a serine/threonine kinase (Tc-akt-1) than in A. suum, suggesting potentiated functional roles for these molecules in regulating larval diapause and reactivation. A relatively conserved machinery was proposed for DA synthesis in the two ascaridoids, and endogenous Δ4- and Δ7-DAs were detected in them by LC-MS analysis. Differential transcription analysis between T. canis and A. suum suggests that ins-17 and ins-18 homologues are specifically involved in regulating development and migration in T. canis larvae in host tissues.

Conclusion

The findings of this study provide a basis for functional explorations of insulin-like peptides, signalling hormones (i.e. DAs) and related nuclear receptors, proposed to link to development and/or parasite-host interactions in T. canis. Elucidating the functional roles of these molecules might contribute to the discovery of novel anthelmintic targets in ascaridoids.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-3265-y) contains supplementary material, which is available to authorized users.

Tissue expression pattern of ABCG transporter indicates functional roles in reproduction of Toxocara canis

Toxocara canis is a zoonotic parasite with worldwide distribution. ATP-binding cassette (ABC) transporters are integral membrane proteins which involve in a range of biological processes in various organisms. In present study, the full-length coding sequence of abcg-5 gene of T. canis (Tc-abcg-5) was cloned and characterized. A 633 aa polypeptide containing two conserved Walker A and Walker B motifs was predicted from a continuous 1902 nt open reading frame. Quantitative real-time PCR was employed to determine the transcriptional levels of Tc-abcg-5 gene in adult male and female worms, which indicated high mRNA level of Tc-abcg-5 in the reproductive tract of adult female T. canis. Tc-abcg-5 was expressed to produce rabbit polyclonal antiserum against recombinant TcABCG5. Indirect-fluorescence immunohistochemical assays were carried out to detect the tissue distribution of TcABCG5, which showed predominant distribution of TcABCG5 in the uterus (especially in the germ cells) of adult female T. canis. Tissue transcription and expression pattern of Tc-abcg-5 indicated that Tc-abcg-5 might play essential roles in the reproduction of this parasitic nematode.

Human toxocariasis

Parasitic nematodes of the genus Toxocara are socioeconomically important zoonotic pathogens. These parasites are usually directly transmitted to the human host via the faecal-oral route and can cause toxocariasis and associated complications, including allergic and neurological disorders. Although tens of millions of people are estimated to be exposed to or infected with Toxocara spp, global epidemiological information on the relationship between seropositivity and toxocariasis is limited. Recent findings suggest that the effect of toxocariasis on human health is increasing in some countries. Here we review the salient background on Toxocara and biology, summarise key aspects of the pathogenesis, diagnosis, and treatment of toxocariasis, describe what is known about its geographic distribution and prevalence, and make some recommendations for future research towards the prevention and control of this important disease.

Toxoplasma gondii exposure and Parkinson's disease: a case-control study

OBJECTIVES

To determine the association between Toxoplasma gondii infection and Parkinson's disease and to investigate whether T. gondii seropositivity is associated with the general characteristics of patients with Parkinson's disease.

DESIGN

Case-control study.

SETTING

Cases and controls were enrolled in Durango City, Mexico.

PARTICIPANTS

65 patients with Parkinson's disease and 195 age- and gender-matched control subjects without Parkinson's disease.

PRIMARY AND SECONDARY OUTCOME MEASURES

Serum samples of participants were analysed for anti-T. gondii IgG and IgM antibodies by commercially available enzyme-linked immunoassays. Prevalence of T. gondii DNA was determined in seropositive subjects using PCR. The association between clinical data and infection was examined by bivariate analysis.

RESULTS

Anti-T. gondii IgG antibodies were found in 6/65 cases (9.2%) and in 21/195 controls (10.8%) (OR 0.84; 95% CI 0.32 to 2.18; p=0.81). The frequency of high (>150 IU/mL) antibody levels was similar among cases and controls (p=0.34). None of the anti-T. gondii IgG positive cases and four of the anti-T. gondii IgG positive controls had anti-T. gondii IgM antibodies (p=0.54). The prevalence of T. gondii DNA was comparable in seropositive cases and controls (16.7% and 25%, respectively; p=1.0). Seroprevalence of T. gondii infection was associated with a young age onset of disease (p=0.03), high Unified Parkinson Disease Rating Scale scores (p=0.04) and depression (p=0.02). Seropositivity to T. gondii infection was lower in patients treated with pramipexole than in patients without this treatment (p=0.01). However, none of the associations remained significant after Bonferroni correction.

CONCLUSIONS

The results do not support an association between T. gondii infection and Parkinson's disease. However, T. gondii infection might have an influence on certain symptoms of Parkinson's disease. Further research to elucidate the role of T. gondii exposure on Parkinson's disease is warranted.

Cerebral Toxocariasis: Silent Progression to Neurodegenerative Disorders?

Toxocara canis and T. cati are highly prevalent nematode infections of the intestines of dogs and cats. In paratenic hosts, larvae do not mature in the intestine but instead migrate through the somatic tissues and organs of the body. The presence of these migrating larvae can contribute to pathology. Toxocara larvae can invade the brains of humans, and while case descriptions of cerebral toxocariasis are historically rare, improved diagnosis and greater awareness have contributed to increased detection. Despite this, cerebral or neurological toxocariasis (NT) remains a poorly understood phenomenon. Furthermore, our understanding of cognitive deficits due to toxocariasis in human populations remains particularly deficient. Recent data describe an enhanced expression of biomarkers associated with brain injury, such as GFAP, AβPP, transforming growth factor β1 (TGF-β1), NF-L, S100B, tTG, and p-tau, in mice receiving even low doses of Toxocara ova. Finally, this review outlines a hypothesis to explore the relationship between the presence of T. canis larvae in the brain and the progression of Alzheimer's disease (AD) due to enhanced AD-associated neurodegenerative biomarker expression.