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Lyons MR, Arantes T, Vieira BR, Furtado JM, Smith JR. Impact of gender on clinical features and outcomes of ocular toxoplasmosis. Br J Ophthalmol 2024; 108:710-714. [PMID: 37225390 DOI: 10.1136/bjo-2023-323227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
AIM To investigate the effect of gender on the clinical features and outcomes of ocular toxoplasmosis. METHODS 262 patients (139 women and 123 men) presenting to a tertiary referral uveitis service in Ribeirão Preto, Brazil, with serological and clinical evidence of ocular toxoplasmosis were prospectively enrolled in an observational study. Predefined data items including demographics, descriptors of uveitis and ocular toxoplasmosis, best-corrected visual acuity and ocular complications were disaggregated by gender and compared statistically. RESULTS Approximately equal numbers of women and men had active versus inactive ocular toxoplasmosis. In both women and men, most infections were remotely acquired. Men were significantly more likely to present with primary active disease than women (24.4% vs 12.9%); conversely, women were significantly more likely to present with recurrent active disease than men (36.0% vs 28.5%). One toxoplasmic retinal lesion was observed in more eyes of men than eyes of women (50.4% vs 35.3%), while women's eyes were more likely to have multiple lesions than men's eyes (54.7% vs 39.8%). Lesions in women's eyes were significantly more likely to occur at the posterior pole compared with those in men's eyes (56.1% vs 39.8%). Measures of vision were similar for women and men. There were no significant differences in measures of visual acuity, ocular complications, and occurrence and timing of reactivations between the genders. CONCLUSION Ocular toxoplasmosis has equivalent outcomes in women and men, with clinical differences in the form and type of disease, as well as characteristics of the retinal lesion.
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Affiliation(s)
- Matilda R Lyons
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tiago Arantes
- Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil
| | - Barbara R Vieira
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Joao M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Račka K, Bártová E, Hamidović A, Plault N, Kočišová A, Camacho G, Mercier A, Halajian A. First detection of Toxoplasma gondii Africa 4 lineage in a population of carnivores from South Africa. Front Cell Infect Microbiol 2024; 14:1274577. [PMID: 38352059 PMCID: PMC10861644 DOI: 10.3389/fcimb.2024.1274577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction There have only been a few molecular studies conducted on the detection of T. gondii in tissues of carnivores in South Africa, with no data on the genetic diversity of this parasite. That is why the aim of this study was to detect and genotype T. gondii DNA in tissues of selected wild and domestic carnivores in South Africa. Methods Samples were collected from 80 animals of 20 species (mainly road-killed) in the four provinces of Limpopo (n=57), Mpumalanga (n=21), Gauteng (n=1) and Free State (n=1) during the period 2014-2018. Samples of brain (n=31), heart (n=4), liver (n=40), spleen (n=2) and lung (n=3) were used to detect T. gondii by real-time PCR targeting a 529 bp repeating fragment of T. gondii DNA. Samples that were positive in real-time PCR were genotyped using 15 microsatellite markers. Results T. gondii DNA was detected in 4 (5 %) samples: in the brain from a Black-backed Jackal (Canis mesomelas), in the liver from a African Wildcat (Felis silvestris lybica) and in the liver and heart of two Rusty-spotted Genets (Genetta maculata) respectively. The DNA sample from Black-backed Jackal was genotyped and characterized as belonging to the type Africa 4 lineage (equivalent to RFLP genotype ToxoDB#20), that is a widespread lineage in Africa. Discussion This is the first genetic characterization of T. gondii isolated from a wild carnivore on the African continent and the first report of T. gondii in Black-backed Jackal. The Africa 4 lineage was also confirmed in the region of Southern Africa for the first time.
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Affiliation(s)
- Karol Račka
- Department of Epizootology, Parasitology and Protection of One Health, University of Veterinary Medicine and Pharmacy in Košice, Košice, Slovakia
| | - Eva Bártová
- Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences Brno, Brno, Czechia
| | - Azra Hamidović
- Inserm U1094, IRD U270, CHU Limoges, EpiMaCT - Epidémiologie des Maladies Chroniques en zone Tropicale, Institut d’Epidémiologie et de Neurologie Tropicale, OmegaHealth, University of Limoges, Limoges, France
| | - Nicolas Plault
- Inserm U1094, IRD U270, CHU Limoges, EpiMaCT - Epidémiologie des Maladies Chroniques en zone Tropicale, Institut d’Epidémiologie et de Neurologie Tropicale, OmegaHealth, University of Limoges, Limoges, France
| | - Alica Kočišová
- Department of Epizootology, Parasitology and Protection of One Health, University of Veterinary Medicine and Pharmacy in Košice, Košice, Slovakia
| | - Gerrie Camacho
- Department of Scientific Services, Mpumalanga Tourism & Parks Agency (MTPA), Nelspruit, South Africa
| | - Aurelién Mercier
- Inserm U1094, IRD U270, CHU Limoges, EpiMaCT - Epidémiologie des Maladies Chroniques en zone Tropicale, Institut d’Epidémiologie et de Neurologie Tropicale, OmegaHealth, University of Limoges, Limoges, France
| | - Ali Halajian
- Research Administration and Development, University of Limpopo, Sovenga, South Africa
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Nsiangani Lusambo N, Kaimbo Wa Kaimbo D, Mumba Ngoyi D, Kilangalanga Ngoy J, Ngoyi Bambi MT, Kadima Mutombo T, Kintoki Makela G, Ngandowe Nzamokili L, de-la-Torre A. Clinical and Serological Characteristics of Ocular Toxoplasmosis in the Democratic Republic of Congo. Ocul Immunol Inflamm 2023; 31:1522-1527. [PMID: 36328437 DOI: 10.1080/09273948.2022.2140297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To describe demographic data, clinical features, and serological profiles in a cohort of Congolese patients with ocular toxoplasmosis (OT). METHOD Cross-sectional study, carried out between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa. RESULTS The study comprised 95 participants with OT. Fifty-three patients were male (55.8%). The mean age at presentation was 35.6 ± 14.1 years (range 8-69 years); 71 had active OT (74.7%), among them, 33 had primary OT (46.5%), and 38 had recurrences (53.5%). At presentation, 51 patients (53.7%) had visual impairment (VA < 6/18). Retinochoroidal lesions were located in the central retina in 60 patients (63.1%). Patients with primary OT tend to have higher IgG levels than those with recurrent OT (P = .01). CONCLUSION We report the largest cohort of patients with OT in sub-Saharan Africa. In our setting, most patients had recurrent OT with multiple, extensive, and central retinochoroidal lesions.
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Affiliation(s)
- Nadine Nsiangani Lusambo
- The Department of Eye, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Kaimbo Wa Kaimbo
- The Department of Eye, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Mumba Ngoyi
- The Department of Parasitology, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | | | - Théodore Kadima Mutombo
- National Eye Care Program, Masina Ophthalmology Hospital, Kinshasa, Democratic Republic of Congo
| | - Guy Kintoki Makela
- National Eye Care Program, Masina Ophthalmology Hospital, Kinshasa, Democratic Republic of Congo
| | - Lady Ngandowe Nzamokili
- National Eye Care Program, Masina Ophthalmology Hospital, Kinshasa, Democratic Republic of Congo
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Nsiangani Lusambo N, Kaimbo Wa Kaimbo D, Mumba Ngoyi D, Akilimali Zalagile P, de-la-Torre A. Risk factors for ocular toxoplasmosis among uveitis patients in Kinshasa, DR Congo. BMJ Open Ophthalmol 2023. [DOI: 10.1136/bmjophth-2022-001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
ObjectiveTo identify the risk factors associated with ocular toxoplasmosis (OT) in a cohort of Congolese patients with uveitis.Methods and analysisA cross-sectional study was conducted between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa. Patients with a diagnosis of uveitis were enrolled in the study. Each patient underwent an interview, an ophthalmological examination and serology testing. Logistic regression was performed to identify risk factors for OT.Results212 patients were included in the study with a mean age at presentation of 42.1±15.9 years (limits: 8–74 years) and a sex ratio of 1.1:1. OT concerned 96 patients (45.3%). The age of the patients below 60 years (p=0.001, OR=9.75 CI 95% 2.51 to37.80)), the consumption of cat meat (p=0.01, OR=2.65 CI 95% 1.18 to 5.96)) and undercooked meat (p=0.044, OR=2.30 CI 95% 1.02 to 5.21)) and living in rural area (p=0.021, OR=11.4 (CI 95% 1.45 to 89.84])) were identified as risk factors for OT.ConclusionOT affects more young people. It is associated with dietary habits. Informing and educating the population is necessary to avoid infection.
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Ferreira LB, Furtado JM, Charng J, Franchina M, Matthews JM, Molan AAL, Hunter M, Mackey DA, Smith JR. Prevalence of Toxoplasmic Retinochoroiditis in an Australian Adult Population: a Community-Based Study. Ophthalmol Retina 2022; 6:963-968. [PMID: 35568370 DOI: 10.1016/j.oret.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Toxoplasmic retinochoroiditis is the most common clinical manifestation of an infection with the protozoan parasite, Toxoplasma gondii. Up to 50% of the human population is estimated to be infected with T. gondii. However, the epidemiology of toxoplasmic retinochoroiditis is not widely reported. We sought to estimate the prevalence of toxoplasmic retinochoroiditis in Australia using data collected as part of the Busselton Healthy Ageing Study. DESIGN Cross-sectional, community-based, prospective cohort study. PARTICIPANTS 5,020 Australian adults (2,264 men and 2,756 women; age range of 45-69 years and median age of 58 years). METHODS Retinal color photographs centered on the optic disc and macula were captured on a digital retinal camera following dilation of the pupils. Three uveitis-subspecialized ophthalmologists assessed each pigmented retinal lesion, and complete concordance of opinion was required to assign a toxoplasmic etiology. Serum T. gondii immunoglobulin (Ig)G levels were measured for those participants with retinal lesions judged to be toxoplasmic retinochoroiditis. MAIN OUTCOME MEASURES Prevalence of toxoplasmic retinochoroiditis. RESULTS Eight participants (0.16%) had retinal lesions that were considered to have the characteristic appearance of toxoplasmic retinochoroiditis, plus detectable serum T. gondii IgG, consistent with the diagnosis of toxoplasmic retinochoroiditis. On the assumption that 23.81% of retinal lesions occur at the posterior pole, as reported in a community-based survey conducted in Brazil (Sci Rep. 2021;11:3420), the prevalence of toxoplasmic retinochoroiditis was estimated at 0.67% or 1 per 149 persons. CONCLUSIONS Toxoplasmic retinochoroiditis is common in Australian adults. Efforts to quantify and address risk factors for human infection with T. gondii are justified.
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Affiliation(s)
- Lisia B Ferreira
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - João M Furtado
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Jason Charng
- Centre for Ophthalmology and Visual Science, Lions Eye Institute
| | - Maria Franchina
- Centre for Ophthalmology and Visual Science, Lions Eye Institute
| | - Janet M Matthews
- Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Aus A L Molan
- Edith Cowan University, Perth, Australia; PathWest Laboratory Medicine WA, Perth, Australia
| | - Michael Hunter
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science, Lions Eye Institute
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, Australia; Queensland Eye Institute, Brisbane, Australia.
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Cifuentes-González C, Zapata-Bravo E, Sierra-Cote MC, Boada-Robayo L, Vargas-Largo ÁP, Reyes-Guanes J, de-la-Torre A. Colombian Ocular Infectious Epidemiology Study (COIES): Ocular toxoplasmosis incidence and sociodemographic characterization, 2015–2019. Int J Infect Dis 2022; 117:349-355. [DOI: 10.1016/j.ijid.2022.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022] Open
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Marstrand J, Kurtzhals JAL, Fuchs HJ, Nielsen HV, Jokelainen P. The disease burden of ocular toxoplasmosis in Denmark in 2019: Estimates based on laboratory testing of ocular samples and on publicly available register data. Parasite Epidemiol Control 2022; 15:e00229. [PMID: 35005263 PMCID: PMC8716638 DOI: 10.1016/j.parepi.2021.e00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Toxoplasma gondii is an important zoonotic protozoan parasite with worldwide distribution. Information on the contribution of ocular toxoplasmosis to the disease burden caused by this parasite is limited or lacking from many countries. Methods We estimated the minimum occurrence of ocular toxoplasmosis in Denmark using results from direct detection of T. gondii DNA with qPCR and determination of the Goldmann-Witmer coefficient on ocular samples submitted by ophthalmological clinics and departments to the national reference laboratory in 2003–2019. In addition, we inferred incidence estimates using retrospective data that are publicly available in the National Patient Register, and we used unstructured expert elicitation as the basis for sensitivity analyses. We estimated the disease burden of ocular toxoplasmosis in 2019 in disability-adjusted life years (DALYs). Findings Ocular samples from 263 individuals (median age 57 years, range 2–88) had been tested with at least one of the methods during 2003–2019, and 42 (16%) tested positive (median age 65 years, range 14–85). In 2019, five (16%) of 31 tested individuals were positive, giving a minimum annual incidence estimate of 0.09 per 100.000 population. From this, we calculated a disease burden of at least 4 DALYs (95% confidence interval, 3–5). The age range suggested that this figure represented postnatally acquired ocular toxoplasmosis. The disease burden of ocular toxoplasmosis due to congenital toxoplasmosis has been previously estimated to be at least 12 DALYs, resulting in an estimated minimum total disease burden due to ocular toxoplasmosis of 16 DALYs. In 2005–2018, the mean annual number of diagnoses of ocular toxoplasmosis reported to the National Patient Register was 186, and the corresponding disease burden estimate was 134 DALYs (95% confidence interval, 113–158). Sensitivity analyses focusing on incidence and severity resulted in disease burden estimates in the range of 9–523 DALYs. Interpretation Because most diagnoses of ocular toxoplasmosis are based on clinical observations, ophthalmoscopy, and serology without confirmatory testing, the disease burden caused by ocular toxoplasmosis is likely substantially higher than our minimum estimates. Our results indicate that ocular toxoplasmosis contributes to the disease burden caused by T. gondii in Denmark, but uncertainty about the incidence and severity precludes reliable estimation of its importance.
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Affiliation(s)
- Jonathan Marstrand
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Anders Lindholm Kurtzhals
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Helle Josefine Fuchs
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Vedel Nielsen
- Laboratory of Parasitology, Department of Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Pikka Jokelainen
- Laboratory of Parasitology, Department of Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
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Abraham EG, Moses AE, Motilewa USOO, Uwah AI, Itina EI, Umoh AN. Ocular Toxoplasmosis among Livestock Farmers and Raw Meat Handlers in Uyo, Nigeria. Ethiop J Health Sci 2021; 31:257-266. [PMID: 34158777 PMCID: PMC8188092 DOI: 10.4314/ejhs.v31i2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Toxoplasmosis is the commonest cause of infectious posterior uveitis in humans and can lead to blindness and low vision in both immune-competent and immunecompromised persons worldwide. The aim of this study was to determine the prevalence of Ocular Toxoplasmosis (OT) and potential risk factors among livestock farmers and raw meat handlers in Uyo. METHODS This was a descriptive cross-sectional community-based study involving clinical eye examination, laboratory detection of anti-Toxoplasma gondii IgG antibody and HIV testing. Participants' other information was obtained using interviewer-administered questionnaire. RESULTS There were 339 participants aged 15-78 (mean 34.8±11.6) years,283 (83.5%) were males 56(16.5%) were females; 189 (55.8%) tested seropositive for anti-Toxo. gondiiIgG antibodies. Eight (2.4%) had presumed ocular toxoplasmosis (POT); 6 of the 8 were seropositive for anti-T.gondiiIgG antibody; and 2 of the 8 POT (25%) were HIV-seropositive. Of the 189 who were anti-T.gondiiIgG antibody seropositive, 6 (3.2%) had OT. Factors associated with OT were age (31-50 years) and female gender (P = 0.049 and 0.001, respectively). HIV infection was associated with POT (P=0.033). Most of the ocular lesions (87.5%) were unilateral and located at the posterior pole (77.7%). CONCLUSION The prevalence of presumed ocular toxoplasmosis (POT) and ocular toxoplasmosis (OT) among livestock farmers and raw meat handlers in Uyo are 2.4% and 1.8%, respectively. Potential risk factors are being female, and persons between fourth and fifth decades of life. Awareness creation on toxoplasmosis among this occupational group is advocated.
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Affiliation(s)
- Emem Godwin Abraham
- Department of Ophthalmology, University of Uyo Teaching Hospital, Uyo, Nigeria
| | | | | | | | - Eme Iwat Itina
- Department of Ophthalmology, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Anthony N Umoh
- Department of Microbiology, University of Uyo Teaching Hospital, Uyo, Nigeria
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Hamidović A, Etougbétché JR, Tonouhewa ABN, Galal L, Dobigny G, Houémènou G, Da Zoclanclounon H, Amagbégnon R, Laleye A, Fievet N, Piry S, Berthier K, Pena HFJ, Dardé ML, Mercier A. A hotspot of Toxoplasma gondii Africa 1 lineage in Benin: How new genotypes from West Africa contribute to understand the parasite genetic diversity worldwide. PLoS Negl Trop Dis 2021; 15:e0008980. [PMID: 33571262 PMCID: PMC7904144 DOI: 10.1371/journal.pntd.0008980] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/24/2021] [Accepted: 11/12/2020] [Indexed: 12/16/2022] Open
Abstract
Through international trades, Europe, Africa and South America share a long history of exchanges, potentially of pathogens. We used the worldwide parasite Toxoplasma gondii to test the hypothesis of a historical influence on pathogen genetic diversity in Benin, a West African country with a longstanding sea trade history. In Africa, T. gondii spatial structure is still non-uniformly studied and very few articles have reported strain genetic diversity in fauna and clinical forms of human toxoplasmosis so far, even in African diaspora. Sera from 758 domestic animals (mainly poultry) in two coastal areas (Cotonou and Ouidah) and two inland areas (Parakou and Natitingou) were tested for T. gondii antibodies using a Modified Agglutination Test (MAT). The hearts and brains of 69 seropositive animals were collected for parasite isolation in a mouse bioassay. Forty-five strains were obtained and 39 genotypes could be described via 15-microsatellite genotyping, with a predominance of the autochthonous African lineage Africa 1 (36/39). The remaining genotypes were Africa 4 variant TUB2 (1/39) and two identical isolates (clone) of Type III (2/39). No difference in terms of genotype distribution between inland and coastal sampling sites was found. In particular, contrarily to what has been described in Senegal, no type II (mostly present in Europe) was isolated in poultry from coastal cities. This result seems to refute a possible role of European maritime trade in Benin despite it was one of the most important hubs during the slave trade period. However, the presence of the Africa 1 genotype in Brazil, predominant in Benin, and genetic analyses suggest that the triangular trade was a route for the intercontinental dissemination of genetic strains from Africa to South America. This supports the possibility of contamination in humans and animals with potentially imported virulent strains. The parasite Toxoplasma gondii is a worldwide-distributed pathogen, able to infect all warm-blooded animals. There are important differences in the clinical expression of the infection in direct relation with the parasite genetic profile. In some regions, the geographical structuration of its genetic diversity points towards a crucial role of human activities in some lineages introduction or sorting. Benin is a West African country with a history of extensive transcontinental exchanges. Our genetic study of Toxoplasma in Benin shows a surprisingly homogeneous and autochthonous diversity, which contrasts with previous studies from other West and Central African countries. In Benin, the absence of European Toxoplasma lineages may be explained by the extreme rarity of the house mouse (Mus musculus), a host species that was previously described as highly susceptible to the mouse-virulent African strains. Might Benin be the origin region for the Africa 1 lineage, our results suggest that Guinean Gulf coasts may be a starting point of this lineage towards South America, especially Brazil, during the slave trade. As a whole, the present study provides further insights into the recent evolutionary history of Toxoplasma gondii and its consequences on human and animal health.
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Affiliation(s)
- Azra Hamidović
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
- * E-mail:
| | - Jonas Raoul Etougbétché
- UAC, EPAC, Laboratoire de Recherche en Biologie Appliquée, Unité de Recherche sur les Invasions Biologiques, Cotonou, Benin
| | | | - Lokman Galal
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Gauthier Dobigny
- UAC, EPAC, Laboratoire de Recherche en Biologie Appliquée, Unité de Recherche sur les Invasions Biologiques, Cotonou, Benin
- Centre de Biologie pour la Gestion des Populations, IRD, CIRAD, INRA, Montpellier SupAgro, MUSE, Montpellier, France
| | - Gualbert Houémènou
- UAC, EPAC, Laboratoire de Recherche en Biologie Appliquée, Unité de Recherche sur les Invasions Biologiques, Cotonou, Benin
| | - Honoré Da Zoclanclounon
- Laboratoire d’Expérimentation Animale, Unité de Biologie Humaine, Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
| | - Richard Amagbégnon
- Laboratoire de biologie médicale, Centre Hospitalo-Universitaire de la Mère et de l’Enfant Lagune (CHU-MEL), Cotonou, Bénin
| | - Anatole Laleye
- Laboratoire d’Expérimentation Animale, Unité de Biologie Humaine, Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin
| | - Nadine Fievet
- UMR216-MERIT, IRD, Université Paris-5, Sorbonne Paris Cité, Paris, France; Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE), Cotonou, Bénin
| | - Sylvain Piry
- Centre de Biologie pour la Gestion des Populations, IRD, CIRAD, INRA, Montpellier SupAgro, MUSE, Montpellier, France
| | - Karine Berthier
- Centre de Biologie pour la Gestion des Populations, IRD, CIRAD, INRA, Montpellier SupAgro, MUSE, Montpellier, France
| | - Hilda Fátima Jesus Pena
- Department of Preventive Veterinary Medicine and Animal Health, Faculty of Veterinary Medicine, University of São Paulo, São Paulo, Brazil
| | - Marie-Laure Dardé
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
- Centre National de Référence Toxoplasmose/Toxoplasma Biological Resource Center, CHU Limoges, Limoges, France
| | - Aurélien Mercier
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
- Centre National de Référence Toxoplasmose/Toxoplasma Biological Resource Center, CHU Limoges, Limoges, France
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Frequency and visual outcomes of ocular toxoplasmosis in an adult Brazilian population. Sci Rep 2021; 11:3420. [PMID: 33564078 PMCID: PMC7873183 DOI: 10.1038/s41598-021-83051-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
Although ocular toxoplasmosis is a leading cause of posterior uveitis worldwide, there is scarce information about the real-life frequency of ocular lesions, visual outcomes, and risk factors for poor prognosis. We conducted a community-based cross-sectional study with 721 adults living in Cássia dos Coqueiros, Southeast Brazil, consisted of visual acuity measurement, dilated ocular examination, a risk-factor questionnaire, and peripheral blood collection for anti-T. gondii serology. Presumed toxoplasmic lesions were recorded on video and analyzed by experienced and masked ophthalmologists. Ocular toxoplasmosis was determined if at least one suspected lesion was appointed by two graders in the presence of positive anti-T. gondii serology. Forty-eight eyes (n = 42 participants; 6.7% among those with positive anti-T. gondii serology) with ocular toxoplasmosis were found. Most lesions were single (n = 28; 58.3%), peripheral (n = 34; 77.1%) and unilateral (85.7% of participants); no active lesions were found. Older age was associated with lesions larger than one-disc diameter (p = 0.047), and lower social stratum (OR: 2.89; CI 1.2-6.97; p = 0.018) was associated with the presence of toxoplasmic lesions. Although there were no differences in visual acuity between participants and eyes with or without ocular lesions (p > 0.05), unilateral blindness associated with ocular toxoplasmosis was identified in a reduced number of individuals.
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Ajamil-Rodanes S, Luis J, Bourkiza R, Girling B, Rees A, Cosgrove C, Pavesio C, Westcott M. Ocular toxoplasmosis: phenotype differences between toxoplasma IgM positive and IgM negative patients in a large cohort. Br J Ophthalmol 2021; 105:210-215. [PMID: 32345603 DOI: 10.1136/bjophthalmol-2019-315522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate the differences in demographics and clinical characteristics of patients diagnosed with ocular toxoplasmosis according to their IgM status. METHODS Retrospective case note analysis was carried out on patients who tested positive for serum Toxoplasma gondii-specific IgM antibodies (IgM+) as well as a comparator group who tested negative for serum IgM (IgM-), but positive for serum IgG. Patient demographics and clinical features were compared between the two groups to evaluate for any significant differences. RESULTS One hundred and six patients were included in the study between March 2011 and June 2018, consisting of 37 in the IgM +group and 69 in the IgM- group. Patients in the IgM +group were significantly older (51.1 vs 34.1 years, p<0.0001), more likely to present with central macular lesions (32% vs 12%, p=0.012), and more likely to develop rhegmatogenous retinal detachment (11% vs 1%, p=0.049). In contrast, patients in the IgM- group were more likely present with pain (20% vs 3%, 0.017) and exhibit more severe inflammation of the anterior chamber and vitreous (p<0.05). Overall, retinal lesions were more likely to be superotemporal (55%) and superonasal (31%). Furthermore, age was associated with larger (p=0.003) and more peripheral lesions (p=0.007). CONCLUSIONS This study demonstrated significant differences in clinical characteristics of ocular toxoplasmosis according to serum IgM status. IgM+ patients were older, less likely to report pain, had lower levels of intraocular inflammation, but were more likely to have macular involvement. We also found age to be correlated with larger and more peripheral lesions.
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Affiliation(s)
| | - Joshua Luis
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Rabia Bourkiza
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Benedict Girling
- Ophthalmology Department, Barts Health NHS Trust, London, London, UK
| | - Angela Rees
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Catherine Cosgrove
- Infectious Department, St George's University Hospital NHS Foundation Trust, London, UK
| | - Carlos Pavesio
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Mark Westcott
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Ophthalmology Department, Barts Health NHS Trust, London, London, UK
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Nsiangani-Lusambo N, Reyes-Guanes J, Uribe-Reina P, Kaimbo Wa Kaimbo D, Mumba Ngoyi D, de-la-Torre A. Ocular Toxoplasmosis in Africa: A Narrative Review of the Literature. Ocul Immunol Inflamm 2020; 30:342-347. [PMID: 32976046 DOI: 10.1080/09273948.2020.1801761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To present a narrative review about ocular toxoplasmosis epidemiology, disease burden and prevalent African parasitic strains. METHODS An initial search for MeSH terms was conducted with a posterior advanced search in two electronic databases. Full text reading was performed. RESULTS Animal African studies have identified Toxoplasma gondii type II, type III, Africa 1, and Africa 3 strains. Seroprevalence varies from 6.4% to 74.5%. Nevertheless, there is a scarcity of epidemiology and serotyping information about ocular toxoplasmosis. African studies have demonstrated that uveitis patients present high frequencies of ocular toxoplasmosis. There is a lack of studies describing specific clinical characteristics, which can be related, to environmental and socioeconomic factors, parasite serotype and genotype, and genetic susceptibility of the host. CONCLUSION As Toxoplasma gondii has more virulent strains in the Southern hemisphere, it is relevant to determine African strain types and the correlation between the infecting strains and the clinical manifestations.
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Affiliation(s)
- Nadine Nsiangani-Lusambo
- Eye Department, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Juliana Reyes-Guanes
- Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia.,Grupo de Investigación en Neurociencia (Neuros), Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Pilar Uribe-Reina
- Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia.,Grupo de Investigación en Neurociencia (Neuros), Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Dieudonné Kaimbo Wa Kaimbo
- Eye Department, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Mumba Ngoyi
- Parasitology Department, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Alejandra de-la-Torre
- Grupo de Investigación en Neurociencia (Neuros), Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá, Colombia
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Agordzo SK, Badu K, Addo MG, Owusu CK, Mutala AH, Tweneboah A, Abbas DA, Ayisi-Boateng NK. Seroprevalence, risk factors and impact of Toxoplasma gondii infection on haematological parameters in the Ashanti region of Ghana: a cross-sectional study. AAS Open Res 2020; 2:166. [PMID: 32734139 PMCID: PMC7369427 DOI: 10.12688/aasopenres.13022.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Toxoplasma gondii is an obligate, intracellular, apicomplexan parasite that causes toxoplasmosis. Although the global prevalence of toxoplasmosis has been estimated to be approximately 30%, there is limited seroprevalence data in Ghana, with a dearth of information on the impact of T. gondii on haematological parameters in exposed persons. Methods: Questionnaires were administered to 300 consenting individuals to obtain demographic information and assessment of their risk of exposure to T. gondii. Using anti- T. gondii IgG/IgM combo test kits, seropositivity to parasite-specific IgG and/or IgM was determined. A haematological analyser was used to measure haematological parameters. Results: There was an overall seroprevalence of 50.3% (n=151), with 49.7% (n=149) of the study participants seropositive for IgG and 1% (n=3) testing positive for IgM. Furthermore, the observed seroprevalence among pregnant women was 56.4% (n=62). With regard to settlement type, a seroprevalence of 55.6% was observed in the rural community, 50.6% in the peri-urban community and 47.1% in the urban community. The study identified cat ownership, contact with cat litter, contact with raw meat [RR (95% CI: 1.76 (1.23-2.53), 1.66 (1.03-2.67), 1.25(1.00-1.57)] and age (p<0.001) as risk factors for infection. Analyses of haematological data revealed significant reduction in the white blood cell, lymphocytes and mean corpuscular volume levels in seropositive males (p=0.0223, 0.0275, and 0.0271) respectively. Only the mean corpuscular volume of seropositive females reduced significantly as compared to the seronegative counterparts (p=0.0035). Conclusions: About half of the study population, including women of reproductive age carried antibodies against T. gondii, raising concerns about the risk of congenital toxoplasmosis and anaemia. We, therefore, recommend that screening for Toxoplasma gondii be included in the routine screening of pregnant women seeking antenatal care and further investigation should be conducted on the haematological implications of infection in humans.
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Affiliation(s)
- Samuel Kekeli Agordzo
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Kingsley Badu
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
- Kumasi Centre for Collaborative Research for Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mathew Glover Addo
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Christian Kwasi Owusu
- Kumasi Centre for Collaborative Research for Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul-Hakim Mutala
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Austine Tweneboah
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Dawood Ackom Abbas
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Nana Kwame Ayisi-Boateng
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- The University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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14
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Agordzo SK, Badu K, Addo MG, Owusu CK, Mutala AH, Tweneboah A, Abbas DA, Ayisi-Boateng NK. Seroprevalence, risk factors and impact of Toxoplasma gondii infection on haematological parameters in the Ashanti region of Ghana: a cross-sectional study. AAS Open Res 2019; 2:166. [PMID: 32734139 PMCID: PMC7369427 DOI: 10.12688/aasopenres.13022.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 03/30/2024] Open
Abstract
Background: Toxoplasma gondii is an obligate, intracellular, apicomplexan parasite that causes toxoplasmosis. Although the global prevalence of toxoplasmosis has been estimated to be approximately 30%, there is limited seroprevalence data in Ghana, with a dearth of information on the impact of T. gondii on haematological parameters in exposed persons. Methods: Questionnaires were administered to 300 consenting individuals to obtain demographic information and assessment of their risk of exposure to T. gondii. Using anti- T. gondii IgG/IgM combo test kits, seropositivity to parasite-specific IgG and/or IgM was determined. A haematological analyser was used to measure haematological parameters. Results: The participants included 58 males and 242 females, and ranged in age from 6 months to 84 years, with a median age of 27 years. There was an overall seroprevalence of 50.3% (n=151), with 49.7% (n=149) of the study participants seropositive for IgG and 1% (n=3) testing positive for IgM. Furthermore, the observed seroprevalence among pregnant women was 56.4% (n=62). With regards to the different communities in which the hospitals were located, a seroprevalence of 55.6% was observed in the rural community, 50.6% in the peri-urban community and 47.1% in the urban community. The study identified cat ownership, contact with cat litter [RR (95% CI: 1.76 (1.23-2.53), 1.66 (1.03-2.67), 1.25(1.00-1.57)] and age (p<0.001) as risk factors for infection. Analyses of haematological data also revealed significant differences between the red blood cell counts (p=0.038) and mean corpuscular volumes (p=0.0007) of seropositive and seronegative study participants. Conclusions: About half of the study population, including a significant number of women of reproductive age carried antibodies against T. gondii, raising questions about the risk of congenital toxoplasmosis, as well as possible links to anaemia. We, therefore, recommend that screening for Toxoplasma gondii be included in the routine screening of pregnant women seeking antenatal care.
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Affiliation(s)
- Samuel Kekeli Agordzo
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Kingsley Badu
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
- Kumasi Centre for Collaborative Research for Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mathew Glover Addo
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Christian Kwasi Owusu
- Kumasi Centre for Collaborative Research for Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul-Hakim Mutala
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Austine Tweneboah
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Dawood Ackom Abbas
- Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, AK 192, Ghana
| | - Nana Kwame Ayisi-Boateng
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- The University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Galal L, Sarr A, Cuny T, Brouat C, Coulibaly F, Sembène M, Diagne M, Diallo M, Sow A, Hamidović A, Plault N, Dardé ML, Ajzenberg D, Mercier A. The introduction of new hosts with human trade shapes the extant distribution of Toxoplasma gondii lineages. PLoS Negl Trop Dis 2019; 13:e0007435. [PMID: 31295245 PMCID: PMC6622481 DOI: 10.1371/journal.pntd.0007435] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/03/2019] [Indexed: 01/01/2023] Open
Abstract
Toxoplasma gondii is a zoonotic protozoan with a worldwide occurrence, but the determinants of the current pattern in the geographical distribution of T. gondii lineages and strains remain poorly understood. To test the influence of human trade on T. gondii populations, we conducted a population genetic study of 72 T. gondii animal isolates from Senegal, a West African country in which the ongoing inland progress of invasive murine hosts (introduced in port cities of Senegal since the 16th century by European sailors) is well described. Isolates were mainly collected on free-range poultry, which are considered as relevant bioindicators of T. gondii strain diversity in the domestic environment. Sampling was conducted in two port cities of Senegal (Dakar and Saint-Louis) and in one inland region (Kedougou). Population genetic analyses using 15 microsatellite markers revealed different patterns between port cities where lineages non-virulent for mice (type II, type III, and Africa 4) were predominant, and Kedougou where the mouse-virulent Africa 1 lineage was the most common. By considering the current spatial pattern in the inland progress of invasive rodents in Senegal, our results suggest that the invasive house mouse Mus musculus domesticus counter-selects the Africa 1 lineage in the invaded areas. The comparison of the microsatellite alleles of type II strains from Senegal to type II strains from other areas in Africa and Western Europe, using discriminant analysis of principal components and Network analysis, point to a mainly Western European origin of the type II lineage in Senegal. Collectively, these findings suggest that human-mediated intercontinental migrations of murine hosts are important vectors of T. gondii strains. Differential susceptibility of endemic and introduced murine hosts to various T. gondii strains probably determines the persistence of these strains in the environment, and therefore their availability for human and animal infection.
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Affiliation(s)
- Lokman Galal
- INSERM, Univ. Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Amedine Sarr
- INSERM, Univ. Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Thomas Cuny
- INSERM, Univ. Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Carine Brouat
- CBGP, IRD, CIRAD, INRA, Montpellier SupAgro, Univ. Montpellier, Cedex, France
| | - Fatoumata Coulibaly
- Laboratory of Parasitology-Mycology, Faculty of Medicine and Pharmacy, University of Cheikh Anta Diop, Dakar, Senegal
- Département de Biologie, Unité de formation et de recherche en Sciences Biologiques, Université Péléforo Gon Coulibaly, Korhogo, Côte d'Ivoire
| | - Mbacké Sembène
- Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Moustapha Diagne
- Département de Biologie Animale, Faculté des Sciences et Techniques, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | | | - Aliou Sow
- BIOPASS, CBGP-IRD, ISRA, UCAD, Dakar, CP, Senegal
| | - Azra Hamidović
- INSERM, Univ. Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Nicolas Plault
- INSERM, Univ. Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Marie-Laure Dardé
- INSERM, Univ. Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
- Centre National de Référence Toxoplasmose/Toxoplasma Biological Resource Center, CHU Limoges, Limoges, France
| | - Daniel Ajzenberg
- INSERM, Univ. Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Aurélien Mercier
- INSERM, Univ. Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
- Centre National de Référence Toxoplasmose/Toxoplasma Biological Resource Center, CHU Limoges, Limoges, France
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Kwofie KD, Ghansah A, Osei JHN, Frempong KK, Obed S, Frimpong EH, Boakye DA, Suzuki T, Ohta N, Ayi I. Indication of Risk of Mother-to-Child Toxoplasma gondii Transmission in the Greater Accra Region of Ghana. Matern Child Health J 2016; 20:2581-2588. [DOI: 10.1007/s10995-016-2084-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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