Seroepidemiology and Risk Factors of Toxoplasma gondii Infection among the Newly Enrolled Undergraduates and Postgraduate Students in China

Prevalence and Predictors of Toxoplasma gondii Infection in Psychiatric Inpatients in Fars Province, Southern Iran

BACKGROUND

Psychiatric patients are at increased risk of exposure to Toxoplasma gondii infection, which may be linked to their living facilities and behaviors. Limited knowledge on the prevalence of T. gondii infection and its associated risk factors in psychiatric patients are available to the international medical communities. Thus, the aim of the current study was to assess seroprevalence of T. gondii and its associated risk factors in psychiatric inpatients in Fars Province, southern Iran.

METHODS

This cross-sectional study was carried out on psychiatric patients hospitalized in Ibn Sina Hospital affiliated to Shiraz University of Medical Sciences, Fars Province, southern Iran, March to July 2021. Blood samples were collected from 318 psychiatric patients and assessed for the detection of IgG against T. gondii using enzyme-linked immunosorbent assay (ELISA). Moreover, structured questionnaires were completed for the participants at the time of sampling. Logistic regression analysis was used to assess possible associations between the latent toxoplasmosis and the variables.

RESULTS

The overall seroprevalence of anti-T. gondii IgG in psychiatric inpatients was 22.3% (71/318; 95% CI = 17.9-27.3). Multivariate analyses revealed that age > 30 years [adjusted odds ratio (AOR) = 2.24, 95% CI = 1.10-4.60, p = 0.03], contact with cats (AOR = 2.52, 95% CI = 1.14-5.58, p = 0.03), raw vegetable consumption (AOR = 3.65, 95% CI = 1.74-7.65, p = 0.001), raw/undercooked meat consumption (AOR = 4.30, 95% CI = 1.47-12.63, p = 0.008), suicide attempt (AOR = 3.77, 95% CI = 1.58-8.97, p = 0.003) and cigarette smoking history (AOR = 0.38, 95% CI = 0.17-0.83, p = 0.02) were independent risk factors for T. gondii infection.

CONCLUSION

The current results demonstrated that contact with cats, raw vegetable consumption and raw/undercooked meat consumption were independent risk factors for T. gondii seropositivity. Moreover, the current study showed significant associations between seropositivity of T. gondii and suicide attempts as well as negative associations between seropositivity of T. gondii and cigarette smoking in psychiatric inpatients using multivariate logistic regression.

Molecular detection and genetic characterization of Toxoplasma gondii in pork from Chongqing, southwest China

Raw or undercooked meat is an important source of Toxoplasma gondii infection in China, but there is little research data on these infections in Chongqing. This study determined the prevalence of T. gondii, and its genotypes, in pork. A total of 1,223 diaphragm muscle samples were collected from eight slaughterhouses and 79 markets and detected by PCR amplification of the ITS gene. All of the positive samples were used for genotype identification by PCR-RFLP with 11 genetic markers. The total positive rate of T. gondii in Chongqing pork was 8.7%, and differences in T. gondii infection rates were found between different districts (0%-23.3%), seasons (e.g., 4.3% from Spring, 7.3% from Summer, 11.4% from Autumn, 12.0% from Winter) and years (2.7%-14.3%). Six samples were successfully genotyped, of which one was identified as ToxoDB#9 and five were ToxoDB#9-like. This was the first continuous study about the prevalence of T. gondii in pork in Chongqing for several years. Slaughterhouses in different districts, pork source, farm scale, season and year were potential risk factors for T. gondii contamination by the univariate logistic regression, and using multivariate logistic regression districts, pork source and year were the independent risk factor. These data may help reducing the levels of toxoplasmosis in pigs and humans in Chongqing.

Toxoplasmosis in immunocompetent Saudi women: Correlation with vitamin D

Objective:

Toxoplasma gondii (T. gondii) is a life-threatening parasite particularly infecting the immunocompromised women. Deficiency of vitamin D is well reported in several infectious disorders. This study was undertaken to investigate a correlation of vitamin D deficiency with the onset of T. gondii infection in immunocompetent women from the central of Saudi Arabia.

Methods:

Blood samples were collected from 304 Saudi women from the Qassim region of Saudi Arabia. Specific immunoassays were used to determine the levels of T. gondii immunoglobulin G and vitamin D. The SPSS and the Prism Graph Pad statistical software were used for the data analysis.

Results:

Out of 304 women, 18.8% were found to be positive for toxoplasmosis. Interestingly, the serum levels of vitamin D in toxoplasma positive cases were found to be significantly low as compared with the levels of vitamin D in toxoplasma negative cases. Moreover, sociodemographic risk factors such as age, residence location, and consumption of fruits/vegetables were also found to be associated with vitamin D deficiency and with the seroprevalence of toxoplasmosis.

Conclusion:

This study investigated a direct correlation of vitamin D deficiency with the severity of the toxoplasmosis in Saudi women. Therefore, it is predicted that vitamin D supplementation may provide protection against toxoplasma infection.

Potential linkage between Toxoplasma gondii infection and physical education scores of college students

Objective

Toxoplasma gondii is a worldwide protozoan parasite that could infect virtually all warm-blooded animals, including humans. Our study aimed to investigate the prevalence of T. gondii infection in college students at Anhui province, China and to assess risk factors for T. gondii infection in college students. Moreover, growing studies demonstrated the association between T. gondii infection and host behavioral changes. We also studied the linkage between T. gondii and physical education (PE) scores of college students.

Methods

A total of 2704 serum samples of medical school students attending physical education lessons were collected from September 2017 to September 2019 and evaluated for T. gondii IgG antibodies using an enzyme-linked immunosorbent assay (ELISA). Questionnaires and statistical analysis were used to determine the risk factors for T. gondii infection. We also analysed PE scores of T. gondii -infected students and T. gondii-uninfected students.

Results

The overall seroprevalence of T. gondii was 11.5%. The main risk factors related to T. gondii infection in college students were cat in the household and gardening or agriculture activity. Furthermore, in the basketball group and the soccer group, scores of T. gondii seropositive students were significantly higher than those of seronegative students, while in other sports there was no difference between scores of T. gondii-infected students and T. gondii uninfected students.

Conclusion

This is the first report of T. gondii seroprevalence in college students in Anhui province, China.

Exposure to Toxoplasma gondii Through Consumption of Raw or Undercooked Meat: A Systematic Review and Meta-Analysis

Toxoplasma gondii is a globally distributed protozoan that mainly causes health issues in the fetuses of pregnant women who have never been exposed to this parasite and patients with deficient immune systems. Except in these vulnerable populations, the primary infection generally goes unnoticed in most healthy individuals. Apart from transplant/transfusion, congenital transmission, direct contact with infected cats or their feces, and environmental contamination (i.e., oocysts in food, water, and soil) pathways, humans can acquire the parasite through consumption of animal tissues infected by T. gondii. This meta-analysis estimated the risk of acquiring T. gondii by consuming raw or undercooked meat, regardless of which animal species are eaten. Using a random-effect model, crude and adjusted pooled measures of association (risk and odds ratio) were estimated according to study design (cohort, case-control, and cross-sectional studies). The meta-analysis included measures of heterogeneity as well as quality rating scales for each study design. Our results suggest that individuals who eat raw or undercooked meat have, respectively, 1.2-1.3 times the risk and 1.7-3.0 times the odds of T. gondii infection compared to those who thoroughly cook meat, regardless of the animal species they consume. These results align with the current understanding that adequately cooking meat inactivates the parasite and decreases the risk of transmission. Seroprevalence ranged from 1.3% to 88.6%, while the proportion of individuals eating raw or undercooked meat fluctuated from 0.7% to 98.3% across the studies in the meta-analysis. These numbers reflect various preferences with regard to eating meat (i.e., eating tartar, sausages, or salamis) as well as individual, cultural and religious food habits, and personal awareness.

Low Prevalence of Antibodies Against Toxoplasma gondii in Chinese Populations

Toxoplasma gondii has been found to infect almost all warm-blooded animals, including humans. In this study, a total of 3,275 human serum samples were collected from hospitals in five provinces of China. About 5.13% (168/3,275) (95% CI, 4.42–5.94) of the serum samples tested positive for T. gondii IgG antibody by a modified agglutination test (MAT) (cut-off: 1:20). Significant associations were detected between geographic location (OR = 1.763), age (OR = 3.072), infertility in women (OR = 2.4409) and T. gondii infection in humans (p < 0.05). To minimize infection, citizens need to be informed about the best practices for toxoplasmosis prevention, including eating well-cooked meat, drinking boiled water, washing vegetables and fruits, and being careful during contact with cats.

Seroprevalence of Toxoplasma gondii among School Children in Pyin Oo Lwin and Naung Cho, Upper Myanmar

Toxoplasma gondii is an apicomplexan parasite that can cause toxoplasmosis in a wide range of warm-blooded animals including humans. In this study, we analyzed seroprevalence of T. gondii among 467 school children living in the rural areas of Pyin Oo Lwin and Naung Cho, Myanmar. The overall seroprevalence of T. gondii among school children was 23.5%; 22.5% of children were positive for T. gondii IgG, 0.4% of children were positive for T. gondii IgM, and 0.6% of children were positive for both T. gondii IgG and IgM. Geographical factors did not significantly affect the seroprevalence frequency between Pyin Oo Lwin and Naung Cho, Myanmar. No significant difference was found between males (22.2%) and females (25.0%). The overall seroprevalence among school children differed by ages (10 years old [13.6%], 11–12 years old [19.8%], 13–14 years old [24.6%], and 15–16 years old [28.0%]), however, the result was not significant. Polymerase chain reaction analysis for T. gondii B1 gene for IgG-positive and IgM-positive blood samples were negative, indicating no direct evidence of active infection. These results collectively suggest that T. gondii infection among school children in Myanmar was relatively high. Integrated and improved strategies including reinforced education on toxoplasmosis should be implemented to prevent and control T. gondii infection among school children in Myanmar.

ROP9, MIC3, and SAG2 are heparin-binding proteins in Toxoplasma gondii and involved in host cell attachment and invasion

Toxoplasma gondii (T. gondii) is an obligatory intracellular parasite that can infect varieties of warm-blooded animals, including humans and birds. Heparan sulfate (HS) is widely distributed on the eukaryotic cell surface of vertebrates and can inhibit T. gondii invasion. In this study, we investigated the transcription and expression of the level of TgROP9, TgMIC3, and TgSAG2 in T. gondii RH strain, and found that the expression levels of these three proteins in invading parasites were higher compared to those free ranging parasites. The recombinant proteins showed specific binding activity to both heparin and host cell surface. Incubation of these proteins with the host cells could block T. gondiiinvasion. Furthermore, protein-specific antibodies also blocked parasite invasion. Antibodies in the sera of T. gondii infected individuals recognized the recombinant TgROP9, TgMIC3, and TgSAG2, which suggested the exposure of these proteins to human immune system. Mice immunized with the three proteins exhibited protective immunity against lethal challenge. The data collectively suggested that these parasitic proteins may be used as candidate antigens for development of anti-toxoplasmosis vaccine.

A Large-Scale Serological Survey of Toxoplasma gondii Infection Among Persons Participated in Health Screening in Yunnan Province, Southwestern China

Surveys of Toxoplasma gondii infection in animals have been reported in Yunnan province, southwestern China. However, limited information is available regarding the epidemiology of T. gondii infection among persons participated in health screening in Yunnan. From January 2014 to December 2016, a large-scale and cross-sectional serological survey was conducted to reveal the seroprevalence of T. gondii infection in persons participated in health screening in three major hospitals. A total of 64,533 serum samples were collected and anti-T. gondii antibodies were examined by commercially available enzyme-linked immunosorbent assay kits. The total seroprevalence of T. gondii infection was 6.67% (4306/64,533). Of these, 3721 persons (5.77%, 3721/64,533) were positive for Immunoglobulin G (IgG) only, 473 persons (0.73%, 473/64,533) were positive for Immunoglobulin M (IgM) only, and 112 persons (0.17%, 112/64,533) were positive for both IgG and IgM. Female seroprevalence (6.83%, 3167/46,389) was higher than male (6.28%, 1139/18,144). The highest seroprevalence of T. gondii infection was found in the age range of 41-50 years (10.60%, 228/2150) (p < 0.001). The seroprevalence in 2014, 2015, and 2016 were 6.39% (1083/16,946), 6.24% (1261/20,201), and 7.16% (1962/27,386), respectively. The results showed that T. gondii infection is common in persons participated in health screening in Yunnan province, which has significant public health concern. Thus, improved integrated measures should be executed to prevent and control T. gondii infection humans and animals in Yunnan province.

Toxoplasma gondii Infection in Diabetes Mellitus Patients in China: Seroprevalence, Risk Factors, and Case-Control Studies

The association between Toxoplasma gondii (T. gondii) infection and diabetes mellitus remains controversial. With the improvement of living standards, the prevalence rate of diabetes is steadily increasing in China. Thus, it is necessary to explore the possible association between toxoplasmosis and diabetes mellitus in China. Hence, case-control studies were conducted to explore the T. gondii seroprevalence and identify the risk factors and possible transmission routes of T. gondii infection in different types of diabetes, including type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM) patients in China. Four hundred serum samples for each type of diabetes mellitus, matched with 400 control subjects for each group, were collected and examined for anti-T. gondii IgG and IgM antibodies using commercially available enzyme immunoassay kits. The total T. gondii seroprevalence in T1DM, T2DM, and GDM patients was 16.50%, 23.50%, and 21.25%, respectively. Each type of diabetes mellitus patients had a significantly higher T. gondii seroprevalence than the control subjects. Multivariate regression identified three variables as risk factors for T. gondii infection in diabetes patients, including keeping cats at home and consumption of raw oysters for T1DM patients and consumption of raw/undercooked meat and raw oysters for T2DM patients, which may help to guide future research and control policies in diabetes mellitus patients.

Environmental risk factors for Toxoplasma gondii infections and the impact of latent infections on allostatic load in residents of Central North Carolina

BACKGROUND

Toxoplasma gondii infection can be acquired through ingestion of infectious tissue cysts in undercooked meat or environmental oocysts excreted by cats. This cross-sectional study assessed environmental risk factors for T. gondii infections and an association between latent infections and a measure of physiologic dysregulation known as allostatic load.

METHODS

Serum samples from 206 adults in the Durham-Chapel Hill, North Carolina area were tested for immunoglobulin (IgG) responses to T. gondii using commercial ELISA kits. Allostatic load was estimated as a sum of 15 serum biomarkers of metabolic, neuroendocrine and immune functions dichotomized at distribution-based cutoffs. Vegetated land cover within 500 m of residences was estimated using 1 m resolution data from US EPA's EnviroAtlas.

RESULTS

Handling soil with bare hands at least weekly and currently owning a cat were associated with 5.3 (95% confidence limits 1.4; 20.7) and 10.0 (2.0; 50.6) adjusted odds ratios (aOR) of T. gondii seropositivity, respectively. There was also a significant positive interaction effect of handling soil and owning cats on seropositivity. An interquartile range increase in weighted mean vegetated land cover within 500 m of residence was associated with 3.7 (1.5; 9.1) aOR of T. gondii seropositivity. Greater age and consumption of undercooked pork were other significant predictors of seropositivity. In turn, T. gondii seropositivity was associated with 61% (13%; 130%) greater adjusted mean allostatic load compared to seronegative individuals. In contrast, greater vegetated land cover around residence was associated with significantly reduced allostatic load in both seronegative (p < 0.0001) and seropositive (p = 0.004) individuals.

CONCLUSIONS

Residents of greener areas may be at a higher risk of acquiring T. gondii infections through inadvertent ingestion of soil contaminated with cat feces. T. gondii infections may partially offset health benefits of exposure to the natural living environment.