Seroprevalence, Seroconversion, and Risk Factors for Toxoplasmosis among Pregnant Women in Taipei, Taiwan

Assessment of the clinical benefits of prenatal screening for toxoplasmosis in southern Taiwan

OBJECTIVE

The present study aimed to investigate the seroprevalence and risk factors for toxoplasmosis among pregnant women in southern Taiwan and to determine the clinical benefits of screening for the same.

MATERIALS AND METHODS

The current study included 458 pregnant women who received prenatal care from the first trimester at the Kaohsiung and Chiayi Chang Gung Memorial Hospitals during the time period from 2014 to 2015. Serological tests performed to detect the presence of Toxoplasma IgG and IgM antibodies. Amniocentesis was scheduled and real-time polymerase chain reaction (PCR) was employed to detect Toxoplasma DNA. Moreover, the maternal characteristics and risk factors, perinatal outcomes related to the seropositivity for Toxoplasma infection were analyzed.

RESULTS

Among the pregnant patients included in the current study, 39/458 (8.5%) were IgG+ and 2/458 (0.6%) were IgM+. The present study analyzed the maternal characteristics and risk factors, perinatal outcome pertaining to the IgG seropositive group by means of the multiple logistic regression analysis revealed a female predominance (10.8%), compared to the males (6.4%), (adjusted OR = 0.48 (95%, 0.24-0.98), P = 0.043∗). The number cases with gestational age above 37 weeks at the time of delivery was significantly lower, compared to the cases below 37 weeks (adjusted OR = 0.32 (0.12-0.94), P = 0.038∗). Among one case with low avidity cannot exclude recent infection, the amniocentesis did not show any evidence of vertical transmission.

CONCLUSION

The scenario may not warrant general screening and the results will not influence the clinical decisions. Although the present study failed to identify the maternal risk factors related to Toxoplasma infection, the results imply that health education is essential, owing to the slightly higher rate of preterm delivery in the IgG seropositive group.

Toxoplasma gondii infection: seroprevalence and associated risk factors for women of childbearing age in Osun State, Nigeria

Toxoplasmosis is a common parasitic infection caused by an obligate intracellular protozoan, Toxoplasma gondii. Prevalence and risk factors of T. gondii infection in women of childbearing age in Osun State, Nigeria are unknown. This study was aimed to determine the seroprevalence and potential risk factors in acquiring T. gondii infection by women of childbearing age in Osun State, Nigeria. A community-based cross-sectional study was conducted from May 2019 to December 2019 in childbearing age women. Sera of 415 women aged 18-49 years randomly selected were collected and analyzed by enzyme-linked immunosorbent assay (ELISA) test. A questionnaire survey was administered for all study participants to collect socio-demographic and risk factors data. The study revealed that the overall seroprevalence of T. gondii infection was 76.63%, which comprised 6.02% positivity for anti-T. gondii IgM (25/415), 44.10% for IgG (183/415) and 26.51% for IgG plus IgM (110/415). Seroprevalence of IgM antibodies to T. gondii (6.02%) suggested recent infections. Women residing in rural communities and women of Islam religion showed significant association with anti-T. gondii seropositivity (p < 0.05). Residence location and women who are of Islam religion are risk factors to acquire T. gondii infection. Hence, health education and awareness on the disease and its transmission to women of childbearing age group in general and pregnant women in particular should be created during antenatal follow up to reduce the risk of T. gondii infection in pregnant women.

Seroepidemiology and Associated Risk Factors of Toxoplasma gondii in Hemodialysis Patients

PURPOSE

Immunocompromised patients may be at risk for reactivation of the toxoplasmosis infection, because of defection in cell-mediated immunity. Therefore, early diagnosis would be highly desirable in these individuals. This case-control study was designed to increase information about toxoplasmosis in hemodialysis (HD) patients in Guilan province, Iran.

METHODS

The study was performed among 150 patients and 150 controls referred to hospitals of Guilan University of Medical Sciences during 2018-2019. Questionnaire forms, including demographic and epidemiological information, were completed. Peripheral blood samples were taken for serum separation and were collected into tubes and then kept at - 20 °C until use. IgG and IgM antibodies to Toxoplasma gondii were detected by a commercial ELISA kit. Accordingly, IgG absorbance levels < 9 were considered negative, 9-11 was considered borderline, and > 11 was positive; IgM absorbance levels < 0.9 were considered negative, 0.9-1.1 was assumed to be borderline, and > 1.1 was positive.

RESULTS

Throughout the study, 72.0% of HD patients and 64.7% of the control group were positive for anti-Toxoplasma IgG antibody subsequently. 2% of HD patients and 0.7% of the control group were positive for anti-Toxoplasma IgM antibody and these difference weren't significant between control and ones with HD (P > 0.05). There was no significant difference between dialysis duration factor and the seropositivity rate. Seroprevalence of T. gondii infection did not vary significantly with age, educational level, residence and presence of a cat at home. On the contrary, seroprevalence varied significantly with gender and consumption of raw vegetables.

CONCLUSION

Because of the high percentage of positivity for Toxoplasma IgG antibodies in hemodialysis patients, we suggest a periodically screening program to carry out for monitoring and evaluating the possible dissemination of toxoplasmosis during hemodialysis.

Seroprevalence of Toxoplasma gondii infections in Syrian pregnant refugee women in Turkey

OBJECTIVE

Congenital infections in refugee women have been very rarely studied. The purpose of this study is to investigate the Toxoplasma gondii (T. gondii) seroprevalence in Syrian pregnant refugee women living in Turkey and to discuss the differences with Turkish pregnant women.

STUDY DESIGN

This is a retrospective cohort study including 752 pregnant refugee women and is based on the nine-year data of a reference public hospital in Ankara.

RESULTS

In the study group, T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) seropositivity rates were 47 % and 0.4 %, respectively. Compared with a recent study conducted in the same center on Turkish native pregnant women, there was a significant difference in IgG seropositivity and no significant difference in IgM seropositivity.

CONCLUSION

Due to the seroprevalence difference between the indigenous and refugee groups, the Syrian refugee women has to be specifically considered in the prevention of congenital toxoplasmosis infections in Turkey.

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

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

Diagnosis of acute toxoplasmosis by IgG avidity method in pregnant women referred to health centers in south-eastern Iran

Toxoplasmosis, one of the most common parasitic infections, can cause abortions in human. The purpose of this study was to determine seroprevalence of toxoplasmosis and acute form of toxoplasmosis in pregnant women. 208 pregnant women who referred to health centers in south-eastern Iran were taken under study after signing the informed consent forms and filling out the checklists. For those with high levels of IgG or IgM antibody titers, IgG Avidity test was performed to determine the acute infection. High level of IgG anti-body were found in sera of 81 pregnant women and 7 persons had borderline titer. IgM antibody results were positive in 33 and borderline in 4 cases. Then, the samples with positive and borderline results for IgM and IgG were evaluated by IgG avidity test. In this study, approximately 60% of pregnant women were not immune to risks posed by Toxoplasma gondii. Therefore, this group are at risk of acquiring primary infection of toxoplasmosis during gestation.

Endemicity of Toxoplasma infection and its associated risk factors in Cebu, Philippines

Toxoplasma gondii is a single-celled intracellular apicomplexan parasite that causes toxoplasmosis. It is capable of infecting humans and nearly all warm-blooded animals including pigs, but cats are the only known definitive host. This ubiquitous zoonotic pathogen can cause abortion, stillbirth and fetal abnormalities, and has been associated with mental and behavioral changes in humans. Acute infection is potentially fatal in immunocompromised individuals. The present study aimed to assess the Toxoplasma seroprevalence in pigs, humans and cats after its initial reported detection in pigs about three decades ago in Cebu, Philippines. A total of 924 humans, 104 cats and 514 slaughter pigs were tested for antibodies against T. gondii using a commercial latex agglutination test. The results revealed positive detection rates of 26.3% (244/924) for humans, 42.3% (44/104) for cats and 13.4% (69/514) for slaughter pigs. Statistical analyses revealed that the area (P = 0.004), cat ownership (P = 0.020), the frequency of contact with cats (P < 0.0001) and consumption of street foods (P = 0.043) were significantly associated with seropositivity for T. gondii in humans. Meanwhile, the use of litter trays (P = 0.001) and contact with other animals (P = 0.007) were significantly associated with seropositivity in cats. The odds ratio for selected significant factors revealed that living in suburban areas (OR 1.66, 95% CI: 1.20–2.31), owning a cat (OR 1.482, 95% CI: 1.07–2.07) and eating street foods (OR 1.585, 95% CI: 1.01–2.48) were associated with an increased risk of T. gondii exposure in humans. In cats, the use of a litter tray (OR 4.5, 95% CI: 1.73–11.71) was associated with an increased risk of exposure. None of the profile parameters were found to be significantly associated with seropositivity in slaughter pigs (P > 0.05). This study is the first report of the serological detection of T. gondii in humans and cats in Cebu, Philippines, and the first assessment of the prevalence of the parasite in pigs in the area since its initial detection in 1982. This is also the first report documenting the seropositivity of T. gondii in pregnant women in the country. The confirmed seropositivity of T. gondii in Cebu, Philippines, in the present study implies the endemicity of toxoplasmosis in this area and highlights the need for routine testing and increased public awareness.

Toxoplasma gondii seroprevalence among pregnant women attending antenatal clinic in Northern Tanzania

BACKGROUND

Acute Toxoplasma gondii infection during pregnancy represents a risk for congenital disease, especially among women without previous exposure to infection. There is, however, a paucity of information about the epidemiology of T. gondii infection in pregnant women in Tanzania. This study aimed to determine the seroprevalence of T. gondii infection and associated demographic, clinical, and behavioral risk factors in pregnant women attending ante-natal clinic (ANC) at Kilimanjaro Christian Medical Center (KCMC), a referral medical center in Northern Tanzania.

METHODS

A hospital-based cross-sectional study was carried out from 1 February to 30 April 2017. Data on maternal demographic characteristics, obstetric history, knowledge, and practices related to T. gondii infection were collected from 254 pregnant women attending antenatal care at KCMC. A sample of 4 mL of blood was collected from each participant and sera prepared from each sample. Serum samples were tested for the presence of specific T. gondii IgG and IgM antibodies by indirect Enzyme-Linked Immunosorbent Assay (ELISA). DNA was extracted from whole blood for polymerase chain reaction (PCR) testing, targeting the DNA sequence coding for the Internal Transcribed Spacer 1 (ITS1).

RESULTS

The overall T. gondii seroprevalence, including both IgM- and IgG-positive individuals, was 44.5%. Of the 254 tested women, 102 and 23 were seropositive for T. gondii-specific IgG and IgM antibodies respectively and 113 individuals had antibodies of either or both classes. All IgM-positive samples were also tested by PCR, and all were negative. The majority (90%) of the women surveyed had never heard about toxoplasmosis. Consumption of raw vegetables [aOR = 0. 344; 95% CI 0.151-0.784; p = 0.011] and having regular contact with soil [aOR = 0.482; 95% CI 0.268-0.8681; p = 0.015] were both associated with T. gondii antibody status. Inverse relationships with probability of T. gondii exposure were observed, such that these practices were associated with reduced probability of antibody detection.

CONCLUSION

Based on serology results, we report widespread exposure to T. gondii infection among pregnant women attending ANC in KCMC. The complex interaction of risk factors for T. gondii infection needs to be studied in larger longitudinal studies.

Toxoplasmosis seroprevalence in Iranian women and risk factors of the disease: a systematic review and meta-analysis

BACKGROUND

Toxoplasmosis is caused by an intracellular obligatory parasite, Toxoplasma gondii, and it has global distribution. The purposes of this systematic review and meta-analysis were to evaluate the seroprevalence of toxoplasmosis in Iranian pregnant women, and girls and women of childbearing age, and identify potentially preventable risk factors.

METHODS

Between November 2014 and February 2017, nine electronic databases that reported data on the T. gondii seroprevalence in Iranian women were searched. Our search resulted in 83 reports published from 1994 to 2017.

RESULTS

The results showed that the pooled estimation for the prevalence of T. gondii using a random-effect model was 43% (95% confidence interval (CI) = 38-48%) in pregnant women and 33% (95% CI = 23-43%) in girls and the childbearing age groups. There was a significant association between the T. gondii seroprevalence with age and the gestational age of conception in pregnant women and those who had contact with cats in both groups.

CONCLUSIONS

This is the first comprehensive systematic review of T. gondii infection seroprevalence in Iranian women, which showed a high prevalence of Toxoplasma infection. Around 57% of pregnant women and 67% of girls and the childbearing age groups were seronegative and thus were susceptible to infection and should be monitored.

Toxoplasmosis awareness, seroprevalence and risk behavior among pregnant women in the Gampaha district, Sri Lanka

BACKGROUND

Primary gestational toxoplasmosis can be transmitted to the fetus with deleterious effects on the pregnancy. There is very little information regarding gestational toxoplasmosis in Sri Lanka. This survey was done to determine the prevalence and awareness of toxoplasmosis and to identify risk factors of infection among pregnant women in the Gampaha district, Sri Lanka.

METHODS

Women attending obstetric clinics at the Colombo North Teaching Hospital in 2014 were tested for Toxoplasma gondii (T. gondii) specific Immunoglobulins G (IgG) and M (IgM) subtypes using the OnSite Toxo IgG/IgM Rapid Test-Dip Strip(®). Disease awareness and risk behaviors of the participants were investigated.

RESULTS

Of the 293 participants (mean age 27 years, SD ± 5.92), 38% were primigravidae with a mean gestational age of 16.2 weeks (SD 7). The prevalence of anti-T. gondii IgG and IgM antibodies was 12.3% (n = 36) and zero, respectively. Unadjusted and adjusted odds ratios were calculated to determine risk factors of infection (cat-ownership, handling cats, consumption of meat, commercial meals and unwashed raw vegetables and fruits, handling soil and not washing hands after handling soil). On bivariate analysis, eating commercially prepared meals weekly or more was associated with toxoplasma seroprevalence with marginal statistical significance. On multivariate analysis, none of the considered risk factors were significant. Toxoplasma awareness was 4.4% (n = 13); health personnel (46.2%, n = 6) and media (53.8%, n = 7) being sources of information.

CONCLUSIONS

Health education programs to increase awareness of toxoplasmosis is recommended at antenatal clinics.