Is Toxoplasma Gondii Infection a Risk Factor for Leukemia? An Evidence-Based Meta-Analysis

Serological and molecular detection of Toxoplasma Gondii among cancer patients in Sohag, Upper Egypt: a case-control study

Toxoplasma gondii (T. gondii) affects around 30% of humans worldwide. Recently, it has emerged as a significant opportunistic pathogen to immunocompromised patients. Data available is still lacking about toxoplasmosis in cancer patients in Egypt. This study aimed to reveal the current trend of T. gondii in cancer patients in Sohag, Egypt. Sera from 50 cancer patients and 50 healthy controls were screened for Toxoplasma IgG and IgM. Further, buffy coats from both groups were used for detection of T. gondii B1 and RE genes via conventional and nested PCR, respectively. The overall seroprevalence of T. gondii IgG was high (58%). IgG and IgM were detected in 30% and 9% cancer patients, respectively. Patients with solid cancers exhibited a greater IgG seropositivity compared to those with hematologic tumors (77.27% and 46.43%, respectively) (P = 0.03). Concerning the molecular results, only 4 (9%) were positive regarding both PCR assays. In conclusion, T. gondii is highly prevalent in cancer patients in Sohag, Egypt. PCR is strongly recommended to complement serology to diagnose acute or reactivated toxoplasmosis in cancer patients. B1 PCR was found to be equivalent to RE PCR. Nevertheless, thorough large-scale research must be implemented.

Foodborne transmission of Toxoplasma gondii infection in the last decade. An overview

Toxoplasmosis is a zoonotic disease of global distribution and importance. It is caused by the protozoan parasite Toxoplasma gondii, the only species in the Toxoplasma genus. This parasite can infect most warm-blooded animals, including humans and livestock. Main routes of transmission are by ingestion of tissue cysts in raw or undercooked meat of infected animals, ingestion of raw vegetables or water contaminated with T. gondii oocysts from cat feces, and transplacental. Around one-third of human beings are chronically infected with T. gondii. Most infections appear to be asymptomatic in immunocompetent persons, but toxoplasmosis can be fatal to the fetus and immunocompromised adults. Water and foodborne outbreaks have been caused by this parasite worldwide, but few are well documented. Importantly, T. gondii is a parasite of high importance in animal health, causing reproductive failure, particularly in small ruminants, and clinical toxoplasmosis in many species. This overview discusses the knowledge of T. gondii infections in the last decade focusing on the foodborne transmission of this parasite.

Seroprevalence of toxoplasma gondii infection: An umbrella review of updated systematic reviews and meta-analyses

Objectives:

Toxoplasmosis is one of the neglected parasitic disease in humans and animals that produced via toxoplasma gondii. This study we implemented an umbrella review of all existing systematic reviews, meta-analyzing studies to apprise, and summarize seroprevalence of human toxoplasmosis in worldwide.

Methods:

The search was carried out in databases including: Pub Med, Google Scholar, Science Direct, Scopus, Web of Science, Cochrane, and global health from their start dates until December 2018 in Persian and English language. A total of 21 systematics review and meta-analysis met the inclusion criteria of umbrella review. The Q test and the I² statistic were used to evaluate heterogeneities. Quality assessment were performed and made use of the AMSTAR tool.

Results:

The estimated pooled seroprevalence of T. gondii infection in blood donors, Immunocompromised patients, childbearing age women, general population, newborns and children, pregnant women and overall was 33% (95% CI, 29.0–38.0%), 42.0% (95 CI, 34.0–49.0%), 32.0% (CI, 26.0–38.0%), 42.0% (CI, 38.0–45.0%), 4.0% (CI, 2.0–5.0%), 40.0% (CI,37.0–44.0%), and 36% (CI, 24.0–48.0%), respectively.

Conclusion:

The results of our umbrella review show a higher seroprevalence of T. gondii infection in immunocompromised patients, general population, pregnant women, blood donors, childbearing age women, and newborn groups, respectively. Routine serologic screening test and health education by primary care physicians for Toxoplasmosis is recommended to be conducted in high-risk groups in the endemic region.

Serological Evaluation of Anti-Toxoplasma gondii Antibodies in Patients with Acute Leukemia and Lymphoma through Chemotherapy

BACKGROUND

Toxoplasma gondii is a protozoan parasite that belongs to the family Coccidae. We aimed to evaluate IgG avidity and the changes of anti-Toxoplasma immunoglobulins M (IgM) and G (IgG) in patients with acute leukemia and lymphoma.

METHODS

Ninety eight patients with Acute myeloid leukemia (AML), Acute Lymphoblastic Leukemia (ALL) and lymphoma, selected from patients referring to Imam Reza Hospital of Tabriz (38°04'N 46°18'E), in terms of the presence of anti-Toxoplasma IgM, IgG, IgG avidity antibodies and the major risk factors were evaluated.

RESULTS

The results of pre-chemotherapy evaluation showed that of the examined patients, only two cases, one patient with ALL and another patient with lymphoma, had a positive IgM titer. Overall, 46 cases had positive IgG titers, including 20 patients with AML, 15 patients with ALL and 11 patients with lymphoma. Three (3.06%) patients were positive for anti-T. gondii IgM and one of them was with new infection of toxoplasmosis in lymphoma patients. The post-chemotherapy IgG titer evaluation showed 46 [46.9% (95% CI 37.4-56.7)] positive IgG cases that this result was similar to the result of pre-treatment phase. One [1% (95% CI 0.2-5.6)] positive IgG avidity case was detected using ELISA method, in a patient with lymphoma whose IgM was also positive. There was no significant difference between the type of leukemia and the history of contact with cat.

CONCLUSION

Performing specialized tests to diagnose toxoplasma infection before starting treatment, in immunodeficiency patients who undergo chemotherapy, is necessary; therefore, these tests should be considered in therapeutic protocols.

Increased risk of Toxoplasma gondii infection in cancer patients: A meta-analysis of current evidence based on case-control study

Toxoplasma gondii (T. gondii) is an intracellular protozoan parasite that often infects warm-blooded animals or causes opportunistic infections if exists a suppressed immunity. This study aims to investigate the seroprevalence of T. gondii and its odds ratio (OR) in patients with cancer in compared with healthy individuals, and to find the possible factors. Related literatures reported the seroprevalence of T. gondii in cancer/tumor patients and controls (health individuals) were retrieved from electronic databases PubMed, EMBASE, Chinese Web of Knowledge and The Cochrane Library from inception until Aug 31 2018. The non-weighted prevalence of T. gondii, pooled estimates of OR and its 95% confidence intervals (CI) were calculated through random-effect model. Between-study heterogeneity was tested with Cochrane Q, and statistic I² was to quantify the results. Funnel plot depiction and Egger's linear regression test were combined to evaluate the potential of publication bias. The literature identified a total of 2216 potential studies; the final 18 studies were incorporated, with 6001 cancer/tumor patients and 6067 controls. Our results demonstrated that, the cancer/tumor patients had an elevated seroprevalence of T. gondii (18.43% vs 8.19%), and an increased risk of T. gondii infection (OR = 3.18, 95% CI: 2.65-3.82) when compared with the controls. Subgroup analyses suggested that publication year, study sample size and diagnostic options are closely associated with the seroprevalence of T. gondii. Overall, our study indicates that there is an increased risk of T. gondii infection in cancer/tumor patients, suggesting a precautionary monitoring of T. gondii and related risk factors in patients with cancer/tumor.

Seroprevalence and risk factors of Toxoplasma gondii infection in children with leukemia in Shandong Province, Eastern China: a case-control prospective study

Limited information is available concerning the epidemiology of Toxoplasma gondii infection in children with leukemia in Eastern China. Therefore, a case-control study was conducted to estimate the seroprevalence of toxoplasmosis in this patient group and to identify risk factors and possible routes of infection. Serum samples were collected from 339 children with leukemia and 339 age matched health control subjects in Qingdao from September 2014 to March 2018. Enzyme linked immunoassays were used to screen anti- T. gondii IgG and anti- T. gondii IgM antibodies. Forty-eight (14.2%) children with leukemia and 31 (9.1%) control subjects were positive for anti-T. gondii IgG antibodies (P < 0.05), while 13 (3.8%) patients and 14 (4.1%) controls were positive for anti-T. gondii IgM antibodies (P = 0.84). Multivariate analysis showed exposure to soil and a history of blood transfusion were risk factors for T. gondii infection. Compared with IgG, patients with a history of blood transfusion were more likely to present anti- T. gondii IgM (P = 0.003). Moreover, patients with chronic lymphocytic leukemia and acute lymphocytic leukemia had higher T. gondii seroprevalence in comparison to control subjects (P = 0.002 and P = 0.016, respectively). The results indicated that the seroprevalence of T. gondii infection in children with leukemia is higher than that of healthy children in Eastern China. This information may be used to guide future research and clinical management, and further studies are necessary to elucidate the role of T. gondii in children with leukemia.

Screening of toxoplasmosis in cancer patients: a concern

Toxoplasmosis is an opportunistic infectious disease in immunocompromised patients, including cancer patients, whose detection is by molecular and serological methods. A total of 106 blood samples from patients with different types of cancer were evaluated for anti- Toxoplasma gondii IgG and IgM antibodies by the enzyme-linked immunosorbent assay (ELISA) and the parasite DNA by nested polymerase chain reaction (PCR). These were detected in 41.51% (44/106) and 0.94% (1/106), respectively, but T. gondii IgM antibody was not detected at all. These results suggest that the screening of toxoplasmosis should be considered more routinely in cancer patients.

Association between Toxoplasma gondii exposure and paediatrics haematological malignancies: a case-control study

The possible association between Toxoplasma gondii infection and paediatric haematological malignancies in a group of patients and control subjects was evaluated in the present study. We performed an age-, gender- and residence frequency-matched case-control study of 101 blood cancer patients under 18 years of age, all of which were treated in Amirkola Pediatric Hospital. One hundred and thirty-eight control samples were gathered from the outpatient clinic in the hospital. All cases and controls were tested for the presence of anti-Toxoplasma IgG antibodies and then IgG-positive subjects were evaluated for IgM antibodies by enzyme-linked immunoassays. Anti-T. gondii IgG antibodies were found in 37 (36.6%) of the cases and 12 (8.7%) subjects in the control group (odds ratio 6.07, 95% confidence interval 2.963-12.437, P < 0.0001). The median and interquartile range (IQR) of IgG titre from case group (7.7 (IQR 0.25-13.5)) was higher than the control (0.2 (IQR 0.1-0.5)) (P < 0.0001). The frequency of anti-T. gondii antibodies (IgG) in lymphoblastic leukaemia (acute lymphoblastic leukaemia), Hodgkin's lymphoma and T-cell lymphoma were 33 (31.9%), 3 (50%) and 1(100%), respectively. Anti-T. gondii IgM was not detected in the IgG-positive patients in case group. In the case subjects, no significant difference was seen in the positive rates of T. gondii infection between genders (37.3% in male; 35.7% in female; P = 0.52) and ages groups (P = 0.31). This study demonstrated that T. gondii infection is prevalent in children with blood cancer. It also showed that toxoplasmosis may possibly be linked with an increased risk of childhood haematologic malignancies. Furthermore, these results may be helpful in research on blood neoplasia aetiology.

Seroprevalence and risk factors of Toxoplasma gondii infection in oral cancer patients in China: a case-control prospective study

Over the recent years, potential associations between Toxoplasma gondii (T. gondii) infection and cancer risk have attracted a lot of attention. Nevertheless, the association between T. gondii infection and oral cancer remains relatively unexplored. We performed a case-control study of 861 oral cancer patients and 861 control subjects from eastern China with the aim to detect antibodies to T. gondii by enzyme-linked immunosorbent assay (ELISA) in these patients. The results showed that oral cancer patients (21.72%, 187/861) had a significantly higher seroprevalence than control subjects (8.25%, 71/861) (P < 0.001). Among them, 144 (16.72%) oral cancer patients and 71 (8.25%) control subjects were positive for IgG antibodies to T. gondii, while 54 (6.27%) oral cancer patients and 9 (1.05%) controls were positive for IgM antibodies to T. gondii. In addition, multiple logistic analysis showed that T. gondii infection in oral cancer patients was associated with blood transfusion history, keeping cats at home, and oyster consumption. To our knowledge, this is the first study that provided a serological evidence of an association between T. gondii infection and oral cancer patients. However, further studies are necessary to elucidate the role of T. gondii in oral cancer patients.

The Toxoplasma gondii ME-49 strain upregulates levels of A20 that inhibit NF-κB activation and promotes apoptosis in human leukaemia T-cell lines

Background

Acute T-lymphocyte leukaemia is a form of haematological malignancy with abnormal activation of NF-κB pathway, which results in high expression of A20 and ABIN1, which constitute a negative feedback mechanism for the regulation of NF-κB activation. Clinical studies have found that acute T-lymphocyte leukaemia patients are susceptible to Toxoplasma gondii infection; however, the effect of T. gondii on the proliferation and apoptosis of human leukaemia T-cells remains unclear. Here, we used the T. gondii ME-49 strain to infect human leukaemia T-cell lines Jurkat and Molt-4, to explore the effect of T. gondii on proliferation and apoptosis, which is mediated by NF-κB in human leukaemia T-cells.

Methods

The Tunel assay was used to detect cell apoptosis. Cell Counting Kit-8 was used to detect cell proliferation viability. The apoptosis level and the expression level of NF-κB related proteins in human leukaemia T-cells were detected by flow cytometry and Western blotting.

Results

Western blotting analyses revealed that the T. gondii ME-49 strain increased the expression of A20 and decreased both ABIN1 expression and NF-κB p65 phosphorylation. By constructing a lentiviral-mediated shRNA to knockdown the A20 gene in Jurkat T-cells and Molt-4 T-cells, the apoptosis levels of the two cell lines decreased after T. gondii ME-49 infection, and levels of NF-κB p65 phosphorylation and ABIN1 were higher than in the non-konckdown group. After knockingdown ABIN1 gene expression by constructing the lentiviral-mediated shRNA and transfecting the recombinant expression plasmid containing the ABIN1 gene into two cell lines, apoptosis levels and cleaved caspase-8 expression increased or decreased in response to T. gondii ME-49 infection, respectively.

Conclusions

Our data suggest that ABIN1 protects human leukaemia T-cells by allowing them to resist the apoptosis induced by T. gondii ME-49 and that the T. gondii ME-49 strain induces the apoptosis of human leukaemia T-cells via A20-mediated downregulation of ABIN1 expression.