Seroprevalence of Toxoplasma gondii and its associated risk factors among women of reproductive age in Saudi Arabia: a systematic review and meta-analysis

Toxoplasmosis Knowledge and Preventive Behaviours Among Pregnant Women in Jeddah, Saudi Arabia: A Cross-Sectional Study

Background: Toxoplasmosis is an infection caused by the parasite Toxoplasma gondii and is considered asymptomatic in most cases. In pregnant women, however, the disease can be transmitted to the foetus, causing severe congenital consequences. Congenital toxoplasmosis can be avoided by practising simple preventive lifestyle measures during pregnancy. Method: This cross-sectional study assessed the toxoplasmosis knowledge and preventive behaviours among 135 pregnant Saudi women in Jeddah, Saudi Arabia. Data were collected by face-to-face interviews using a validated questionnaire covering sociodemographic characteristics, knowledge of toxoplasmosis, and preventive behaviours towards toxoplasmosis between January and April 2023 using convenience snowball sampling. SPSS Statistics was used for data analysis and the qualitative parameters were described as frequencies and percentages. Result: Approximately 45.2% of the participants displayed a poor knowledge of toxoplasmosis. Moreover, participants aged 31-40 years exhibited significantly higher knowledge compared to those aged less than 30 years. Most participants practised effective preventive behaviours, as demonstrated by 90.4% and 86.7% of them reporting that they habitually washed their hands after handling raw meat and did not eat rare meat, respectively. Conclusion: Overall, the poor knowledge of toxoplasmosis among pregnant women in Jeddah highlights the importance of implementing targeted antenatal health education campaigns and interventions to protect pregnant women and minimise the risk of congenital toxoplasmosis.

The Prevalence of Toxoplasma gondii in Saudi Arabia (1994-2023): A Systematic Review and Meta-Analysis

Toxoplasmosis is one of the most common parasites affecting humans in diverse populations caused by T. gondii. This study aims to systematically review and analyze the prevalence of T. gondii infection among various population categories in Saudi Arabia. Our search was done in five databases: PubMed, Scopus, Cochrane Library, Embase, and Web of Science to find the relevant studies from inception to November 2023. The pooled prevalence of toxoplasmosis among the total population living in Saudi Arabia was estimated using a random-effect meta-analysis approach, and Comprehensive Meta-Analysis software was utilized for this analysis. Our study included 30 case-control and retrospective studies published from 1994 to 2023 involving 20,699 patients from different regions in the Kingdom of Saudi Arabia. Various cities were included, such as Al-Ahsa, Najran, Riyadh, Arar, Mecca, al Khobar, Mushait, Tabuk, jazan, Hail City, Almadinah Almunawwarah, AL-Ahsa, and Abha; 27 reported outcomes related to IgG seroprevalence, revealing an overall toxoplasmosis prevalence of 27.5% in Saudi Arabia. Fifteen studies that measured IgM seroprevalence found an overall toxoplasmosis prevalence of 2.2%. Specifically for pregnant women, IgG seroprevalence was 28%. Among different age categories, the highest toxoplasmosis prevalence was observed in the group aged 31-45 years, reaching 32.5%, while the lowest prevalence was in the 10-20 years category at 19.3%. Regarding gravidity, the grand multi-gravida group exhibited the highest prevalence at 32.9%, with an upper limit of 47.8%. Furthermore, individuals who consumed freshwater demonstrated a higher incidence than those drinking bottled water, with respective prevalence rates of 33.5% and 29.4%. In conclusion, the prevalence of toxoplasmosis in Saudi Arabia is lower than the global average, with significant variations across different age groups, water sources, and dietary habits. Targeted educational programs and public health interventions are essential to raise awareness and reduce the risk of T. gondii infection. Future research should focus on improving study quality and exploring the broader implications of toxoplasmosis on public health in Saudi Arabia.

Seroprevalence and Distribution of Toxoplasma gondii Infections among Patients in the West Bank, Palestine (2017-2021)

Toxoplasmosis is a zoonotic disease caused by the obligate intracellular protozoan Toxoplasma gondii. The current study assessed the seroepidemiological status and risk factors of T. gondii in the West Bank, Palestine. We conducted a retrospective study among 1,475 patients referred for serological examination for toxoplasmosis between 2017 and 2021 at the Central Public Health Laboratory. The overall prevalences of anti-T. gondii IgG and IgM antibodies were 1.0% [18.9-23.0%] and 1.0% [0.5-1.6%], respectively. Multifactorial analysis showed that age and sex were significantly associated with the presence of IgG antibodies. The prevalence of IgG antibodies was highest in 2018 and decreased significantly each year until 2021. Routine serological screening in women of childbearing age and pregnant women is recommended.

Serosurvey of Toxoplasma gondii and Toxocara spp. co-infection in pregnant women in low-income areas of Brazil

Introduction

Despite human toxoplasmosis and toxocariasis having been listed among the top six most neglected parasitic zoonoses worldwide, presenting similar associated risk factors and transmission routes, few studies have been conducted in pregnant women and the consequences of concurrent infection remain to be fully established. Accordingly, the present study has serologically assessed the co-infection and associated risk factors for Toxoplasma gondii and Toxocara spp. in pregnant women, assisted by the public Unified National Health System (SUS) in southeastern Brazil.

Materials and Methods

Blood samples were collected and tested for IgG antibodies against Toxoplasma gondii by chemiluminescence immunoassay and against Toxocara spp. by enzyme-linked immunosorbent assay (ELISA). An epidemiological questionnaire was applied to gather socioeconomic information to assess the risk factors associated with seropositivity to toxocariasis/toxoplasmosis by univariate analysis followed by logistic regression.

Results

Overall, seropositivity was 69/280 (24.6, 95% CI: 19.96-30.01) for T. gondii and 56/280 (20.0, 95% CI: 15.73-25.08) for Toxocara spp. Co-infection was observed in 25/280 (8.9, 95% CI: 6.12-12.85) pregnant women, with increased odds (OR: 3.3, CI 95%: 1.77-6.14, p = 0.0002). Logistic regression revealed that a higher educational level (high school or college) significantly reduced the likelihood of co-infection seropositivity, owning cats increased the odds of toxocariasis, and older pregnant women presented significantly higher T. gondii seropositivity.

Conclusion

Co-infection herein highlights the importance of educational programs in the prevention of toxocariasis and toxoplasmosis in pregnant women and other high-risk populations.

Seroprevalence of Toxoplasma gondii in Females Aged 15-45 Years from Bihor County, Western Romania

Toxoplasma gondii is a protozoan parasite that causes an important worldwide zoonosis called toxoplasmosis. This infection is often asymptomatic in immunocompetent people. If the infection occurs in pregnant women, it poses great risks to the infant due to its clinical manifestations as mental retardation, seizures, or chorioretinitis. In this study, we evaluated the seroprevalence of IgG antibodies against T. gondii in females aged 15-45 years in Bihor County, Romania. Serum samples drawn from 1935 females aged 15-45 years were screened for IgG antibodies against T. gondii. T. gondii antibodies were found in 706 females (36.48%) and the proportion of IgG positive females tended to increase with age. The seroprevalence was higher in females residing in rural areas (47.79%) compared with those from urban areas (30.95%). This is the first study on the seroprevalence of toxoplasmosis in females aged 15-45 years from Bihor County, Romania. Our survey brings new and important data regarding the seroepidemiology of T. gondii and provides an insight into the demographic risk factors as a basis for a future prevention program for toxoplasmosis.

[Clinical complications during pregnancy: a systematic review of studies with pregnant Brazilian women]

The scope of this paper was to describe the main clinical complications among pregnant Brazilian women reported in the literature, identifying the most relevant exposure factors and their outcomes in maternal and child health. This is a systematic review of articles published between 2010 and 2018. Three reviews and 36 empirical articles were included; mental disorders (n=9), infectious diseases (n=9) and severe maternal morbidity (n=8) were the main clinical complications during pregnancy. In addition, four articles focused on determining the main conditions or causes of hospitalization, with a higher frequency of Urinary Tract Infection, anemia and hypertensive diseases. Maternal age at reproductive extremes, lower schooling, socioeconomic vulnerability, racial characteristics and the use of public health services were the most relevant exposure factors. Unfavorable health outcomes associated with clinical complications in pregnancy were verified in the eight articles with this profile. The frequency of pregnant women with potential life-threatening clinical complications is high in the country, highlighting the importance of primary care coverage and the implementation of interventions to reduce and prevent adverse maternal and child outcomes.

Maternal toxoplasmosis and the risk of childhood autism: serological and molecular small-scale studies

Background

Toxoplasmosis resulting from infection with the Toxoplasma parasite has become an endemic disease worldwide. Recently, a few studies have reported a high prevalence of Toxoplasmosis infections among Saudi Arabian women. This disease could become life threatening for pregnant women and for immunodeficient people. There is evidence that infections during pregnancy, especially in the early stages, are associated with neurodevelopmental disorders. Autism disorder represents one of the most common neurodevelopmental disorders worldwide; it is associated with delayed language development, weak communication interaction, and repetitive behavior. The relationship between prenatal toxoplasmosis and autism in childhood remains unclear. The present study aims to report a link between maternal toxoplasmosis and autistic offspring among Saudi Arabian women.

Method

Blood samples (36 maternal, 36 from their non-autistic children, and 36 from their autistic children) were collected for serological and molecular evaluation.

Results

A toxoplasmosis infection was reported for 33.34% of participants using an ELISA assay (5.56% IgG+/IgM+, 11.11% IgG−/IgM+, and 16.67% IgG+/IgM-); however, a nested PCR assay targeting B1 toxoplasmosis specific genes recorded positive tests for 80.56% of the samples. In addition, the present study detected several points of mutation of mtDNA including NADH dehydrogenase (ND1, ND4) and Cyt B genes and the nDNA pyruvate kinase (PK) gene for autistic children infected with toxoplasmosis.

Conclusion

Considering previous assumptions, we suggest that a maternal toxoplasmosis infection could have a role in the development of childhood autism linked to mtDNA and nDNA impairment.

Potential risk factors associated with seropositivity for Toxoplasma gondii among pregnant women and HIV infected individuals in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Toxoplasma gondii is an obligate intracellular and neurotropic apicomplexan protozoan parasite infecting almost all warm-blooded vertebrates including humans. To date in Ethiopia, no systematic study has been investigated on the overall effects of potential risk factors associated with seropositivity for Toxoplasma gondii among pregnant women and HIV infected individuals. We intended to determine the potential risk factors (PRFs) associated with seropositivity for Toxoplasma gondii from published data among pregnant women and HIV infected individuals of Ethiopia.

METHODOLOGY

An systematic review of the previous reports was made. We searched PubMed, Science Direct, African Journals Online, and Google Scholar for studies with no restriction on the year of publication. All references were screened independently in duplicate and were included if they presented data on at least two risk factors. Meta-analysis using the random or fixed-effects model was made to calculate the overall effects for each exposure.

RESULTS

Of the 216 records identified, twenty-four reports met our eligibility criteria, with a total of 6003 individuals (4356 pregnant women and 1647 HIV infected individuals). The pooled prevalences of anti-Toxoplasma gondii antibodies were found at 72.5% (95% CI: 58.7% - 83.1%) in pregnant women and 85.7% (95% CI: 76.3% - 91.8%) in HIV infected individuals. A significant overall effect of anti-Toxoplasma gondii seropositivity among pregnant women (p < 0.05) was witnessed with age, abortion history, contact with cats, cat ownership, having knowledge about toxoplasmosis, being a housewife and having unsafe water source. Age, cat ownership, and raw meat consumption were also shown a significant effect (p < 0.05) to anti-Toxoplasma gondii seropositivity among HIV infected individuals.

CONCLUSIONS

This review showed gaps and drawbacks in the earlier studies that are useful to keep in mind to design accurate investigations in the future. The pooled prevalence of anti-Toxoplasma gondii antibodies was found to be higher among pregnant women and HIV infected individuals. This suggests that thousands of immunocompromised individuals (pregnant women and HIV infected patients) are at risk of toxoplasmosis due to the sociocultural and living standards of the communities of Ethiopia. Appropriate preventive measures are needed to reduce the exposure to Toxoplasma gondii infection. Further studies to investigate important risk factors are recommended to support the development of more cost-effective preventive strategies.

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.