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

Toxocara infection in pregnant women: seroprevalence and risk factors

BACKGROUND

Human toxocariasis caused by T. canis is a worldwide and typically neglected zoonotic parasitic disease. Certain behaviors such as a geophagia habit, poor personal hygiene, close contact with young dogs, and ingestion of raw meat, as well as age, and socioeconomic status, affect the prevalence of the disease. In this study, we aimed at investigating the frequency of Toxocara infection among pregnant women and the epidemiological factors associated with disease.

METHODS

Toxocariasis-specific IgG antibodies were measured using a commercial ELISA technique in 200 pregnant women between December 2021 and May 2022. A questionnaire filled by participants included options for demographic information (age, gender, residency), gestational age, number of previous pregnancies, history of abortion, drug use, comorbidities, history of parasitic disease, and keeping pets (dogs or cats).

RESULTS

In total, 15 (7.5%) of the 200 participants (mean age 29.7 ± 18.7 years) had anti-T. canis antibodies. High-titer antibodies were most prevalent among the subjects aged 25-29 years. Logistic regression analysis showed that the pregnant women who had a history of abortions (P = 0.029), and keeping pets and contact with dogs and cats (P = 0.031) had an increased risk of acquiring toxocariasis. The study showed that demographic characteristics such as age group, pregnancy trimester, and underlying conditions were not significantly associated with toxocariasis (P > 0.05).

CONCLUSION

Considering the significant prevalence of toxocariasis in pregnant women as well as its health risks, preventive health measures against the toxocariasis risk factors seem more necessary.

Global seroprevalence of Toxoplasma gondii in pregnant women: a systematic review and meta-analysis

BACKGROUND

Toxoplasmosis in pregnancy is associated with serious and irreversible maternal and fetal detrimental consequences. Also, different seroprevalence of Toxoplasma gondii in pregnancy is reported in many countries. The present systematic review and meta-analysis study aimed to determine the global seroprevalence of Toxoplasma gondii in pregnant women.

METHODS

This study was conducted based on the PRISMA 2020 criteria. Initial searching was conducted using MeSH (Medical Subject Headings)-based keywords with no time limitation (by August 1, 2024). Collected papers were transferred to Citation Management Software (EndNote). Duplicate studies were merged and primary and secondary screenings were applied based on the inclusion/exclusion criteria. Validation was considered to find high-quality assessments. Finally, eligible extractable papers were enrolled for data collection. Data was analyzed using Comprehensive Meta-Analysis software (v.2) The random effects model was used in case of I2 index above 50%.In order to investigate the factors affecting the heterogeneity of studies, meta-regression tests were used to examine factors such as sample size and year of study.

RESULTS

One hundred thirty-eight eligible studies with a total sample size of 135,098 pregnant women individuals were selected for data extraction and analysis. The heterogeneity index was found high (I2:98.9) and the random effect model was used for analysis. The egger test revealed the absence of publication bias in collected studies (p:0.088). Thus, the global seroprevalence of Toxoplasma gondii in pregnant women was reported at 36.6% (95%CI:33.7-39.6). the highest prevalence reported based on meta-analysis was reported in South America with 52.8% (95% CI:46.6-59), while only 15 studies were reviewed in this continent, most of which were in Brazil. Therefore, after the continent, the highest prevalence reported was reported in Africa with 46.8% (95% CI:39.5-54.3). Also, the lowest prevalence reported based on meta-analysis was in North America with 19.7% (95% CI:8.4-39.6) and Europe with 24.6% (95% CI:17.8-32.9).

CONCLUSION

This study revealed a high level of seroprevalence of Toxoplasma gondii in pregnant women worldwide. This value mostly depends on the individual's age, lifestyle, and disease awareness regarding toxoplasmosis in pregnant women. Thus, public awareness, along with comprehensive health programs regarding the detrimental effects of toxoplasmosis in pregnant women, seems necessary for prevention or even early diagnosis of toxoplasmosis in pregnant women.

Seroprevalence of Toxoplasma gondii and Associated Risk Factors in Pregnant Women in Araçatuba, São Paulo, Brazil: A Multi-Level Analysis

This study assessed the seroprevalence of Toxoplasma gondii and risk factors among 428 pregnant women attending Basic Health Units (BHUs) in Araçatuba, São Paulo, Brazil. The seroprevalence was 55.14%, indicating high exposure to the parasite in this population. Using a multi-level logistic regression model, this study analyzed these predictors to determine their association with a higher seropositivity rate, with BHUs included as a random factor. Predictors associated with higher seropositivity included older age (36-45 years), with a 71.64% prevalence in this group, and multiparity (61.65%). Women with lower educational levels were also more likely to be infected, with 59.46% seropositivity recorded among those who had only completed elementary school. Despite identifying several risk factors, no significant correlation was found between undercooked meat consumption or contact with soil and infection. These findings highlight the need for targeted public health interventions, particularly for educating high-risk groups about toxoplasmosis prevention, such as safe food handling and avoiding raw dairy products. Additionally, BHUs play a critical role in early detection and prevention. These units are important for providing healthcare access and preventive education for vulnerable populations. Given the high seroprevalence, this study underscores the urgency of implementing prenatal screening and educational programs to reduce the risks of congenital toxoplasmosis in this region.

Coinfection of Toxoplasma gondii and Other Microorganisms: A Systematic Review and Meta-Analysis

Toxoplasmosis is a disease caused by the intracellular protozoan Toxoplasma gondii, which has infected a third of the global population. Immunocompromised individuals and children with congenital disorders are most likely to be impacted by toxoplasmosis, and accurate diagnosis is essential. Toxoplasmosis is associated with HIV, schizophrenia, and diabetes. However, few studies have analyzed the association with other microorganisms. The purpose of this study was to determine the prevalence of coinfection of Toxoplasma gondii with other pathogens. From November 1997 to June 2024, PubMed, Science Direct, LAT index, Web of Science, Google Scholar, and Research Gate were searched. The keywords used were "Toxoplasma and microorganism coinfection", "Toxoplasma coinfection and parasites", "Toxoplasma coinfection and Protozoans or Bacteria or Helminths or Nematodes or Trematodes or Mycobacterium", "Toxoplasma gondii in coinfection with virus", and "Human Toxoplasmosis and coinfection". Next, OpenMeta Analyst Software version 12.11 was used for meta-analysis, creating forest plots, and determining heterogeneity I2. A total of 17,535 patients in 48 articles, of whom 5848 were seropositive to T. gondii, were included in this review. Population studies showed that the prevalence of virus infection was most frequent (32%), followed by parasites (18.4%), bacteria (29.7%), and fungi (5.8%). The pooled prevalence of coinfection was found to be 29.1%, with a lower bound of 0.232, an upper bound of 0.350, a standard error of 0.030, and p < 0.001. Heterogeneity (I2) was 99.12%, p < 0.001, with a global variance tau2 = 0.042. Toxoplasma gondii is an opportunist that mainly affects immunocompromised populations. The main coinfections were found to be viral infections, with HIV ranking first, followed by cytomegalovirus, hepatitis B and C, rubella, herpes simplex 1 and 2, SARS-CoV-2, and coxsackie virus.

Toxoplasma gondii Seropositivity and Co-Infection with TORCH Complex Pathogens in Pregnant Women from Araçatuba, Brazil

This study examined the seropositivity of T. gondii and coinfections with other TORCH pathogens among pregnant women attending 17 Basic Health Units (UBS) in Araçatuba, SP, Brazil. Of the 711 pregnant women seen at these UBS, only 297 were tested for T. gondii. Of the women tested for T. gondii (n = 297), 26.9% had IgG antibodies, 6.7% had IgM, and 32.0% tested positive for either or both. Only 1.4% showed both IgG and IgM antibodies, while 67.7% were non-reactive. The seropositivity was 17.1% for syphilis, 63.2% for rubella, 0.9% for hepatitis C, 0.9% for dengue, 17.9% for COVID-19, and 0.9% for herpes simplex (types 1/2). Coinfections with syphilis, rubella, and herpes simplex were also noted. Higher education levels appeared to protect against T. gondii seropositivity. The findings highlight a significant prevalence of T. gondii among pregnant women, with variation across UBSs, pointing to socioeconomic, behavioral, and environmental factors as influential. We also observed co-occurrence with other infections, such as syphilis, rubella, and herpes simplex. The study underscores the need for targeted public health interventions to reduce the risks of congenital infections.