Toxoplasma gondii Infection Among Institutionalized Children with Down syndrome in Sana'a city, Yemen: Implications of Low IgG Seroprevalence

Purpose

To assess the IgG seroprevalence of Toxoplasma gondii as an indicator of past exposure and immunity against infection among children with Down syndrome (DS) in Sana’a city, Yemen. This preliminary study is justified by the primary immunodeficiency of children with DS and the opportunistic nature of the parasite, considering the vague situation of anti-Toxoplasma IgG seroprevalence among children with DS because of neglecting its study on local and global scales.

Methods

This descriptive, facility-based, cross-sectional study was conducted among 107 children with DS hosted in six randomly selected rehabilitation centers for children with special needs in Sana’a city. Demographics of children and their mothers’ knowledge of toxoplasmosis were collected using a pre-designed, structured questionnaire. Anti-Toxoplasma IgG antibodies were measured in the sera of children using electrochemiluminescence assay.

Results

Of 107 children with DS, 3 (2.8%) were seropositive for anti-Toxoplasma IgG. Approximately two-thirds (71/106) of the mothers of children with DS were aware of toxoplasmosis. Of whom, 83.1% (59/71) were aware of its congenital complications.

Conclusion

The majority of children with DS in Sana’a city are seronegative for anti-Toxoplasma IgG, where the seropositivity rate is lower than 3.0%. Therefore, children with DS are non-immune and susceptible to the acquisition of primary infections during their life. Further analytical studies are recommended to determine whether the defective immune response of children with DS is associated with false seronegativity, to assess the role of their mothers’ knowledge in reducing their exposure to infection if they were confirmed truly seronegative and to identify the predictors of infection among them.

Seroprevalence and Public Health Significance of Toxoplasmosis in Small Ruminants of Pastoral Community in Yabello District, Borana Zone, Southern Ethiopia

Toxoplasmosis is a zoonotic protozoan disease. Data on seroepidemiology of toxoplasmosis in Ethiopia is scarce, almost null in the pastoral area of the Borana zone. The study was carried out to determine the seroprevalence, to identify risk factors of toxoplasmosis in sheep and goats, and to assess the awareness level of pastoralists about toxoplasmosis in the Yabello district of Borana zone, Southern Ethiopia. A cross-sectional study was conducted from November 2016 to April 2017 in six peasant associations of the Yabello district of Borana zone, Southern Ethiopia. A total of 400 serum samples of randomly selected small ruminants owned by pastoralists were examined to detect antibodies specific to Toxoplasma gondii using Latex Agglutination Test (SPINREACT, Girona, Spain). A semistructured questionnaire survey was used to conduct a face-to-face interview with owners (n = 100) of sampled flocks. Logistic regression analysis was used to determine the association of hypothesized risk factors. The overall seroprevalence was 52.8% of which 57.8 and 47.8% were sheep and goats, respectively. Univariate logistic regression analysis revealed a higher seroprevalence ratio of T. gondii infection in sheep than goats (COR: 1.95, 95% CI: 1.226-3.112; P = 0.005). Multivariate logistic regression analysis indicated significantly higher odds of acquiring T. gondii infection in adult animals (sheep: (AOR = 2.26, 95% CI: 1.323-3.874; P = 0.003), goats: (AOR = 2.15; 95% CI: 1.009-4.579; P = 0.047)), female sheep (AOR = 2.45; CI: 1.313-4.568; P = 0.005), animals from lowland areas (sheep: (AOR = 2.28; CI: 1.190-4.356; P = 0.013), goat: (AOR = 3.27; CI: 1.386-7.723; P = 0.007)), animal drinking lake water (sheep: (AOR = 1.93; CI: 1.011-3.698; P = 0.046), goat: (AOR = 2.96; CI: 1.297-6.771; P = 0.010)), and goats with history of abortion (AOR = 2.42; CI: 1.242-4.711; P = 0.009) than young animals, male (sheep), animals from midland areas, animals drinking wells water, and flock with no history of abortion (goat), respectively. Among respondents, 97.0% had no knowledge about toxoplasmosis and 75.0% drink raw milk and consume the meat of sheep and goats. 80.0% of respondents had no knowledge about the risk of cats to human and animal health while 70.0% of them had domestic cats and practice improper fetal body handling. Highly prevailing toxoplasmosis in small ruminants of the Yabello district might pose a serious economic loss and be a potential public health threat to the extremely vulnerable pastoralists. Therefore, awareness and further studies are warranted to tackle the economic and public health consequences of T. gondii infection.

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.

Human toxoplasmosis in Mozambique: gaps in knowledge and research opportunities

Toxoplasmosis is a parasitic zoonotic disease caused by Toxoplasma gondii that afflicts humans worldwide and wild and domestic warm-blooded animals. In immunocompetent individuals, the acute phase of infection presents transient low or mild symptoms that remain unnoticed. In immunocompromised patients, T. gondii is a life-threatening opportunistic infection, which can result from the reactivation of latent infection or primary infection. Moreover, congenital toxoplasmosis, which results from the transplacental passage of tachyzoites into the fetus during a pregnant primary infection, can lead to miscarriage, stillbirth, or ocular and neurologic disease, and neurocognitive deficits in the newborns. Thus, the present review aims to address the current knowledge of T. gondii infection and toxoplasmosis in Africa and especially in Mozambique, stressing the importance of identifying risk factors and promote awareness among the health care providers and population, assessing the gaps in knowledge and define research priorities. In Mozambique, and in general in southern African countries, clinical disease and epidemiological data have not yet been entirely addressed in addition to the implications of T. gondii infection in immunocompetent individuals, in pregnant women, and its relation with neuropsychiatric disorders. The main gaps in knowledge in Mozambique include lack of awareness of the disease, lack of diagnostic methods in health facilities, lack of genetic data, and lack of control strategies.

Prevalence and predictors of Toxoplasma gondii infection in pregnant women from Dhamar, Yemen

BACKGROUND

Toxoplasmosis is a common and serious parasitic infection caused by the ubiquitous obligatory intracellular protozoan organism, Toxoplasma gondii. Although infection with T. gondii is usually asymptomatic in healthy individuals, it can lead to severe pathological effects in congenital cases and immunocompromised patients. This study aimed to determine the seroprevalence of T. gondii and its predictors among pregnant women seeking prenatal and medical care at the general maternal and child health facility in Dhamar district of Dhamar governorate, Yemen.

METHODS

A total of 420 pregnant women were randomly selected for this cross-sectional study. Participants were screened for anti-T. gondii antibodies (i.e. immunoglobulin M; IgM and immunoglobulin G; IgG) using electrochemiluminescence immunoassay. Demographic, socioeconomic, obstetric and behavioural data were collected using a pretested questionnaire via face-to-face interview. Univariate and multivariate analyses were used to identify the independent predictors of T. gondii seroprevalence.

RESULTS

The overall seroprevalence of anti-T. gondii antibodies (IgG and/or IgM) among the participants was 21.2% (89/420; 95% CI = 17.3-25.1). Anti-T. gondii IgG antibodies were detected in 20.0% (84/420) of the women of which 12.9% (54/420) were positive for only IgG and 7.1% (30/420) were positive for both IgG and IgM antibodies. Moreover, 5 women (1.2%) were reactive only for IgM antibodies. Significant associations between T. gondii seroprevalence and history of spontaneous abortion (P <  0.001), raw vegetables consumption (P = 0.036), and presence of cats in household (P = 0.049) were reported. Multivariate analysis confirmed that history of spontaneous abortion (AOR = 4.04; 95% CI = [2.46, 6.63]) and presence of cats in household (AOR = 1.77; 95% CI = [1.02, 3.07]) are significant predictors of T. gondii seroprevalence among the studied participants.

CONCLUSION

The study found a high seroprevalence (21.2%) of T. gondii infection during pregnancy in Dhamar district, which is significantly associated with adverse pregnancy outcomes. The provision of adequate maternal healthcare and health education pertaining to the prevention of T. gondii infection is therefore imperative to curtail the prevalence of infection among the studied population.

The Seroprevalence and Risk Factors of Toxoplasmosis Among Female Undergraduate University Students in Saudi Arabia

Objectives

Toxoplasma gondii (T. gondii) is a serious public health issue, but limited data has been published to date on the seroprevalence of T. gondii infection in Saudi Arabia. Therefore, this study aimed to establish the seroprevalence and risk factors of T. gondii infection using a sample of females enrolled at a university in Northern Saudi Arabia.

Methods

Using a cross-sectional research approach, we recruited a convenience sample of 180 healthy females studying at the University of Tabuk between February and June 2016. We used a questionnaire to gather sociodemographic data on the participants to establish the risk factors leading to exposure to toxoplasma. Blood samples were taken from the participants and analyzed to detect T. gondii antibodies (immunoglobulin M and immunoglobulin G) via the enzyme-linked immunosorbent assay technique. Multivariate logistic regression modeling was employed to establish the potential predictor variables for T. gondii infection.

Results

Of the 180 participants, 17 (9.4%) were seropositive for T. gondii IgG. None tested positive for IgM antibodies exclusively. The sole variable positively associated with seropositive T. gondii IgG was the participants' consumption of raw, unwashed fruit or vegetables (odds ratio = 3.36, 95% confidence interval: 1.11-10.22).

Conclusions

Our findings emphasize the need for higher awareness of toxoplasmosis in Saudi Arabia, specifically knowledge of the way toxoplasma infection occurs so that women can more easily avoid it. Large-scale research is therefore required to inform the design of future public health interventions.

Seroprevalence and potential risk factors of T. gondii infection in pregnant women attending antenatal care at Bonga Hospital, Southwestern Ethiopia

OBJECTIVES

To determine the seroprevalence and associated risk factors of T.gondii infection in pregnant women attending antenatal care at Bonga Hospital, Southwestern Ethiopia.

METHODS

A cross-sectional study was carried out from February to May 2016. Systematic sampling technique was used to collect sera from 210 pregnant women. Sample was tested for anti-T.gondii- antibodies by Latex Agglutination Test (LAT). Risk factors associated with T.gondii infection in pregnant women was assessed through structured questionnaire. Univariate and multivariate logistic regression analysis was used to check association of T.gondii infection with different risk factors using SPSS version 20.

RESULTS

The overall seroprevalence of T.gondii infection in pregnant women was 75.7% (95% CI: 69.9-81.5). Multivariate logistic regression analysis indicated that the odds of T.gondii infection was higher in pregnant women between age range of 36-44 (AOR=2.82; 95% CI:1.2-7.82; P=0.031), in multigravidae (AOR=3.3; 95% CI:1.36-8.04; P=0.009), in those eating raw meat (AOR=5.1; 95% CI:2.22-11.68; P=0.000), in those eating raw vegetables (AOR=5.5; 95% CI:1.03-29.5; P=0.046), in those who have history of abortion (AOR=4.4;95% CI:1.10-17.49; P=0.036), in women who drink river/streams water (AOR=5; 95% CI: 1.67-15.44; P=0.004) and in those who didn't handle raw meat (AOR=2.4; 95% CI: 1-5.56; P=0.049).

CONCLUSION

The present result shows high seroprevalence of T.gondii infection in pregnant women. Public education on identified risk factors and screening of pregnant women during their antenatal care should be recommended.