Toxoplasma gondii Infection Is Associated with Low Birth Weight: Findings from an Observational Study among Rural Bangladeshi Women

Seroprevalence of Toxoplasma gondii Antibodies and Associated Risk Factors Among Women in Zakho City, Iraq

Toxoplasmosis, an infectious disease caused by the obligate intracellular protozoan parasite, poses varying degrees of risk, ranging from asymptomatic cases in immunocompetent individuals to severe, life-threatening conditions in immunocompromised individuals and developing fetuses, especially when infection occurs during early pregnancy. While the disease is endemic in Iraq, there is a notable lack of precise information regarding its seroprevalence among females of childbearing age and pregnant women, along with associated risk factors in the Zakho district. This cross-sectional study aimed to address this gap by determining the prevalence of anti-Toxoplasma gondii IgG and IgM antibodies using the ELISA assay. The study involved 610 females aged 18-79 years from various residential areas within Zakho district, Iraq. The findings revealed a seroprevalence of 32.46% for anti-Toxoplasma IgG antibodies and 8.86% for IgM antibodies. Significant variations in IgG antibody seroprevalence were observed across different age groups (P=0.008), with the highest prevalence noted among those aged 46-55 years (47.73%). Conversely, IgM antibody seroprevalence, while non-significant (P>0.05), displayed the highest rate of 10.05% among ages 18-25 years. The study identified residence as a variable significantly associated with toxoplasmosis. Additionally, contact with cats, marital status, a history of abortion, and the consumption of homemade food showed significant associations with anti-Toxoplasma IgM antibodies only. These findings strongly suggest that Toxoplasma gondii is a prevalent causative agent of infection in Zakho city, Iraq. This study contributes valuable insights into the seroprevalence and associated risk factors, providing a foundation for targeted interventions and further research in this region.

Seroprevalence, Risk Factors and Maternal-Fetal Outcomes of Toxoplasma gondii in Pregnant Women from WHO Eastern Mediterranean Region: Systematic Review and Meta-Analysis

BACKGROUND

The protozoan parasite Toxoplasma gondii may cause serious illness in the immunocompromised. The Toxoplasma gondii seropositive prevalence in pregnant women in WHO Eastern Mediterranean Region countries is inconsistent in the literature and it is associated with outcomes that have not be fully elucidated, hence the need for a better understanding of the pooled seroprevalence and associated maternal and fetal outcomes.

OBJECTIVE

The objective was to conduct a systematic literature review and determine the pooled prevalence of WHO Eastern Mediterranean Regional countries' pregnant women's seroprevalence of Toxoplasma gondii and the maternal-fetal outcomes.

METHODS

This quantitative study examined WHO Eastern Mediterranean countries' maternal-fetal outcomes and Toxoplasma gondii prevalence in pregnant women. The targeted population was pregnant women, while the primary outcome was seropositivity of Toxoplasma gondii, while other outcomes such as maternal and fetal associations and risk factors were determined PubMed, SCOPUS, MEDLINE, and Index Medicus for the Eastern Mediterranean Region (IMEMR) databases were searched up until 30 January 2023. The search terms used were "Toxoplasma gondii" OR "Toxoplasma infection" AND "Pregnant woman" or pregnan* OR Antenatal OR Prenatal OR Gravidity OR Parturition OR Maternal AND WHO Eastern Mediterranean Region). OpenMeta-Analyst and Jamovi were used to analyze the generated data.

RESULTS

In total, 95 of 2947 articles meeting the inclusion criteria examined Toxoplasma gondii prevalence in pregnant women from WHO Eastern Mediterranean countries. The pooled prevalence of Toxoplasma gondii in pregnant women was 36.5% (95%CI: 32.6-40.4) with a median value of 35.64%, range values of 1.38-75.30%, with 99.61% heterogeneity. The pooled seroprevalence of IgG of Toxoplasma gondii was 33.5% (95%CI: 29.8-37.2) with a median value of 33.51%, and a range values of 1.38-69.92%; the pooled seroprevalence of IgM was 3.6% (95%CI: 3.1-4.1)) with a median value of 3.62 and range values of 0.20-17.47%, while cases of pooled seroprevalence of both IgG and IgM positivity was 3.0% (95%CI: 1.9-4.4) with a median value of 2.05 and a range values of 0.05-16.62%. Of the Toxoplasma gondii seropositive women, 1281/3389 (34.8%) 174/1765 (32.9%), 1311/3101 (43.7%), and 715/1683 (40.8%) of them had contact with cats, drank unprocessed milk, ate raw or undercooked meat and ate unwashed raw vegetables, respectively. The maternal-fetal outcomes associated with Toxoplasma gondii seropositivity were a history of abortions, miscarriage, stillbirth, intrauterine fetal death, and premature birth, which were found in 868/2990 (32.5%), 112/300 (36.1%), 111/375 (25.7%), 3/157 (1.9%) and 96/362 (20.1%) of women who tested positive for Toxoplasma gondii antibodies.

CONCLUSION

The study found a high proportion of Toxoplasma gondii seroprevalence in pregnant women in the WHO Eastern Mediterranean Region, which may be linked to poor outcomes for mothers and their babies. Thus, pregnant women require monitoring and comprehensive prevention strategies for Toxoplasma gondii infection.

Seroprevalence of Toxoplasma gondii among Pregnant Women in Ardabil, Iran (2021-2022)

Background

Toxoplasmosis during pregnancy can causes adverse outcomes. Regarding its importance in prenatal care, seroprevalence of Toxoplasma gondii infection among pregnant women was studied in Ardabil City, during 2021-2022.

Methods

In a cross-sectional study with a cluster sampling, 244 pregnant women that attended in health care centers of Ardabil City, Ardabil Province, Iran in 2021-2022 were selected. Serum samples were collected and Anti-Toxoplasma IgM (immunoglobulin M) and IgG (immunoglobulin G) was detected. Furthermore, a questionnaire filled for all participants during samples collection and risk factors assessed. Data were analyzed by SPSS software.

Results

Participant's age ranged from 16 to 43 years with average of 23± 5.24 years. IgG anti-T. gondii antibody was detected in 22.1% of pregnant women (54/244). In none of participants IgM anti-Toxoplasmosis antibody was detected. There was no significant relationship between demographic variables and risk factors of toxoplasmosis with serology test results.

Conclusion

Approximately, 77.9% of pregnant women had no antibody against the T. gondii infection. Therefore, health education, counseling of pregnant women and screening in high-risk pregnant women is recommended to prevent from fetal complications.

Locally generated C3 regulates the clearance of Toxoplasma gondii by IFN-γ-primed macrophage through regulation of xenophagy

Exogenous pathogen infection can induce autophagy in cells. Autophagy is essential for cell survival, development, and homeostasis. It not only regulates cell defense and stress, but also has a close relationship with innate and adaptive immunity. Complement is an important part of innate immunity, which could be activated by three approaches, including classic, alternative, and lectin pathways. All the three pathways result in the activation of C3, and generate anaphylatoxin fragments C3a and C5a, and formation of the membrane attack complex. Either C3a or C5a induces the inflammatory cytokines through binding to C3aR or C5aR, respectively. However, it is still unknown whether the complement could regulate the autophagy of intracellular microorganisms or not. In this study, we constructed a Toxoplasma gondii (T. gondii) and macrophages co-culture experimental model using T. gondii expressing enhanced green fluorescence protein (EGFP) fluorescence and C3^−/-C57BL/6 J mice for that T. gondii invaded peritoneal macrophages in mice. Western blot, laser confocal microscopy (LCM), and transmission electron microscopy (TEM) were used to observe the changes of autophagy between the macrophages from wild-type (WT) and C3^−/− mice. Flow cytometry and LCM were used to investigate the effect of autophagy on the killing ability of macrophages against T. gondii. Here, we found that local C3 could suppress not only the canonical autophagy of macrophage, but also the xenophagy to T. gondii. Interestingly, the inhibition of C3 on host cell autophagy could significantly suppress the clearance of T. gondii by the IFN-γ-primed macrophage. Finally, we investigated the mechanism of the autophagy regulation of C3 that the effect of C3 on the macrophage-specific autophagy against T. gondii depends on mTOR. And, there is C3a but not C5a/C5aR involved in regulating macrophage xenophagy against T. gondii. Collectively, our findings suggest locally generated C3 regulates the clearance of T. gondii by Macrophage through the regulation of the non-canonical IFN-γ-dependent autophagy pathway, and paint a clearer picture in the regulation of autophagy by innate immune components.