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Toxoplasmosis among pregnant women: High seroprevalence and risk factors in Kinshasa, Democratic Republic of Congo
Abstract
To determine the seroprevalence of toxoplasmosis in pregnant women, as well as the proportion of acutely infected and risk factors in the Democratic Republic of Congo.
Thirty maternities in Kinshasa were randomly selected and women attending antenatal consultation were invited to participate. They were interviewed with a structured questionnaire about known risk factors (age, meat consumption, contact with soil, and presence of cat) and a venous blood sample was taken. Sera were analysed for total immunoglobulins (Ig) by VIDAS Toxo Competition using Enzyme Linked Fluorescent Assay. IgM was determined by VIDIA Toxo IgM and IgG avidity by VIDAS Toxo IgG avidity.
A total of 781 women were included. Median age was 28 years old (IQR: 8.5). And 627 women (80.3%; 95% CI: 77.5-83.1) were found to be positive to total Ig and 17 out of 387 (4.4%; 95% CI: 2.3-6.4) were positive to IgM. IgG avidity was low for 2 (11.8%) women, intermediate for 2 (11.8%) and high for 13 women (76.4%). There was no statistically significant association between Toxoplasma gondii infection and any risk factors assessed.
In Kinshasa, toxoplasmosis endemicity is highly prevalent. One woman out of twenty five had a recent toxoplasmosis infection and 20% were not protected against primo-infection, indicating a need for measures to prevent and control toxoplasmosis during pregnancy.
... The study utilized data collected from 273 pregnant women, with a median age of 30 years (interquartile range: 26-33 years (13). Certain studies have suggested that toxoplasmosis is diagnosed more frequently in urban areas than in rural ones (14,15). ...
... In a study conducted in Poland, a total of 101 soil samples were collected from various locations in the DYSKUSJA Zamieszkiwanie na obszarach wiejskich jest uważane za czynnik ryzyka toksoplazmozy. Jednak ostatnie badania przedstawiają niejednoznaczne wyniki w tym zakresie i różnią się w zależności od regionu przeprowadzonego badania (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Wykazaliśmy, że zarażenie Toxoplasma gondii było częściej wykluczane u kobiet mieszkających w miastach (51/154; 33,8% vs. 20/119; 16,8%, p=0,0023), co oznacza wyższy odsetek kobiet, u których obecne były przeciwciała przeciwko T. gondii, wśród kobiet mieszkających na obszarach wiejskich. ...
... Wykazaliśmy, że zarażenie Toxoplasma gondii było częściej wykluczane u kobiet mieszkających w miastach (51/154; 33,8% vs. 20/119; 16,8%, p=0,0023), co oznacza wyższy odsetek kobiet, u których obecne były przeciwciała przeciwko T. gondii, wśród kobiet mieszkających na obszarach wiejskich. Podobne wyniki uzyskali inni autorzy (8)(9)(10)(11), niemniej istnieją badania, w których nie występuje korelacja między miejscem zamieszkania a odsetkiem osób, które posiadają przeciwciała (12,13). Doudou i wsp. ...
b>INTRODUCTION. Toxoplasma gondii is a protozoan parasite. While this infection typically exhibits no symptoms in humans, it poses a potential threat to the developing fetus in pregnant women. Several risk factors contribute to toxoplasmosis infection. Adherence to hygiene protocols and avoiding the consumption of raw meat, unwashed vegetables, and fruits may mitigate the risk of this disease. OBJECTIVE. This study aimed to compare the prevalence of toxoplasmosis risk factors among pregnant women suspected of toxoplasmosis living in rural areas with those residing in urban areas. MATERIAL AND METHODS. A retrospective observational study was conducted by analyzing data from the medical records of pregnant women suspected of toxoplasmosis. These women were consulted at the Provincial Infectious Diseases Hospital between September 2019 and March 2020. The analysis encompassed patients’ demographic data and information concerning toxoplasmosis risk factors. A total of 273 women’s data were included in the analysis. Diagnosis relied on serological verification using the VIDAS® analyzer (bioMérieux, Lyon, France). RESULTS. Women residing in rural areas were less likely to report a good socio-economic status (p=0.0064), and toxoplasmosis infection was less frequently ruled out (p=0.0023). In comparison to women living in urban areas, pregnant women from rural regions were more likely to have confirmed primary toxoplasmosis (p=0.0164). Additionally, they were more prone to working in gardens without gloves (p < 0.0001), consuming unwashed vegetables (p= 0.0025), eating raw meat during pregnancy (p=0.0008), and cats caregiving during pregnancy (p=0.0002). This exposure included both care for domestic cats before and during pregnancy (p=0.0069) and interactions with wild cats (p < 0.0001). CONCLUSIONS. Pregnant women living in rural areas exhibited significantly higher exposure to toxoplasmosis risk factors. They also displayed a higher incidence of primary infections during pregnancy and a lower rate of excluded infections.
... 8 A study conducted in Kinshasa in 2014; by Doudou et al found a high seroprevalence of the infection in 80.3% of pregnant women tested. 9 There are few studies on seroprevalence and risk factors for toxoplasmosis in ophthalmology patients 18 25-27 (table 4). In our series, we found a high seroprevalence of toxoplasmosis of 86%; it is higher than that found in the general population by Doudou et al. 9 This could partly explain why toxoplasmosis is the first aetiology of uveitis in the DRC. ...
... 9 There are few studies on seroprevalence and risk factors for toxoplasmosis in ophthalmology patients 18 25-27 (table 4). In our series, we found a high seroprevalence of toxoplasmosis of 86%; it is higher than that found in the general population by Doudou et al. 9 This could partly explain why toxoplasmosis is the first aetiology of uveitis in the DRC. 14 The main factors associated with the significant variability in the distribution of T. gondii infection among geographical regions are socioeconomic, environmental and cultural differences as well as those related to the living and eating habits of the residents of a given area. ...
... The study carried out in Kinshasa by Doudou et al on pregnant women also failed to identify risk factors significantly associated with Toxoplasma infection. 9 Other studies carried out in populations with high seroprevalence also failed to identify risk factors associated with Toxoplasma gondii infection. 30 31 The high prevalence of the infection in the study populations can be the cause. ...
Objective
To identify the risk factors associated with ocular toxoplasmosis (OT) in a cohort of Congolese patients with uveitis.
Methods and analysis
A cross-sectional study was conducted between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa. Patients with a diagnosis of uveitis were enrolled in the study. Each patient underwent an interview, an ophthalmological examination and serology testing. Logistic regression was performed to identify risk factors for OT.
Results
212 patients were included in the study with a mean age at presentation of 42.1±15.9 years (limits: 8–74 years) and a sex ratio of 1.1:1. OT concerned 96 patients (45.3%). The age of the patients below 60 years (p=0.001, OR=9.75 CI 95% 2.51 to37.80)), the consumption of cat meat (p=0.01, OR=2.65 CI 95% 1.18 to 5.96)) and undercooked meat (p=0.044, OR=2.30 CI 95% 1.02 to 5.21)) and living in rural area (p=0.021, OR=11.4 (CI 95% 1.45 to 89.84])) were identified as risk factors for OT.
Conclusion
OT affects more young people. It is associated with dietary habits. Informing and educating the population is necessary to avoid infection.
... 4 The Democratic Republic of the Congo (DRC) is the most impacted nation in the region, with a seroprevalence of roughly 80.3%, making Central Africa the region with the highest seroprevalence. 5,6 Ocular toxoplasmosis (OT) is the most common infectious etiology of posterior uveitis globally, responsible for up to 85% of cases in immunocompetent individuals. 2,7,8 More than 25% of patients with the condition experience permanent visual impairment (VA). ...
... There are few data on the incidence, clinical features, and progression of OT in African patients, despite the high seroprevalence of Toxoplasma infection in Africa. 6,18,19 Therefore, this study aimed to describe demographic data, clinical features, and serological profiles in a cohort of Congolese patients with OT. ...
Purpose
To describe demographic data, clinical features, and serological profiles in a cohort of Congolese patients with ocular toxoplasmosis (OT).
Method
Cross-sectional study, carried out between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa.
Results
The study comprised 95 participants with OT. Fifty-three patients were male (55.8%). The mean age at presentation was 35.6 ± 14.1 years (range 8–69 years); 71 had active OT (74.7%), among them, 33 had primary OT (46.5%), and 38 had recurrences (53.5%). At presentation, 51 patients (53.7%) had visual impairment (VA < 6/18). Retinochoroidal lesions were located in the central retina in 60 patients (63.1%). Patients with primary OT tend to have higher IgG levels than those with recurrent OT (P = .01).
Conclusion
We report the largest cohort of patients with OT in sub-Saharan Africa. In our setting, most patients had recurrent OT with multiple, extensive, and central retinochoroidal lesions.
... A Toxoplasmose é uma infecção causada pelo protozoário Toxoplasma gondii, e em diferentes lugares do mundo, foi demonstrado que mais de 60% da população já foi infectada em algum momento da vida (El Deeb et al., 2012;Doudou et al., 2014). Surtos da toxoplasmose associados à contaminação de reservatórios de abastecimento de água foram relatados em diferentes cidades do Brasil (Gangneux, Dardé, 2012). ...
A toxoplasmose é uma zoonose de distribuição mundial, com taxas de incidência e prevalência que variam entre as regiões. Esta doença é causada pelo protozoário Toxoplasma gondii, cuja transmissão ocorre mais frequentemente pela ingestão de água contaminada, alimentos crus não lavados, carne crua ou mal passada e por transmissão congênita. A primoinfecção durante a gestação tem grande importância epidemiológica e na saúde pública devido aos diversos danos causados ao feto. Para analisar a soroprevalência da toxoplasmose em gestantes bem como os fatores de risco associados à infecção por este protozoário, foi realizada uma coleta de dados nas unidades básicas de saúde do município de Tangará, Rio Grande do Norte. Os dados mostraram que das 155 gestantes entrevistadas, 67 (43,2%) apresentaram sorologia positiva para toxoplasmose enquanto 88 (56,8%) apresentaram sorologia negativa. Este resultado indica uma grande porcentagem de gestantes suscetíveis a infecção pelo protozoário. Uma análise estatística mostrou associação entre a infecção e o grau de escolaridade (p=0,000). Em relação ao comportamento alimentar, observou-se associação com o consumo de dindim, sucos e açaí fora de casa (p=0,018). Uma das formas de prevenir a toxoplasmose congênita é por meio da educação das gestantes não imunes ou suscetíveis sobre comportamentos preventivos. A ocorrência de formas graves em gestantes demonstra a necessidade de expandir o programa profilático primário às mulheres grávidas. Em nosso entendimento percebemos que se torna necessário a união dos esforços da Academia e do Sistema de Saúde para o entendimento da toxoplasmose no âmbito da sua importância para a Saúde Pública.
... , Faculty of Nursing, Tanta University, fetus. In adults, the incubation period ranges from 10 to 23 days from ingestion of undercooked meat, and from 5 to 20 days from ingestion of oocysts from cat feces 2001; Doudou et al., 2014). The prevalence of toxoplasmosis infection varies among different countries depending on their habits, hygienic conditions, the presence of infected cats and the surrounding climate (Walle et al., economic level of the third world coun Asia and Africa has been the primary risk factor as it has been associated to the high prevalence finding in these countries (Swai and Schoonman 2009). ...
... Moreover, this prevalence was comparable to those described in neighboring countries in North Africa due to the same socio-cultural behaviors [6][7][8][9]. However, the prevalence was lower than recorded in other African countries of West, East and Central Africa [10][11][12]. This discrepancy in prevalence between these countries may be ascribed to differences in economic development levels, hygienic conditions, and feeding habits, such as eating raw meat in Ethiopia [13]. ...
Background
Toxoplasmosis is a zoonotic disease. It is due to an obligate intracellular protozoan called Toxoplasma gondii (T. gondii). Felids are considered definitive hosts, and humans take part as intermediate hosts. At least one-third of the world’s population is seropositive to the parasite. In addition, to the known modes of transmission, the infection can be transmitted through blood transfusions. The aim of this study is to assess the immune status of blood donors about this disease and estimate the potential risk by blood components.
Methodology
A single cross-sectional study was conducted based on the search for T. gondii antibodies (IgG and IgM) in blood donors. This research was performed using a latex particle agglutination assay confirmed by an enzyme-linked immunosorbent assay (ELISA).
Results
In all, 103 blood donors were involved in this study. The sex ratio of male/ female was 0.75. The recorded rate of exposure to toxoplasmosis in blood donors was 47.7% (95% CI: 35.1-54.3). Significant differences were observed between the prevalence and those of other African countries in West, East, and Central Africa, but not with those of Algerian pregnant women and neighboring North African countries. There was no association between T. gondii seropositivity and the following factors: sex, age, and blood group ABO or Rhesus. Antitoxoplasma IgG was detectable in all positive donors, while IgM was undetectable. All seropositive donors had an IgG titer ≥9 IU/ml. The potential risk of T. gondii transmission ranges from 1 per 100,000 to 17 per 100,000 blood donations.
Conclusion
The seroprevalence of T. gondii infection was comparable to those found in Algerian pregnant women and neighboring North African countries. However, the seroprevalence rate was lower than recorded in other African countries. There is even a risk of transmission of toxoplasmosis through blood transfusions. There is a need to enhance blood safety measures for pregnant, immunocompromised, and multi-transfused people. As the immune status of blood donors may vary by region, there is a need to extend the national studies to the entire country. This study provides the first data on the seroprevalence of T. gondii infection among Algerian blood donors and the risk of its transmission by transfusion of blood components.
... The study showed that the seroprevalence of toxoplasmosis in pregnancy was 80%. This is similar to 80.3% obtained in the Democratic Republic of Congo (DRC) amongst pregnant women [36]. However, this was lower than 85.5% reported in Ethiopia [37] and 92.5% in Ghana [18]. ...
Background:
Toxoplasmosis, caused by Toxoplasma gondii in pregnant women, is a significant public health problem due to risk of mother to child transmission. The aim of the study was to determine the seroprevalence of toxoplasmosis in pregnant women and corresponding cord blood among women attending Biyem-Assi and CASS Nkoldongo hospitals in Yaoundé, Cameroon.
Methods:
An institutional based cross-sectional study was conducted between June 2019 and May 2020 on 300 pregnant women from late second trimester to third trimester. A total of 259 cord blood samples were collected at birth from these women. Toxoplasma gondii-specific IgG and IgM antibodies in maternal and cord blood were detected using the Toxoplasma Enzyme Immunosorbent Assay kit, and potential risk factors captured through questionnaire were identified using binary logistic regression model. Statistical significance was measured at P < 0.05.
Results:
The overall seroprevalence of gestational and neonatal toxoplasmosis was 80% and 88%, respectively. IgG seropositivity was 72.7%, IgM only was 1.3% and cooccurrence of IgG/IgM was 6% amongst pregnant women. Out of 259 newborn cord bloods, 72.2% were positive for IgG only, 8.9% for IgM only, and 23.9% for both IgG/IgM. Pregnant women 15-24 years (AOR = 4.6, P = 0.011) and women with primary level of education (AOR = 3.9, P = 0.042) were significantly at risk of infection with Toxoplasma gondii.
Conclusion:
Gestational and neonatal toxoplasmosis appears to be more common with higher risk of infection in younger women and less educated women. Hence, these findings will serve as baseline data for further investigations on mother to child transmission of toxoplasmosis in Yaoundé and the need for reinforcement of pregnant women toxoplasmosis-related health measures.
Background
Toxoplasmosis is a serious endemic zoonotic disease caused by the protozoan parasite Toxoplasma gondii. Toxoplasma infection during pregnancy can result in congenital transmission and serious fetal and neonatal complications. This systematic review and meta-analysis aimed to assess the pooled seroprevalence of T. gondii infection and its determinants among pregnant women in African countries.
Methods
All articles reporting the seroprevalence of toxoplasmosis among pregnant women in African countries and published from 2010 to 2023 were searched using various databases. The pooled prevalence of toxoplasmosis was calculated using a random-effect model. The variation between the included studies was assessed using a funnel plot and I² heterogeneity statistics. To identify the sources of heterogeneity, sub-group analysis was further conducted by country, diagnostic method, and sub-African region. The association of prevalence rates with the socio-economic level and geoclimatic parameters was also explored.
Results
In total, 29,383 pregnant women from 60 articles were included for analysis. The pooled T. gondii seroprevalence was 42.89% with high heterogeneity (I² = 99.4%, P < 0.001). Sub-group analysis revealed variation by country (ranging from 2.62% in Namibia to 80.28% in Congo), diagnostic method used (from 8.66% in studies using a rapid diagnostic test to 55.69% in those using an agglutination test), and sub-African region (from 4.14% in regions of Southern Africa to 53.96 in Central Africa). Cat ownership (OR = 1.58) and the consumption of raw meat (OR = 1.50) and raw vegetables (OR = 1.48) had a statistically significant combined effect on T. gondii seroprevalence. No association was found between T. gondii prevalence and the level of income of the country or geoclimatic parameters.
Conclusion
The prevalence of toxoplasmosis infection among pregnant women in Africa is high, particularly in Central and Eastern Africa. The determinants of prevalence are multifactorial. Therefore, efforts should be made to increase the awareness of women concerning the risk factors for toxoplasmosis.
Objective: Toxoplasma gondii, rubella, cytomegalovirus (CMV) infections during pregnancy may cause clinical
symptoms such as jaundice, cataract, microcephaly, fetal death in fetus and newborn. Therefore, we aimed to
investigate the seroprevalence of these agents in pregnant women.
Methods: The serology test results of pregnant women aged within 16-49 years, performed in the our
laboratory between March 1st, 2017 and February 28th, 2022, were evaluated in terms of T. gondii, rubella
and CMV. A total of 982 anti-T. gondii IgM and IgG, 1018 anti-Rubella IgM and IgG, 456 anti-CMV IgM and IgG
test results were analyzed retrospectively, using the hospital patient follow-up program. For the detection of
antibodies specific to T.gondii, Rubella and CMV, Enzyme Linked Fluorescent Assay (ELFA-VIDAS, bioMérieux,
France) method was used in accordance with the manufacturer’s instructions.
Results: Our study results shows that the positivity rates of anti-T. gondii IgM and IgG were 9.87% and 28.30%,
respectively; anti-Rubella IgM and IgG were 1.96% 98.13%, respectively; and anti-CMV IgM and IgG were 1.53%
and 99.78%, respectively. In addition, the increase in anti-T. gondii IgM positivity rate was found to be increased
statistically with decreasing age in our study.
Conclusion: The higher anti-T. gondii IgM positive rates in Konya may be due to meat-based diet, undercooked
meat consumption, socioeconomic level, Konya’s being an agriculture and livestock region, and the use of
highly sensitive and specific ELFA method within our laboratory. The possibility of contamination risk should be
decreased by necessary measures in young women.
Keywords: Pregnancy, Toxoplasma, Rubella, Cytomegalovirus, Seroprevalence.
Toxoplasmosis in pregnancy may have serious consequences on the pregnancy outcome. Vertical transmission to the fetus may range
from obstetrics complications such as abortion, intrauterine growth restriction, stillbirth to congenital malformations. This review aimed to
assess the seroprevalence rate of toxoplasmosis in pregnant women in Africa so that a proper management policy can be initiated. Four
databases that include Google Scholar, ScienceDirect, Scopus, and PubMed were searched for primary studies reported on the prevalence
of toxoplasmosis among pregnant women in African countries. From the search, total of 39 studies were included for the study from 1980
to 2018. Total of 11986 pregnant women were the study participants in the included studies. By using the DerSimonian-Liard random
effects method, the pooled prevalence of toxoplasmosis was estimated as 47% (95%CI=38.4% to55.4%). Publication bias was assessed
using Egger's test, 2.88 (95%CI= -8.8% to 14.5%) and it did not indicate any significant (P = 0.619) influence of the studies on the pool
estimate. Again, the pooled estimates of toxoplasmosis among pregnant women in first, second and third trimesters were 29%
(95% CI= 17.0% to 42.0%), 35.0% (95%CI= 27% - 43%) and 30.9% (95%CI= 22% - 41%), respectively. Pooled prevalence for risk factors such
as 'contacts with cat', cat ownership and consumption of raw or poorly cooked meat were estimated at 50% (95% CI= 35% to 66%), 26.2%
(95% CI=17.9% to 35.5%) and 43.3% (95% CI = 30% to 50%) respectively. This study estimates the overall prevalence of toxoplasmosis in
pregnancy and some possible risk factors through which majority of pregnant women can be infected. Proper screening against this
infection should be instituted in full capacity to curb the endemicity and consequences of the infection on the fetus.
the Democratic Republic of Congo (DRC) committed to the mitigation of the effects of climate change by signing the Kyoto Protocol for climate change and other related environmental management protocols. Since 1994, DRC has produced two national climate change communication documents (RDC, Ministère de l’Environnement, Conservation de la Nature, Eaux, et Forêts 2001; RDC, Ministère de l’Environnement, Conservation
de la Nature et Tourisme 2009). These documents give the strategic orientation for the application of the climate change convention with a focus on sec-tors vulnerable to climate change, the extent of greenhouse gas emissions, and the potential for carbon sequestration, adaptation, and mitigation strategies. This research monograph focuses on agriculture. It looks at indicators of economic growth among the sectors most vulnerable to climate change and gives future scenarios for the 10 major crops in the country according to four cli- mate models.
Background:
Toxoplasma infection during pregnancy exposes the fetus to risks of congenital infection and sequelae that depend heavily on gestational age (GA) at time of infection. Accurate risk estimates by GA are necessary to counsel parents and improve clinical decisions.
Methods:
We analyzed data from pregnant women diagnosed with acute Toxoplasma infection in Lyon (France) from 1987 to 2008 and assessed how the risks of congenital toxoplasmosis and of clinical signs at age 3 years vary depending on GA at the time of maternal infection.
Results:
Among 2048 mother-infant pairs, 93.2% of mothers received prenatal treatment and 513 (24.7%) fetuses were infected. Because of a significant reduction in risk since 1992 when monthly screening was introduced (59.4% vs 46.6% at 26 GA weeks; P = .038), probabilities of infection were estimated on the basis of maternal infections diagnosed after mid-1992 (n = 1624). Probabilities of congenital infection were <10% for maternal infections before 12 weeks of gestation, rose to 20.0% at 19 weeks, and then continued increasing to 52.3% and almost 70% at 28 and 39 GA weeks, respectively. Because of a significant reduction in risk of clinical signs of congenital toxoplasmosis in infected children born from mothers diagnosed after 1995 when polymerase chain reaction testing on amniotic fluid was initiated (87/794 vs 46/1150; P = .012), probabilities of clinical signs at 3 years were estimated based on 1015 maternal infections diagnosed after 1995 including 207 infected children, with symptoms in 46 (22.2%).
Conclusions:
These analyses demonstrated that introduction of monthly prenatal screening and improvement in antenatal diagnosis were associated with a significant reduction in the rate of congenital infection and a better outcome at 3 years of age in infected children. Our updated estimates will improve individual management and counseling in areas where genotype II Toxoplasma is predominant.
Background
Toxoplasmosis, a zoonotic disease distributed worldwide, is an infection caused by the ubiquitous obligatory intracellular coccidian protozoan organism, Toxoplasma gondii. It is a major public health concern because the disease is serious in terms of mortality or physical and /or psychological sequellae in patients with HIV disease. The aim of the study was to assess the seroprevalence of Toxoplasma gondii IgG and IgM antibodies and associated risk factors in HIV infected and non-infected individuals attending Felege Hiwot referral hospital, Bahir Dar, Northwest Ethiopia.
Methods
A cross sectional study was conducted at Felege Hiwot referral hospital, Bahir Dar, Amhara National Regional State. Venous blood samples were collected from 103 HIV infected pre anti-retroviral therapy patients at Felege Hiwot referral hospital and 101 HIV negative apparently healthy voluntary blood donors at the blood bank. Serum samples were analyzed for anti-Toxoplasma gondii IgG and IgM antibodies using a commercially available ELISA kit. Socio-demographic and associated risk factors for Toxoplasmosis from each individual were also obtained and the data was analyzed using SPSS version 18.
Results
Of the examined HIV seropositive individuals, 87.4% (90/103) and 10.7% (11/103) were positive for anti-T. gondii IgG and IgM antibodies, respectively. Multivariate analysis using logistic regression showed that anti-T. gondii seropositivity was independently significantly associated with undercooked or raw meat consumption (adjusted OR=5.73, 95% CI=1.35-24.39; P=0.02) and having contact with cat (adjusted OR= 4.29, 95% CI=1.08-16.94; P=0.04) in HIV positive individuals. In HIV negative apparently healthy blood donors, prevalence of anti-T. gondii antibodies were 70.29% and 2.97% for IgG and IgM, respectively. Multivariate analysis showed that undercooked or raw meat consumption (adjusted OR=6.45, 95% CI=2.16-19.28; p=0.001) and sex (OR=6.79, 95% CI=2.14-21.60; p=0.001) were independently significantly associated with anti-T. gondii IgG seropositivity, with a significantly higher number of males affected than females.
Conclusion
The present findings showed a high sero-prevalence of anti-T. gondii antibodies in HIV infected pre-ART and HIV non-infected apparently healthy blood donors in Bahir Dar. Consumption of undercooked or raw meat might greatly contribute towards acquiring T. gondii infection in HIV infected pre-ART and HIV non-infected apparently healthy blood donors. It may be appropriate to include routine serological screening test for determination of anti-T. gondii antibodies in HIV infected pre-ART individuals and HIV negative apparently healthy blood donors. In addition, health education towards avoiding eating undercooked and raw meat, and avoiding contact with cats were recommended.
Toxoplasma infection in pregnant women may cause congenital toxoplasmosis. Diagnosis of infection is based on serological tests aimed at detecting IgM and IgG antibodies against Toxoplasma gondii. However, IgM antibodies are not an accurate marker for discriminating between acute and latent infection. Detection of residual or persistent IgM may occur months or even years after primary infection, while the IgG avidity test is a rapid means for identifying latent infections in pregnant women who exhibit both IgG and IgM anti-Toxoplasma antibodies on initial testing during pregnancy. In this study, we assessed and compared the performance of four commercially available Toxoplasma IgG avidity tests in immunocompetent and immunocompromised patients with acute and latent toxoplasmosis. Positive predictive value of high avidity to confirm latent toxoplasmosis was 100% for all the assays indicating that high avidity is a hallmark of latent infection. However, negative predictive value of high avidity ranged from 99.2% (bioMérieux) to 95.3% (Abbott) indicating that that acute toxoplasmosis could not be reliably diagnosed based on low IgG avidity alone. Thus, the avidity test provides a rapid means for identifying latent Toxoplasma infection in immunocompetent pregnant women presenting both IgG and IgM anti-Toxoplasma antibodies on initial testing. In terms of cost-effectiveness, avidity testing is a powerful tool that optimizes screening and follow-up of pregnant women while it minimizes the costs of screening by avoiding subsequent costly maternal and fetal investigation and unnecessary treatment. The cheapest assay, VIDAS® Toxo IgG Avidity, also had the best performance for the diagnosis of latent toxoplasmosis.
Global warming has had serious implications on dispersion of infectious diseases like toxoplasmosis. Since the frequency of Toxoplasma gondii largely depends on climatic conditions, we studied its prevalence by means of 3599 samples of the National Health Survey 2000 (NHS-2000) and 2916 of the National Health and Nutrition Survey 2006 (NHNS-2006) serum banks, obtained from 1–98 year old subjects of both genders and all states of Mexico. Anti-T.gondii IgG antibodies were determined by ELISA and confirmed by western blot. Crude, epidemiologically weighted and diagnosis-performance-adjusted prevalence values were calculated. Seroprevalence changes were compared between both surveys and among regions (north, center and coast). Also, correlations between changes in temperature or humidity and those in prevalence were measured. National crude prevalence was 60.1% and 62.6% for NHS-2000 and NHNS-2006, respectively. Weighted and adjusted values were 62.5% and 40.0% for NHS-2000, and 63.7 and 43.1% for NHNS-2006. Coastal states and children presented the largest increases between surveys, while the center of the country showed a decrease. An apparently higher prevalence of T. gondii infection was observed in both surveys compared to that performed in 1987, while a geographical re-distribution was found from 2000 to 2006, with a positive correlation between temperature and frequency deltas in 21 states where prevalence increased.
Toxoplasma gondii, an Apicomplexan, is a pathogic protozoan that can infect the central nervous system. Infection during pregnancy can result in a congenial infection with severe neurological sequelae. In immunocompromisedindividuals reactivation of latent neurological foci can result in encephalitis. Immunocompetent individuals infected with T. gondii are typically asymptomatic and maintain this infection for life. However, recent studies suggest that these asymptomatic infections may have effects on behavior and other physiological processes. Toxoplasma gondii infects approximately one-third of the world population, making it one of the most successful parasitic organisms. Cats and other felidae serve as the definite host producing oocysts, an environmentally resistant life cycle stage found in cat feces, which can transmit the infection when ingested orally. A wide variety of warm-blooded animals, including humans, can serve as the intermediate host in which tissue cysts (containing bradyzoites) develop. Transmission also occurs due to ingestion of the tissue cysts. There are three predominant clonal lineages, termed Types I, II and III, and an association with higher pathogenicity with the Type I strains in humans has emerged. This chapter presents a review of the biology of this infection including the life cycle, transmission, epidemiology, parasite strains, and the host immune response. The major clinical outcomes of congenital infection, chorioretinitis and encephalitis, and the possible association of infection of toxoplasmosis with neuropsychiatric disorders such as schizophrenia, are reviewed.
The prevention of congenital toxoplasmosis is based on providing information to women, serologic diagnosis and treatment of the infected mother and child. In this article we present the results of 12 years of implementation of a congenital toxoplasmosis prevention program in which we measured the mother's infection incidence rate, the transmission rate and the number and severity of infection in newborns. The study was performed on 12035 pregnant women in the period 2000-2011. The prevalence rate of antibodies against Toxoplasma gondii was 18.33% (2206/12035). Thirty-seven out of 9792 susceptible women presented acute infection and the mother's infection incidence rate was 3.78 per 1000 births. The transplacental transmission rate was 5.4% (2/37). Two newborns presented congenital toxoplasmosis infection, one had no clinical signs while the other presented strabismus and chorioretinitis. Thirty-five infected mothers and the two children with congenital infection were treated. The transmission rates obtained allow consider this prevention program as a valid resource to minimize the impact of congenital toxoplasmosis.
Toxoplasmosis can be due to congenital infection or acquired infection after birth and is one of the leading illnesses associated
with foodborne hospitalizations and deaths. Undercooked meat, especially pork, lamb, and wild game meat, and soil contaminated
with cat feces on raw fruits and vegetables are the major sources of foodborne transmission for humans. The new trend in the
production of free-range organically raised meat could increase the risk of Toxoplasma gondii contamination of meat. Foodborne transmission can be prevented by production practices that reduce T. gondii in meat, adequate cooking of meat, washing of raw fruits and vegetables, prevention of cross contamination in the kitchen,
and measures that decrease spread of viable oocysts into the environment.
Between 2005 and 2007 we examined 2356 pregnant women. We interviewed the patients concerning their dietary behaviour and lifestyles during pregnancy in correlation with the possibility of contracting toxoplasmosis. Our purpose was to ascertain the importance of different risk factors in a group of Italian patients and assess the level of knowledge on this matter. The survey questions were related to: 1) eating rare/raw meat; 2) eating commercial or homemade ham or other pork derivatives such as dry sausage and salami; 3) owning a garden or a plot for fruit and vegetables; 4) owning pets, especially cats; 5) living in town or in the country; 6) eating fresh uncooked vegetables. On the basis of serological tests (Toxo IgG, IgM, IgA, avidity test) we identified three groups of women: those with primary infection, seronegative women (control), and those with inactive infections. Comparison of the first two groups showed that each risk factor significantly increases the likelihood of acquiring toxoplasmosis. Higher odds ratios were observed for those living in the country and for those consuming homemade cured meat.
Toxoplasmosis is a zoonosis caused by infection with Toxoplasma gondii and is prevalent worldwide under various climatic conditions. It is usually asymptomatic, but infection in pregnant women can pose serious health problems for the fetus. However, epidemiological information regarding toxoplasmosis in Japanese pregnant women is limited. This study aimed to determine the prevalence of anti-Toxoplasma antibodies, the primary infection rate, and the risk factors for toxoplasmosis in Japanese pregnant women. We measured anti-Toxoplasma antibody titers in 4,466 pregnant women over a period of 7.5 years and simultaneously conducted interviews to identify the risk factors for toxoplasmosis. The overall prevalence of anti-Toxoplasma antibodies was 10.3%, and it was significantly higher in women aged above 35 years. The rate of primary Toxoplasma infection during pregnancy was estimated to be 0.25%. A possibility of infection in the later stages of pregnancy was identified for those women who were not infected in the early stages. A history of raw meat intake was identified to be a risk factor related to toxoplasmosis. Therefore, to lower the risk of toxoplasmosis, pregnant women should refrain from eating raw and undercooked meat and maintain personal hygiene.