Seroepidemiology of Toxoplasma gondii infection in pregnant women in rural Durango, Mexico

The epidemiology of Toxoplasma gondii infection in pregnant women in rural Mexico is largely unknown. The seroepidemiology of T. gondii infection in 439 pregnant women from 9 communities in rural Durango State, Mexico was investigated. Using commercial enzyme-linked immunoassays, sera were tested for T. gondii IgG, IgM, and avidity antibodies. Prevalences of T. gondii IgG antibodies in the communities varied from 0% to 20%. Overall, 36 (8.2%) of the 439 women had IgG T. gondii antibodies. Ten (2.3%) women had also T. gondii IgM antibodies; IgG avidity was high in all IgM-positive women, suggesting chronic infection. None of the women, however, had delivered a known T. gondii-infected child. The seroprevalence was significantly higher (P < 0.05) in women from low socio-economic conditions (14%) than in those with higher socio-economic status (6.6%). Multivariate analysis showed that T. gondii infection was associated with soil floors at home (adjusted OR = 2.89; 95% CI: 1.12-7.49). This is the first epidemiological study of T. gondii infection in pregnant women in rural Mexico.     

Association of the presence of residual anti-Toxoplasma gondii IgM in pregnant women and their respective family groups in Miracema, Northwest Rio de Janeiro, Brazil

The seroprevalence of toxoplasmosis in 832 pregnant women in Miracema, Rio de Janeiro, was determined and 75.1% (625) and 2.0% (17) were anti-Toxoplasma gondii IgG and IgM positive, respectively. Out of the 17 IgM positive pregnant women, only one had low avidity IgG corresponding to the acute phase of the infection. All the other women presented with high avidity IgG and also presented with residual IgM anti-T. gondii. Of this sample, 106 received home visits (this includes 11 family nuclei of pregnant women with residual IgM anti-T. gondii, 68 nuclei of only IgG positive pregnant women and 27 nuclei of pregnant women with no antibodies to anti-T. gondii), resulting in 267 individuals visited. Out of these 267 individuals, 21 were positive for IgG and IgM anti-T. gondii and were candidates for the IgG avidity test. All of them presented with high avidity IgG and residual IgM. Five of these IgM+ individuals were (5/238; 2.1%) relatives of IgM negative pregnant women. The other 16 (16/29; 55.2%) were relatives of IgM+ pregnant women who were positive for residual IgM anti-T. gondii. This association was statistically significant (p = 0.0000). The analysis presented herein raises questions regarding the presence of residual IgM anti-T. gondii such as genetic determinants or even constant antigenic stimuli for the same family cluster.     

Seroprevalence and risk factors for Toxoplasma gondii infection on pig farms in central China

Toxoplasma gondii is a protozoan parasite that causes severe diseases in mammals, including humans, around the world. In China, pork is the main meat source; accordingly, T. gondii in pigs is considered an important source for human toxoplasmosis. Understanding the epidemiology of toxoplasmosis in pig farms is thus important for control of the disease in humans. The purpose of the present study was to investigate the epizootiology of T. gondii infections in pig farms in central China by assessing the seroprevalence and risk factors of this disease. In the present study, 3,558 sera samples were collected from pigs in 37 large-scale pig farms in this region and tested by AG-ELISA. The total seroprevalence was 24.5%, with the greatest prevalence in breeding pigs. The risk factors for toxoplasmosis suggest that high frequency of the contact of pigs with cats (P ≤ 0.01; IC 95%), high density of pig breeding (P ≤ 0.01; IC 95%), the presence of mosquitoes and flies (P ≤ 0.01; IC 95%), semi-patency pens (P ≤ 0.05; IC 95%), and low frequency of scavenging (P ≤ 0.01; IC 95%) were all associated with seroprevalence. In addition, the use of sulfonamides (P ≤ 0.01; IC 95%) significantly decreased seroprevalence. This is the first report of anti- T. gondii antibodies in pigs on large-scale pig farms in central China. The findings will provide useful information for designing control strategies of toxoplasmasis in pig farms.     

Toxoplasmosis in Kosovo pregnant women

This study presents the initial results of a collaborative project aimed at the evaluation of Toxoplasma seroprevalence in a population of Kosovar pregnant women. The serum samples of 334 pregnant women were tested to detect IgG, IgM, IgG avidity for toxoplasmosis. Data regarding age, occupation, area of origin and education were also obtained for the pregnant women examined; 97/334 (29.4%) resulted positive for IgG antibodies, four of whom (4.1%) were also positive for IgM, (1.2% of the total population examined). All four IgM-positive pregnant women also demonstrated low avidity tests. The rate of IgG seroprevalence found in our study was lower than that observed in various European countries, especially those of western Europe. Conversely, the percentage of recent infections was higher than expected. The higher rate of infections could be the result of a recent toxoplasmosis epidemic in Kosovo, most likely due to the altered hygienic conditions caused by the forced transfer of the ethnic-Albanian population from an area of low (Serbia) to high (Kosovo) toxoplasmosis prevalence.     

Toxoplasma gondii infection in pregnant women in China

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is one of the most common parasitic infections in humans. Primary infection in pregnant women can be transmitted to the fetus leading to miscarriage or congenital toxoplasmosis. Carefully designed nationwide seroprevalence surveys and case-control studies of risk factors conducted primarily in Europe and America, have shaped our view of the global status of maternal and congenital infection, directing approaches to disease prevention. However, despite encompassing 1 in 5 of the world's population, information is limited on the status of toxoplasmosis in China, partly due to the linguistic inaccessibility of the Chinese literature to the global scientific community. By selection and analysis of studies and data, reported within the last 2 decades in China, this review summarizes and renders accessible a large body of Chinese and other literature and aims to estimate the seroprevalence in Chinese pregnant women. It also reviews the prevalence trends, risk factors, and clinical manifestations. The key findings are (1) the majority of studies show that the overall seroprevalence in Chinese pregnant women is less than 10%, considerably lower than a recently published global analysis; and (2) the few available appropriate studies on maternal acute infection suggested an incidence of 0·3% which is broadly comparable to studies from other countries.     

Seroprevalence of Toxoplasma gondii infection and risk factors associated with seropositivity of pregnant women in Korea

A total of 351 serum samples was examined for anti-T. gondii antibody titers; the overall seroprevalence was 3.7%. The Sabin-Feldman dye test (DT), latex agglutination test (LAT), and IgG enzyme-linked immunosorbent assay (IgG ELISA) indicated seroprevalences of 3.7%, 3.4%, and 4.0%, respectively. Compared with the DT, the sensitivities of the LAT and IgG ELISA were 84.6% and 100.0%, respectively, and the specificities of the LAT and IgG ELISA were both 99.7%. An increase in T. gondii seroprevalence with increasing age was detected, but the difference was not significant. The overall seroprevalence of T. gondii-antibody titers in pregnant Korean women was relatively low compared to those of Europeans and Americans. A multivariate analysis of risk factors showed that T. gondii infection was positively correlated with eating raw meat, but was not associated with the consumption of unwashed vegetables, drinking untreated water, a history of raising a cat, or blood transfusion. The consumption of raw or undercooked meat may, therefore, be the main route of T. gondii infection in Korea.     

Seroprevalence of toxoplasmosis in Korean pregnant women

This study was performed in order to evaluate the sero-epidemiological status of toxoplasmosis in pregnant Korean women. Among 5,175 sera and 750 amniotic fluid samples obtained from pregnant women, 41 serum samples (0.79%) and 10 (1.33%) amniotic fluid samples tested positive for IgG antibodies by ELISA. Fifty one cases showing a score more than 0.25 on ELISA were tested for PCR reaction against the SAG1 gene. Only one case of the 51 ELISA positive cases exhibited a positive reaction on all tests. This case had a history of acute nephropyelitis during early pregnancy, but fortunately, had delivered a phenotypically healthy baby. In this study, the seroprevalence of toxoplasmosis in pregnant women was found to be comparatively low, consistent with previous reports from Korea. However our trials, performed with a variety of diagnostic tools, were considered to be useful for the precise diagnosis of congenital toxoplasmosis.     

Toxoplasmosis snapshots: Global status of Toxoplasma gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis

Toxoplasma gondii’s importance for humans refers mainly to primary infection during pregnancy, resulting in abortion/stillbirth or congenital toxoplasmosis. The authors sought to evaluate the current global status of T. gondii seroprevalence and its correlations with risk factors, environmental and socioeconomic parameters. Literature published during the last decade on toxoplasmosis seroprevalence, in women who were pregnant or of childbearing age, was retrieved. A total of 99 studies were eligible; a further 36 studies offered seroprevalence data from regions/countries for which no data on pregnancy/childbearing age were available. Foci of high prevalence exist in Latin America, parts of Eastern/Central Europe, the Middle East, parts of south-east Asia and Africa. Regional seroprevalence variations relate to individual subpopulations’ religious and socioeconomic practices. A trend towards lower seroprevalence is observed in many European countries and the United States of America (USA). There is no obvious climate-related gradient, excluding North and Latin America. Immigration has affected local prevalence in certain countries. We further sought to recognise specific risk factors related to seropositivity; however, such risk factors are not reported systematically. Population awareness may affect recognition of said risks. Global toxoplasmosis seroprevalence is continuingly evolving, subject to regional socioeconomic parameters and population habits. Awareness of these seroprevalence trends, particularly in the case of women of childbearing age, may allow proper public health policies to be enforced, targeting in particular seronegative women of childbearing age in high seroprevalence areas.     

Seroprevalence of acquired toxoplasmosis in HIV-infected and apparently healthy individuals in Jos, Nigeria

Toxoplasma gondii IgG antibody seroprevalence was studied in two different populations of 219 HIV-infected patients and 144 apparently healthy individuals (AHIs). Clinical toxoplasmosis was assessed among the HIV-infected patients. Antibodies to T. gondii were detected in 85 (38.8%, 95% CI: 32.36%-45.26%) of the HIV-infected patients and in 30 (20.8%, 95% CI: 14.20%-27.46%) of the AHIs. Among the AIHs, males represented 22.0% of infections compared to females (20.0%) and individuals within age group 21-30 years accounted for the highest prevalence of 33.3% (95% CI: 11.56%-55.10%). There was no significant difference in the trend (Chi-square, P < or = 0.05). Assessment of epidemiological factors showed higher seroprevalence of Toxoplasma antibodies among those who eat rodents (29.6%) and those who constantly have contact with the soil (21.2%). Among the HIV-infected, individuals 31-40-years-old had the highest T. gondii seroprevalence (36.5%). Evaluation of the clinical findings of patients with concomitant toxoplasmosis and HIV infection greatly implicated fever (63.5%), headache (44.7%), rashes (41.2%) and anorexia (34.1%). This study contributes to the development of guidelines for the prevention and management of toxoplasmosis in HIV-infected patients and in apparently healthy individuals in a resource scarce setting.     

T cell mediated immune responses to Toxoplasma gondii in pregnant women with primary toxoplasmosis

The aim of this study was to investigate T cell immunity to Toxoplasma gondii (Tg) in pregnant women with primary toxoplasmosis. This issue has never been addressed before in humans and available information derives from murine models. Peripheral blood mononuclear cells (PBMC) from pregnant women with primary Tg infection were stimulated with Tg tachyzoites, excretory-secretory antigens (ESA) or recombinant surface antigen-1 (rSAG-1), and tested for proliferation, immunophenotype, cytokine production and antigen specific cytotoxic activity. Pregnant women with primary toxoplasmosis displayed a significant decrease of the CD4/CD8 T cell ratio and a significant increase of circulating T cell receptor (TCR) gammadelta+ cells as compared to their uninfected counterparts. T cells from Tg infected pregnant women proliferated to Tg tachyzoites, ESA or rSAG-1. Most tachyzoite and ESA specific T cell blasts were CD4+, whereas SAG-1 specific blasts were CD4+ and CD8+. ESA and tachyzoite specific T cell blasts displayed a Th1 or Th0 cytokine profile with overexpression of IFN-gamma. This pattern was unchanged upon in vitro exposure of T cells to progesterone, tested at a concentration close to that reached in vivo at the maternal-fetal interface. Finally, tachyzoite or ESA specific T cell blasts lysed, through a granule exocytosis dependent mechanism, autologous lymphoblastoid cell lines presenting Tg antigens. In conclusion, pregnant women with primary toxoplasmosis mounted in vitro Tg-specific Th1/Th0 responses whose impact on neonatal infection warrants further investigation.     

Prevalence of Toxoplasma gondii antibodies and DNA in dogs in Shanghai, China

The aim of this study was to estimate the prevalence of Toxoplasma gondii infection in dogs in Shanghai, China. A total of 1,736 sera (1,178 from the city center and 558 from the outskirts) was collected from healthy dogs and tested for T. gondii infection by indirect hemagglutination; 56 sera (3.2%) were considered positive, with titers > 1∶64. The seroprevalence in dogs from the outskirts of the city (town dogs, 6.0%; countryside dogs, 9.8%) was significantly higher (P > 0.05) than that in city center dogs (1.3%). The age of the dog has an apparent association with T. gondii infection; that is, the seroprevalence ranged from 1.9% (in dogs ≤ 1 year old) to 3.6% (in dogs > 5 years old). There was no significant difference in gender (P ≥ 0.05), that is, 1.4% versus 1.1% for male and female dogs in the city center, 6.2% versus 5.9% in town dogs, and 8.4% versus 11.5% in country dogs, respectively. These results suggest that T. gondii infections are common in dogs from the city center and outskirts of Shanghai, but the T. gondii seroprevalence in dogs is considerably lower than in other regions in PR China. The presence of T. gondii DNA was investigated by nested PCR on 110 blood samples from city center dogs, but no positive samples were found, which may suggest that there were no acute infections of T. gondii in the city center samples. Our results indicate that the control and treatment of toxoplasmosis in Shanghai has been effective. However, it is still essential to further implement integrated strategies to prevent and control T. gondii infection in dogs in both the city center and the outskirts.     

Prevalence of antibodies to Toxoplasma gondii in horses in Riyadh Province, Saudi Arabia

The aim of the present study was to determine the seroprevalence of Toxoplasma gondii in horses used for sporting purposes in the Province of Riyadh, Saudi Arabia. In total, 266 serum samples from clinically healthy horses were analyzed for anti- T. gondii antibodies using the Sabin-Feldman dye test. Antibodies to T. gondii were found in 84 (31.6%) horses, with specific titers of 1∶16 (78 with a prevalence of 29.3%), 1∶64 (4 with a prevalence of 1.5%), and 1∶256 (2 with a prevalence of 0.8%). The number of seropositive horses in Shaqra (43.7%) was considerably higher than in other regions, with the lowest occurring in Al-Majmaah (11.0%). However, the differences in seroprevalence between the 6 locations were not statistically significant (P > 0.05). In contrast, the overall seroprevalence in Riyadh province was higher than that reported in other countries. Horses are not a direct source of infection for human toxoplasmosis in this region. Usually human infection is facilitated via cats, which are the reservoir hosts for this parasite.     

Environmental Factors Associated with the Seroprevalence of Toxoplasma gondii in Wild Boars (Sus scrofa), France

Toxoplasma gondii is a protozoan parasite infecting humans and animals. Wild boars Sus scrofa are a potential source of human infection and an appropriate biological model for analyzing T. gondii dynamics in the environment. Here, we aimed to identify environmental factors explaining the seroprevalence of toxoplasmosis in French wild boar populations. Considering 938 individuals sampled from 377 'communes', overall seroprevalence was 23% (95% confidence interval: [22-24]). Using a Poisson regression, we found that the number of seropositive wild boars detected per 'commune' was positively associated with the presence of European wildcats (Felis silvestris) and moderate winter temperatures.     

Evaluation of two Toxoplasma gondii serologic tests used in a serosurvey of domestic cats in California

We evaluated the sensitivity (Se) and specificity (Sp) of an IgG enzyme-linked immunosorbent assay (ELISA) and IgG indirect fluorescent antibody test (IFAT) for detection of Toxoplasma gondii-specific antibodies in sera from 2 cat populations using a Bayesian approach. Accounting for test covariance, the Se and Sp of the IgG ELISA were estimated to be 92.6% and 96.5%, and those of the IgG IFAT were 81.0% and 93.8%, respectively. Both tests performed poorly in cats experimentally coinfected with feline immunodeficiency virus and T. gondii. Excluding this group, Se and Sp of the ELISA were virtually unchanged (92.3% and 96.4%, respectively), whereas the IFAT Se improved to 94.2% and Sp remained stable at 93.7%. These tests and an IgM ELISA were applied to 123 cat sera from the Morro Bay area, California, where high morbidity and mortality attributable to toxoplasmosis have been detected in southern sea otters. Age-adjusted IgG seroprevalence in this population was estimated to be 29.6%, and it did not differ between owned and unowned cats. Accounting for Se, Sp, and test covariances, age-adjusted seroprevalence was 45.0%. The odds for T. gondii seropositivity were 12.3-fold higher for cats aged >12 mo compared with cats aged <6 mo.     

Evaluation of the mood-stabilizing agent valproic acid as a preventative for toxoplasmosis in mice and activity against tissue cysts in mice

Toxoplasma gondii is a common intracellular protozoan infection of humans worldwide. Severe disease can occur in immunocompromised individuals and the in the fetuses of nonimmune pregnant women. Chronic infection is associated with vision and hearing problems, and functional mental alterations, including schizophrenia. The mood-stabilizing agent valproic acid has been shown to inhibit the development of T. gondii in vitro at dosages that are normally achieved in the serum and cerebral spinal fluid of human patients and to have positive effects on the behavior of rats chronically infected with T. gondii. The present study was done to examine the in vivo activity of valproic acid against acute toxoplasmosis in mice. Two studies were done with valproic acid given in the drinking water at concentrations of 1.5 mg/ml (Experiment 1) or 3.0 mg/ml (Experiment 2). In a third experiment (Experiment 3), valproic acid was injected intraperitoneally (i.p.) at doses of 200 or 300 mg/kg every 12 hr. Valproic acid was not effective in preventing acute toxoplasmosis. All mice treated with valproic acid died or were killed and did not (P > 0.05) live significantly longer than the controls. Tachyzoites were demonstrated in the tissues of infected valproic-acid-treated mice. A fourth study was done to determine if valproic acid has activity against T. gondii tissue cysts in chronically infected mice. Mice were chronically infected with the ME-49 strain of T. gondii for 8 wk and then treated orally with valproic acid at approximately 6.6 mg/ml (800 mg/kg/day) in the drinking water for 10 wk (amount was varied due to increasing mouse weights). No significant differences (P > 0.05) were present in tissue cyst numbers in valproic-acid-treated T. gondii chronically infected mice and in mice chronically infected with T. gondii but not given valproic acid. Our results indicate that valproic acid, although effective in vitro against T. gondii tachyzoites, is not effective as a preventative in mice inoculated with T. gondii tachyzoites. Additionally, no activity against tissue cysts was observed in chronically T. gondii-infected valproic-acid-treated mice.     

Immunization against Toxoplasma gondii

The emergence of Toxoplasma gondii as a major opportunistic organism in immunocompromised individuals and the steady increase in economic losses due to animal toxoplasmosis have fuelled the interest in vaccine development. In this review, Fausto Araujo addresses aspects of vaccination against T. gondii with regard to the problem posed by this parasite to pregnant women and to severely immunocompromised individuals.     

Performance of the immunoglobulin G avidity and enzyme immunoassay IgG/IgM screening tests for differentiation of the clinical spectrum of toxoplasmosis

Toxoplasmosis has been well known as an important human infection to consider especially in pregnant women. Although many serologic methods are available, the diagnosis of toxoplasmosis can be extremely difficult. The presence of increased levels of Toxoplasma-specific IgG antibodies indicates an infection, but it does not differentiate between a recent and past infection. The purpose of our study was to compare the performance of the ELISA T. gondii IgG/IgM test, a widely used enzyme-linked immunosorbent assay, to the ELISA IgG avidity method. One hundred and four serum samples (from 38 males and 66 females) were tested and evaluated from symptomatic patients (chorioretinitis, lymphadenopathy), and from women in their first trimester of pregnancy who were suspected of having toxoplasmosis. The high IgG avidity and ELISA IgG antibody levels were in agreement for 51 of the specimens (49.0%). Thirty-eight discrepant (borderline) results from the IgG avidity method were positive for IgM (3 specimens) and IgG (37 specimens). Interestingly, out of the eight serum samples that were positive for both IgG and IgM antibodies, two samples were low IgG avidity, and three samples were borderline. There was no statistically significant relation observed between the results of the IgG avidity method and the ELISA IgG test, and the IgG avidity method and ELISA IgM test (chi2 = 1.987; p = 0.370 and chi2 = 2.152; p = 0.341, respectively). The IgG avidity method was considered easy to perform and an acceptable approach for the differentiation of discrepant results (recent/chronic) and for the current detection of T. gondii antibodies. We concluded that the determination of IgG avidity is a helpful tool for the diagnosis of the ocular form of toxoplasmosis and it is a safe method for screening this disease in the first trimester of pregnancy.     

Toxoplasmosis in livestock in Italy: an epidemiological update

Infection with Toxoplasma gondii is one of the most common parasitic infections of human being and other warm-blooded animals. It has been found worldwide from Alaska to Australia. Public health organizations repeatedly encourage the collection of accurate data about T. gondii in animals and humans due to its medical importance as a major source of parasitic zoonosis. For these reasons, epidemiological updates on toxoplasmosis in livestock are strongly advised also to plan control strategies. In the present paper, seroprevalence data on T. gondii that have been recorded in livestock from different Italian regions over the last 3 decades are reviewed, showing the high level of exposure of livestock to this parasite.     

Natural toxoplasma gondii infections in European brown hares and mountain hares in Finland: proportional mortality rate, antibody prevalence, and genetic characterization

In material examined postmortem in Finland from May 2006 to April 2009, acute generalized toxoplasmosis was the immunohistochemically confirmed cause of death in 14 (8.1%) of 173 European brown hares (Lepus europaeus) and four (2.7%) of 148 mountain hares (Lepus timidus). Sera from 116 of the European brown hares and 99 of the mountain hares were screened with a commercial direct agglutination test for Toxoplasma gondii-specific IgG antibodies at a dilution of 1:40. All sera from cases of fatal toxoplasmosis had high titers of antibodies reactive to T. gondii. In contrast, none of 107 European brown hares and four (4%) of 96 mountain hares that died of other causes were antibody-positive. The proportional mortality rates and the T. gondii antibody prevalences among noncases differed significantly between the two host species (P<0.05). Direct genetic characterization of the causative agent was performed on DNA extracted from formalin-fixed, paraffin-embedded tissue of the hares with fatal toxoplasmosis. Based on the results with six microsatellite markers (B18, TUB2, TgM-A, W35, B17, and M33; all six in 15 cases and four in three cases), all the cases were caused by T. gondii genotype II; the size of the PCR product at the seventh marker (M48) varied (213-229 base pairs). The presence of T. gondii genotype II, which is endemic in Europe, is now confirmed in Finnish wildlife: Natural infections with T. gondii parasites belonging to this widespread genotype caused fatal generalized toxoplasmosis in the two species of wild hares.     

Seroprevalence of Toxoplasma gondii infection in female sterility patients in China

Toxoplasmosis is an important parasitic disease worldwide and is related to certain psychiatric disorders and sterility. In the present study, serum samples from 882 female sterility patients and 107 pregnant-puerperant women were assayed for anti- T. gondii IgG antibodies using ELISA. The overall T. gondii seroprevalence was 14.8%. In the female sterility patients, 15.9% (140/882) were seropositive and, in the pregnant-puerperant women, 5.6% (6/107) were positive for anti- T. gondii IgG antibodies. There was a significant difference between the 2 groups ( P < 0.05). The samples were further divided into 5 groups based on age, but no significant difference was found among the 5 groups (P > 0.05). Results of the present study argue for more attention to prevention of T. gondii infection in the female population and, in particular, women of childbearing age.