Printer Friendly

Serologic Evidence of Toxoplasma gondii Infection among Pregnant Females in Qassim Region, Saudi Arabia.

Byline: Abdelmageed Imam and Mohammed Al-Mansour

Abstract

Background: Acute primary maternal Toxoplasma gondii infection is a risk factor of congenital toxoplasmosis where the newborn may suffer visual and hearing loss, mental and psychomotor retardation, hepato-splenomegaly or death. Serologic testing for anti-Toxoplasma IgM and/or IgG antibodies is usually the initial step for diagnosing acute primary maternal toxoplasmosis.

Objective: To determine the frequency of clinically suspected acute primary maternal toxoplasmosis in pregnant women of Qassim region, Kingdom of Saudi Arabia using Toxoplasma IgM antibody testing.

Materials and Methods: Case records were reviewed for the past 2 years on all pregnant women referred to Maternity and Children Hospital, Qassim and who were tested for anti-Toxoplasma IgM antibodies.

Results: Out of a total 586 of pregnant women, 07 (1.2%) were found positive for anti-Toxoplasma IgM antibodies. The positivity ranged from 1.302.20 and it varied with age. IgM positivity was highest (greater than 2.0) among women aged below 30 years.

Conclusion: In this study, anti-Toxoplasma IgM antibodies were identified in 1.2% pregnant cases. Further tests are required to confirm vertical transmission of Toxoplasma gondii to the fetus.

Key words: Toxoplasma gondii, congenital toxoplasmosis, serology, Qassim.

Introduction

Toxoplasma gondii is a protozoa which has infected around 30% of the world's human population1. The infection is mainly acquired through undercooked infected meat, or consuming contaminating food. Acute infection in woman during pregnancy may be transmitted to the fetus leading to congenital toxoplasmosis (CT). Consequently, the fetus is at risk of visual and hearing loss, mental and psychomotor retardation, hepato-splenomegaly, or death2-4. The burden of toxoplasmosis, as food borne disease, was described as highest in terms of Disability Adjusted Life Years (DALYs), in a report from Netherlands5.

Most pregnant women with acute primary toxoplasmosis do not experience any obvious symptoms or signs6. In clinically suspected cases, the diagnosis is usually based on detection of anti-Toxoplasma IgM and/or IgG antibodies. Presence of IgM suggests acute infection, however, these antibodies in some cases may persist for greater than 1 year following acute infection7,8. Therefore, to confirm infection during pregnancy, Toxoplasma DNA detection in maternal blood is recommended9. Vertical transmission of T.gondii to the fetus is confirmed by Toxoplasma DNA detection in amniotic fluid6.

This study was done to determine the serologic presence of T. gondii infection in pregnant women who were referred to Maternity and Children Hospital (MCH), Qassim region, for anti-Toxopmlasa IgM antibody testing.

Materials and Methods

The study population were all pregnant women who were referred to MCH, Qassim, in central part of KSA for serologic testing of anti-Toxoplasma IgM antibodies. This study was done over two year's period (January 2007 January 2009). The data was collected from the electronic medical records system of MCH, Qassim for secondary analysis.

Five ml of venous blood were collected in a dry tube; serum was separated and stored in a tube at 2.0 6.0 degrees centigrade. The serum samples were processed next day for T. gondii IgM using ELISA commercial Enzywell Kits (Sensitivity 98.4%, Specificity 98.9%), Ref D91041, were obtained from Disease Diagnostics Co. (Italy). ELISA Gladiator machine it was used (Austria).

The positive and negative control samples were run with the test samples. The OD for the positive control sample was 0.95, while for the negative control sample was 0.21. A value of greater than 1.20 was considered positive.

Results

A total of 568 pregnant women were referred to MCH Qassim, central KSA for Toxoplasma IgM testing. Seven (1.2%) were positive by ELISA at the cut-off of 0.28 (Table-1). The positivity range was 1.32.2 and it varied with the age of the pregnant women. It was highest (greater than 2.0) in pregnant women who were aged below 30 years (Table-2).

Table 1: Serology profile of antenatal women who tested positive for anti-Toxoplasma IgM antibodies.

###OD test sample###OD cut-off sample###Positivity Ratio

Case 1###0.504###0.28###1.80

Case 2###0.616###0.28###2.20

Case 3###0.392###0.28###1.40

Case 4###0.364###0.28###1.30

Case 5###0.588###0.28###2.10

Case 6###0.392###0.28###1.40

Case 7###0.420###0.28###1.50

Discussion

In the present study, 1.2% pregnant women were found positive for toxoplasma antibodies IgM which are the first antibody isotype to be detected in Acute Primary Maternal Toxoplasmosis (APMT)6. These positive pregnant women were suspected to be suffering from acute toxoplasmosis, with the risk of transmission to the fetus leading to congenital infection and its complications. In some cases this marker of acute infection may persist for over a year, and such cases might need special testing like PCR to confirm acute maternal and fetal infection.

A recent study from Abha, Southern KSA9, concluded that Toxoplasma DNA should be done for confirmation of acute infection. The 1.2% Toxoplasma IgM sero-positivity rate of the present study are comparable to studies from Dammam, Eastern KSA10 (0.56%), Italy11 (1.23%), and Iraq12 (0.97%). These figures are much lower than from neighboring country Kuwait13 which has 13.8% frequency. The reason for these variations is unclear but exposure to risk factors for toxoplasmosis would be the main factor. An important risk factor for acquisition of T. gondii infection include contact with cats, and consumption of undercooked meat14. The latter is not a recognized part of the culture in Qassim, central KSA, while cats were reported as a risk factor in a study among pregnant women from Alahsa, eastern KSA15.

The frequency of Toxoplasma IgM positivity in this study varied with the age of pregnant women. It ranged from 1.3 to 2.2, and was highest (greater than 2.00) among women aged below 30 years (Table-2). This is in contrast to a study from Southern India16 where Toxoplasma IgM positivity increased with advancing maternal age, mainly over 30 years. Although advancing age increases the probability of exposure to infection, however, other co-existing risk factors cannot be excluded. For example, dietary habits are well recognized risk factors for the disease and these vary in different countries, and populations within the same country17. These unexplained phenomenon raise the need to better understand maternal toxoplasmosis in terms of human as well as parasite behavior.

Although this report provides important information on maternal toxoplasmosis from Qassim, central KSA, there are some limitations. Firstly, anti-Toxoplasma IgG was not evaluated. This antibody if showing a rising titer within 2-4 weeks, could suggest acute infection. Secondly, this was a retrospective study; therefore we do not have data on fetal outcome. Toxoplasma DNA detection using PCR, should be added for all ELISA positive cases to confirm acute infection and possibility of vertical transmission of T. gondii to the fetus. The disease is a handicap for children, and is an emotional and economic burden for their parents.

Table 2: Clinical profile of pregnant women who tested positive for anti-Toxoplasma IgM antibodies.

Cases###Age (year)###Nationality###Residence###Gestational age (week)###Normal deliveries (n)###IgM positivity ratio

Case 1###33###Saudi###Urban###33###2###1.80

Case 2###29###Saudi###Urban###15###1###2.20

Case 3###39###Egyptian###Urban###29###3###1.40

Case 4###26###Saudi###Rural###18###1###1.30

Case 5###28###Egyptian###Urban###34###2###2.10

Case 6###27###Saudi###Rural###32###3###1.40

Case 7###30###Sudanese###Urban###28###0###1.50

References

1. Pappas G, Roussos N, Falagas ME. Toxoplasmosis: Global status of seroprevalence and implications for congenital toxoplasmosis and pregnancy. Int J Parasitol 2009; 39: 1385-8.

2. Furtado JM, Winthrop KL, Butler NJ, Smith JR. Ocular toxoplasmosis: parasitology, epidemiology, and public health. Clin Experiment Ophtmolhal 2013; 41(1): 82-94.

3. Berrebi A, Bardou M, Bessieres MH, Nawacowska D, Castagno R, Rolland M, et al. Outcome for children infected with congenital toxoplasmosis in the first trimester: A study of 36 cases. Euro J Obstet Gynaecol Reprod Biol 2007; 135: 53-7.

4. Burrowes D, Boyer K, Swisher CN, Noble AG, Sautter M, Heyednmann P, et al. Spinal cord lesions in congenital toxoplasmosis demonstrated with neuroimaging. J Neuroparasitology 2012; Mar; 3(2012).

5. Havelaar AH, Haagsma JA, Manjen MJ, Kemmeren JM, Verhoef LP, Vijgen SM, et al. Disease burden of food borne pathogens in the Netherlands. Int J Food Microbiol 2012; 156(3): 231-8.

6. Montoya JG, Remington JS. Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2008; 47: 554-6.

7. Bamba S, Some DA, Chemia C, Geers R, Guiguemde TR, Villena I. Serological analysis of toxoplasmosis during pregnancy: risk assessment and perspectives of prenatal screening at a university hospital in Burkina Faso. Pan Afr Med J 2012; 12: 43-6.

8. Meek B, Gool T, Gilis H, Peek R. Dissecting the IgM response during the acute and latent phase of toxoplasmosis. Diag Microbiol Infect Dis J 2001; 41:131-7.

9. Bin Dajem SM, Al Mushait MA. Detection of Toxoplasma gondii DNA by PCR in blood samples collected from pregnant Saudi women from Aseer region, Saudi Arabia. Ann Saudi Med 2012; 32(5): 507-12.

10. Alqurashi AM. Antibodies against Toxoplasma gondii in paired sera from pregnant women and cord blood: A hospital based study. Ann Saudi Med 2000; 20: 336-8.

11. Paschale MD, Agrappi C, Belvisi L, Cagnin D, Cerulli T, Clerici P, et al. Revision of the positive predictive value of IgM anti-Toxoplasma antibodies as an index of recent infection. New Microbiol 2008; 31: 105-11.

12. Razzak AH, Wais SA, Saeid AY. Toxoplasmosis: the innocent suspect of pregnancy wastage in Duhok, northern Iraq. East Mediter Health J 2005; 11(4): 625-32.

13. Iqbal J, Khalid N. Detection of acute Toxoplasma gondii infection in early pregnancy by IgG avidity and PCR. J Med Microbiol 2007; 56: 1495-9.

14. Sroka S, Bartelheimer N, Winter A, Heukelbach J, Ariza L, Ribeiro H, et al. Prevalence and risk factors of toxoplasmosis among pregnant women in northeastern Brazil. Am J Trop Med Hyg 2010; 83(3): 528-33.

15. Almohammad HI, Balaha MH, Amin TT, Eldamarany EE, Dewedar A. The accuracy of IgGavidity for detection of acute toxoplasmosis among pregnant Saudi women. Prev Med Bull (Turkey ) 2010; 9: 7-14.

16. Sarkar MD, Anuradha B, Sharma N, Roy RN. Seropositivity of toxoplasmosis in antenatal women with bad obstetric history in a tertiary care hospital, Andhra Pradesh, southern India. J Health Popul Nutr 2012; 30(1): 87-92.

17. Buffalano W. Congenital toxoplasmosis: The state of art. Parasitologia ( Italy ) 2008; 50(2): 37-43.
COPYRIGHT 2015 Asianet-Pakistan
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2015 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:Pakistan Journal of Medical Research
Date:Sep 30, 2015
Words:1744
Previous Article:Pattern of Cigarette Smoking among College Students of Mardan.
Next Article:Prescription Pattern of Antidiabetic Drugs among Type 2 Diabetes Patients of Sir Ganga Ram Hospital, Lahore.
Topics:

Terms of use | Privacy policy | Copyright © 2020 Farlex, Inc. | Feedback | For webmasters