Download Seroprevalence of Toxoplasma gondii in pregnant women in some

Seroprevalence of Toxoplasma gondii in
pregnant women in some areas of Basrah
Province, Iraq
Khalid J. K. Al-Zihiry
Department of Microbiology , College of Medicine, University of Thi-Qar.
Mahdi M. Thueni
Department of Pathology , College of Medicine, University of Thi-Qar.
Kassim H. Khalaf
M.Sc. Biochemistry, Al-Qurna General Hospital, Basrah
Abstract
The current study was carried out to detection the seroprevalence of Toxoplasma gondii in
pregnant women in some areas of Basrah Province (Al-Qurna and Talha) by examination of 63 blood
serum in Al-Qurna hospital for the period from January to June 2007 using indirect haemagglutination
test. From collected samples 50 (79.3 %) was positive for T. gondii antibodies in different dilutions.
No significant differences in seroprevalence between age groups of examined pregnant sera.
Also it showed the strongly correlation between the infection by Toxoplasmosis and incidence
of abortions in the studied areas.
‫الخالصة‬
‫متتاةدا ايةل تتل‬
‫اتن لداةتة‬
‫لدايدةتتل لداداالرلتل دتترل لداةتة لديدلاتتم لتا ةاتتة لدااتة‬
‫ عالاتل ر ألتذ‬63
‫ لاترأة ابتةةل دت‬50 ‫اتة‬
‫لدر لرةتتل لديةدلتل دديرالتتر ل ادمتةر لدابت ا مبتةةة‬
‫ دذدت اتن لتفح ليت‬2007 ‫يل) د ارة بالن مهر كتةادن لداتةاا داهةلتل متهر ينيترلن‬
‫لدافيدبتل كةات‬
‫لدر لرةتتل لديةدلتتل عتتر دجتتدر ةلاتتل ااادلتتل‬
‫لدتدفنن لدتراد ب اتن بتالن لداالاتة‬
‫ب بالا ت‬% 79.3 ‫د اةتتةل بتتةةل‬
‫داةدمفى لديرال لداتة ة رييتل ليت‬
‫أجريت‬
,‫لدةبرة(لديرال‬
‫لديدلام لدارلجاة‬
‫ديرالتتر ة اتتن لتتفح يا هتتة دمجةتتة لدااتتةرة دتترل لدايدةتتة‬
‫ ااة الؤكر عتر دتياالر عاتر لداترأة لديةاتم لتا‬,‫د نيةرة لد فلفل لديةب ل لا اةةل لمبةةل اع دير لديدلام ةةداار لا لدفئل لدااريل لداةدال‬
‫لدررلةل لديةدلل ل ردةتة لدداالت بتالن دجتدر لمبتةةل بترل لدايدةتل لداداالرلتل‬
‫دترل لداةتة لديدلاتم‬
‫ كاة أداي‬,‫لدارردةل‬
‫اةب لمبةةل ةةدارة لا لدااة‬
‫ديردث لألجهةظ عار لديدلاتم ااتة لا تا اؤمت لر دلاتية ع تى ردر لد فال تا لداتذكدر لتا يترلث د ت لألجهةاتة‬
‫لدررلةل دايةل ل لدةبرةب‬
‫لا ااة‬
Introduction
Toxoplasmosis is a zoonotic disease caused by intracellular coccidian parasites,
Toxoplasama gondii (Reiter-Owona, 2005; Song et al., 2005), it infect at least 500
millions people worldwide (Feron et al., 2001), and developed several potential routes
of transmission within and between different host species (Cabanacan-Salibay and
Claveria, 2006) such as swine (Mendonca et al., 2004) , Rodents (Kuticic et al.,
2005), Sheep (Oncel and Vural, 2006) and Goats (Karaca et al., 2007). The definitive
hosts of the parasite are domestic cats and other felines (Oncel et al., 2005).
Infection is acquired by ingestion the sporulated oocyst excreted by cats that
contaminate food and water and via ingestion of bradyzoites in the tissue of numerous
food animals.(Oncel and Vural, 2006). Congenital toxoplasmosis results from the
transplacental transmission of the parasite to the fetus (Wallon et al., 2004) causing
various degree of damage, depending on the virulence of the parasites, the immune
response of the mother and on the pregnancy period of the women when infected,
resulting in fetal death or in severe clinical symptoms (Lopez et al., 2007).
Primary infection with T.gondii in pregnancy is usually asymptomatic,
nevertheless infection may be transmitted to the fetus (Morris and Croxson, 2004),
and can cause severe damage such as microcephaly, retinochoroditis and cerebral
calcification (Falavigna et al., 2007) especially if a women get infection for the first
time in her life (Al-Harthi et al., 2006). Infections occurring in the first trimester have
a 10% chance of transmission to the fetus and have the worst prognosis because of the
risk of extensive central nervous system involvement, while the infection occurring in
the later pregnancy is transmitted to the fetus more frequently but does not cause such
extensive damage (Morris and Croxson, 2004).
Toxoplasmosis is diagnosed in laboratory by immunological testing that give the
titer of circulating antibodies, and in fetus toxoplasmosis based on direct identification
of the parasite by inoculation of amniotic liquid and /or fetal blood in mice, as well as
cell culture (Lopez et al., 2007). The seroprevalence of pregnant toxoplasmosis were
reported in many countries as reaching 81% in Brazil, 71% in France, 42% in Italy,
37% in Slovenia, 47.1% in Jordan, 66.9 % in Kuwait, 43.4% in Saudi Arabia
(Mendonca et al., 2004; Jumaian, 2005; Iqbal and Khalid, 2007).
In Iraq little studies were carried out about pregnant toxoplasmosis.The aim of the
present study to investigate the seroprevalence of T. gondii antibodies among
pregnant women in North Basrah and discuss some factors associated with infections.
Materials and Methods
A total of 63 pregnant women was examined by collect a blood sample for the
period from January to June 2007 in Al-Qurna hospital to determine Toxoplasma
gondii antibodies. One sample for each pregnant was collected in tubes (5 ml), stored
in container at 4C°. The sera was separated by centrifugation at 4000 rpm for ten
minutes in room temperature, stored at -20 until use. The indirect haemagglutination
test (IHAT) (BioKit, Barcelona, Spain) were used for serodiagnosis (IgM, IgG) of
toxoplasmosis at dilutions 1:16-1:256. SPSS programme were used for statistical
analysis.
Results
Out of 63 blood samples that collected from pregnant women in present study,
50 (79.3 %) were seropositive for Toxoplasma gondii in Al-Qurna hospital at titres
1:16-1:256. The seroposivity was distributed in different dilutions: 3 (7.5 %) at 1:16
dilution, 16 (40 %) at 1:32 dilution, 7 (17.5 %) at 1:64 dilutions, 16 (40 %) at 1:128
dilutions and 8 (20 %) at 1:256 dilutions.
There is no significant differences in infection percentage between age groups of
pregnant( P<0.05), although there is clearly decrease in this percentage in (20-29
years) group. Table 1.
Table (1): Distribution of toxoplasmosis at age groups
Age groups(Years)
Examined
Infected
Percentage %
20>
20-29
30-39
11
9
81.8
35
17
27
14
77.1
82.3
Our results show that the seroposivity is gradually increase with number of
previous abortions. The pregnant with two and three abortions had a highest
percentage of toxoplasmosis antibodies. (Table 2)
Table (2): Toxoplasmosis compared with previous abortions.
No.
Abortions
None
Examined
Infected
Percentage %
7
4
57.1
1
44
34
77.2
2
2
2
100
3
2
2
100
Discussion
The importance of infection with Toxoplasma gondii is acquired by causing fetal
infection if its acquired during pregnancy, with unpredictable manifestations in the
fetus and neonatal and it can cause morbidity and mortality in immunocompromised
patients(Foulon
et
al.,
2000;
Razzak
et
al.,
2005).
High percentage (79.3 %) were obtained in T. gondii antibodies in pregnant
women of Basrah city compared with those in other locations of Iraq, these result can
be attributed to that the Basrah city has a warm, moist climate which is regarded a
favorable condition to longer viability for T.gondii oocyst. This suggest is supported
by Remington et al., 2001; Dupouy-Camet et al., 2003; Hatam et al., 2005 who
reported regional variations in the incidence of T.gondii infection rate from one
country to another or even within the same country because climate, cultural
differences
regarding
hygienic
and
feeding
habits.
No significant differences has been recorded at seroprevalence of toxoplasmosis in
three age groups that showed in table (1). The suspected reason for this is the equal
degree of exposing to causing agent (oocyst) of toxoplasmosis between the previous
age groups. The present result is differ from most of studies carried out in Iraq and in
the world which showed that the seroposivity of T.gondii increase with older age (AlHamdani and Mahdi, 1997; Song et al., 2005; Al-Harthi et al., 2006 and Yacoub et
al., 2006).
The increasing of infection with pregnant age is discussed by Jumaian (2005) that
associated with soil exposure, which is greatest during childhood years, the principal
mechanism by which people are exposed to T. gondii.
The gradually increase of seropositivity with number of previous abortions shows
the closely correlation between infection by T.gondii as a major causative agent of
abortions in pregnant women in Southern Iraq.
The prevention of toxoplasmosis
including education of women at childbearing age about minimizing their risk for
infection. Educational interventions assume that increase knowledge results in
awareness. Health managers should emphasize the importance to avoiding raw or
undercooked meat, handling raw meat safely and preventing close contact with cats
(Foulon et al., 1994).
References
Al-Hamdani, M.M. and Mahdi, N.K.(1997). Toxoplasmosis among women with
habitual abortion. Eastern Mediterranean Health j., 3(2): 310-315.
Al-Harthi, S.; Jamjoom, M.B. and Ghazi, H.O.(2006). Seroprevalence of Toxoplasma
gondii among pregnant women in Makkah, Saudi Arabia. Umm Al-Qura Univ. J.
Sci. Med. Eng., 18(2): 217-227.
Cabanacan-Salibay, C. and Claveria, F.G.(2006). Toxoplasma gondii infection in
Philippines Rattus spp. confirmed through bioassay in Mus musculus. Vet. Arhiv,
76(4): 351-361.
Falavigna, D.L.M.; Roncada, E.V.; Nakazora, D.; Pelloso, M.C.; Falavigna, L.F.M.;
Araujo, S.M. and Falavigna-Guilherme, A.L.(2007). Congenital Toxoplasmosis
in Dizygotic Twins, Parana, Brazil. Rev. Inst. Med. trop. S. Paulo, 49(2): 117118.
Feron, E.J.; Klaren, V.N.A.; Wierenga, E.A.; Verjans, G.M.G.M.and
Kijlstra,
A.(2001). Characterizationof Toxoplasma gondii-Specific T cells recovered from
Vitreous fluid of patients with ocular Toxoplasmosis. Invest.
Ophthalmol. Vis. Sci., 42(13): 3228-3232.
Foulon, W.; Naessens, A. and Drede, M.P.(1994). Evaluation of the possibilities for
preventing congenital toxoplasmosis. Am. J. Perinatol., 11: 57-62.
Foulon, W.; Naessens, A. and Ho-Yen, D.(2000). Prevention of congenital
toxoplasmosis. J. Perinatal Med., 28(5): 337-345.
Hatam, G.; Shamseddin, A. and Nikouee, F.(2005). Seroprevalence of Toxoplasmosis
in high school girls in Fasa district, Iran. I.J.J., 2(3): 177-181.
Iqbal, J. and Khalid, N.(2007). Detection of acute Toxoplasma gondii infection in
early pregnancy by IgG avidity and PCR analysis. J. Med. Microbiol., 56:14951499.
Jumaian, N.F. (2005). Seroprevalence and risk factors for Toxoplasma infection in
pregnant women in Jordan. Eastern Mediterranean Health j., 11(1/2): 45-51.
Karaca, M.; Babur, C.; Celebi, B.; Akkan, H.A.; Tutuncu, M.; Keles, I.; Uslu, B.A.
and Kilic,S.(2007). Investigation on the Seroprevalence of Toxoplasmosis,
Listeriosis and Brucellosis in Goats living in the
region of Van, Turkey.
Yyu. Vet. Fak. Derg., 18(1): 45-49.
Kuticic, V.; Wikerhauser, T. and Gracner, D.(2005). A survey of rats and mice for
latent toxoplasmosis in Croatia: a case report. Vet. Med. Czech, 50(11): 513-514.
Lopez, F.M.R.; Goncalves, D.D.; Mitsuka-Bregano, R.; Freire, R.L. and Navarro,
I.T.(2007). Toxoplasma gondii infection in Pregnancy. Brazilian J. Infec. Dis.,
11(5): 496-506.
Mendonca, A.O.; Domingues, P.F.; Da Silva, A.V.; Pezerico, S.B. and Langoni,
H.(2004). Detection of Toxoplasma gondii in swine sausage. Parasitol. Latinoam.
59(42-45): 42-45.
Morris, A. and Croxson, M.(2004). Serological evidence of Toxoplasma gondii
infection among pregnant women in Auckland. New Zealand Med. J., 117(1189):
1-7.
Oncel, T. and Vural, G. (2006). Occurrence of Toxoplasma gondii antibodies in
sheep in Istanbul, Turkey. Vet.Arhiv, 67(6): 547-553
Oncel, T.; Vural, G; Babur, C. and Kilic, S.(2005). Detection of Toxoplasmosis
gondii Seropositivity in sheep in Yalova by Sabin Feldman Dye Test and Latex
Agglutination test. Turkish Soc. Parasitol., 29(1): 10-12.
Razzak, A.H.; Wais, S.A. and Saeid, A.Y.(2005). Toxoplasmosis: the innocent
suspect of pregnancy wastage in Duhok, Iraq. Eastern Mediterranean Health j.,
11(4): 625-632.
Reiter-Owona, I. (2005). Laboratory diagnosis of toxoplasmosis-possibilities and
limitations. J. Lab. Med., 29(6): 439-445.
Remington, J.S.; McLeod, R.; Thulliez, P. and Desmonts, G.(2001). Toxoplasmosis,
Infectious diseases of the fetus and newborn infant; in Remington, J.S. and Klein,
J. 5th ed., W. B. Saunders, Philadelphia, 205 pp. Dupouy-Camet, J.; Gavinet,
M.F.; Paugam, A. and Tourte-Schaeffer, C.(2003). Transmission incidence and
prevalence of toxoplasmosis. Med. Mal. Infect. 23: 139.
Song, K. J.; Shin, J.C.; Shin, H. J. and Nam, H.W.(2005). Seroprevalence of
toxoplasmosis in Korean pregnant women. Korean J. Parasitol., 43(2): 69-71.
Walon, M.; Kodjikian, L.; Binquet, C.; Garweg, J.; Fleury, J.; Quantin, C. and Peyron,
F.(2004). Long-Term ocular prognosis in 327 children with congenital
Toxoplasmosis. Pediatrics, 113(6): 1567-1572.
Yacoub, A.A-H; Bakr, S.; Hameed, A-H; Al-Thamery, A.A-A and Fartoci,
M.J.(2006). Seroepidemiology of selected zoonotic infections in Basra region of
Iraq. Eastern Mediterranean Health j., 12(1/2): 112- 118.