Â Objective: Toxoplasmosis is an important disease which is caused by the coccidian parasite Toxoplasma gondii. The aim of this study was to determineseroprevalence of and risk factors for T. gondii among pregnant women in Abyek township of Qazvin province by enzyme-linked immunosorbentassay method.Methods: Blood samples were taken from 200 pregnant women referred to the health centers of Abyek township. Immunoglobulin M (IgM)and IgGtiters and effects of some factors on incidence of the disease were evaluated. The collected data were statistically analyzed with SPSS 17 using Chisquaretest.Results: Anti toxoplasma IgM and IgG were positive in 2% and 29% respectively. Seropositive subjects were more frequently seen in women withage &gt;30 years compared to younger women. No significant relationship was found between the seroprevalence of T. gondii infection and level ofeducation, residence area, history of abortion and gestational age.Conclusion: It was indicative of having a latent infection due to the previous exposure to toxoplasma parasite in this region.Keywords: Toxoplasma gondii, Prevalence, Pregnant women, Enzyme-linked immunosorbent assay, Immunoglobulin M

Golestani, Mohsen

Mafi, Hadi

Mafi, Morteza

Maleki, Fatemeh

Shahmohammad, Narges

Tabatabaie, Fatemeh

English

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Vol 8, Issue 1, 2015 ISSN - 0974-2441SEROPREVALENCE OF AND RISK FACTORS FOR TOXOPLASMA GONDII AMONG PREGNANT WOMEN IN ABYEK TOWNSHIP OF QAZVIN PROVINCE, IRAN 2013FATEMEH TABATABAIE1, MORTEZA MAFI1, HADI MAFI2, MOHSEN GOLESTANI3, MARYAM SADEGHI1, BEHNAZ JALALIZADEGAN1, NARGES SHAHMOHAMMAD1,  MARYAM AYAZI4, MOHAMMAD SABERI NASAB1, ALI KERMANJANI1*1Department of Parasitology and Mycology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran. 2Department of Laboratory Sciences, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. 3Department of Biology, Payame Noor Received: 30 September 2014, Revised and Accepted: 02 November 2014ABSTRACTObjective: Toxoplasmosis is an important disease which is caused by the coccidian parasite Toxoplasma gondii. The aim of this study was to determine seroprevalence of and risk factors for T. gondii among pregnant women in Abyek township of Qazvin province by enzyme-linked immunosorbent assay method.Methods: Blood samples were taken from 200 pregnant women referred to the health centers of Abyek township. Immunoglobulin M (IgM)and IgG titers and effects of some factors on incidence of the disease were evaluated. The collected data were statistically analyzed with SPSS 17 using Chi-square test.Results: Anti toxoplasma IgM and IgG were positive in 2% and 29% respectively. Seropositive subjects were more frequently seen in women with age >30 years compared to younger women. No significant relationship was found between the seroprevalence of T. gondii infection and level of education, residence area, history of abortion and gestational age.Conclusion: It was indicative of having a latent infection due to the previous exposure to toxoplasma parasite in this region.Keywords: Toxoplasma gondii, Prevalence, Pregnant women, Enzyme-linked immunosorbent assay, Immunoglobulin M.INTRODUCTIONToxoplasmosis is a global zoonosis that can infect almost one-third of the world’s population by a protozoan parasite, Toxoplasma gondii. It may appear in several forms, infections in humans are usually clinically latent that usually persists for life, which is not seen as a health threat except in the case of pregnancy and immunocompromised persons. T. gondii can be transmitted to humans by eating raw or uncooked meat, by consuming oocysts those cats have passed in their feces, either from a garbage box or from soil, by transmitting the infection from infected pregnant women to their unborn fetus it can be happened. This parasite can cause congenital disease and abortion in humans and livestock. In most cases, the laboratory diagnosis of acute and chronic toxoplasmosis relies on the detection of T. gondii specific immunoglobulin G (IgG) and IgM antibodies and the avidity test of T. gondii specific IgG antibodies has also been very useful in the diagnosis. Many serological tests as an example of the latex agglutination test, enzyme-linked immunosorbent assay (ELISA), indirect fluorescence antibody test and hemagglutination test have been used [1,2]. There are many studies on the prevalence of anti-T. gondii antibody among Iranian women. Seropositivity of T. gondii is 48-74.6% in northern areas [3-5], 33-44% in northwest [6-10], 22-37% in south [11,12] and 27-54% in central parts of Iran [13-16]. This study was performed to determine the Toxoplasma antibodies in pregnant women in Abyek township by ELISA method because of its high sensitivity and specificity, easier technique and lower expanse, which is preferred in order to screening toxoplasmosis. This research was novel and modern work because was not done previously.METHODSStudy areaThis study was carried out in Abyek township, Abyek is situated at 36.07° North latitude, 50.55° East longitude and 1495 m elevation above the sea level. Abyek is a town in Iran, having about 55128 inhabitants. Abyek lies roughly half way between Qazvin to the northwest and Karaj to the southeast.Patients and blood samplingIn this descriptive-cross sectional study, after providing written informed consent, 3 ml of venous blood sample randomly were drowning from 200 pregnant women (βHCG-positive) women referred to the health centers of Abyek township and transferred to parasitology laboratory in Faculty of Para Medical Sciences, Iran University of Medical Sciences maintained under standard conventional conditions in <2 hrs and centrifuged at 3000 rpm for 15 minutes then isolated sera were frozen by Alicot method and were stored at −20°C until assays. Additional frozen sera were reserved for further surveys. Simultaneously, a questionnaire including demographic and educational characteristics of the subjects was filled. The samples were tested for anti-Toxoplasma IgM and IgG antibodies using Toxoplasma IgM and IgG ELISA kit (Dia-Pro, Milan, Italy) according to the manufacturer’s instructions. The present work has been approved by Iran University of Medical Sciences Ethics Committee.Statistical analysisThe Chi-square test was used to analyze the data in SPSS version 11.5 (SPSS Inc., 233 South Wacker Drive, 11th Floor, Chicago, IL 60606-6412). Differences between variants were considered significant when p<0.05.RESULTSThe overall seroprevalence of toxoplasmosis in pregnant women was 31% (62/200 cases). IgG and IgM anti-Toxoplasma antibodies were positive in 58/200 cases (29%) and 4/200 cases (2%), respectively. The results, including seroprevalence data together with personal and demographic variables are detailed in Table 1. The proportion Research ArticleUniversity of Mashhad, Mashhad, Iran. 4Medical doctor (M.D.), Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: a.kermanjani@gmail.comAsian J Pharm Clin Res, Vol 8, Issue 1, 2015, 1-3 Tabatabaie et al. 2of seropositive women increased with increasing age, from 7% in ≤20 years old to 24.5% in >30 years old women (p=0.025). No significant relationship was found between the seroprevalence of T. gondii infection and their level of education. The prevalence rate showed no significant differences between women resident in rural and those in urban areas, neither the history of abortion had a significant association with Toxoplasma seroprevalence rate. The surveyed pregnant women at their first, second and third gestational trimesters showed in different rates of the Toxoplasma infection. The data of the above variables are epitomized in Table 1.DISCUSSIONToxoplasmosis is a zoonotic infection in the world. The prime invasion during pregnancy can lead to irreversible effects on the fetus. This parasite is one of the opportunistic infections in immunocompromised patients. The 29% prevalence of chronic toxoplasmosis (IgG positive) and 2% recently acquired infections (IgM positive) during pregnancy were found in this study that is accordance with weather and geological conditions of this area. In Iran, at least 35% of people have been found seropositive for anti-T. gondii in most regions. Low level of education was associated with a higher rate of toxoplasmosis [7,17,18]. We did not find a significant relationship between the seroprevalence of T. gondii infection and the level of education. There are similar reports in Turkey and Hamadan [6,19]. Some other studies showed a significance decreases in seropositivity as the level of the education increases [7,12,20]. In the present study, we found no statistical difference among seroprevalence of T. gondii and the residence areas, which is in accordance with other reports [7,18,21], but some studies showed higher seropositivity in urban than in rural areas [22,23]. In addition, in the present research similar to the results of previous studies no significant relationship was found between the seroprevalence of T. gondii infection and history of abortion in pregnant women. No significant association of the infection with gestational age was remarked [19,24]. The prevalence of toxoplasmosis in the women with bad obstetric history is known to be significantly higher than those without it. Some reports on congenital toxoplasmosis were issued in some parts of Iran [25-27]. Women older than 30 years had a significantly higher seroprevalence (24.5%) compared to those who were 20 or less (7%) (p=0.025). Results of the present study showed a significant increasing rate of seropositivity with age (Table 1), which is predictable, because older individuals have more chances for exposure to an infectious form of parasite. In studies conducted in Venezuela and Croatia, the peak age of acquisition of the infection was ages <15 years. In another study in 12 provinces in Iran, most people acquired the infection for 30 years and the seroconversion rate was slightly more in 10-19 years age group, which is compatible with our results. The difference in the peak age of acquisition in various regions could be due to different climate conditions, dissimilar nutritional and behavioral patterns of life, which expose the population to the infective form of parasite in different ages. The highest acquisition of the infection in active social ages in Iran is alarming which necessitates preventive programs from toxoplasmosis in these high-risk age groups [28-31].CONCLUSIONIn conclusion, this study showed to require care to avoid parasite exposure during their pregnancies. The measurement of the serial titration of these patients especially in pregnant women (negative serum - high risk) should be done and undergone the anti-parasitic treatments. The results of this study confirm that the determination of the diagnostic toxoplasmosis is a necessary test during pregnancy. Increased knowledge through higher education and its consequence on patterns of life and behaviors may lead to a decrease in T. gondii infection, and may have an indirect effect on environmental and cultural factors involved in T. gondii infection. REFERENCES1. Krick JA, Remington JS. Toxoplasmosis in the adult – An overview. N Engl J Med 1978;298(10):550-3.2. Dubey JP, Beattie CP. Toxoplasmosis of Animal and Man. Boca Raton, FL: CRC Press; 1988. p. 1-220.3. Saeedi M, Veghari GR, Marjani A. Seroepidemiologic evaluation of anti-toxoplasma antibodies among women in north of Iran. Pak J Biol Sci 2007;10(14):2359-62.4. Youssefi MR, Sefidgar AA, Mostafazadeh A, Omran SM. Serologic evaluation of toxoplasmosis in matrimonial women in Babol, Iran. Pak J Biol Sci 2007;10(9):1550-2.5. Sharif M, Ajami A, Daryani A, Ziaei H, Khalilian A. Serological survey of toxoplasmosis in women referred to medical health laboratory before marriage northern Iran. Int J Mol Med Adv Sci 2006;2(2):134-7.6. Fallah M, Rabiee S, Matini M, Taherkhani H. Seroepidemiology of toxoplasmosis in primigravida women in Hamadan, Islamic Republic of Iran, 2004. East Mediterr Health J 2008;14(1):163-71.7. Hashemi HJ, Saraei M. Seroprevalence of Toxoplasma gondii in unmarried women in Qazvin, Islamic Republic of Iran. East Mediterr Health J 2010;16(1):24-8.8. Fallah M, Rabiee S, Matini M, Taherkhani H. Seroepidemiology of Toxoplasma infection in women aged 15-45 years in Hamadan west of Iran. J Res Health Sci 2003;3(1):9-12.9. Mansoori FL. Seroepidemiology of toxoplasmosis in Kermanshah province west of Iran. Behboud 2004;7(2):12-9.10. Abdi J, Shojaee S, Mirzaee A, Keshavarz H. Seroprevalence of toxoplasmosis in pregnant women in Ilam province Iran. Iran J Parasitol 2008;3(2):34-7.11. Sharifi Mood B, Hashemi Shahri M, Salehi M, Naderi M, Naser Poor T. Seroepidemiology of Toxoplasma infection in the pregnant women in Zahedan, Southeast of Iran. J Res Health Sci 2006;6(1):1-3.12. Fouladvand M, Barazesh A, Naeimi B, Zandi K, Tajbakhsh S. Seroprevalence of toxoplasmosis in high school girls in Bushehr city South-west of Iran 2009. Afr J Microbiol Res 2010;4(11):1117-21.13. Manouchehri Naeini K, Deris F, Zebardast N. The immunity status of the rural pregnant women in Chaharmahal and Bakhtyari province against Toxoplasma infection 200-2002. J Shahrekord Med Sci 2004;6(3):63-72.14. Keshavarz Valian H, Nateghpour M, Zibaee M. Seroepidemiology of toxoplasmosis in Karaj Iran in 1998. Iran J Public Health 1998;27(3-4):73-8.15. Keshavarz Valian H, Mamishi S, Daneshvar H. Prevalevce of toxplasmosis in hospitalized patient of Kerman hospitals Iran. J Med Sci Kerman 2000;7(2):126-39.16. Arbabi M, Talari SA. Seroprevalence of Toxoplasma infection in pregnant women in Kashan Iran. Feiz J 2001;22:28-38.17. Nash JQ, Chissel S, Jones J, Warburton F, Verlander NQ. Risk factors for toxoplasmosis in pregnant women in Kent, United Kingdom. Epidemiol Infect 2005;133(3):475-83.18. Jones JL, Kruszon-Moran D, Wilson M, McQuillan G, Navin T, McAuley JB. Toxoplasma gondii infection in the United States: Table 1: Seroprevalence of T. gondii in pregnant women in Abyek townshipRisk factors N (%) P valueSeropositivity SeronegativityAge groups (year)≤20 years 14 (7) 70 (35) 0.02821-30 years 17 (8.5) 30 (15)>30 years 49 (24.5) 20 (10)EducationIlliterate 14 (7) 29 (14.5) 0.155High school 20 (10) 41 (20.5)Diploma 26 (13) 40 (20)University graduated 12 (6) 18 (9)Residence areaUrban 86 (43) 40 (20) 0.64Rural 48 (24) 26 (13)Gestational ageFirst trimester 30 (15) 35 (17.5) 0.167Second trimester 20 (10) 30 (15)Third trimester 25 (12.5) 60 (30)History of abortionYes 60 (30) 80 (40) 0.89No 20 (10) 40 (20)Asian J Pharm Clin Res, Vol 8, Issue 1, 2015, 1-3 Tabatabaie et al. 3Seroprevalence and risk factors. Am J Epidemiol 2001;154(4):357-65.19. Ertug S, Okyay P, Turkmen M, Yuksel H. Seroprevalence and risk factors for Toxoplasma infection among pregnant women in Aydin province, Turkey. BMC Public Health 2005;5:66.20. 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Prevalence of Toxoplasma gondii antibodies in women of Zanjan Hakim Hidajy hospital. J Zanjan Med Sci 2000;8(32):4-11.25. Sharma P, Gupta I, Ganguly NK, Mahajan RC, Malla N. Increasing Toxoplasma seropositivity in women with bad obstetric history and in newborns. Natl Med J India 1997;10(2):65-6.26. Ghorbani M, Farzaneh I, Voshtani H, Rezaian M. Congenital toxoplasmosis. Iran J Publ Health 1977;6:1-5.27. Yasodhara P, Ramalakshmi BA, Lakshmi V, Krishna TP. Socioeconomic status and prevalence of toxoplasmosis during pregnancy. Indian J Med Microbiol 2004;22(4):241-3.28. Diaz-Suárez O, Estevez J. Seroepidemiology of toxoplasmosis in women of childbearing age from a marginal community of Maracaibo, Venezuela. Rev Inst Med Trop Sao Paulo 2009;51:13-7.29. Punda-Polic V, Tonkic M, Capkun V. Prevalence of antibodies to Toxoplasma gondii in the female population of the County of Split Dalmatia, Croatia. Eur J Epidemiol 2000;16(9):875-7.30. Assmar M, Amirkhani A, Piazak N, Hovanesian A, Kooloobandi A, Etessami R. Toxoplasmosis in Iran. Results of a seroepidemiological study. Bull Soc Pathol Exot 1997;90:19-21.31. Bonilla LC, Chavez YS, Estevez J, Larreal Y, Molero E. Prevalence of human toxoplasmosis in San Carlos Island Venezuela. Interciencia 2003;28(8):457-62.

Seroprevalence of and Risk Factors for Toxoplasma gondii  among Pregnant Women  in Abyek Township of Qazvin Province , Iran (2013)

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Seroprevalence of and Risk Factors for Toxoplasma gondii among Pregnant Women in Abyek Township of Qazvin Province , Iran (2013)

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