Sero-epidemiological Study of Toxoplasmosis in Neonates and Postpartum Mothers Referred to Health Centers of Yazd in Iran during 2020

Fattahi Bafghi, Ali; Eslami, Gilda; Rezaee, Elham; Barzegar, Kazem; Vakili, Mahmoud; Dehghani Ashkezari, Maryam

doi:10.30699/ijmm.16.6.601

year 16, Issue 6 (November - December 2022) Iran J Med Microbiol 2022, 16(6): 601-606 | Back to browse issues page

‎ 10.30699/ijmm.16.6.601

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Fattahi Bafghi A, Eslami G, Rezaee E, Barzegar K, Vakili M, Dehghani Ashkezari M. Sero-epidemiological Study of Toxoplasmosis in Neonates and Postpartum Mothers Referred to Health Centers of Yazd in Iran during 2020. Iran J Med Microbiol 2022; 16 (6) :601-606
URL: http://ijmm.ir/article-1-1520-en.html

Sero-epidemiological Study of Toxoplasmosis in Neonates and Postpartum Mothers Referred to Health Centers of Yazd in Iran during 2020

Ali Fattahi Bafghi¹

, Gilda Eslami¹

, Elham Rezaee²

, Kazem Barzegar³

, Mahmoud Vakili⁴

, Maryam Dehghani Ashkezari⁵

1- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3- Assistant professor of TEFL, Department of Foreign Languages, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4- MD, MPH, Associate Professor in Community Medicine, Health Monitoring Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran , Dehghani.maryam5960@gmail.com

Keywords: IgG, IgM, postpartum mothers, seroepidemiology, toxoplasmosis

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Introduction

Toxoplasmosis is a common disease in all warm-blooded vertebrates and humans. It is caused by a protozoan called Toxoplasma gondii, an obligatory intracellular parasite (1). Infection is transmitted to humans by foods such as undercooked meat or drinks contaminated with oocysts or tissue cysts. Also, organ transplantation and congenital transmission are other ways of transmission this infection (2).
In the United States, approximately 400 to 4,000 babies are born with congenital toxoplasmosis each year. Involvement of the placenta triggers this infection (3). As the pregnancy progresses, the likelihood of acquiring an infection increases, and the severity of the clinical disease decreases (4). The affliction of pregnant women with this infection, especially in the first trimester of pregnancy, can lead to miscarriage or birth of a baby with complications of the nervous and ocular systems (5). A newborn whose mother has become infected with T. gondii during pregnancy can be born naturally but develops symptoms years after birth (6). In addition, infection with the parasite in AIDS patients, transplant recipients, and consumers of immunosuppressive drugs can be severe and thus life-threatening (7).
Owing to the wide range of toxoplasmosis infections in human societies, predominantly asymptomatic infection in pregnant women, determining the seroepidemiology of specific anti-toxoplasma antibodies in this group in different parts of Iran, including Yazd, and also investigating the potential incidence of infection in their infants are of critical significance. Therefore, conducting such studies can provide appropriate strategies for treating and preventing these complications. Consequently, due to the issue's importance, this study was designed and conducted to investigate the seroepidemiology of toxoplasmosis in neonates and postpartum mothers referred to health centers in Yazd, Iran, in 2020.

Materials and Methods

This descriptive cross-sectional study was conducted on samples selected randomly from patients referring to health centers in Yazd. Blood samples were taken from 184 mothers who had experienced delivery, out of whom 184 umbilical cords were obtained after signing written consent, and they completed the relevant questionnaire, including the following points (pet keeping, consumption of raw meat, level of education, blood type, job, living area, number of deliveries and type of delivery). The serum was then separated and stored in the freezer at -20 ° C. Once the samples were deleted, the IgM and IgG titers were measured using the instructions of the ELISA kit (Anti-Toxoplasma gondii ELISA (IgM, IgG) EI2410-9601 M & G, Euroimon, Germany), and the results were recorded. Data were then analyzed using SPSS18, and the findings were presented in frequency distribution tables. Appropriate statistical tests such as chi-square, T-test, and ANOVA were used for analysis. Ethics Committee for Human Research at Yazd Shahid Sadoughi University of Medical Sciences approved the study proposal with the ethics code: IR.SSU.MEDICINE.REC.1395.290.

Results and Discussion

A total of 368 subjects (184 mothers and 184 infants) were included in the study. The results of measuring maternal and IgG, neonatal IgM levels, and the presence or absence of toxoplasmosis are summarized in Table 1. As it can be observed, 8 (4.35%) and 7 (3.80%) mothers were seropositive in terms of IgG and IgM, respectively, but the others were within the normal range. IgM antibodies of all the newborns were also within the normal range.
The presence or absence of toxoplasmosis infection with underlying variables is shown in Table 2.
The effect of the type of delivery (normal or cesarean section) and the number of deliveries on Toxoplasma prevalence are summarized in Table 3. Normal delivery or cesarean section failed to increase or decrease the prevalence of toxoplasmosis (P=0.127 and P=0.629, respectively). However, the results revealed that the number of deliveries significantly affects the prevalence of toxoplasmosis (P=0.014).
Maternal and neonatal blood type did not significantly affect the prevalence of Toxoplasma (P=0.411, P=0.295 and P=0.770, respectively) as set out in Tables 4 and 5.

Table 1. Maternal IgG and IgM levels, neonatal IgM, and presence or absence of toxoplasmosis.

Variable	Mother				Neonate
	IgM		IgG		IgM
	Negative	Positive	Negative	Positive	Negative	Positive
Frequency	177	7	176	8	184	0
Percent	96.20	3.80	95.65	4.35	100	0

Table 2. Evaluation of the relationship between underlying variables and Toxoplasma prevalence

		IgG		P-value	IgM		P-value
		Positive	Negative	P-value	Positive	Negative	P-value
Living area	Urban	7	160	0.496	7	160	0.632
Living area	Rural	1	16	0.496	0	17	0.632
Education	Illiterate	2	21	0.429	1	22	0.896
	High School	3	114		5	112
	Bachelor	3	38		1	40
	Master and higher	0	3		0	3
Job	Housewife	7	164	0.488	7	164	0.669
Job	Employee	1	12	0.488	0	13	0.669
How to eat meat	Raw	0	9	0.629	0	9	0.615
How to eat meat	Baked	8	167	0.629	7	168	0.615
Pet	Keeping	1	16	0.895	0	17	0.584
Pet	Not keeping	7	160	0.895	7	160	0.584

Table 3. Effect of the type of delivery (normal or cesarean section) and number of deliveries on Toxoplasma prevalence

		IgG		P-value	IgM		P-value
		Positive	Negative	P-value	Positive	Negative	P-value
Type of delivery	Normal	4	91	0.629	4	91	0.127
Type of delivery	Cesarean	4	85	0.629	3	86	0.127
Number of deliveries	1	1	66	0.014	2	65	0.899
	2	3	44		3	44
	3	0	37		2	35
	4	3	18		0	21
	5	1	6		0	7
	6	0	2		0	2
	7	0	2		0	2
	8	0	1		0	1

Table 4. Evaluation of the relationship between maternal blood type and Toxoplasma prevalence.

		IgG		P-value	IgM		P-value
		Positive	Negative	0.552	Positive	Negative	0.411
Blood type	A+	1	48		0	49
	A-	1	7		0	8
	B+	1	49		0	50
	B-	2	8		2	8
	AB	0	13		0	13
	O+	3	46		4	45
	O-	0	5		1	4

Table 5. Evaluation of the relationship between neonatal blood type and Toxoplasma prevalence

		IgG		P-value	IgM		P-value
		Positive	Negative	0.552	Positive	Negative	0.295
Blood type	A+	2	56		0	58
	A-	0	3		0	3
	B+	0	45		1	44
	B-	0	6		0	6
	AB+	0	14		0	14
	AB-	0	2		0	2
	O+	5	45		6	44
	O-	1	5		0	6

Toxoplasmosis is common in Iran (8). Due to the harmful effects of this parasite in neonates, the identification of susceptible cases of acute infection during pregnancy should be considered to prevent toxoplasmosis and reduce congenital complications with contraceptive methods (9). This study demonstrated that among the mothers studied, 4.35% and 3.80% of them had high levels of IgG and IgM antibodies, respectively, and the other antibody levels were within the normal range. All the newborns were within the normal limits (WNL) in terms of IgM levels. A similar study by Anvaritafti & Ghafourzadeh in Yazd projected 32% prevalence of this infection in the studied population (10). Due to the great statistical population in their study, their reported prevalence was higher than what we observed in our study. Besides, our study showed a low prevalence of infection in women compared to the study conducted by Mohammadi et al. on females around the age of marriage (11). The highest prevalence of toxoplasmosis in Iran has been reported in northern temperate regions, compared to temperate and arid foothills (12). Its low prevalence in this study can be attributed to the climatic conditions of Yazd, which is unsuitable for developing oocytes. As a result, lower levels of IgG and IgM are normal in hot and dry climates compared to the country's northern regions. In a study conducted in Shiraz by Omidian et al., the prevalence of serum IgM in infants was reported as too low, which is almost in line with our research (13). In our study, no statistically significant relationship was observed between education level and toxoplasmosis, which is in line with the study conducted by Rostamzadeh et al., in Urmia (14).
Probably, differences in prevalence can be ascribed to the high level of public awareness and health status among educated people compared to illiterate people. Another evaluated variable was mothers' occupation, as Velasquez-Hernandez's study showed the importance of mothers being homemakers in the higher prevalence of infection (15); however, no significant difference was observed in our study. Our study also suggested no significant relationship between raw or undercooked raw meat consumption and Toxoplasma prevalence. The result of our study was consistent with that of Mostafavi et al. (16). The lack of significant correlation in our study could be attributed to the low number of people who consume raw meat. One of the most important factors in increasing the prevalence of Toxoplasma infection is the close relationship with pets, especially cats as the hosts. In the present study, no statistically significant difference was identified between the two groups of people keeping cats and not keeping cats; this may be due to the small number of people who kept domestic cats in this study (17). In addition, Davoodi et al. detected no significant relationship between the prevalence of toxoplasmosis and the history of keeping cats at home. However, in some other studies, this relationship exists (18). The living area appears to be one of the most important risk factors for the prevalence of Toxoplasma infection. Therefore, this variable was evaluated in our probe, and people were divided in terms of being urban or rural and compared in terms of the prevalence of infection. This part of the study showed the prevalence of positive cases of IgG and IgM antibodies in urban residents being higher than that in rural residents. However, no significant difference was observed between urban and rural variables and the prevalence of Toxoplasma. These results were not consistent with those of Davoodi et al., who examined the prevalence of human toxoplasmosis in men and women referred to the central laboratory of Miyaneh city (18), but the results of our study were consistent with those of Daryani & Sagha in Ardabil (19). Another variable examined was maternal and neonatal blood type, which had no significant effect on Toxoplasma prevalence. In a similar study by Smael et al., (20) on women with miscarriage, no significant relationship was found between toxoplasmosis and each ABO phenotype (20). The type of delivery (normal delivery or cesarean section) failed to have a significant effect on the prevalence of infection; this was consistent with that of Saki et al. (21). However, we showed that the number of deliveries exerts a significant effect on the prevalence of toxoplasmosis, which is consistent with the study by Smereka et al. in Poland (22). Overall, the differences between the present study results and other studies are probably due to geographical and social differences, the type of meat consumed, and eating habits among different communities.

Conclusion

This study showed no congenital transmission and a low prevalence of Toxoplasma infection in postpartum mothers. This can be attributed to the impact of the study area, people's lifestyle, way of eating meat, and improper contact with pets, especially cats. The results also demonstrated no statistically significant relationship between the risk factors and the prevalence of Toxoplasma; however, more investigations are needed.

Acknowledgment

The authors would like to express their sincere gratitude to the Vice Chancellor for Research at Shahid Sadoughi University of Medical Sciences for his financial support. Also, special thanks go to everyone who contributed to this project.

Ethical Approval

The authors have completely observed ethical issues (including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.).

Conflicts of Interest

The authors stated no conflict of interest.

Funding

This project was carried out with the financial support of the Vice Chancellor for Research in Shahid Sadoughi University of Medical Sciences in Yazd.

Type of Study: Brief Original Article | Subject: Medical Parasitology
Received: 2021/10/17 | Accepted: 2022/06/28 | ePublished: 2022/09/9

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