Seroprevalence of Toxoplasma Gondii Infection among Pregnant Women in River Nile State, Sudan, from April to June 2017

Table of contents

1. I. Introduction

oxoplasmosis is worldwide distribution disease, about 20% to 90% of the adult population in the world are reported with toxoplasmosis [1].

It is third leading infections cause of food-borne death after salmonellosis and listerosis.

In Sudan first report of human toxoplasmosis was dated back to 1996 with different prevalence rates [2] Toxoplasma gondii is an obligate intracellular protozoan parasite that infects most species of warm blooded animals including humans and causing toxoplasmosis [3]

2. a) Morphology

During different period of its life cycle,individual parasites convert into various cellular stages with each stage characterized by a distinct cellular morphology.

This stages include tachyzoites, merozoites, bradyzoites and sporozoites.

3. b) Life cycle

The life cycle of T.gondii can be broadly summarized into two components, sexual part that occur only within cats.

The second part isasexual, it is occur within virtually all warm blooded animals include humans, cats and birds [4] . because T.gondii can sexually reproduce only within cats, they are called definitive host and other hosts in asexual reproduction are defined as intermediate hosts.

4. c) Sexual reproduction

When the cat is infected with T.gondii (example by consuming on infected mouse carrying the parasites tissue cyst), the parasite survive passage through the stomach, eventually infecting epithelial cell of the cat's small intestine. [4] Inside their intestine cells the parasite undergo sexual development and reproduction, producing millions of thick walled zygote containing cyst called as oocyst.

Epithelial cells rupture and release oocysts into intestine's lumen, then shed in cat's feces. Oocysts can spread to soil, water, food and it can survive and remain infective for many months in cold dry climate [5] , Ingestion ofoocysts by human or other warm-blooded animals is one of the common routes of infection. [6] Other infected stages are tachyzoites of rapid division, and bradyzoites of slow division within tissue cysts, Tissue cysts in brain and muscle tissue formabout 7-10 days after initial infection. [7]

5. d) Asexual reproduction

Inside host cells the tachyzoites replicate inside specialized vacuoles called parasitophorus vacuoles, and multiply inside it until host cells dye and rupture releasing and spreading the tachyzoites via blood stream to all organs and tissues including brain. tachyzoites convert into any organ. Severe toxoplasmosis causing damage to the brain lead to encephalitis and damage in eye and other organs .most severe cases are individuals who have weak immune system.

Infant who are infected while still in womb have no symptoms at birth, but they may develop symptoms later in life.

6. II. Stages Toxoplasmosis Infection

Tissue cysts can be maintained in host tissue for the life time of the animal. However the presence of cysts appear to be due to periodic process of cyst rupturing and re encysting rather than a perpetual life span of individual cysts or bradyzoites. [8] It can passed between intermediate hosts via cycle of consumption of tissue cyst in meat, however parasite's life cycle begins and completes only when passed to host. Infection of T.gondii during third trimester of pregnancy have high risk of congenital transmission, it causing severe damage to the fetus or abortion. Also can cause manifestation such as hydrocephalus, cerebral calcification and chorioretinitisin the new born. [9,10]

7. c) Diagnosis

T.gondii infection can be identified with serologic testing or aminocentesis or presence of abnormal ultra sound findings.

Several serological tests are available for detection of T.gondii antibodies such as Sabin field man dye test, Indirect Immune fluorescent test "IFAT", Modified agglutination test "MAT", latex agglutination test and Enzyme -linked Immuno sorbent assay "ELISA".

Serologic testing is the first step in diagnosis by using IgG and IgM antibodies ,the diagnostic challenge is differentiating between primary and chronic infection and result of IgG and IgM testing can often be difficult to interpret, for this reason it is important to consult with an expert area when confirming the diagnosis.

The presence of IgM cannot be considered reliable for making diagnosis for acute toxoplasmosis infection, its titer rise from five day to week following acute infection and reaching maximum after one to two months and decline rapidly than IgG. [11] Also IgM antibodies can decrease to low or undetectable levels in many cases.

IgG antibodies appear later than IgM and are usually detectable within one to two weeks after infection, with peak reached within 12 weeks to 6 months after acute infection, but it will be detectable for years after acquired infection and usually present thorough life. [12] -If IgG and IgM are both negative this indicate the absence of infection or extremely recent acute infection. [13] -If testing reveals positive IgG and negative IgMit indicates an old infection (more than one year ago). -If both IgG and IgM are positive this indicates either a recent infection or false positive test result. [12] If acute infection is suspected repeat testing is recommended within two or three weeks [11, 12], rise in IgG antibodies titers between tests indicates a recent infection. [14] There for when positive result is appear, it should confirm by confirming test such as ELISA, Sabin Feldman test and IFAT [11,12] .

Knowing when infection occurred during pregnancy is very important in evaluating the risk of fatal transmission, so initial antibiotic therapy and ensure appropriate prenatal counseling [13] .

8. d) Justification

Seroprevalence of T.gondii infection particularly in pregnantwomen, are still in conclusive. In River Nile State has no published studies on the seroprevalence of T.gondii infection among pregnant women and this were motivated us to carry out this study to determine the seroprevalence of T.gondii infection among pregnant women in Atbara and ALdamer.

9. e) Objectives i. General objectives

To determine the prevalence of T.gondii infection among pregnant women in Atbara & ALdamer -River Nile state.

10. g) Sample size

A total of 50 blood samples were drawn from pregnant women who come to Atbara and ALdamer Hospitals. This figure was arrived at using the relation

?? = ?? 2 ????(1 ? ??) ?????????? 2

Where N= Sample size, Constant set by convention Z= 1.96, P= Previous study's prevalence. P = 92.5% (0.996). Error was calculated at 5% (0.05). N= [1.962 X 0.996X (1-0.996)]/0.052 And Questionnaires were administered, completed and returned for analysis.

11. h) Sample Collection

The blood samples were collected by venipuncture using 5 ml syringe into plain containers.

12. i) Sample processing

Serum obtained by centrifugation of the blood at 5000 rpm for 10 minute. Detection by Latex Agglutination test. Then +ve Result Confirmation by ELISA Test.

Firstly sample diagnosed with latex agglutination test then confirm with ELISA. Total of 50 pregnant women were enroll in this test from Atbara hospital, data collect by medical field. Take about 5 ml of venous blood by disposable syringes under sterile aseptic technique 2.5 ml in plain tube for latex agglutination test and 2.5 ml also in plain tube for confirming + ve result by detecting IgM and IgG Abs of T.gondii.

13. j) Principle of latex agglutination test

Latex agglutination is observed when sample containing the specific antigen (or antibody) is mixed with an antibody (or antigen). Which is coated in the surface of latex particles.

The reaction between aparticular antigen and an antibody results in visible clumping called agglutination.

14. k) Principle of ELISA Test

Enzyme Linked Immunosorbent Assay Combine the specificity of antibodies with the sensitivity of simple enzyme assays, by using antibodies or antigens coupled to an easily assayed enzyme. ELISAs can be provide useful measurement of antigen or antibody concentration.

15. l) Study variables

-Presence of cats in the house -History of abortion in family -History of delivery -Type of Delivery -Educational level -Raw meat and vegetable habit gestational period blood and organ transfusion -Nature of home ground surface.

16. m) Ethical consideration -Approval from EAEUEC (Elsheikh Abdallah Albadri

University Ethical Committee) -The purpose and procedures involved in this study were explained and written inform consent were obtained from all participants. Blood were collected with the consent of the volunteers n) Data analysis Statistical analysis of data was done by using Statistical package for social science (SPSS).

17. IV. Result

Out of 50 samples of serum collected from pregnant women in Atbara and ALdamer Hospitals and screened by using latex agglutination test, the number of positive cases was found to be (22.2%) Table (1 The current study is one of the few studies carried out to explore the seroprevalence of T. gondii infection among pregnant women in ALdamer and Atbara Towns and further studies are required with large sample size and various diagnostic methods.

Figure 1.
Seroprevalence of Toxoplasma Gondii Infection among Pregnant Women in River Nile State, Sudan, from
April to June 2017
f) Symptoms
Most people of toxoplasmosis are
asymptomatic, some
Year 2017
Volume XVII Issue I Version I
D D D D ) C
(
Medical Research
Global Journal of e) Modes of transmission
-Ingestion of undercooked, contaminated meat with
infective stage of T.gondii.
-Drinking water contaminated with T.gondii or
contact with contaminated soil.
-Accidently swallowing the parasite through contact
with cat's feces that contain toxoplasma.
-Vertical (Transplacental) transmission.
-Organs transplantation.
-Sexual transmission.
-Inhalation of infective stage.
Figure 2. Table 1 :
1
Sample size Positive Negative
50 12(24%) 38(76%)
Figure 3. Table 2 :
2
T. gondii antibodies(IgG & IgM)
among pregnant women
IgG frequency Percentage%
positive 12 24%
Negative 38 76%
IgM
positive 9 18%
Negative 41 82%
Figure 4. Table 3 :
3
Age frequency Percentage
18-20 13 26%
21-30 24 48%
331-40 13 26%
Figure 5. Table 4 :
4
Volume XVII Issue I Version I
D D D D ) C
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Medical Research
Global Journal of
Figure 6. Table 5 :
5
Toxoplasmosis latex ELISA IgG test
agglutination Positive Negative
Positive 12 0
Negative 0 38
Toxoplasmosis latex ELISA IgM test
agglutination Positive Negative
Positive 9 3
Negative 0
1
2

Appendix A

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  2. 3-population structure and epidemiology of toxoplasma gondii in Wess, Darde , D; Ml; Ajzenberg , Smith . 2011. LM.
  3. seroprevalence of T.gondii and associated risk factors among pregnant women in jimma town, south western Ethiopic. E Zemene , Abera S Yew Halaw D , T Belay , A Samuel . BMC infect dis 2012. 12 p. 337.
  4. the incidence of T.gondii antibodies in Sudanese. F S Carter , D G Fleck . Trans Rsoc Trop Med Hyg 1966. 60 p. .
  5. A comparative serological study of toxoplasmosis in pregnant women by CLIA and ELISA methods in Chalus City Iran, H Kaboosi , Faghih Nasiri , A Tabatabaie , S S Golhasani-Keshtan , F Zaboli , F . 2014. Iran Red Crescent Med J. 16 p. e15115.
  6. , J G Montoya , Iesen Feldo . Toxoplasmosis lancet 2004. 363 p. .
  7. History of the discovery of the life cycle of Toxoplasma gondii. Jp Dubey . 10.1645/GE-2774.1. 21539466. International Journal of Parasitology Jul2009. 97 (5) p. .
  8. sporulation and survival of Toxoplasma gondiioocycts in different types of commercial cat litter. J P Dubey , Ferreira , Lr , J Martins , Jl Jones . 10.1645/GE-2774.1. The journal of parsitology october 2011. 97 (5) p. .
  9. recent primary toxoplasma infection indicated by specific IgG. K Hedman , M Seppalai , O Makela . J infected Did 1989. 159 p. .
  10. the model apicomplexan. perspectives and methods. London: Academic Press\Elsevier, K Toxoplasmagondii . p. .
  11. , M Louis , Kami Weiss , Kim . 2011.
  12. , M Louis , Kami Weiss , Kim . 2011.
  13. Improved diagnosis of primary toxoplasma gondii infection in early pregnancy by determination antitoxoplasma immunoglobulin G activity. P A Jenum , B Stray-Pedresen , A G Gundersen . J Clinmicrobial 1997. 35 p. .
  14. new agglutination test for the diagnosis of acute and chronic toxoplasma infection. P Thulliez , J S Remington , F Santoro , G Ovalque , S Dharma , G Desmonts . pathology Biol 1986. 34 p. .
  15. Remington Js Mc Lead R , P Thulleiz , G Desmonts . infectious disease of the fetus and newborn infant, Js Rimington, Klein (ed.) 2006. p. . (WB saunder)
  16. Epidemiology and diagnostic strategies for toxoplasmosis. Robert -Gangneux , Marie Florence : Darde , Laure . 22491772. doi:10. 1128\CMR. Clinical Microbiology Reviews 2012. 25 (2) p. . (PMC3346298.)
Notes
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© 2017 Global Journals Inc. (US)
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© 2017 Global Journals Inc. (US)Year 2017
Date: 2017-01-15