Antenatal detection of IgM and IgG antibodies to Toxoplasma gondii in a hospital from central India

Kamlesh Kumar Patel; Gunjan Shrivastava; Ganesh Bhatambare; Trupti Bajpai

doi:10.4103/2347-9019.142188

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ORIGINAL ARTICLE

Year : 2014 | Volume : 2 | Issue : 3 | Page : 133-135

Antenatal detection of IgM and IgG antibodies to Toxoplasma gondii in a hospital from central India

Kamlesh Kumar Patel, Gunjan Shrivastava, Ganesh Bhatambare, Trupti Bajpai
Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College, Indore, Madhya Pradesh, India

Date of Web Publication

4-Oct-2014

Correspondence Address:
Kamlesh Kumar Patel
Department of Microbiology, Sri Aurobindo Institute of Medical Sciences Medical College, MR 10 Crossing, Indore Ujjain Road, Indore - 453 111, Madhya Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2347-9019.142188

Abstract

Context: Toxoplasma gondii, the causative agent of toxoplasmosis can cause significant morbidity and mortality in the developing fetus if the mother acquires acute infection during pregnancy. Transmission rate to the fetus increases from 15-65% with increasing gestational age. However, the severity of congenital disease decreases with increasing gestational age. Aims: To study the seroprevalance of Toxoplasma gondii in central India. Subjects and Methods: A total of 68 pregnant women between gestational age of 24-36 weeks were included in this prospective study during July to December 2013. All were attended at the antenatal clinic of Department of Obstetrics and Gynecology and most of them belonged to rural areas. Samples were collected and antibodies for Toxoplasma gondii were detected by using commercial ELISA kit from Calbiotech Inc, USA. Results: In our study, 14 (20.58%) out of 68 pregnant women were positive for toxoplasma IgG antibodies and 19 (27.94%) out of 68 were positive for IgM antibodies. However, only two i.e. 2.94% were both IgM and IgG positive. Acute infection during pregnancy was diagnosed if IgM positivity is there. Conclusions: Our study recommended that pregnant women should be screened and educated concerning the risk factors that contribute to toxoplasma infections and the importance of taking preventive measures.

Keywords: IgG, IgM, Toxoplasma gondii

How to cite this article:
Patel KK, Shrivastava G, Bhatambare G, Bajpai T. Antenatal detection of IgM and IgG antibodies to Toxoplasma gondii in a hospital from central India. Int J Health Syst Disaster Manage 2014;2:133-5

How to cite this URL:
Patel KK, Shrivastava G, Bhatambare G, Bajpai T. Antenatal detection of IgM and IgG antibodies to Toxoplasma gondii in a hospital from central India. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2023 Sep 21];2:133-5. Available from: https://www.ijhsdm.org/text.asp?2014/2/3/133/142188

Introduction

Toxoplasmosis is the most widespread zoonosis and an important human disease, particularly in children whom it could cause visual and neurological impairment, mental retardation, ^[1] and also associated with diversion of sex ratio towards male. ^[2] Toxoplasmosis is caused by a protozoan parasite called Toxoplasma gondii, the most clever pathogen on earth. It can cause severe congenital infections in developing fetus if the mother acquires acute infection during pregnancy. ^[3] With increasing gestational age, the transmission rate increases while severity of infection decreases. ^[4] Manifestations of congenital infection ranges from asymptomatic to in-utero death of fetus, includes chorioretinitis, hydrocephalous, mental impairment, psychomotor retardation, and hearing difficulties. In response to early infection, IgM type of antibodies develop, followed by the development of IgG antibodies hens acute infection characterized by the presence of IgM type of antibodies while chronic infection or previous infection was characterized by the presence of IgG type of antibodies. Various serological methods are available in the market to detect these antibodies from serum sample. Other congenital infections are also prevalent in India like Rubella, Cytomegalo virus (CMV), Herpes infections, Syphilis, Hepatitis B, and Human immuno virus (HIV) which can transmit through transplacental route. ^[5] In central India, the exact seroprevalence of toxoplasmosis is not known, so it is highly imperative to assess the status of seroprevalence of toxoplasmosis in central India, especially in pregnant women based on suitable serological kits.

Subjects and Methods

A total of 68 pregnant women between gestational age of 24-36 weeks were included in this prospective study during July to December 2013. All were attended at the antenatal clinic of Department of Obstetrics and Gynecology and most of them belonged to rural areas. Serum sample were collected after taking verbal consent. The outcome of delivery was recorded, wherever available. Age-group which was included in the study belongs to reproductive age-group (15-44 yrs) and only married women were included. Also, 2-5 cc blood was collected by venepuncture from the subject after explaining the procedure in detail and taking verbal consent (between 24-36 weeks of gestation). Serum was separated and stored at - 20°C until tested. Each sample was tested for presence of IgG and IgM antibodies for Toxoplasma gondii and also studied for other organisms of Toxoplasma, Rubella, Cytamegallo, Herpes (ToRCH) group, includes Toxoplasma gondii, Rubella, Cytomegalovirus, and Herpes simplex virus. Antibodies for Toxoplasma gondii were detected by using commercial ELISA kit from Calbiotech Inc, USA. Cut-off Optical density (OD) values were provided along with the kit. Sample with OD value of 0.9 or below was considered negative and above 1.1 was considered positive for both IgG and IgM type of antibodies.

Data were recorded and presented in the form of tables and graphs and calculated the incidence and prevalence of maternal toxoplasmosis.

There was no ethical issue.

Results

In our study, 14 (20.58%) out of 68 pregnant women were positive for toxoplasma IgG antibodies and 19 (27.94%) out of 68 were positive for IgM antibodies [Table 1]. However, only two i.e. 2.94% were both IgM and IgG positive [Table 2]. Acute infection during pregnancy was diagnosed if IgM positivity is there. There was a significant difference in the seropositivity in rural vs. urban areas, 10 out of 42 (23.80%) and 4 out of 26 (15.38%), respectively and also difference was observed in the incidence of acute infections during pregnancy [14 (33.33%) in rural vs. 5 (19.23%) in urban-[Table 1]]. The outcome of infection was not known in all the cases because many of the women went away from the follow-up.

Table 1: Seroprevalence of toxoplasmosis in pregnant women

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Table 2: Association of acute toxoplasmosis (positive for IgM) with other ToRCH infections

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Our study showed association of other ToRCH infections with acute toxoplasmosis. Out of 19 cases of acute toxoplasmosis, 5 cases were associated with acute infection with Rubella virus [Table 2].

According to [Table 3], out of 14 cases of IgG positive for Toxoplasmosis gondii, 10 were showed positivity for IgG of Cytomegalovirus, 7 for IgG of Rubella virus, and 8 for IgG of Herpes simplex (type I and II).

Table 3: Association of chronic toxoplasmosis (positive for IgG) with other ToRCH infections

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Discussion

Intra uterine infections are usually associated with a wide spectrum of complications in new born ranging from mare asymptomatic infection to death. In utero, it can also be associated with congenital abnormalities, intra uterine growth retardation, and neurological impairment. In India, the overall seropositivity for Toxoplasmosis gondii antibodies has been reported to vary from 9.63-41.67%. ^{[4],[6],[7],[8],[9],[10]} In the present study, a seroprevalence of 20.58% was reported in pregnant women which lies in the previously reported range. ^{[4],[6],[7],[8],[9],[10]} This may be because the women in this region resemble the rest of the population. An acute infection during pregnancy was documented in 27.94% of pregnant women. A high prevalence of toxoplasma infection has typically been associated with warm and humid environments, contaminated water supplies, poor cooking habits, lack of hygiene. Increased awareness and the education at patient and government level is required. ^[11] Program on primary prevention reduced the rate of Toxoplasmosis gondii seroconversion among pregnant women by 60%. ^[12] As with study, our study also showed more prevalence of toxoplasmosis in rural area (23.80% in comparison to 15.38% in urban areas), which is suggestive of the above-mentioned reasons for its causation. ^[4] During pregnancy, presence of both IgG and IgM types of antibodies simultaneously in 2.94% cases in our study is favored by other studies also. ^[4],[8] Our study showed association of other ToRCH infections with acute toxoplasmosis. Out of 19 cases of acute toxoplasmosis, 5 cases were associated with acute infection with Rubella virus. Out of 14 cases of IgG positive for Toxoplasmosis gondii, 10 were showed positivity for IgG of Cytomegalovirus, 7 for IgG of Rubella virus, and 8 for IgG of Herpes simplex (type I and II).

Acknowledgement

The authors wish to thank the Chairperson and Dean of the institute for providing laboratory facilities and healthy working atmosphere during the study period. The authors are also thankful to the technical staff of the institute for providing necessary helping hand during the endeavour.

References

1.	Sonar SS, Brahmbhatt MN. Toxoplasmosis: An important protozoan zoonosis. Vet World 2010;3:436-9.
2.	Kancova S, Sulc J, Nouzová K, Fajfrlík K, Frynta D, Flegr J. Women infected with parasite Toxoplasma have more sons. Naturwissenschaften 2007;94:122-7.
3.	Garcia LS. Diagnostic medical parasitology. 5 ^th ed. Washington DC: ASM press; 2007.
4.	Khurana S, Bagga R, Aggarwal A, Lyngdoh V; Shivapriya, Diddi K, et al. Serological screening for antenatal toxoplasma infection in India. Indian J Med Microbiol 2010;28:143-6. [PUBMED]
5.	Koneman EW. Koneman′s Color Atlas and Textbook of Diagnostic Microbiology, 2006.
6.	Sucilathangam G, Palaniappam N, Sreekumar C, Anna T. IgG-Indirect fluorescent antibody technique to detect seroprevalence of Toxoplasma gondii in immunocompetent and immunodeficient patients in southern districts of Tamil Nadu. Indian J Med Microbiol 2010;28:354-7. [PUBMED]
7.	Borkakoti BJ, Borthakur AK, Gohain M. Prevalence of Toxoplasma gondii infection amogst pregnant women in Assam, India. Indian J Med Microbiol 2007;25:431-2.
8.	Singh S, Pandit AJ. Incidence and prevalence of toxoplasmosis in Indian pregnant women: A prospective study. Am J Reprod Immunol 2004;52:276-83.
9.	Khairul Anuar A, Nissapatorn V, Noor Azimi MA, Fong MY, Init I, Rohela M, et al. Toxoplasma antibody in pregnant women in northern Peninsular Malaysia. Diagnosis 1991;5:18-23.
10.	Nissapatorn V, Noor Azmi MA, Cho SM, Fong MY, Init I, Rohela M, et al. Toxoplasmosis: Prevalence and risk factors. J Obstet Gynecol 2003;23:618-24.
11.	Cook AJ, Gilbert RE, Buffolano W, Zufferey J, Petersen E, Jenum PA, et al. Sources of toxoplasma infection in pregnant women: European multicentre case-control study. European Research Network on Congenital Toxoplasmosis. BMJ 2000;321:142-7.
12.	Breugelmans M, Naessens A, Foulon W. Prevention of toxoplasmosis during pregnancy-an epidemiologic survey over 22 consecutive years. J Perinat Med 2004;32:211-4.

Tables

[Table 1], [Table 2], [Table 3]

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