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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 2  |  Page : 113-116

Toxoplasmosis prevalence in Egyptian diabetic patients


1 Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
2 Department of Parasitology, Al-Azhar University, Cairo, Egypt

Date of Submission17-Jun-2018
Date of Acceptance26-Sep-2018
Date of Web Publication27-Feb-2019

Correspondence Address:
Mahmoud H Hemida
Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AZMJ.AZMJ_53_18

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  Abstract 

Background Infection with Toxoplasma gondii is one of the most common parasitic infections in humans worldwide. Nearly one-third of individuals worldwide have been exposed to this parasite. Diabetes mellitus is an important factor that increases the susceptibility and risk of various infestations in the host.
Objective This study aimed to shed light on and evaluate the seroprevalence of T. gondii infection in diabetic patients.
Patients and methods T. gondii antibodies were tested serologically in 50 patients with diabetes mellitus and 50 apparently healthy individuals as controls using the enzyme-linked immunosorbent assay technique.
Results The seropositivity for anti-Toxoplasma immunoglobulin (Ig)G antibodies in the study groups was 46% in diabetic patients (group I) and 24% in the control group (group II), with P value of 0.03 indicating a statistically significant difference between the two groups. Only one patient in the diabetic group (group I) was positive for anti-Toxoplasma IgM, with P value of 0.98, showing no statistically significant difference between the two groups.
Conclusion The seropositivity for anti-Toxoplasma antibodies in diabetic patients was found to be higher than that in nondiabetic patients. Anti-Toxoplasma IgG antibodies 46 versus 24% (P=0.03).

Keywords: diabetes mellitus, enzyme-linked immunosorbent assay, Toxoplasma gondii


How to cite this article:
Hemida MH, Shahat SA, Bayoumy AM, Mohamed KA, Hassan SM. Toxoplasmosis prevalence in Egyptian diabetic patients. Al-Azhar Assiut Med J 2018;16:113-6

How to cite this URL:
Hemida MH, Shahat SA, Bayoumy AM, Mohamed KA, Hassan SM. Toxoplasmosis prevalence in Egyptian diabetic patients. Al-Azhar Assiut Med J [serial online] 2018 [cited 2020 Jul 6];16:113-6. Available from: http://www.azmj.eg.net/text.asp?2018/16/2/113/253091


  Introduction Top


Toxoplasma infection is usually asymptomatic or subclinical in immunocompetent individuals, whereas it may be lethal in neonates and immunocompromised patients; the majority of individuals suffer no discernible illness and the acute infection passes unnoticed [1]. Nearly one-third of individuals worldwide have been exposed to this parasite [2]. During the first few days after exposure, the infection typically manifests with a mild flu-like illness or no illness. However, immunosuppressed patients, such as those with AIDS, pregnant women, and diabetics, may become seriously ill, and it can occasionally be fatal [3].

The parasite can cause encephalitis and neurological diseases, and can also affect the cardiac tissue, liver, inner ears, and eyes, causing chorioretinitis [4]. Some studies have also linked toxoplasmosis with attention deficit hyperactivity disorder, obsessive compulsive disorder, and schizophrenia [5]. Numerous studies have shown a positive association between toxoplasmosis and suicidal tendency in humans [6].

Toxoplasma gondii show genetic diversity in different geographical areas [7]. Further, T. gondii remains dormant as bradyzoites in immune competent individuals, which can convert to tachyzoites when the host immune system is suppressed; tachyzoites and bradyzoites show different antigenic profiles [8]. Diabetes mellitus is a metabolic disease that occurs when the beta cells of the pancreas cannot produce insulin or when the body cannot effectively use the insulin that it produces [9].

A strong association has been found between toxoplasmosis and both types of diabetes [9]. Diabetes mellitus suppresses the immunity and increases the risk of susceptibility to various infections [10]. On the basis of statistics, the number of patients diagnosed with diabetes was in excess of 2.5 million within the age range of 25–65 years in 2007 [11]. It is predicted that 366 million will develop diabetes worldwide by 2030 [12].

Confirmation of the diagnosis of T. gondii infection is necessary by laboratory tests. Although the number of cases with toxoplasmosis is high, a sensitive and suitable method is not available for the detection of this infection in most diagnostic laboratories, which can lead to mismanagement of the involved cases. Among the serologic methods, enzyme-linked immunosorbent assay, immunofluorescence assay, and the indirect hemagglutination test are standard methods for examination of anti-T. gondii antibodies [13]. Toxoplasmosis is diagnosed mainly by detecting parasite-specific IgM or IgG antibodies in serum samples. Most of the available tests use T. gondii antigens derived from fast-growing tachyzoites, which may result in variations in the accuracy of detection. Recombinant antigens have been used as a diagnostic tool

However, their accuracy requires extensive experimental validation [14].

The aim of this study was to shed light on and evaluate the incidence of T. gondii infection in diabetic patients and to determine the association between possible risk factors and toxoplasma seropositivity.


  Patients and methods Top


The present study included a total of 100 patients (44 men and 56 women) selected randomly from Al-Hussein University hospital in the period of time from June 2014 to January 2015. The age of the patients included ranged from 18 to 60 years. The patients were classified into two groups. Group I (n=50) included patients with diabetes mellitus type 1 and type 2 (previously diagnosed at the diabetic clinic of Al-Hussein University Hospital). Group II (n=50)included apparently healthy nondiabetic individuals (with normal blood glucose levels), and were recruited from among those attending outpatient clinics and medical staff and personnel. All patients and controls were subjected to a complete assessment of history and clinical examination, and laboratory investigations including anti-Toxoplasma antibodies (IgM and IgG) and glycated hemoglobin (HbA1c). All serum samples were tested for anti-Toxoplasma IgG and IgM antibodies using an enzyme-linked immunosorbent assay technique using the available kits (Calbiotech Inc., Spring Valley, California, USA). The sensitivity (%) and specificity (%) of this test were 97 and 92%. The present study included a questionnaire sheet taken from all cases to verify the possible risk factors of toxoplasma infection. The questionnaire included questions on age, sex, occupation, residence, consumption of undercooked meat and unwashed vegetables, contact with cats, contact with soil, and history of blood transfusion or organ transplantation.

Ethical considerations

  1. Before data collection, verbal consent was provided by the ethical committee of Al-Azhar Faculty of Medicine.
  2. Informed consent was obtained from every patient for participation in this study.


Statistical analysis

Data were analyzed using the SPSS software (version 25.0; SPSS Inc., Chicago, Illinois, USA). The χ2-test was used to compare the seroprevalence values related to the characteristics of the patients. Correlations were assessed using Spearman’s test. The comparison of the variables with a normal distribution was performed using an unpaired t-test, and the comparison of the variables without a normal distribution was performed using a Mann–Whitney U-test. The categorical variables were compared using Pearson’s χ2-test and a P value less than 0.05 was considered statistically significant.


  Results Top


Patient characteristics and demographic data

The current study was carried out at the outpatient clinic at Al-Hussein University Hospital. The study population included the following two groups: group I included 50 diabetic patients and group II included 50 apparently healthy individuals (control group).

Laboratory Immunoassay data

Positive proportions of IgM and IgG anti-Toxoplasma antibodies were 2 and 46% in the patient group and 0 and 24% in the control groups, with P value of 0.98 for IgM (nonsignificant) and P value of 0.03 (significant) for IgG ([Table 1] and [Table 2]).
Table 1 Age and sex distribution of patient and control groups

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Table 2 Proportions of immunoglobulin M and immunoglobulin G anti-Toxoplasma antibodies in the patient and control groups

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Comparison of IgG anti-Toxoplasma antibodies results with other parameters

Comparison of IgG anti-Toxoplasma antibodies results in terms of sex (0.156, nonsignificant) and type of DM in the patient group (0.051, significant) is shown in [Table 3].
Table 3 Comparison of immunoglobulin G anti-Toxoplasma antibodies results with sex and diabetes mellitus type of the patient group

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Correlation of IgG anti-Toxoplasma antibodies results with HbA1c of the patient group was nonsignificant (r=−0.06, P=0.64) and it was significant for age (r=−0.23, P=0.10) as shown in [Table 4].
Table 4 Correlation of immunoglobulin G anti-Toxoplasma antibodies results with the glycated hemoglobin of the patient group

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  Discussion Top


Infection with T. gondii is one of the most common parasitic infections of humans. Diabetes is a dangerous disease; it is one of the important causes that increase the exposure to other diseases [15]. In terms of the qualitative results (seropositive or seronegative) for anti-Toxoplasma IgG and IgM antibodies among the study groups, the seropositivity for anti-Toxoplasma IgG antibodies in the study groups was 46% in diabetic patients (group I) and 24% in the control group (group II).

P value of 0.03 indicated a statistically significantly difference between both groups. Only one of the diabetic patients was positive for anti-Toxoplasma IgM, with P value of 0.98, indicating no statistically significant differences between the two groups. However, Gokcec et al. [16] reported that the studies on toxoplasmosis in diabetic patients are scarce. In their study, the overall seroprevalence of toxoplasmosis was 59%: 56.6 and 2.4% for anti-Toxoplasma IgG and IgM antibodies, respectively.

Shirbazou et al. [17] found that diabetes mellitus is an important risk factor that increases the susceptibility and risk of opportunistic infections in the host. At the same time, diabetes may be caused by T. gondii. The presence of T. gondii in the pancreas could directly undermine the pancreas beta cells. When β cells are destroyed, insulin secretion would then be affected [9]. In terms of the anti-Toxoplasma IgM results in this study, none of the participants in the control group were seropositive for anti-Toxoplasma IgM antibodies, whereas one patient in the diabetes group was seropositive for anti-toxoplasma IgM antibodies, with no statistically significant difference between the two groups.

However, Siyadatpanah et al. [18] reported that there was no statistically significant difference in the incidence of toxoplasmosis in diabetic and nondiabetic individuals. In terms of the relation between age and seropositivity in the study population, there was a negative relation between seropositivity and older age (r=0.23, P=0.1) and this was nonsignificant. In contrast, Wong et al. [19] found an increase in anti-toxoplasma seropositivity with age. Also, Dae-Whan et al. [20] suggested that the incidence of toxoplasmosis tended to increase with age, despite the fact that this increase was not statistically significant, and that the peak incidence was found in the 40–50 age group (9.7%). Petersen et al. [21] found that increasing anti-Toxoplasma antibodies were marked in children up to 9 years.

In adults, the increase was less marked up to 50 years, when peak values were reached, and then positivity declined [21],[22]. Spalding et al. [23] reported that increasing anti-toxoplasma seropositivity with age might be correlated with more exposure to several exogenous factors that might promote transmission of infection. In their study, no statistically significant differences in seropositivity for anti-toxoplasma IgG were reported among the study population (r=0.20, P=0.16). Dae-Whan et al. [20] found that toxoplasma seropositive rates of men and women were 6.3 and 7.2%, respectively.

However, the results were not in agreement with the previous report of Ghorbani et al. [24], who found that the incidence of seropositivity for anti-Toxoplasma antibodies was higher in women.

Also, Excler et al. [25] found that the incidence of toxoplasmosis is higher in men. The study population was asked about contact with cats, handling and consumption of raw or undercooked meat, and contact with soil (gardening). Also, evaluation of the socioeconomic and environmental pattern, which might predispose to T. gondii infection among the study groups, was performed. In this study, there was no statistical difference in seroprevalence between rural and urban areas (r=−0.06, P=0.67), although it was found in other studies that living in rural areas had a higher risk of toxoplasmosis than those in urban areas [26]. In terms of the correlation between the seroprevalence of toxoplasmosis and type of DM in our study, there was a statistically significant difference between type I DM and type II DM (69.2 and 37.8%, respectively, and P=0.05). However, the correlation of IgG anti-Toxoplasma antibodies results with HbA1c of the patient group was nonsignificant (r=−0.06, P=0.64).


  Conclusion Top


The seropositivity for anti-Toxoplasma antibodies in diabetic patients was found to be higher than that in nondiabetic patients. Anti-Toxoplasma IgG antibodies were 46 versus 24% (P=0.03).

Acknowledgements

The authors thank members of the laboratory in Al-Hussein University Hospital for help with the preparation of this manuscript.

All contributers contributed toward the research, the study, analysis of the results, and the discussion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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