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| ORIGINAL ARTICLES |
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| Year : 2023 | Volume
: 20
| Issue : 1 | Page : 188-193 |
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Facts and fictions about Toxoplasma gondii in women of Misan province
Rasha Khalil Abduljalil Alsaad
Department of Microbiology, Faculty of Medicine, University of Misan, Misan, Iraq
| Date of Submission | 16-Dec-2022 |
| Date of Acceptance | 11-Jan-2023 |
| Date of Web Publication | 27-Apr-2023 |
Correspondence Address:
Rasha Khalil Abduljalil Alsaad
Department of Microbiology, Faculty of Medicine, University of Misan, Misan 62001
Iraq
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/MJBL.MJBL_334_22
Background: Toxoplasma gondii (T. gondii) is one of the most common protozoa worldwide that infects human and animals. Because of lack of data about the facts and myths of T. gondii infection in human Iraq, this study was aimed to define and answered all the related questions in a scientific knowledge manner. Materials and Methods: A survey study was conducted among women to assess their knowledge about facts and myths of toxoplasmosis in the Department of Microbiology, Faculty of Medicine, University of Misan, Misan, Iraq, from November 1, 2018 to July 30, 2022. All women answered all the questions. A total of 6055 women, aged from 18 to 68 years, were enrolled, only comprising women who lived in Misan. A questionnaire was constructed upon the objectives and involved questions correlated to personal, demographic, social, economic, and educational information. The questionnaire investigated facts and myths concerning T. gondii. Results: All women completed the survey lists with a response rate of 100%. The mean age was 41.53 ± 20.74 years. Most individuals (3133, 51.74%) were grouped to 18–40 years of age. In terms of the knowledge of toxoplasmosis, women who knew a person with toxoplasmosis (23.15%), though it affects men (47.46%), thought that it is an infectious disease (86.16%), thought that it can be prevented (68.22%), thought that it can be treated or cured (82.84%), thought that it is a hereditary condition (59.64%), thought that cats are a causative agent of toxoplasmosis (74.15%) and thought that it transmits by intersexual course (34.32%). Concerning risk knowledge, women who thought the risk of toxoplasmosis transport by eating unhealthy food are 70.45%, women who thought the risk is raised when wearing tight underwear are 42.25%, women who thought the risk was raised with old age are 49.58%, women who thought the risk could be raised when they use contraceptives are 31.11%, women who thought the risk increased with pregnancy are 84.23%, and women who thought the risk could be raised with smoking and alcohol intake are 45.70%. Of 6055 women, a total of 5578 (92.12%) women said that toxoplasmosis is a zoonotic disease. About 96.10% of the sample said that it transmits by cats. Almost always, 99.45% of women thought that it is a cause of abortion, stillbirth, and congenital anomalies. In addition, only 16.99% of women in this survey know that there are over two million new cases of toxoplasmosis in the world annually. About 11.33% of women thought that toxoplasmosis cases are asymptomatic whereas others thought that they have a fever, gastro intestinal tract symptoms, genito urinary tract symptoms, and ophthalmologic symptoms. Conclusions: Many facts and myths can affect the knowledge of women about toxoplasmosis. In kinds of literature, there are no real modes for studying myths about infectious diseases in particular toxoplasmosis which may be of benefit in preventing and managing processes. Keywords: Cats, myths, protozoa, Toxoplasma gondii, toxoplasmosis
How to cite this article:
Abduljalil Alsaad RK. Facts and fictions about Toxoplasma gondii in women of Misan province. Med J Babylon 2023;20:188-93 |
| Introduction | |  |
The trilogy of abortion or congenital malformations in pregnancy contributed to one, two, or all of three pathogens Toxoplasma gondii, Rubella virus, and Cytomegalovirus.[1]T. gondii is one of the most common protozoa worldwide that infect human and warm-blooded animals, due to ingestion of well-uncooked meat or food contaminated with infected animal feces.[2],[3] Toxoplasmosis presented as a zoonotic disease caused by coccidian protozoa, T. gondii.[4] Human beings become infected through ingested tissue containing cysts in uncooked meat or contaminated water, soil, and food with oocyst, or directly from cats and other feline species’ feces.[5] It is an important tropical disease and globally spreading, which found that is infectious to 30% of the human population worldwide.[6] Furthermore, the vertical transmission or congenital infection of T. gondii was reported. The life cycle is complete when the parasite passes from warm-blooded intermediate hosts to human, Felidae is the only known host in which the parasite can reproduce sexually and produce oocysts then shed oocysts in the feces of domestic cats.[7] The infection can be diagnosed using many laboratory tests, including serological tests, polymerase chain reaction methods, and histological seen of parasites in infected tissue or body fluids or by animal inoculation.[8] Clinically, the symptoms of toxoplasmosis are fever, anorexia, or dyspnea, and the signs are neural, respiratory, cutaneous, and ocular can be involvement. The diagnosis can be complicated due to the wide range of clinical signs.[9],[10] The disease is enhanced by some factors such as environmental conditions, social, nutritional, economic, cultural habits, and hygiene, and its prevalence in hot and humid climates is higher than that in warm and dry regions.[11] The screening of IgG and IgM antibodies by enzyme-linked immunosorbent assay study is routinely done. The IgM antibodies are seen in the first week and reached the maximum level after 3 weeks of infection. Whereas IgG antibodies were seen two weeks after infection and reached a peak within 8–10 weeks of infection.[12],[13]
Regarding the lack of data about the facts and myths of T. gondii infection in human in Misan province, Iraq, this study was aimed to define and answered all these questions in a scientific knowledge manner.
| Materials and Methods | | |
A survey study was conducted among women to assess their knowledge about facts and myths of toxoplasmosis in the Department of Microbiology, Faculty of Medicine, University of Misan, Misan, Iraq, from November 1, 2018 to July 30, 2022. The recruitment period began on the first day until the last day of study ended. All women answered all the questions. A total of 6055 women, aged from 18 to 68 years, were enrolled, only comprising women who lived in Misan. A survey using a questionnaire was constructed upon the objectives and involved questions correlated to personal, demographic, social, economic, and educational information. The survey questionnaire investigated facts and myths concerning T. gondii.
Ethical considerations
This study was approved by the University of Misan, Faculty of Medicine Committee Board (ID No. 1002/Feb 2021).
Data collection
The knowledge about toxoplasmosis was assessed by eight questions (1–8). Toxoplasmosis risk factors were reported by six questions (9–14). Facts of toxoplasmosis consist of four questions (15–18). Knowledge of symptoms assessed by one question ([Box 1]).
Statistical analysis
The data were analyzed using SPSS software (Version 20.0, IBM®, New York, NY). The categorical and quantitative variables were presented as percentages and mean. The likelihood ratio for the multinomial logistic regression model of facts and myths was used. The P value of ≤ 0.05 was set as the level of significance using a two-sided test.
| Results | | |
The participants in this work comprised 6055 women who were residents of Misan, Iraq. All women were eligible by meeting the research criteria, all of them completed the survey with a response rate of 100%, and all questionnaire data were subjected to a statistical analysis. The mean age of participants was 41.53 ± 20.74 years. Most individuals (3133, 51.74%) were grouped between 18 and 40 years of age. A large group of women (1543, 25.48%) were illiterate. The low economic status (3153, 52.07%) was frequently recorded. The majority of women were married (2821, 46.59%), whereas 1139 (18.81%) were single [Table 1].
In terms of the knowledge of toxoplasmosis, women who answered “Yes” Q1 in (23.15%), Q2 at (47.46%), Q3 at (86.16%), Q4 at (68.22%), Q5 at (82.84%), Q6 at (59.64%), Q7 in (74.15%), and Q8 in (34.32%) [Table 2].
[Table 3] showed the percentage of women in relation to risk knowledge. Women who said “Yes” were (70.45%) for Q9, (42.25%) for Q10, (49.58%) for Q11, (31.11%) for Q12, (84.23%) for Q13, and (45.70%) for Q14.
Data concerning facts about toxoplasmosis are listed in [Table 4]. A total of 5578 (92.12%) women said “Yes” for Q15. About 96.10% of the sample said “Yes” for Q16, 99.45% for Q17, and 16.99% for Q18.
About 11.33% of women thought that toxoplasmosis cases are asymptomatic, whereas 98.76% thought that they have a fever, 62.25% said that they suffer from gastro intestinal tract symptoms, 99.92% said that they suffer from genito urinary tract symptoms and 8.72% thought that they complain of ophthalmologic symptoms [Table 5].
The multinomial logistic regression model of the participants’ knowledge included 23 covariates. In total, 13 covariates showed a statistical association after modeling the likelihood ratio: Q3 (P = 0.05), Q4 (P = 0.05), Q5 (P = 0.001), Q7 (P = 0.0001), Q9 (P = 0.05), Q13 (P = 0.001), Q15 (P = 0.0001), Q16 (P = 0.0001), and Q17 (P = 0.0001). Furthermore, knowledge about symptoms revealed that thoughts about fever, gastro intestinal tract, and genito urinary tract symptoms have significant differences (P = 0.0001, 0.001, 0.0001), respectively [Table 6]. | Table 6: The likelihood ratio for multinomial logistic regression model of facts and myths of toxoplasmosis knowledge
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| Discussion | | |
The participants comprised 6055 women who lived in Misan. All women completed the survey lists with a response rate of 100%. The mean age was 41.53 ± 20.74 years. Most individuals (3133, 51.74%) were grouped in the range of 18–40 years of age. This agrees with T. gondii, and other viral infections are commonly infected in all age groups and are generally asymptomatic illnesses; however, the infection in pregnant women may cause abortion or fetal congenital malformations.[14] Also, our findings agree with Puccio et al.,[15] in Italy and Simpore et al.,[16] in Burkina Faso. Toxoplasmosis is an important infection in pregnant women up to the time of infection and the virulence of the organism type, and many transmitted parasites from mother to fetus are related to a variety of symptoms and complications.[17]
In terms of the knowledge of toxoplasmosis, women who knew a person with toxoplasmosis (23.15%), though it affects men (47.46%), thought that it is an infectious disease (86.16%), thought that it can be prevented (68.22%), thought that it can be treated or cured (82.84%), thought that it is a hereditary condition (59.64%), thought that cats are a causative agent of toxoplasmosis (74.15%) and thought that it transmits by intersexual course (34.32%). Meylan et al.,[18]; Moghimi et al.,[19] and Acharya,[20] revealed similar data. However, in India, Yasodhara et al.,[21] in Turkey, Parlak et al.,[22] and in Switzerland, Boubaker et al.,[23] disagree with these thoughts.
Pribakovic et al., concluded that these knowledge points are influenced by age, educated women, society, economy, and environmental factors.[24] The youngest females have the highest risk of acquiring this disease during pregnancy.[25],[26]
In relation to risk knowledge, women who thought the risk of toxoplasmosis is transported by eating unhealthy food are70.45%, women who thought the risk is raised when wearing tight underwear are 42.25%, women who thought the risk raised with old age are 49.58%, women who thought the risk raised when using contraceptives are 31.11%, women who thought the risk increased with pregnancy are 84.23%, and women who thought the risk raised with smoking and alcohol intake are 45.70%. In the former studies, authors reported similar findings for these thoughts, indicating the greatest myths in the regions with a higher prevalence of toxoplasmosis.[27] The data from other surveys showed a different percentage of these thoughts in China,[28] and in London.[10]
In Hormozgan province in Iran, the toxoplasmosis prevalence was high; besides, there were several unpleasant myths about the disease,[29] when compared with other two similar studies on pregnant women by Makiani et al.,[30] and Setoodeh Jahromi et al.,[31] which are different from our data. The reason for these differences resulting from comparison seems to have been influenced by many environmental and population factors such as selected samples, pregnant women, and hospital policies.
A significant relationship was found between the distribution of many thoughts about T. gondii infection and the age of patients and their education level confirmed which was by Doni et al.,[32] in Turkey and Ghadamgahi et al.,[33] and Ajami et al.,[34] in Iran.
Of 6055 women, a total of 5578 (92.12%) women said that toxoplasmosis is a zoonotic disease. About 96.10% of the sample said that it is being transmitted by cats. Almost always, 99.45% of women thought that it is a cause of abortion, stillbirth, and congenital anomalies. In addition, only 16.99% of women in this survey know that there are over two million new cases of toxoplasmosis in the world annually. About 11.33% of women thought that toxoplasmosis cases are asymptomatic whereas others thought that they have a fever, gastro intestinal tract symptoms, genito urinary tract symptoms, and ophthalmologic symptoms. The findings showed a meaningful correlation between these facts and Toxoplasma, too. Thus, probably this is a way for people to describe this infection in high-prevalence regions.[29] However, so far, no study has been conducted on this subject to show similar data to our study.
Setoodeh Jahromi et al.,[31] documented a significant correlation found between the history of contact with cats and the presence of anti-Toxoplasma antibodies in pregnant women which indicates a mode of transmission.
Some authors advise combining thoughts and scientific facts to help the population to distinguish between reality and delusion about this zoonotic infection.[35]
Biological contaminants refer to environmental contamination and food source with living microorganisms such as bacteria, molds, viruses, protozoa, and fungi, in addition to mites, house dust, and pollen that affect infection.[36] The contamination of soil with T. gondii oocyst could act as the source of acquiring toxoplasmosis.[37]
| Conclusions | | |
Many facts and myths can affect the knowledge of women about toxoplasmosis. In kinds of literature, there are no real modes for studying myths about infectious diseases in particular toxoplasmosis which may be of benefit in preventing and managing processes.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Adam RW, Al-Labban HMY, Aljanaby AAJ, Abbas NA Synthesis, characterization and antibacterial activity of some new of novel 1,2,3-triazol-chalcone derivatives from n-acetyl-5h-dibenzo [b,f] azepine-5-carboxamide. Nano Biomed Eng 2019;11:99-110.  |
| 2. | Al-Labban HMY Synthesis, characterization and study of biological activity of some new 1,2,3,4-tetrazole derivatives. Res J Pharm Technol, 2017;10:3645-52. |
| 3. | Mirza Alizadeh A, Jazaeri S, Shemshadi B, Hashempour-Baltork F, Sarlak Z, Pilevar Z, et al. A review on inactivation methods of toxoplasma gondii in foods. Pathog Glob Health 2018;112:306-19. |
| 4. | Schlüter D, Däubener W, Schares G, Groß U, Pleyer U, Lüder C Animals are key to human toxoplasmosis. Int J Med Microbiol 2014;304:917-29. |
| 5. | Wilking H, Thamm M, Stark K, Aebischer T, Seeber F Prevalence, incidence estimations, and risk factors of toxoplasma gondii infection in Germany: A representative, cross-sectional, serological study. Sci Rep 2016;6:22551. |
| 6. | Onosakponome EO, Wokem GN, Abah AE Comparison of ELISA and rapid immunochromatographic tests in diagnosis of toxoplasmosis in Port Harcourt, Nigeria. Int J Trop Dis Health 2020;41:54-9. |
| 7. | Djurković-Djaković O, Dupouy-Camet J, Van der Giessen J, Dubey JP Toxoplasmosis: Overview from a one health perspective. Food Waterborne Parasitol 2019;15:e00054. |
| 8. | Mcauley JB, Jones JL, Singh K Toxoplasma. In: Man Clin Microbiol. James HJ, Karen CC, Guido F, et al., Editors. 11th ed. USA: Wiley Online Library; 2015. p. 2373-86. |
| 9. | Stillwaggon E, Carrier CS, Sautter M, McLeod R Maternal serologic screening to prevent congenital toxoplasmosis: A decision-analytic economic model. PLoS NeglTrop Dis 2011;5:e1333. |
| 10. | Zhou P, Chen Z, Li HL, Zheng H, He S, Lin RQ, et al. Toxoplasma gondii infection in humans in China. Parasit Vectors 2011;4:165. |
| 11. | Meerburg BG, Kijlstra A Changing climate-changing pathogens: Toxoplasma gondii in North-Western Europe. Parasitol Res 2009;105:17-24. |
| 12. | Villard O, Cimon B, L’Ollivier C, Fricker-Hidalgo H, Godineau N, Houze S, et al. Serological diagnosis of Toxoplasma gondii infection: Recommendations from the French National Reference Center for Toxoplasmosis. Diagn Microbiol Infect Dis 2016;84:22-33. |
| 13. | Zhang K, Lin G, Han Y, Li J Serological diagnosis of toxoplasmosis and standardization. Clin Chim Acta 2016;461:83-9. |
| 14. | Majeed HT, Hasan TH, Aljanaby AAJ Epidemiological study in women infected with Toxoplasma gondii, Rubella virus, and Cytomegalo virus in Al-Najaf governorate-Iraq. Int J Pharm Res 2020;12:1142-7. |
| 15. | Puccio G, Cajozzo C, Canduscio LA, Cino L, Romano A, Schimmenti MG, et al. Epidemiology of toxoplasma and CMV serology and of GBS colonization in pregnancy and neonatal outcome in a Sicilian population. Ital J Pediatr 2014;40:23. |
| 16. | Simpore J, Savadogo A, Ilboudo D, Nadambega MC, Esposito M, Yara J, et al. Toxoplasma gondii, HCV, and HBV seroprevalence and co-infection among HIV-positive and -negative pregnant women in Burkina Faso. J Med Virol 2006;78:730-3. |
| 17. | Montoya JG, Remington JS Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2008;47:554-66. |
| 18. | Meylan P, Paris L, Liesenfeld O Multicenter evaluation of the elecsys toxo IgG and IgM tests for the diagnosis of infection with Toxoplasma gondii. Eur J Microbiol Immunol 2015;5:150-8. |
| 19. | Moghimi M, Doosti M, Vahedian-Ardakani HA, Talebi A, Akhavan-Ghalibaf M, Najafi A, et al. Serological study on cytomegalovirus and Toxoplasma gondii in Thalassemia major patients of Yazd, Iran. Iran J Ped Hematol Oncol 2015;5:149-54. |
| 20. | Acharya MR Study of Toxoplasma gondii, Rubella, CMV and HSV antibodies among pregnant women in Pokhara, Nepal. IOSR J Dental Med Sci 2020;19:42-7. |
| 21. | Yasodhara P, Ramalakshmi BA, Naidu AN, Raman L Prevalence of specific IGM due to toxoplasma, rubella, CMV and c.trachomatis infections during pregnancy. Indian J Med Microbiol 2001;19:52-6. [ PUBMED] [Full text] |
| 22. | Parlak M, Çim N, Nalça Erdin B, Güven A, Bayram Y, Yıldızhan R Seroprevalence of toxoplasma, rubella, and cytomegalovirus among pregnant women in van. Turk J Obstet Gynecol 2015;12:79-82. |
| 23. | Boubaker K, Raeber PA, Vaudaux B, Bucher HC, Garweg JG, Hoesli I, et al. Swiss working group on congenital toxoplasmosis. Toxoplasmosis during pregnancy and infancy. A new approach for Switzerland. Swiss Med Wkly 2008;138(49-50 Suppl 168):1-8. |
| 24. | Pribakovic JA, Katanic N, Radevic T, Tasic MS, Kostic M, Stolic B, et al. Serological status of childbearing-aged women for toxoplasma gondii and cytomegalovirus in northern Kosovo and Metohija. Rev Soc Bras Med Trop 2019;52:e20170313. |
| 25. | Hamzah DN, Aljanaby AAJ Immune response in patients infected with helicobacter pylori in Al-Najaf City, Iraq. Int J Pharm Res 2020;12:1-6. |
| 26. | Wang Y, Hedman L, Nurmi V, Ziemele I, Perdomo MF, Söderlund-Venermo M, et al. Microsphere-based IgM and IgG avidity assays for human parvovirus B19, human cytomegalovirus, and toxoplasma gondii. mSphere 2020;5:e00905-19. |
| 27. | Mostafavi SN, Jalali L Toxoplasmosis epidemiology in Iran: A systematic review. J Isfahan Med School 2012;30:1-15. |
| 28. | Dubey JP, Lago EG, Gennari SM, Su C, Jones JL Toxoplasmosis in humans and animals in Brazil: High prevalence, high burden of disease, and epidemiology. Parasitology 2012;139:1375-424. |
| 29. | Khademi SZ, Ghaffarifar F, Dalimi A, Davoodian P, Abdoli A Prevalence and risk factors of Toxoplasma gondii infection among pregnant women in Hormozgan Province, South of Iran. Iran J Parasitol 2019;14:167-73. |
| 30. | Makiani MJ, Davoodian P, Golsha R, dehghani M, Rajaee M, Mahoori K, et al. Seroepidemiology and risk factors of toxoplasmosis in the first trimester among pregnant women. Int Elec J Med 2012;1:12-7. |
| 31. | Setoodeh Jahromi A, Safa O, Zare S, Davoodian P, Farshid Far G Prevalence of toxoplasma antibodies in pregnant women referred to Shariati Hospital, Bandar Abbas, Iran, 1999–2000. J Hormozgan Uni Med Sci 2003;4:25-30. |
| 32. | Yentur Doni N, Simsek Z, Gurses G, Yildiz Zeyrek F, Demir C Prevalence and associated risk factors of Toxoplasma gondii in female farmworkers of southeastern Turkey. J Infect Dev Ctries 2015;9:08787-093. |
| 33. | Ghadamgahi F, Bahadoran M, Shariat-Bahadori E, Ahmadi-Ahvaz N, Ghadrdoost B, Hejazi SH Study of serological toxoplasmosis and risk factors associated with infection in women referred to labs of Northern Tehran, Iran. J Isfahan Med School 2013;31:1258-66. |
| 34. | Ajami A, Sharif M, Saffar MJ, Zyaee H Serological study of toxoplasmosis in women referred to medical health laboratory before marriage, Mazandaran, 2000. J Mazandaran Uni Med Sci 2006;2:134-7. |
| 35. | Iqbal J, Khalid N Detection of acute toxoplasma gondii infection in early pregnancy by IgG avidity and PCR analysis. J Med Microbiol 2007;56:1495-99. |
| 36. | Hussain HH, Ibraheem NT, Al-Rubaey NKF, Radhi MM, Hindi NKK, AL-Jubori RHK Review of airborne contaminated microorganisms associated with human diseases. Med J Babylon 2022;19:115-22. |
| 37. | Abdullah AM, Merza NS, Merza AS Detection of toxoplasma gondii oocysts in contaminated soils using polymerase chain reaction analysis in Duhok City Iraq. Med J of Babylon 2022;19:271-4. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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