Seroprevalence and risk factors of toxoplasmosis in pregnant women of district Swabi

Toxoplasmosis is parasitic infection that causes severe abnormalities in newborn babies when transmitted from mothers. The present study was conducted to find the seroprevalence and risk factors of toxoplasmosis among the pregnant women of selected samples taken from maternity ward, District Headquarter Hospital Swabi. Furthermore, the selected samples were scrutinized for toxoplasmosis in relation with gestation period, age factor, total number of pregnancies women carried, socioeconomic factors and the source of contamination through which women can be infected. The sera sample was examined for the presence of IgG/IgM anti-Toxo antibodies. For this purpose OnSiteToxo IgG /IgM Rapid test kit was used according to manufacturing protocol CTK biotech (San Diego USA). Overall prevalence of toxoplasmosis was reported to be 12% among which 05 cases were positive for only IgG and remaining 07 were positive both for IgG and IgM. Regarding gestation period, females at the third trimester of pregnancy were at greater risk and about 20% of cases were screened positive. In relation to age factor, women at the age of 31-36 showed high prevalence (25%) for toxoplasmosis. Examining toxoplasmosis in relation to number of pregnancies women carried, high percentage was recorded in women with their first pregnancy (3.96%).The findings also linked the infection with socioeconomic factors i.e. (36.36%) of cases were reported in pregnant women belonging to lower class. Similarly, in reporting results for toxoplasmosis due to contaminated environment, 30% of the cases of toxoplasmosis were mainly caused by the consumption of raw/improperly cooked meat. Other enormous causes included the interaction of women with cats and contaminated soil i.e. 27% each. Proper screening of women at her each trimester of pregnancy and awareness about the infection by health departments may contribute towards the prevention of congenital Toxoplasmosis.


Introduction
Infection with Toxoplasma gondii, an apicomplexecan protozoan, a human pathogenic obligate and intracellular parasite is the causative agent of toxoplasmosis.It is prevalent worldwide in many species of warm-blooded animals and human beings [1-5].Transmission and spread of infection among humans is largely through inhalation or ingestion of oocysts discharged in the faeces of infected cats, inoculation of trophozoites through the skin, drinking raw cow's milk or contaminated water, ingestion of bird's eggs and by eating raw or undercooked infected meat and vegetables [1, 3, 5].The parasite persists in three life forms.Tachyziote is the rapidly dividing and invasive stage.It causes an acute infection by replicating within the cells.This life form of the parasite is responsible for the congenital Toxoplasmosis.It can inhabit and invade several tissues including muscles of heart, liver, spleen, lymph nodes and central nervous system.Bradyziote is slowly dividing in the tissue cyst and it is responsible for the latent infection.Both the tachyziote and bradyziote if present in the meat of infected animals serve as source of infection.The infection can also be caused by consumption of food and water that meets such infected food items [4].Oocyst is the most infectious stage of this parasite that cannot be destroyed by human digestive enzymes.It is environmentally resistant and under favourable condition sit can remain viable for up to one year [4].The parasite has a complex and biphasic life cycle.Asexual reproduction takes place in tissues of human and few birds (intermediate host).Sexual reproduction occurs in the digestive tract of domestic and wild cats (definitive host) belonging to family Felidea [6].A pregnant woman if infected in her first trimester, the placenta would be infected for the rest of her pregnancy acting as a reservoir for the parasite [7].A pregnant woman suffering from primary acute Toxoplasmosis will transfer the parasite into the offspring via placenta.The permeability of placenta varies throughout gestational period and the transfer of parasite is less in the start of pregnancy while afterwards the permeability of placenta increases.Thus, the infection is highly prevalent in the late period of gestation.A total of 10% cases are recorded in the first trimester whereas, 60% to 70% Another similar study regarding the ocular Toxoplasmosis conducted by [18] stated that several cases have been recorded in ocular Toxoplasmosis where the parasite reaches the retina, proliferates within host cells, ruptures the host cells and finally invades into the neighbouring cells to make primary lesions.Evidences collected from pregnant women by researcher [10] in Mwanza Tanzania, 108 (30.9%) were seropositive out of 350 pregnant women for T. gondii specific antibodies.The risk of T. gondii infection increases by 7% with a yearly increase in a woman's age.The seropositivity rate of T. gondii-specific antibodies was higher among pregnant women from the urban than those from rural communities.Similarly employed/business women were more likely to get T. gondii infection.Likewise per [19] in USA approximately 85% of women of childbearing age were found susceptible to acute infection with T. gondii.In pregnant women, acute infection may cause serious health problems to the fetus when it is transmitted from mother to fetus (congenital Toxoplasmosis), including mental retardation, seizures, blindness, and death.So, in this regard the present study was designed with aims and objectives that to find out the risk factors of toxoplasmosis in pregnant women of District Swabi.

Study Area
Present study was conducted to find out the seroprevalence and risk factors of congenital Toxoplasmosis in District Swabi, KPK.The data was collected from March to June 2015.Blood samples were collected from pregnant women of maternity ward at District Head Quarter Hospital Swabi.The women visited from the surrounding villages of district Swabi including Anbar, Asota, Baja, Charbagh, Gohati, kernel sherkilli,kunda, Maneri, Maine, Marghuz, Manki, Panjpeer, Shewa, Shah Mansoor, Tordher, Zaida etc.

Blood Collection
Intra-venomous blood was preferred for this purpose.About 2 mL blood was taken by the disposable syringe through vein puncture.Collected blood was centrifuged at 400 rpm for ten minute.After the isolation, the serum was transferred in to sterilized eppendorf tube with the help of sterilized micro pipette.The serum was then stored in freezer at the temperature of -20ºĊ until the laboratory test and analysis was performed.

Serological Tests
All samples were serologically examined for the presence of IgG and IgM.For this purpose, OnSiteToxo IgG /IgM Rapid test kit was used per manufacturing protocol CTK biotech (San Diego USA).All the positive and negative results were recorded and a clinical report was made.

Statistics
Statistically the data was analyzed by Ms Excel.

Results and discussion
The present study was designed to scrutinize the seroprevalence and risk factors of congenital toxoplasmosis in pregnant women of District Swabi.For this purpose, 100 pregnant women were selected for blood collection which was then analyzed for congenital toxoplasmosis.Congenital toxoplasmosis was examined in the selected samples.Furthermore, it was analyzed in relation with gestation periods, age factor, number of pregnancies, socioeconomic factor and source of contamination from the surroundings.

Overall prevalence of toxoplasmosis in selected samples of district Swabi
According to the laboratory diagnosis 12% (n=12/100) samples were positive for the toxoplasmosis.Out of the 12 infected pregnant women, 07 were screened positive for recent infection i.e. positive for IgG and IgM and 05 were diagnosed only for IgM i.e. the latent infection, as shown in table 1

Relationship of toxoplasmosis with source of infection
In the present study, the patients were asked few questions as per the questionnaire to find out the sources of infection.So during interviewed it was concluded that out of twelve positive cases recorded in the present study, nine (27%) women were exposed to cat which is the host of T. Gondii and remaining three (17%) had no such contact.Likewise, out of the total twelve positive cases seven (30%) patients had taken raw/ improper cooked meat whereas remaining five positive cases had the infection from other sources.Similarly, five females (27%), were reported positive for the toxoplasmosis that had a pervious contact with soil, either from farming or gardening as shown in table 6.

Conclusions and recommendations
Congenital Toxoplasmosis is considered a great reason of abortion and stillbirth in pregnant women of Swabi.In the light of these results and related discussion, it is concluded from the present study that the ratio of prevalence of Toxoplasmosis in this area is threaten towards newborn babies.High percentage has been reported from women carrying their first pregnancy that may leads towards miscarriage.Pregnant women at last trimester of pregnancy were at higher risk to become infected from T. gondii.Regarding age factor, most of cases were reported from women, aged above thirty years.Similarly, the infection was highly prevalent in lower classes as a compared to middle and upper middle classes.High ratios of positive cases were reported from the lower middle.The consumption of inadequately cooked meat was a great risk factor of toxoplasmosis in Swabi as a compared to sources because 30% cases of toxoplasmosis were reported due to consumption of raw meat.It is thus advisable that pregnant women must take properly cooked meat to avoid the high-risk factor infection.Contact with cat and other pet animals was secondary risk factor.Similarly contact with contaminated soil through gardening or through other sources also contributed as a risk factor for the Toxoplasma infection in pregnant women of Swabi.Therefore, to prevent the infection in pregnant women proper screening at each trimester is highly recommended.Laboratory facilities thus are required at each maternity home for early diagnosis of parasite.Proper awareness must be given to female at child bearing age, especially about improperly cooked meat and during contact with soil and cats.Hands must be properly washed while eating or handling food.A woman may wear gloves during contact with soil.Pregnant women should be informed about the dangers of eating soil due to appetite in pregnancy.

Table 1 . Overall prevalence of toxoplasmosis in district Swabi
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