Geographical distribution of Toxoplasma gondii genotypes in Asia: A link with neighboring continents.

Defining the pattern of genetic diversity of Toxoplasma gondii is important to understand its worldwide distribution. During the last decades, a large number of studies have been published on Toxoplasma genotypes circulating in Europe, in North and South America. Two continents are still largely unexplored, Africa and, to a less extent, Asia. In this last continent, an increasing number of publications reported genotypes circulating in diverse provinces of China, but very few data are available for other Asian countries. After a systematic database search, 47 papers related to T. gondii genotypes in Asia were analyzed. Genetic characterization of DNA was performed by microsatellite markers, or more usually by a multiplex PCR using 11 PCR-RFLP markers, allowing data comparison to draw a first global picture of the population structure of this parasite throughout Asia. Overall, 390 isolates or DNA extracts were completely typed by PCR-RFLP and/or microsatellite marker methods, revealing 36 different PCR-RFLP or equivalent microsatellite genotypes: 15 genotypes identified by a ToxoDB number and 21 atypical or unique genotypes. The most common genotype found in Asia is the genotype ToxoDB#9 (Chinese 1). The clonal types I, II and II variant, and III were also commonly found in Asia. The geographical distribution of these genotypes across Asia may reflect either a continuum with Europe for the western part of Asia (presence of Type II), or the circulation of strains through animal migration or human activities between Africa and the Southwestern part of Asia (Africa 1 genotype in Turkey or ToxoDB#20 both I Sri-Lanka and in Ethiopia or Egypt). Although there are some indications of a genetic population structure in Southeast Asian countries different from the rest of Asia, more studies in this tropical part of Asia will be necessary for a region which represent as well as Africa one of the missing links of the T. gondii genetic diversity.

A high prevalence of Toxoplasma in Australian chickens.

A small survey was undertaken of commercially reared free-range chickens in Western Australia using serology and molecular detection. Eighteen out of 20 serum samples showed antibody responses with titers of 1:64 in 5 chickens and ≥ 1:128 in 13 chickens. DNA extracted from 22 out of 50 tissue samples, 10 brains and 12 spleens, were positive by nested PCR, and sequencing at the B1 locus on DNA from 3 brain and 3 spleen samples confirmed that 2 isolates were Toxoplasma gondii, Type I, and 4 Type II/III. The high prevalence of Toxoplasma infection found in commercial, free-range chickens raises public health issues with respect to both exposure in the workplace, during carcass processing, and subsequent transmission during food handling and/or consumption as food. The results of this study emphasize the need for more data on the incidence of Toxoplasma infection in domestic animals and humans in Australia.

Impact of health educational programmes on the prevalence of enterobiasis in schoolchildren in Thailand.

Enterobiasis is a worldwide prevalent disease particularly in low income areas. The budget needed for the prevention, treatment and eradication of the disease has thus far frustrated the limited budgets of global public health systems. A study was undertaken to determine if education in addition to medical treatment of enterobiasis could make a difference to the rates of infection. A total of 777 children (399 male and 378 female) from 11 elementary schools in five districts of Samut Prakan Province, Thailand were examined between December 2000 and March 2002. In five of the 11 schools studied, medical treatments were applied, followed by a programme of educating the children in the prevention of infection. Children in the remaining six schools received medical treatment only. The study showed a decrease in infections among children who received supplementary education. This decrease was significant in comparison to the decrease shown among children who received medical treatment only. The study therefore showed that educating high risk individuals played a key role in the prevention of enterobiasis.

Paroxysm serum from a case of Plasmodium vivax malaria inhibits the maturation of P. falciparum schizonts in vitro.

In concurrent infections in vivo, the blood stages of Plasmodium vivax suppress those of Plasmodium falciparum. To see if the paroxysm (i.e. the periodic febrile episode) of P. vivax infection contributes to this suppression, sera from a P. vivax-infected volunteer were added to cultures of whole blood taken from cases of P. falciparum malaria. The crude 'rate' of schizont generation from the ring forms, measured as the percentage of all asexual parasites that were schizonts after incubation for 24 h, was similar whether the cultures contained serum samples collected during paroxysms or those collected, from the same volunteer, at other times (19.1% v. 18.9%; P=0.842). After a random-effect linear regression was used to adjust for disparities between the P. falciparum isolates, however, the degree of schizont maturation, measured as the mean number of nuclei per schizont, was significantly lower for the cultures with 'paroxysm serum' than for those with 'non-paroxysm serum' (4.8 v. 5.3; P=0.002). The proportion of schizonts considered mature was also significantly lower when 'paroxysm serum' was used (3.7% v. 6.3%: P=0.03). This appears to be the first in-vitro study in which sera collected during a paroxysm of P. vivax have been shown to inhibit the maturation of P. falciparum schizonts. The role of this mechanism in intra- and inter-specific competition is discussed.

Predictive value of latex agglutination test in serological screening for Toxoplasma gondii.

The predictive value of commercial latex agglutination kit (Toxo-Screen DA, bioMerieux) was assessed for use as screening test for Toxoplasma IgG antibody. The sensivity and specificity were also compared with those of the reference standard Sabin-Feldman dye test. Five hundred serum samples were collected from 200 blood donors and 100 each from pregnant women, kidney recipients and HIV infected persons. Eighty (16.0%) out of 500 subjects were positive for Toxoplama IgG antibody by Toxo-Screen DA (bioMerieux) compared with 57 (11.4%) by Sabin-Feldman dye test. The sensivity and specificity of Toxo-Screen DA (bioMerieux) were 100% and 94.8 % respectively which were similar to previous reports from the area of high prevalence of Toxoplasma infection. In present study the positive predictive value of Toxo-Screen DA (bioMerieux) was only 71.3%. The latex agglutination test should be considered as a screening test for Toxoplasma antibody, especially by small laboratories in remote area due to its availability, simplicity, sensitivity and specificity. However, because of its moderate positive predictive value, the test should be used with caution in screening immunocompromised patients and pregnant women living in areas with low prevalence of Toxoplasma infection. Since the number of false seropositive cases would be relatively higher than in a highly prevalent area, confirmation by the dye test would be needed.

Serological study of Toxoplasma gondii in kidney recipients.

Toxoplasma gondii IgG antibodies were determined in 200 kidney recipients by the Sabin-Felmand dye test. Twenty-two (11%) cases were positive for antibody detection. There was a statistically significant difference in the history of taking under-cooked meat, between the number of sero-positive cases and that of sero-negative subjects (63.6% vs 28.8%, p = 0.02). No such significant difference was evident regarding cat ownership (13.6% vs 22.0%, p = 0.3). Sixteen (72.6%) of the 22 subjects with positive Tgondii antibody had undergone kidney transplantation less than one year ago during which a high dose of immunosuppressive drugs were prescribed. The remaining six (27.3%) cases had had transplantation more than one year ago and were on a lower dosage of immunosuprresants. Toxoplasma reactivation seemed to be higher in the former group, which should thus be closely followed-up. Preventive chemoprophylaxis should be considered if there is any indication of toxoplasma reactivation. Since there have been occasional reports of donor-to-host transmission of toxoplasmosis in kidney transplant recipients, serological screening of toxoplasma antibody in kidney donors is advisable. Potential donors with positive toxoplasma antibody should be rejected; but if that is unavoidable, 6-week prophylactic treatment of primary infection in kidney recipients should be administered.

Toxoplasma gondii antibody in HIV-infected persons.

Toxoplasmosis in an immunocompromised host was not documented in Thailand until 1992 when HIV/AIDS infection became pandemic. Patients with toxoplasmic encephalitis and cerebral abscess were recorded, particularly from the northern part of the country. However, data on the prevalence of the disease in HIV/AIDS patients is not yet available. In this study the authors determine the prevalence of T. gondii antibody in HIV persons. During a two-year period 312 serum samples of which 190 were HIV positive and the remaining samples were negative for HIV were tested. In the HIV positive group, 44 samples (23.2%) were positive for toxoplasma IgG antibody, whilst in the HIV negative group 36 samples (29.5%) were positive. All antibody titres found were not higher than 1:64. There is no significant difference of toxoplasma IgG antibody in HIV positive and HIV negative persons (p = 0.25). Among the HIV positive and T. gondii antibody positive group, 19 out of 44 persons (43.2%) had symptoms and signs of acute toxoplasmosis involving the eye and/or the central nervous system. Due to the high reactivation rate, the authors propose that all HIV-infected persons should be tested for T. gondii antibody and prophylactic treatment of opportunistic infection from T. gondii should be considered in those with positive results.

The situation of malaria along the Vietnam-Lao PDR border and some related factors.

This was a descriptive cross sectional study. It was done in 4 communes along the Vietnam-Lao PDR border of two mountainous provinces: Sonla and Nghean. The cluster multistage sampling technique was applied to choose the study sites. The results of the study show: Among the 2,441 persons given blood tests to find malaria parasites, 0.7% of them carry malaria parasite, of whom 0.6% carry P. falciparum and 0.1% carry P. vivax. The malaria morbidity in the year was 6.9%. The mortality due to malaria is 1.59 per 100,000 population per year. Among the 106 hamlet motivators being interviewed, only 75.5% knew that malaria is transmitted by mosquitos, 71.7% knew that malaria patients are a source of transmission, over 50% of the motivators have mistaken understanding about the living environment of malaria mosquitos. Most of them have had mistakes in diagnosis, treatment of malaria, mosquito-killing spraying. Among the 729 adults being interviewed, 59.0% did not know about the causes of malaria, 30.7% did not take part in malaria control activities. Only 69.3% of the adults regularly sleep inside mosquito nets, 68% of adults buy medicine to cure malaria, 39.9% referred patients to health facilities for cure, and 25% use forest herbs to cure malaria. The factors that increased the malaria morbidity in communes along Vietnam-Lao PDR border have been identified.

Difference of Toxoplasma gondii antibodies between Thai and Austrian pregnant women.

Toxoplasma gondii IgG and IgM antibodies of Thai and Austrian pregnant women were studied, in the same laboratory unit, by using the Sabin-Feldman dye test and ISAGA-IgM. In Thai pregnant women, IgG antibody was found in 21.7%, mostly the IgG titers were low and all were negative for IgM antibody. Conversely in Austrian pregnant women, IgG antibody was found in 30.0% with high titer, and there were 19 (6.3%) cases positive for IgM antibody. The seropositivity of T. gondii IgG antibody in Austrian pregnant women was significantly higher than in Thai (p = 0.02) and the titers were much higher. Two possibilities are postulated to explain the data: it may be because Thai women were infected at a younger age than Austrian women, so they were in the chronic infection stage corresponding with their negativity of IgM antibody or it may be due to the difference of strain virulence of T. gondii from the different parts of the world.

Toxoplasma gondii antibody in pregnant women with and without HIV infection.

One thousand two hundred pregnant women were examined for Toxoplasma gondii antibody with the objective of identifying the prevalence and risk factors of the disease. By using Sabin-Feldman Dye test, the prevalence of IgG to Toxoplasma gondii was 13.2%. In this study 19 cases (1.6%) were anti-HIV seropositive. Between HIV-seropositive and HIV-seronegative pregnant women, antibody rates to T. gondii were 21.1% and 13.1% respectively, however, the statistical comparison could not be done due to the very few subjects in the former group (n=4). Concerning the risk factors, among those who had no cat in their house, the prevalence of T. gondii antibody were significantly different between under-cooked and properly-cooked meat consumers (19.5%; and 9.6%; odds ratio=2.28, 95% confidence interval). And when under-cooked meat consumers were excluded, the antibody to T. gondii between two groups (having and not-having cat in the house) were also found the significantly different (31.8% and 19.3%; odd ratio=1.96, 95% confidence interval). In conclusion, consuming under-cooked meat and having a cat in the house, both are risk factors of transmission of toxoplasmosis. Further study with more subjects in HIV-infected pregnant women who had antibody to T. gondii, will be helpful for confirmation of the difference with respect to the non HIV-infected group.