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 ~  Results
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BRIEF COMMUNICATIONS
Year : 2004  |  Volume : 22  |  Issue : 4  |  Page : 241-243
 

Socioeconomic status and prevalence of toxoplasmosis during pregnancy


Departments of Microbiology and Statistics, National Institute of Nutrition, Jamai Osmania PO, Hyderabad - 500 007, India

Date of Submission16-Mar-2004
Date of Acceptance17-Apr-2004

Correspondence Address:
Departments of Microbiology and Statistics, National Institute of Nutrition, Jamai Osmania PO, Hyderabad - 500 007, India

 ~ Abstract 

Two hundred and thirty-six women with previous bad obstetric history (BOH), belonging to different socio-economic groups were investigated for the presence of Toxoplasma specific antibodies (IgG/IgM) using commercial diagnostic kits. The study showed a higher percentage of IgG seropositivity in women of low socioeconomic group (LSG) compared to those of high socioeconomic group (HSG). Specific IgM positivity indicative of possible acute infection, was higher in women of HSG, emphasizing the need for educating pregnant mothers on preventive measures. However, there is a need to undertake in-depth studies to understand the significance of the presence of IgM in women with BOH.

How to cite this article:
Yasodhara P, Ramalakshmi B A, Lakshmi V, Krishna T P. Socioeconomic status and prevalence of toxoplasmosis during pregnancy. Indian J Med Microbiol 2004;22:241-3


How to cite this URL:
Yasodhara P, Ramalakshmi B A, Lakshmi V, Krishna T P. Socioeconomic status and prevalence of toxoplasmosis during pregnancy. Indian J Med Microbiol [serial online] 2004 [cited 2020 Jul 5];22:241-3. Available from: http://www.ijmm.org/text.asp?2004/22/4/241/12815


Toxoplasmosis is usually an asymptomatic disease, but often takes a severe course in foetuses and immunocompromised hosts. Toxoplasmosis is transmitted through oocysts shed in infected cats' faeces and is also transmitted by consumption of contaminated unwashed/unpeeled vegetables, fruits, unpasteurised milk and raw or undercooked infected meat.[1] Acute Toxoplasma infection in pregnancy is usually subclinical and the diagnosis is by serology. Vertical transmission to the foetus occurs by transplacental transfer of organisms from the mother usually following acute maternal infection.[2] The prevalence of toxoplasmosis in women with bad obstetric history (BOH) is known to be significantly higher than those without it.[3],[4],[5],[6],[7],[8] A recent study from Chandigarh reports rising seropositivity to Toxoplasma in women with BOH.[9]
In the present paper, we report the association of socioeconomic status and seropositivity to Toxoplasma in women with bad obstetric history belonging to different socioeconomic groups.

 ~ Materials and Methods Top

One hundred women belonging to low socio-economic group (LSG) from a local Government Hospital with history of repeated foetal wastage were screened for Toxoplasma specific antibodies (IgM/IgG). Specific antibodies were also determined in 136 women with history of repeated foetal wastage during the same period, referred from various private hospitals to the Department of Microbiology, NIMS, Hyderabad, belonging to high socioeconomic group.
Toxoplasma specific antibodies were determined using kits supplied by Diamedix Corporation. Sandwich ELISA technique was performed according to the manufacturer's instructions. Test of proportion was used to compare the groups and to determine the statistical differences.

 ~ Results Top

Specific immunoglobulin types in women belonging to the two socioeconomic groups are shown in the [Figure - 1]. Thirty three percent of the women of LSG and 22.0% of the women of HSG were seropositive for Toxoplasma specific IgG antibodies. Possible acute infection, as indicated by IgM positivity alone, was higher (18.3%) in women of HSG, compared to women from LSG (5%p<0.05). This indicates that the incidence of primary infection is higher in women of HSG and these women are at a greater risk of foetal loss if they conceive during the acute phase. Presence of both IgG and IgM, where one has to distinguish between reinfection and acute infection, was higher among women of LSG compared to women of HSG (18.2% vs 5%; p<0.01). This could probably be due to repeated infections in women of LSG owing to unhygienic surroundings in which these women live. The present study shows an association between socioeconomic status and Toxoplasma infection similar to a study from north India[10] which reports a higher seroprevalence among urban pregnant women living below poverty line. It also shows that pregnant women need to be educated about the various preventive measures.

 ~ Discussion Top

It is being increasingly documented that IgM remains in circulation for longer periods and therefore it is important to distinguish IgM of primary acute/reinfection and reactivation, using the avidity IgG ELISA test[11],[12] developed recently, to enable distinction between acute infection, reinfection and reactivation. Our earlier study[13] indicated that only a small proportion of women of LSG positive for IgM/IgG antibodies have actual acute infection, when avidity ELISA was used as a complimentary test.
Congenital transmission, recurrent abortion, and perinatal mortality during chronic latent toxoplasmosis are controversial subjects. Studies in the early 70s[14] show that women were treated for Toxoplasma to reduce foetal wastages in subsequent pregnancies, while studies by Kimball et al[15] were contradictory. However, studies from India do show an association between Toxoplasma infection and BOH. One study reports high pregnancy wastage in those positive for IgG[6] while in another study 34.5% of women with recurrent pregnancy wastage tested positive for Toxoplasma specific IgM.[7] A recent study from Chandigarh reports an increasing seropositivity to toxoplasmosis in women with BOH.[9] The presence of significant titres of anti Toxoplasma antibodies are considered as indirect evidence of the organism being the cause of BOH in women of reproductive age group.[9]
This study shows a high prevalence of Toxoplasma infection in women, and an association with socio-economic status. While women of higher economic status were serosusceptible and therefore at risk of primary infection, women of low income group could be at risk of repeated infections attributable to the unhygienic environment in which they reside. This observation assumes significance in view of some studies reporting congenital infection due to reinfection[16],[17] although rare. Fortier et al report spontaneous abortion in a woman with previous immunity to Toxoplasma, with the aborted tissue revealing one typical cyst of T. gondii.[16] The authors suggest the possibility of parasitaemia occurring during T. gondii reinfection, leading to transmission to the fetus and miscarriage.[16] However, there is a need for further in-depth studies to understand the significance of Toxoplasma specific IgM in women with history of repeated foetal wastage, especially in the women of low-income group. 

 ~ References Top

1.Koskiniemi M, Lappalainen M, Heman L. Toxoplasmosis needs evaluation. An overview and proposals. AJDC 1989;143:724-728.  Back to cited text no. 1    
2.Field RL, Guerina NG. Toxoplasmosis. Paediatrics in Review 1997;99-107.  Back to cited text no. 2    
3.Ajay M, Ajita CM. Clinical presentation of toxoplasmosis in pregnant women. J Obstet Gynecol India 1990;40:165-170.  Back to cited text no. 3    
4.Dacosta J, Dacosta N, Mehta A, Soonawala R, Wnadros K. Toxoplasma IgM titres in women with BOH. J Obstet Gynecol India 1991;41:158-161.  Back to cited text no. 4    
5.Dashora S, Dube S, Pandre V. Maternal Toxoplasmosis: cases of pregnancy wastages. J Obstet Gynecol India 1991;41:17-20.  Back to cited text no. 5    
6.Mookherjee N, Gogate A, Shah PK. Microbiological evaluation of women with bad obstetric history. Indian J Med Res 1995;101:103-107.  Back to cited text no. 6    
7.Zargar AH, Waani SR, Laway BA, Kakroo DP, Sofi BA, et al. Seroprevalence of Toxoplasmosis in women with recurrent abortions/neonatal deaths and its treatment outcome. Indian J Pathol Microbiol 1999;42(4):483-486.   Back to cited text no. 7    
8.Singh N, Singh K, Shahi SK. Toxoplasmosis in pregnancy. A review article. Indian J Pathol Microbiol 2002;45:513-515.  Back to cited text no. 8    
9.Sharma P, Gupta I, Ganguly NK, Mahajan RE, Malla N. Increasing toxoplasma seropositivity in women with bad obstetric history and in new born. Natl Med J 1997; 10:65-66.  Back to cited text no. 9    
10.Akoijaam BS, Shashikant, Singh S, Kapoor SK. Seroprevalence of Toxoplasma infection among primigravid women attending antenatal clinic at a secondary level hospital in North India. JIMA 2002;100:591-601.  Back to cited text no. 10    
11.Lappalainen M, Koskela P, Koskieniem P, Ammala V, Hiilesmaa K, Raivio KO, Ramington JS, Hedman K. Toxoplasmosis acquired during pregnancy improved serodiagnosis based on avidity of IgG. J Infect Dis 1998;167: 691-92.   Back to cited text no. 11    
12.Pinon JM, Dumon H, Chemla C, et al. Strategy for diagnosis of congenital toxoplasmosis: evaluation of methods comparing mothers and newborns and stansdard methods for post natal detection of immunoglobulin G, M and A antibodies. J Clin Microbiol 2001;39:2267-2271.  Back to cited text no. 12    
13.Yasodhara P, Ramalakshmi BA, MKJ Sarma. A new approach to differentiate recent vs chronic Toxoplasma infection Avidity ELISA in Toxoplasma serology. Ind J Med Microbiol 2001;19:145-148.  Back to cited text no. 13    
14.Sharf M, Eibschitz I, Elan E. Latent Toxoplasmosis and pregnancy. Obstet Gynecol 1973;42:349-354.   Back to cited text no. 14    
15.Kimball AC, Kean DBH, Fuchs F. The role of toxoplasmosis in abortion. Am J Obstet Gynecol 1971;111: 219-226.  Back to cited text no. 15    
16.Fortier B, Aissi E, Ajana P, Dieusart P, Denis E, Dekassale EM, Houcke ML, Vinatier D. Spontaneous abortion and reinfection by Toxoplasma gondii. The Lancet 1991; 338:444.  Back to cited text no. 16    
17.Gavinet MF, Robert F, Firtion G, Delouvrier E, Hennequin C, Maurin JR, Tarte Schaefer C, Dupouy-Camet J. Congenital Toxoplasmosis due to maternal reinfection during pregnancy. J Clin Microbiol 1997;35:1276-77.  Back to cited text no. 17    
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2004 - Indian Journal of Medical Microbiology
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