Document Type : Original Article
Authors
1 Razi Herbal Medicines Research Center, Department of Parasitology and Mycology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
2 Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
3 Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
4 4Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 5Department of Obstetrics and Gynecology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
Abstract
Keywords
Pregnancy is one of the most critical steps in women's
lives, particularly those who want to become a mother
for the first time. Abortion is a problem that any women
might experience during pregnancy, and therefore suffer
from psychological issues and medical expenses, which
make it particularly important. One of the reasons for
abortion is toxoplasmosis, which is due to an infection
caused by
In general, a human typically becomes infected by three
principal routes of transmission including drinking contaminated
water or eating contaminated food, such as the
tissue cyst in half-cooked contaminated meat or food that
is contaminated with oocysts excreted from cat feces, and
congenital transition, that means the transmission from an
infected mother to her fetus (
The global estimated incidence rate of congenital toxoplasmosis
is 190,100 cases annually, with an approximate
incidence rate of 1.5 cases per 1000 live births [95% confidence
interval (CI): 179,300-206,300] (
One of the most popular medical concerns around the
world is how to diagnose acute congenital infections in a
pregnant woman that may lead to spontaneous abortion.
This type of abortion is the disposal of pregnancy products
before the twentieth week of gestation, without the
use of medical and mechanical factors (
With regard to geographical and climatic differences in
the prevalence of toxoplasmosis, and the lack of sufficient
and precise data on the role of the parasite in abortion,
in this study, the seroprevalence of anti-
Lorestan province is the thirteenth province in Iran in
terms of population and is considered as one of the most
populous provinces in Iran. The city of Khorramabad is
the capital of the province. Lorestan province is located
in Western Iran and placed between the latitudes 32. 30´
and 48.1´ N and longitudes 55. 17´ and 61. 15´E. The
long-term annual mean temperature and precipitation are
17.07°C and 580 mm, respectively. The weather of this
province is variable and is classified as a region with a
semi-arid climatic condition (
This case-control study was performed on 240 serum samples from women with first spontaneous abortion referred to the only maternity hospital in Khorramabad city, during 2016, as the case group. The control group consisted of 240 serum samples from women who had a normal delivery and referred to the hospital for a checkup and had no history of abortion. All of the subjects in both the case and control groups had a history of at least one successful pregnancy, as those who did not have successful pregnancies were not included in the study. After obtaining the written consent from the participants in the study, a questionnaire based on age, education (Low literate, Diploma, Academic degree), occupation (Employee, Student, Housewife), place of residence (Urban, Rural), contact with cats, and consumption of raw/half-cocked meat was filled out by the participants. The blood sampling and serum isolation procedures were done under sterile conditions.
The level of anti-T. gondii IgM and IgG antibodies were
measured in serum samples using the commercial kit, de
EIA de
To distinguish between the acute and chronic infections,
all IgM- and IgG-positive samples of the case group were
examined to evaluate IgG avidity by using the ELISA kit
according to the manufacturer.s instruction (ELISA: Euro
immune Kit, Germany). The test result is expressed as
relative index avidity (RIA). According to the kit manual,
the values less than 40% were considered as negative
while the value more than 60% were considered positive
and the borderline ranged between 40-60% (
Statistical analysis was done using the SPSS 22.0 software
(SPSS Inc., Chicago, IL, USA). The Logistic regression
and chi-square tests were used to evaluate the association
between the
This study was approved by The Ethics Committee of Lorestan University of Medical Sciences (No. 200.93.11707). The written informed consent was obtained from all the participants before sampling.
The results of the
Additionally, there was no significant difference between the case and control groups in terms of the prevalence of abortion in relation to education level (P=0.645) or the place of residence (city versus rural areas) (P=0.404). Out of all participants, 75.8% (182/240) of the case group and 72.5% (58/240) of the control group were living in the city. The results also showed that most of the women who had an abortion (67.1%) were housewives, and most of the women in the control group (61.7%) were employees, indicating that there is a significant difference in the relationship between occupation status and abortion rate (P<0.001). Also, 15% (36/240) of the women in the case group and 13.8% (33/240) of the control group kept a cat at home, but there was no significant difference between the two groups with regards to living near a cat (P=0.39).
Compare of seroprevalence of toxoplasmosis between women with first spontaneous abortion and control group
Variable | Case group n=240 | Control group n=240 | P value | |
---|---|---|---|---|
Age (Y) | 27 ± 6.499 | 27.01 ± 6.459 | 0.989 | |
Level of education | 0.645 | |||
Low literate | 73 (30.4) | 69 (28.8) | ||
Diploma | 109 (45.4) | 104 (43.3) | ||
Academic degree | 58 (242) | 67 (27.9) | ||
Occupation | <0.001 | |||
Employee | 168 (70) | 79 (32.9) | ||
Housewife | 72 (30) | 161 (67.1) | ||
Residence in the city | 0.404 | |||
Urban | 182 (75.8) | 174 (72.5) | ||
Rural | 58 (24.2) | 66 (27.5) | ||
Contact with cats | 0.696 | |||
Yes | 36 (15) | 33 (13.8) | ||
No | 204 (85) | 207 (86.2) | ||
Seropositivity rate for | 0.019 | |||
Yes | 8 (3.3) | 1 (0.4) | ||
No | 232 (96.7) | 239 (99.6) | ||
Seropositivity rate for | 0.784 | |||
Yes | 114 (47.5) | 111 (46.3) | ||
No | 126 (52.5) | 129 (53.7) | ||
Data are presented as mean ± SD or n (%).
All samples, which were positive in terms of anti-Toxoplasma IgM in both groups (9 samples) and IgG in the case group (114 samples), were evaluated by IgG avidity. Seven out of 8 (87.5%) sera, which were related to the case group, had low avidity indicating acute infection, whereas all positive IgG sera (100%) and 1 positive IgM sample, which was related to the control group had high avidity indicating chronic infection.
Maternal acute toxoplasmosis or congenital toxoplasmosis
during pregnancy is one of the important factors
that increase the chance of abortion. It was previously
believed that the congenital toxoplasmosis is due to an
initial infection that occurs during pregnancy (
In this survey, we found that 8 out of 240 cases had the
With regards to other issues that may play as risk factors
for abortion, our results showed that there was no significant
relationship between the rate of abortion and urban or
rural residence. Based on the results of this study with those
of the present research, it can be concluded that health education
and training classes for villagers has been effective
in increasing the level of knowledge and personal care. Although
there was no significant relationship between the
level of education and prevalence of abortion, a significant
correlation was observed between having a job and
prevalence of abortion, since in the case group, 67.1% of
the IgG-positive cases were housewives, and in the control
group, 61.7% of the women were employees. The reason
can be referred to as the lifestyle, which can affect the level
of information. Furthermore, according to our results, there
was no relationship between keeping a cat at home and the
rate of abortion (
Due to the wide range of clinical signs of toxoplasmosis
and the chance of getting confused with other diseases, it
is necessary to use laboratory methods to confirm the clinical
diagnosis. The serological assays have different sensitivities
and specificities and are based on the affinity and
avidity of antibodies. Detection of specific IgG antibodies
is rarely a problem and has good sensitivity and specificity
in different methods (
In this study, IgG avidity test was used to evaluate IgM-
and IgG-positive cases. The result showed that 8 cases
of IgM-positive in the case group had low avidity, which
indicated an acute phase of infection. On the other hand, 1
case of IgM-positive in the control group had high avidity,
indicating a chronic phase of infection. Disagreement in
the results of different studies may be due to the patients’
varying health status, differences in consumption of raw
or undercooked meat, and keeping cats as pets at home
(
Healthcare providers in women’s hospitals should know that in the case of a pregnant woman the avidity test is not a validated and final test to be used solely for decision making, and that an equivocal IgG avidity result should not be considered in the diagnosis process.
According to the findings of this study, it is suggested
that the necessary health information, especially on the