Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Short Communication, J Womens Health Issues Care Vol: 5 Issue: 6

The Prevalence of Toxoplasma IgG Antibody in a Selected Population of Northern Italian Region

Montanelli Alessandro1, Bianchi Paolo2, Brambilla Simona2, Assandri Roberto2, Maura Federica2, Motta Lucia2, Levi Setti Paolo3, Monari Marta2*
1Laboratorio analisi chimico cliniche e microbiologiche, Spedali Civili di Brescia, Brescia, Italy
2Clinical Investigation Laboratory, Humanitas Clinical and Research Center Via Manzoni, 56, 20089 Rozzano (MI)-Italy
3Unit of Gynaecology and Reproductive Medicine, Humanitas Clinical and Research Center, Via Manzoni, 56, 20089 Rozzano, Milan, Italy
Corresponding author : Dr. Marta Monari
Humanitas Clinical and Research Center, Clinical Investigation Laboratory, via Manzoni 56, Rozzano, Milan, IT 20089
Tel:
+39-02-82244763
Fax: +39-02-82244790
E-mail: [email protected]
Received: September 16, 2016 Accepted: October 14, 2016 Published: October 19, 2016
Citation: Monatanelli A, Bianchi P, Brambilla S, Assandri R, Maura F, et al. (2016) The Prevalence of Toxoplasma IgG Antibody in a Selected Population of Northern Italian Region. J Womens Health, Issues Care 5:6. doi: 10.4172/2325-9795.1000254

Abstract

Toxoplasmosis is a common zoonosis in humans and is still a serious problem for pregnant women also in western industrialized countries. The infection may be acquired or congenital and in pregnant women, may be transferred to the fetus causing miscarriage or congenital malformations. In Italy, a nationwide epidemiological surveillance system for Toxoplasmosis is still lacking. Aim of the present study is an assessment of the prevalence of anti-Toxoplasma gondii antibodies IgG in a Northern Italian region. We have performed a retrospective study in which we analyzed 16937 samples (16.118 female, 819 male all in fertile period). All samples were analyzed using Toxo IgG Architect®, for the quantitative determination of IgG antibodies in human serum or plasma. The data were classified following manufacturer’s guide (<1.6 IU/mL negative; ≥ 1.6 <6 IU/mL as doubt immunity; and ≥ 6.0 IU/mL immunity). Using these cut-offs we reported 14967 women (93%) and 455 men (55.6%) susceptible to Toxoplasma gondii infection for a total of 15422 persons (90.2%). Our data showed that the level of attention for the possible infection in pregnant women should not be lowered, to avoid possible malformations of the foetus. An active screening for Toxoplasma gondii during pregnancy should be introduced, but we also suggest introducing pre-pregnancy controls to closely assess the susceptibility and to exclude the immune women in further retest.

Keywords: Toxoplasma gondii; IgG antibody; Pregnancy

Keywords

Toxoplasma gondii; IgG antibody; Pregnancy
In our western industrialized world the infection of Toxoplasma gondii is still a serious problem for pregnant women, and the use of generalized screening is still debated. Toxoplasmosis is a common zoonosis found in humans, and human infection may be acquired or congenital. The acquired infections occurs after the ingestion of contaminated raw or undercooked meat, contaminated water, and soil contaminated with cat feces, especially while handling it during gardening and horticultural activities. Congenital infection, in pregnant women, may be transferred to the foetus through the placenta and moreover, if acquired during pregnancy, toxoplasmosis can cause miscarriage or congenital malformations affecting brain, eyes or other organs of the foetus. Congenital Toxoplasma infection may arise in 25% of acute maternal infections during pregnancy. To reduce the risk of foetal infection, several EU countries have implemented in the last three decades have implemented mandatory or recommended prenatal testing programs: these test are applied in various ways in France, Belgium, Switzerland and Austria [1,2] but these are not recommended for routine application in United Kingdom, in The Netherlands and Norway [3]. In Italy, a nationwide epidemiological surveillance system for Toxoplasmosis is still lacking, although surveillance is available on a regional basis. Serological tests for toxoplasmosis are performed as routine prenatal screening during pregnancy, with a first evaluation at 13th week, followed by monthly testing for pregnant women seronegative for toxoplasmosis (5-7 test in total), as indicated by Italian legislation. Recent results of Società Italiana di Neonatologia (SIN) showed a seroprevalence in fertile women equal to 58% in Europe, 51-72% in Latin America and 54- 77% in Africa. A particular focus has been done in Lombardia with a seroprevalence of 22.5% in fertile women [4]. In Italy there is not a clear picture of the real epidemiological status in fertile women. The aim of the present study is an assessment of the prevalence of anti- Toxoplasma gondii antibodies IgG in a Northern Italian region. We have done a retrospective study in which we analyzed 16937 samples (16.118 female, 819 male all in fertile period), collected in 30 months of observations (from October 2013 to April 2016) and all arrived to our medical assisted procreation center. The study was approved by the Hospital Ethics Committee. All samples were collected before the beginning of the assisted reproduction medical practices, and all the fresh sera were analyzed, after centrifugation, in 3 hour from the blood collection. The mean age of women enrolled in this study was 37.8 years (range 32-43 years), while for the men the mean age was 40.5 years (range 35-47 years). All subjects were resident in urban areas and data about their occupation were not available. All samples were analyzed using Toxo IgG Architect®, an immunoassay for the quantitative determination of IgG antibodies in human serum or plasma using chemi-luminescent (CMIA) technology. In all session we analyzed a negative and positive control to verify the analytical performance of the kit for the detection of Toxo IgG, and every month we participated to an external quality validation program for this serological test. The resulting reaction is measured as relative light units (RLUs). For the interpretation of results we adopted <1.6 IU/mL (following manufacturer’s guidelines) as negative cut off, ≥ 1.6 <6 IU/ mL as doubt immunity (1.6-3.0 following manufacturer’s guidelines), and ≥ 6.0 IU/mL immunity, to adopt a more stringent [5]. If we set the cut off of immunity on 1.6 IU/mL (as suggested by Abbott) we registered 14967 women (93%) and 455 men (55.6%) susceptible to Toxoplasma gondii infection for a total of 15422 persons (90.2%; Exact Fisher test P<0.0001). If we adopt a more precautionary set up on 6.0 IU/mL the women susceptible to Toxoplasmosis will increase to 15364 (95.4%) and men to 554 (67.7%), for a total of 15918 (93.4%; Exact Fisher test P<0.0001). Consequently the immune women range from 9.8% (Toxo IgG <1.6 IU/mL) to 4.6% (Toxo IgG<6.0 IU/mL), and men from 44.4% to 32.3% (Table 1).
Table 1: Number and frequencies of women and men susceptible to Toxoplasmosis stratified by different cut-offs.
Our study has confirmed the great impact in adopting the necessary preventive measures to limit Toxoplasma transmission from mother to child. Our data showed a very low prevalence of the immune status in fertile women thus needing laboratory tests including the search for anti-Toxoplasma antibodies at the beginning of pregnancy (best before the 13th week) and, in case of IgG negativity, needing to repeat tests every 30 - 40 days until delivery for a total of -7 screenings. Obviously this protocol requires a high compliance level both from patients and general practitioners. Although frequency of T. gondii infection has been reported in other studies to increase in older age groups [6], and nowadays the age of pregnancy has risen, it should be more likely for pregnant women not to be susceptible to infection. The high frequency of seropositive males raises an intriguing question, about this discrepancy between females and males. The origin areas can’t explain this difference, so that we have no explanations for this discrepancy in the frequency of seropositive subjects between females and males. We can only hypothesize that possible explanations can be found in the work habits, being more common, between males, the contact with possible infection sources during the work (builders, farmers, butchers etc.), and also by different eating habits as already hypothesized by Wilking et al. [7]. Another hypothesis is that men have an active sport life (football, trekking, climbing, etc.) that implies an increased exposure to the infection.
Despite these previous studies, our data showed that the level of attention for the possible infection in these older pregnancies should not be lowered, to avoid possible malformations of the foetus. So it seems appropriate to maintain active screening for Toxoplasma gondii during pregnancy but we also suggest introducing pre-pregnancy controls to closely assess the susceptibility (also in older pregnant women) and to exclude the immune women in further retest.

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