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Sero Burden of Toxoplasma Gondii and Associated Risk Factors Among HIV Infected Persons in Armed Forces Referral and Teaching Hospital, Addis Ababa, Ethiopia

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Sero Burden of Toxoplasma Gondii and Associated Risk Factors Among HIV Infected Persons in Armed Forces Referral and Teaching Hospital, Addis Ababa, Ethiopia iseas al D es ic & p P u ro b T l f i c o l H a e Journal of Tropical Diseases and Public a n r l t u h o J ISSN: 2329-891X Health Research Article Sero Burden of Toxoplasma gondii and Associated Risk Factors among HIV Infected Persons in Armed Forces Referral and Teaching Hospital, Addis Ababa, Ethiopia Fewzia Mohammed1,2*, Mulusew Alemneh Sinishaw3,4, Negash Nurahmed1, Shemsu Kedir Juhar1, Kassu Desta5 1Ethiopian Public Health Institute, Addis Ababa, Ethiopia; 2Armed forces Referral and Teaching Hospital, Addis Ababa, Ethiopia; 3Clinical Chemistry Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 4Clinical Chemistry Department, Amhara Public Health Institute, Bahir Dar, Ethiopia; 5School of Allied Health Science, Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ABSTRACT Background: Toxoplasmosis is a zoonotic disease, worldwide distribution caused by an obligate intracellular coccidian parasite, known as Toxoplasma gondii. T. gondii can lead to serious diseases in immuno-compromised patients such as HIV/AIDS patients. In most cases, central nervous system involvement can lead to encephalitis, which is one of the most important reasons for death among patients with HIV due to reactivation of tissue cysts that remained latent after the primary infection. This study was conducted to assess the sero burden of Toxoplasma gondii infection and identify associated risk factors among HIV infected individuals in Armed Forces Referral and Teaching Hospital, Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted from March to May 2016. After getting an informed consent a pretested questionnaire was used to gather socio-demographic information and data on factors predisposing to T. gondii infection using convenience sampling methods. Serum samples from each volunteered patients were screened for the presence of anti-T. gondii IgG and IgM antibodies by using ELISA test kit (CTKBIOTECH, USA). Data were entered and analyzed using SPSS version 15.0. The chi-square test was used to observe any difference between variables. p-values were determined and taken as a level of significance when they found less than 0.05. Results: The study recruited a total of 174 HIV infected patients, of whom 99 (56.9%) were males. The study also included different age strata ranging from 18-68 years. Most of the sampled subjects were found in the age group of 31-40 years old. About 154 (88.5%), were seropositive for anti-T. gondii IgG antibody and 3 (1.7%) seropositivity for anti-T. gondii IgM antibodies. None were positive for IgM antibody alone. Of all the variables included in the study, only the presence of the cat depicted an association with sero-burden of anti-Toxoplasma gondii IgG antibody (p=0.038). Conclusion: This study revealed a high sero burden of chronic toxoplasmosis in HIV/AIDS patients. HIV/AIDS patients having a domestic cat at their home were at higher risk of T. gondii infection. It would be important to increase public awareness about different routes of transmission of T. gondii. Besides, routine screening for Toxoplasma should be undertaken for all HIV-infected patients to minimize complications related to reactivation. Keywords: HIV/AIDS; Toxoplasma gondii; IgG; IgM Correspondence to: Fewzia Mohammed, Ethiopian Public Health Institute, Addis Ababa, Ethiopia, Tel: +251910439776; E-mail: [email protected] Received date: September 09, 2019; Accepted date: November 07, 2019; Published date: July 24, 2020 Citation: Mohammed F, Sinishaw MA, Nurahmed N, Juhar SK, Desta K (2019) Sero Burden of Toxoplasma gondii and Associated Risk Factors among HIV Infected Persons in Armed Forces Referral and Teaching Hospital, Addis Ababa, Ethiopia. J Trop Dis 8:341. doi: 10.35248/2329-891X. 20.8.341 Copyright: © 2020 Mohammed F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. J Trop Dis, Vol.8 Iss.4 No:341 1 Mohammed F, et al. INTRODUCTION associated with focal neurologic deficits. Progression of the infection can lead to confusion, drowsiness, seizures, Toxoplasma gondii, a member of the phylum Apicomplexa, is an hemiparesis, hemianopsia, aphasia, ataxia, and cranial nerve obligate intracellular parasite [1,2]. The life cycle consists of two palsies. Motor weakness and speech disturbance are seen as the stages (asexual and sexual); the asexual stage takes place in the disease progresses. If not treated promptly, patients may progress intermediate hosts, which are mammals or birds [1]. The sexual to coma within days to weeks. The eyes and lungs are the most stage takes place in the intestine of the definitive host; known common sites of extracerebral manifestation of toxoplasmosis, definitive hosts are members of the feline family, predominantly and such manifestations may occur with or without domestic cats [3]. concomitant encephalitis. Extra cerebral manifestations occur The three typical infections transmission routes of peoples are less frequently than cerebral toxoplasmosis [11]. foodborne, animal-to-human and mother-to-child (congenital) It is generally assumed that approximately 25% to 30% of the [3,4]. Immunocompetent women infected prior to conception world's human population is infected by Toxoplasma [14]. virtually never transmit toxoplasmosis to the fetus, although rare Actually, the prevalence varies widely between countries (from exceptions have been reported [5]. There are also rare instances 10% to 80%) and often within a given country or between of transmission i.e. via tachyzoites contained in blood products, different communities in the same region [15]. Low tissue transplants, or unpasteurized milk, and laboratory workers seroprevalences (10% to 30%) have been observed in North who handle infected blood can also acquire infection through America, in South East Asia, in Northern Europe, and in the accidental inoculation [6]. Sahelian countries of Africa. Moderate prevalence (30% to 50%) The infection of this parasite leads to an asymptomatic infection has been found in countries of Central and Southern Europe, in immune-competent persons. However, 10% to 20% of and high prevalence has been found Latin America and in patients with acute infection may develop cervical tropical African countries. lymphadenopathy and/or a flu-like illness. The clinical course is Toxoplasmosis is a major public health concern because the benign and self-limited; symptoms usually resolve within a few disease is serious in terms of mortality or physical and/or months to a year [7]. Mortality/Morbidity studies show that psychological sequellae in patients with HIV disease [15]. In the immuno-compromised individuals and fetuses are at particularly majority of normal, healthy (immune-competent) subjects, high risk for severe sequelae and even death [8]. Immuno- infection is asymptomatic and frequently results in the chronic deficient patients often have central nervous system disease but persistence of cysts within host tissues; the cysts normally lie may have chorioretinitis, or pneumonitis [9]. In patients with dormant, probably for life. But, in immune-compromised states AIDS, toxoplasmic encephalitis is the most common cause of such as in HIV infections, subjects are at risk of developing intracerebral mass lesions and is thought to be caused by acute toxoplasmosis due to reactivation of the organism if their reactivation of chronic infection [10]. CD4+ T-cell count decreases below 200 cells/μL [11,12]. Since When Toxoplasma infection is acquired by a mother during the pandemic of HIV infection has spread throughout the pregnancy, the parasite presents a significant risk of adverse world, toxoplasmosis has been implicated as one of the most outcomes to the fetus [11]. The risk of transmission from important opportunistic infections in HIV/AIDS patients. mother to fetus is lower when the maternal infection is acquired Moreover, in up to 10% of HIV infected immune-competent in the early stages of pregnancy but the outcome in such cases individuals, it causes cervical lymph-adenopathy or ocular can be severe or life-threatening to the fetus. Conversely, while disease [16-18]. maternal infection acquired later in pregnancy confers a higher In developing countries, Toxoplasma-HIV co-infected patients risk of transmission to the fetus, the clinical outcome is have a risk as high as 30% to 40% of Toxoplasma encephalitis, characteristically less severe, or the child may even be born especially those with significant immuno-suppressant (CD4 cell asymptomatic [12]. Latent T. gondii infection may be reactivated count<200 cells/μL) [2,4]. Thus, identification of latently in immune-deficient individuals (such as HIV-infected women) infected immunocompromised patients by determining anti- and result in the congenital transmission of the parasite [4]. Toxoplasma IgG (immunoglobulin G) antibodies becomes Four clinical signs are thus considered as representative of essential [19]. Studies in the USA showed that about 30% of congenital toxoplasmosis; hydrocephaly or microcephaly, AIDS patients previously exposed to toxoplasma and suffered retinochoroiditis, cerebral calcifications, and neurological injury. from a cerebral reactivation [20]. Consequently, it may be This clinical spectrum, which represents some of the late calculated that 8% of AIDS
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