Detection of toxoplasmosis in patients with end-stage renal disease by enzyme-linked immunosorbent assay and polymerase chain reaction methods

Abstract

Toxoplasmosis caused by Toxoplasma gondii is an opportunistic infection. In healthy individuals, the infection is largely asymptomatic, but in immunocompromised people the parasite can become widely disseminated, causing severe toxoplasmosis. In patients undergoing haemodialysis, the phagocytic process shows a highly significant impairment. Therefore, this study aimed to investigate toxoplasmosis in patients with end-stage renal disease (ESRD) undergoing haemodialysis in Ahvaz hospitals, southwest of Iran. A total of 280 patients and 100 healthy subjects participated in this study. The presence of serum IgM and IgG antibodies against T. gondii was detected by ELISA and the presence of Toxoplasma parasites in whole blood was evaluated by GRA6 PCR. Anti-T. gondii IgG antibodies were detected in 82 (29.3 %) haemodialysis patients and 26 (26 %) controls. In addition, anti-T. gondii IgM antibodies were detected in 7.9 % of patients and in 4 % of controls. For both the antibodies, the differences were statistically significant (P < 0.05). PCR was performed with DNA extracted from blood samples of all patients and controls. PCR gave positive results with four of the 280 blood samples from patients but none for the control blood samples. The results revealed a high percentage of positivity for Toxoplasma antibodies in patients with ESRD undergoing haemodialysis and also confirmed the parasite in whole blood, indicating disseminated infection in these patients. Patients undergoing dialysis have a higher rate of active infection with Toxoplasma likely due to reactivation of a chronic infection. Thus, parasitological examinations of ESRD patients should be periodically carried out for monitoring and evaluating the possible dissemination of toxoplasmosis during haemodialysis.

Comparison of Toxoplasma gondii seropositivity in hemodialysis and peritoneal dialysis patients

“…Opposite to our findings, there are several studies that depicted significant and higher prevalence of seropositivity among HD patients and concluded that the exposure to HD is associated with more risk of toxoplasmosis [1,2,7,8,10,11]. The discordance between our results and other studies may be due to the higher prevalence of Toxoplasma seropositivity in control group when it compared to the studies which found a deleterious effect of the dialysis of seropositivity of toxoplasmosis.…”

Serological and molecular survey of toxoplasmosis in renal transplant recipients and hemodialysis patients in Kashan and Qom regions, central Iran

“…These results indicated the importance of molecular diagnostic tests for detection toxoplasmosis in immunocompromised patients. In this regard, Saki et al 12 detected T. gondii DNA in 1.4% (4/280) of HD patients and none of healthy individuals. They also detected 29.3% and 26% IgG seropositivity and 7.9% and 4% IgM seropositivity among HD patients and control group, respectively (p < 0.05).…”

“…[13][14][15][16][17][18][19][20] Moreover, higher seroprevalence of toxoplasmosis has been reported in hemodialysis and chronic renal failure patients. 12,23,25,32 The diagnosis of toxoplasmosis is based on serology. If an individual was IgM or IgM þ IgG positive, the patient has an active infection.…”

“…[10][11][12] In this regard, several cases of fatal and severe toxoplasmosis have been reported in kidney transplant recipients. [13][14][15][16][17][18][19][20] Hence, early diagnosis of toxoplasmosis is important for successful treatment of this infection.…”

Detection of acute and chronic toxoplasmosis amongst multi-transfused thalassemia patients in southwest of Iran

“…Sera were separated by centrifugation at 4000 rpm for 5 minutes and then stored at -20°C until tested using enzyme-linked immunosorbent assay (ELISA) technique according to the manufacturer's guideline as described earlier [6]. Anti-T. gondii IgG and IgM antibodeis were measured using commerical ELISA kit (IgG and IgM, Trinity Biotech Captia™, Jamestown, NY, USA).…”