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Seroprevalence of Toxoplasmosis Antibodies among Obese Individuals

Waleed M ALI1, Ahmed salih helal2, Mohammed Abdul-Aziz Kadir3 1-Dr. Waleed Mohammed Ali. Consultant physician, Kirkuk general hospital.

[email protected]. (07700909088).

2-Ahmed salih helal.K1 Hospital/North 0il Company. [email protected] , (0770123384).

3-Dr. Mohammed Abdul-Aziz Kadir. Professor of microbiology,Kirkuk University Colleg ofmedicine

.Mohammed [email protected].(07702184904).

Abstract

Background :Obesity has been documented as an emerging important public health problem ; and few studies has been carried out to explore the role of infection as an environmental factor in a concept known as infect obesity , taking an example of Toxoplasma gondii infection in obesity pathogenesis.

Objective : The aim of current study was to show the role of Toxoplasmosis as a causal factor of obesity .

Subjects and Method : Randomly collected 276 subjects attending North oil company outpatient clinic were selected to be enrolled in the study, male to female ratio was 1:1 , their BMI was measured and calculated per WHO criteria .

Serum of all the included subjects was tested of according to available tests following the agreement of the participants on the informed concept .

Results: Out of 276 subjects of both sex in a ratio of 1:1 were included in the study , female had higher infection than male ; the highest infection rate was among low educational level (primary school ) 59% ;the obese with BMI >30 had highest infection rate ( 37%) and IgG level was higher than IgM in both groups .

Conclusion : It was concluded that their was positive causal relationship between obesity and Toxoplasma infection.

Key words : Toxoplasma, BMI , infectobesity .

Introduction

Toxoplasma gondii is the causative agent of toxoplasmosisusually the infection is a symptomatic in adults; while in people with weak immune system a severform of thedisease may be obvious ; one of the most embarrassingSymptom seizer and poor coordination (1).

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The important sequelae of the infection is when a pregnant lady getsthe infection which many lead to a condition known as as congenital toxoplasmosis (2).

Till now few studies has throws light on the detection of antibodiesagainst Toxoplasma in general populationandadolescents , which recorded higher prevalence of the infection among Iraqi population in comparison to near by countries , indicating underestimated rate and concerning it a neglected public health problem (3).

Recently it has been documented that obesity is an important major public health problem and it is projected that in (2030), about 57% of the globe's population will get obese or over weight .

There are many emerging studies the role of infection as potential environmental factor in a concept known as (infectobesity) in obesity pathogenesis (4 ,5).

Toxoplasma gondi has been studied as a potential cause of obesity, being a common parasite worldwide as infects 30% of the population but the vast majority of a asymptomatic.This parasite has many stages of development as the tachyzoite which is characteristic of acute infection stage then itprogressesto slowly replication stage (bradyzoite)in immune competent host , while the sexual reproduction occurs only if the parasite is transmitted to a feline host (6).

In an experimental study on rats , it was clear that studied sample has gained weight after 30 days , followed by weight loss; in has been postulated from the results of the research thatinfection may has central effect on the brain ,affecting hypothalamic function which is triggered by peripheral inflammatory process; while the single study carried on human showed no significant associationbetween obesity and the presence of Toxoplasma anti body .(7)

The objective of the study;

of the currentstudy is to try to find an association between different levels of obesity and the antibody titer of Toxoplasma gondii among peopleattending north oil company clinic.

Subjects and methods ; Setting ;-

The study was carried out on (276 )patients attending out patient diabetic center for early detection of diabetesmellitus with no symptoms or signs related toToxoplasma from 1Nov to 30 Dec 2019.

Sample size and selection:

Defining obesity :

According toWHO definition obesity was defined as body mass index (B M I ) ≥30 , while non-obese was defined as (BMI< 30) .

The available commercial kit was used (medical - biozek kit )which was obtained from source ; and one - step test was performed using the whole blood of all cases to test for the existence of specific anti – gondii IgG , IgM . accordingto the manufacturer's instructions(8).

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Methology ;.

A total of 276 attendant to the diabetic center in North Oil Company/ Kirkuk were selected randomly to detect the existence of toxoplasmosis antibody in their serum. Their ages were ranging from 40 -70years old they have been grouped according to BMI to obese and non-obese according to WHO classification ,while the IgG ,IgM antibodies were detected according to the described methods by the following procedure.In this study,serum samples were analyzed for IgM and IgG antibodies by ELISA method by using method available kits (CODE:TOXM02 and TOXG01 BIOACTIVA DIAGNOSTICA. GERMANY, ELx800 instrument Biotek,USA).Briefly, one of the wells of the plate ELISA kit as blank. Next were added 100 uL of the standards, positive, negative controls and sample into selected wells plate. The wells were incubated for thirty minutes at room temperature. At the end of thirty minutes, the content of the wells were drained and then washed 5 times with wash solution. Except the blankone,100uL of the enzyme conjugate was added into each one and incubated for 30 min at room temperature.Then, contents of the wells were emptied and the wash cycle was repeated.To all wells, 100uL of TMB (tetra methyl blue) substrate solution was added and incubated for exactly 15min at room temperature in the dark. For stoping the reaction of stop solution was added. Absorbance plate wells were read at wavelength of 450-620nm with a plate reader within 30 minutes. To calculate the mean absorbance values, all samples were duplicated.For interpretation of quantitive results in this study,IgG antibody levels greater than 50IU/ML were positive. Toxoplasma IgM antibody were detected in the levels more than 8 UL/mL was considered positive.(8)

Stander curve toxoplasmosis IgM and IgG ANTIBODY

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Statistical analyses

The data were analyses using SPSS version 20 using both description and analytical approach to show the comparison and level of significance among group with P value equal to 0.05 as significant level (9).

Ethical approval

An informed consent was obtained from eachparticipant and official approval was completed from directory of health per MOH recommendations.

Result:Out of 276 enrolled participants in the current study , 146 were male and 130 were female in a ratio of male to female as 1 : 1. The percentage of female with positive anti _toxoplasma antibody was higher (98.43/o) than male (37.6%) with highly significant differences ,P value binge < 0.00. according to table -1- .

Table (1)

Demographic data of study sample Parameter T-gondi seropositivity

p - value Total

Negative sero –ve No .(%)

Positive sero +ve No . (%)

Sex

o.oo>

146 91(62.4%)

55 (37.6%) Male = 146

130 2(1.6%)

128(98.4%) Female = 130

276 total

Age

<0.001 50

28 (30%) 22(12)%

<39 years

90 4 ( 4%)

86(47%) 40 _ 49

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136 61 (66 % )

75 (41 % )

>50 years = 136

276 93(100 %)

183 (100%) total

Education

<0.001 114

15 (16 % ) 99 (54 % )

Primary school

130 59 (63 % )

71 (38.7 % ) Secondary school

32 19 (21 %)

13 ( 7.1 % ) High school

276 93 (100 %)

183 (100%) total

In linking the percentage of antibody positivity with age, it was clear that highest age group affected by in the infection was the group of 40_49 years , while the lowest was among age group <39 years , concerning the correlation between the antibody existence and education level of participants a diverse relation was declared as the highest level ofpositivity was among a primary school level (54%) while the lowest was among those with high school (7.1 %).

In observing as association of infection with BMI , it was obvious thatparticipants with over weight and obesity (BMI 25 _ ≥ 30) had the highest positive antibody (71%) with those with normal (BMI) had the lowest percentage 28% ) as in table (2).

Table -2

Association of Toxoplasmosis with BMI

Total % Study sample

No =276 BMI

Sero _ve No . (%) Sero +ve

No. (%)

81(29.1%) 30(32.3%)

51 (28 %)

< 24.9

93(33.6%) 30(32.3%)

63(34.4%) 25 < 30

102(37%) 33(35.40%)

69(37.60%) Obese≥ 30

276(100%) 93(100%)

183(100%) total

On testing the samples for the type of antibodies against toxoplasma , it was the predominant type was IgG (58 %) followed by IgM (24%) out of total 69 affected participants as shown in table 3

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.Table - 3

Association of T-gondii antibodies with obesity among study sample gondi-T

Non – obese

<24.9,BMI 25> 30 Obese

≥ 30BMI Anti –body

36 (31.5%) 29(24%)

IgM(+ve)

78(68.5%) 40(58%)

IgG (+ve)

114(100%) 69(100%)

total

Discussion

Toxoplasmosis is a parasitic disease caused by Toxoplasma gondii,human being can contract the infection from contaminated food or water with oocysts of under cooked meat, infected cat faces or from mother to child during pregnancy (1)

Obesity being a common public health problem and mostly related to eating habits, so infection by toxoplasma may be associated with ,increasing thy risk of contaminated food like fast food as eating double portions of meat with increase the risk by two folds (6).

In study done in Mexico, aiming to show association between obesity and sex , female had higher percentage the male (10) , this was in agreement with the current study where female had the higher infection rate . In Germany a nationwide study was carried out to show the association between obesity and sero- positively of toxoplasma anti body and the result showed that obesity (BMI) was an independent factor by infectivity presented as IgG (11).

Carter pustulated that obesity is(( a state of chronic inflammation ))and it is plausible that T.Gondi infection could be involved in T2 -D M and obesity (12).

In a research carried on by Reeves and colleagues ; it was reported that a strong positive association was found between obesity and sero-positivety of T. gondii by a two fold odd among obese(BMI>30)in comparison to seronegative individuals, as P value being 0.01; they have hypothesized that infection with T. gondii may stimulate reward _ driven behavior as over eating (6).

It was been reported that anti - toxoplasma seropositivity increases with age , and it was suggested that correlation may be due exposure to environmental factors that’s might aggravate the risk of transmission of the infection (13).

An indirect correlationbetween obesity and T._gondi was speculated by possibility that Toxoplasmosis may lead to activation of auto-immunity pathways by provoking the inflammation of I slets in the pancreas leading to (insulitis ) and developing diabetes , and leading in proper phagocytosis and provoking intracellular response to candida and Toxoplasma being both intracellular pathogens(14).

Conclusion: it was concluded from the current study there was positive correlation betweenToxoplasma gondii infection and obesity as both being chronic inflammatory condition.

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Recommendations :. It Is recommended to carry out further in -depth analysis of the correlation between obesity by its different levels sand their outcome on large scale prospective future researches.

References

1. Unter CA , Sibley LD . Modulation of innate immunity by Toxoplasma gondii virulence effector .Nature Reviews Microbiology .2012 ;10(11) : 766.

2. Mutlaq NH , AL–Harmoosh RA ,Mutlaq EH , et al. Assessment of Toxoplasmosisamong Aborted women AL – Najaf AL Ashraf province. Int. J. Chem Tech Research,2017,10(1):383-390.

3. Abdul_Husssein SQ,_AL marsomy HD.Prevalence of toxoplasma gondii infection among sample of Iraqi adolescents. Annals of Tropical Medicine and public .2020 : 23 ,11 . SP 231121 .DOI ; http://doi .orgl 10 . 362951 ASRO.2020 . 231121.

4. Dhurandhar NV . Infecobesity . obesity of infectious origin. J Nutr (2001)n. 131(10): 2794S-75.

5. Vasilakopoulou A . LE ROUX CW_ Could a virus contribute to weight gain ? Int J Obes (Lond).2007 ,31(9): 1350_6.

6. Reeves GM ,Mazaheri S ,Snitker S ,et al .Apositive association between T.gondii seropositivity and obesity . Frontiers in Public Health .2013 doi: 10.33891 pubh.2013 00073.

7. Thjodleifsson B , Olafsson I , Gislason D,et al.Infection and Obesity : A multinational Epidemiological study . Scand J I Dis (2008) 40(5): 381-6 .

8. Husskinson,P.Stepick-Biek etal:Toxoplasma antigens recognized by immunoglobulin G subclass during acute and chronic infection.J.Clin. Microbio(1989),27:2031.

9. Daniel,W.W and Cross CL,2015.Biostatic.A foundation for analysis in the health science ,5th edition, John Wiley and Sons USA.

10. Esquirel C A , Soto E M ,Anguine LF ,etal.Lack of serological and molecular Association between Toxoplasma gondi Exposure and obesity : A Case – Control study . IntJ Biomed Sci 2017 , (13) 2:74 – 78 .

11. Wilking H , Thamm M , Strak k .etal .Prevalence, Incidence estimation , and risk factors to Toxoplasma gondii infection in Germany , a representativeCross –sectional , serological study. Sci Rep ,2016,6:22551.

12. Carter CJ (2013) Toxoplasmosis and polygenic disease susceptibility genes; extensive toxoplasma gondi host / pathogen interactom enrichment in nine psychiatric or neurological disorders . J .Path (2013) ,http://dx.doi.org/10.1155/2013/965046.

13. SobralCA , Amendoeira M . R . and Teva A , Seroprevalence of infection with Toxoplasma gondii in indigenous Brazilian populations .Am. J. Trop. Med. Hyg (2005),v. 72, n. 1, p. 37-41.

14. Gonzalez _Del Carmen M ,Carrion Calvo L, Vazquez Avails S , et al . The link between Toxoplasmosis and Diabetes Modifications of pancreatic beta cells TC -6 Infected by Toxoplasma gondi tachyzoites .Trop Med Int Health . 2015.

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