Iran J Parasitol: Vol. 12, No. 1, Jan-Mar 2017, pp.

117-122

Iran J Parasitol
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Original Article

Seroepidemiological Study of Toxoplasma gondii Infection

among Psychiatric Patients in Mashhad, Northeast of Iran
Ebrahim ABDOLLAHIAN 1, *Reza SHAFIEI 2, 3, Naghmeh MOKHBER 1, Kurosh KA-
LANTAR 4, *Abdolmajid FATA 3, 5

1. Psychiatry and Behavioral Sciences Research Center, Faculty of Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran
2. Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
3. Dept. of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
4. Dept. of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
5. Research Center for Skin Diseases and Cutaneous Leishmaniasis, Emam Reza Hospital, Mashhad University of
Medical Sciences, Mashhad, Iran

Received 22 Apr 2016 Abstract

Accepted 03 Jul 2016 Background: Psychiatric patients have an increased risk of some infections like
toxoplasmosis. Investigations on Toxoplasma gondii infection among psychiatric pa-
tients have been limited in Mashhad, Northeast of Iran. In this case-control study,
Keywords: prevalence of T. gondii was investigated by serological method.
Toxoplasma gondii, Methods: This case-control study was performed among psychiatric patients ad-
Psychiatric patients, mitted to Avicenna Hospital in Mashhad, Northeast of Iran. Three hundred and
ELISA fifty inpatients and 350 controls were examined in 2012-2013 for detection of IgG
and IgM antibodies against T. gondii in their blood sera by ELISA. Socio-
demographic and clinical manifestations of the patients were obtained.
Results: Anti-T. gondii IgG antibodies was found in 164 (46.85%) of 350 psychia-
tric inpatients and 120 (34.28%) of 350 controls. Seventeen (4.85%) of psychiatric
*Correspondence individuals and 3 (0.85%) of control group were IgM+/IgG- indicating acute form
Emails: of toxoplasmosis. There were no statistically significant differences between the
1-Fataa@[Link] case and control groups. In patient group, schizophrenic patients had the highest
2-shafieir@[Link] positive rate (46.28%) and bipolar mood disorder had the second most prevalent
rate (20%). Of 162 schizophrenia patients, 65 (40.1%) had latent infection which
was higher than that observed in controls.
Conclusion: The prevalence of T. gondii infection among psychiatric patients suf-
fering from schizophrenia was more in Mashhad, compared with control group.

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Introduction

P sychiatric patients are in high risk of

some infections, not only because of
their life style; however, it could be a
common etiologic process. The relationship
between infectious diseases and psychiatric
The aim of this investigation was to check
the prevalence of antibodies against T. gondii in
patients with psychiatric and mood disorders
and in a matched group of control subjects.

disorders has rooted in the epidemiologic sur- Materials and Methods

veys that reports high co-morbidity of these
conditions (1-3). Some infections have been This case-control study was performed in
declared to play a role in the etiology of some 2013 between two populations: psychia-
major psychiatric problems (4, 5). tric/mood disorders patients and control group.
Toxoplasma gondii, is one of the obligate Since Dec 2011 to Mar 2012, all patients re-
intracellular protozoan parasite in the phylum ferred to the only Avicenna Hospital in Mash-
Apicomplexa with a worldwide distribution in had, Northeast of Iran, were invited to enroll in
a wide variety of intermediate hosts including this study. The patients had been diagnosed
humans and other mammals (6). Humans may clinically by psychiatrics. All psychiatric patients
become infected through with ingestion of were included in the study based on the follow-
oocysts in cat feces, or by eating meat of in- ing inclusion criteria: 1) psychiatric inpatients,
fected animals (7). Primary acute toxoplasmo- 2) aged >16 yr, 3) consent to participate in the
sis may be developed in each trimester of study. During the study period, 350 psychiatric
pregnancy and causes severe damage to the disorders patients were hospitalized. The age
foetus (8, 9). Subsequently, usually acquired range of the population was 16-75 (35±11.61)
infections are asymptomatic but in some pa- yr old. All patients had no family history of
tients presented by ocular and central nervous schizophrenia, no evidence of immunodefi-
system manifestations. T. gondii may affect do- ciency or other immunologic abnormalities, no
pamine levels into the brain, causing in altera- history of head trauma, previous meningi-
tions in CNS (10). Earlier investigations ob- tis/encephalitis and brain surgery.
served that latent Toxoplasma infection might Sampling
affect behavior (11), perhaps being a contribu- Three hundred and fifty healthy volunteers
tory, or even causative, factor in some psy- were selected as control group. They were
chiatric disorders, including depression, anxie- screened for the absence of physical and psy-
ty and schizophrenia (1, 10, 12-14). chiatric disorders and matched to patients ac-
Several factors affect prevalence of toxop- cording to sex, socioeconomic status, and age
lasmosis including age, rural or urban setting, (38±13.2 yr old), matched with study group
socioeconomic criteria and nutritional habit (P>0.05).
(15). Furthermore, seroprevalence of infection The Research Ethical Committee of Mash-
rates vary from 10% to 70% in Asia (16), 24% had University of Medical Sciences, Iran, ap-
to 57.5% in two Iranian populations (17, 18). proved this study. All participants signed in-
It is estimated to be about 50% in Iran; there- formed consent form.
fore, toxoplasmosis continues to be a public
health problem in Iran (19). In Northeast of Serological examination
Iran, there is no data about seropositive of T. A sample of 5 ml blood was collected from
gondii infection from health and patients suffer each psychiatric patients and control; then se-
from psychiatric problems, and there is no rum separated by centrifugation at 1000 r.p.m.
information about risk factors between T. gon- and stored at -20 ºC. All samples labeled by
dii antibodies and psychiatric disorders. blind numbers unrecognized to other col-

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 Iran J Parasitol: Vol. 12, No. 1, Jan-Mar 2017, pp.117-122

leagues in this study. The levels of specific Statistical analysis

IgG and IgM antibodies to T. gondii in the se- Socio-demographic data including age,
rum samples were measured using a commer- birthplace, residence, marital status, occupa-
cial enzyme immunoassay kit (Pishtaz Teb Di- tion, educational level and socio-economic
agnostics, Tehran, Iran). The IgG and IgM level were obtained from all patients. Clinical
antibody titers were read at optical density data including blood transfusion or transplant
(OD) of 490 nm using automatic ELISA read- history; and behavioral data including animal
er (Spectra, Molecular Devices, USA). ELISA contacts, cat attender, consumption of meat
cut off for positive and negative results were (raw or undercooked lamb, beef, goat, chicken,
10IU/ml. The results below that considered as sea food and bird), unpasteurized dairy prod-
negative and upper than that considered as ucts, contaminated water, improper washed
positive. raw vegetable or fruits, contact with soil (gar-
SPSS software ver. 16.0 was used for statis- dening or agriculture), were obtained. Clinical
tical analysis. The relative proportions were diagnosis was confirmed by means of the
calculated with a confidence interval of 95%. Structured Clinical Interview as mentioned in
Possible associations were identified using the the Diagnostic and Statistical Manual of Men-
Chi- Square and Fisher’s exact statistical tests tal Disorders, Fourth Edition (DSM-IV) crite-
at a significant level of 5%. ria (20).

Table 1: Seroprevalence of anti-T. gondii IgG/IgM antibodies in psychiatric patients and controls according to
age groups and gender
Age group Controls Psychiatric patients
(yr)
T. gondii infection T. gondii infection
IgG+ IgM+ No. tested IgG+ IgM+ No. tested
No. % No. % No. %
No. % Female Male Female Male
10-20 0 2 (0.58) 9 6 1 (0.28) 9 (2.58) 9 21
21-30 2 (0.58) 20 (5.72) 56 50 5 (1.43) 44 (12.58) 22 78
31-40 0 33 (9.43) 45 40 5 (1.43) 45 (12.85) 33 79
41-50 1 (0.28) 36 (10.29) 46 39 5 (1.43) 13 (3.72) 9 62
51-60 0 16 (4.58) 15 24 1 (0.28) 13 (9.71) 13 18
61-70 0 6 (1.72) 6 7 0 2 (0.58) 1 4
71-80 0 4 (1.14) 3 4 0 0 0 1
Total 3 (0.85) 117 (33.42) 180 170 17 (4.85) 147 (42) 87 263
Total Together 350 350

Results both patients and controls increased with age

(Table 1).
The number of male individuals were 263 There were no statistically significant differ-
(75.1%) and 170 (48.6%) in patient group, re- ences in any of the case and control groups.
spectively. More than 74% of the patients However, the patients in middle age groups in
were citizens of Mashhad. The anti T. gondii control group showed higher rates of IgG+
IgG+/IgM+ antibody was positive in 46.85% seroprevalence
and 34.28% of both case and control group, (P=0.002). According to psychiatric diagno-
respectively. The seroprevalence of latent T. sis based on DSM-IV criteria schizophrenic
gondii infection in the populations studied ac- patients had the highest positive rate (46.28%)
cording to age groups and gender. As you can and by Chi square test, there is significant dif-
observe the prevalence of the infection in ference between IgG and IgM positives in pa-

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 Abdollahian et al.: Seroepidemiological Study of Toxoplasma gondii Infection among …

tients and control group; P=0.019 and according to their psychiatric disorder. The
P=0.001, respectively. Patients with bipolar highest prevalence of latent T. gondii infection
mood disorder were the second most preva- in schizophrenics was found in patients aged
lent group (20%). Table 2 shows the seropre- 21-30 yr old (Table 3).
valences of T. gondii infection in the inpatients

Table 2: Clinical diagnosis and seroprevalence of anti-T. gondii IgG/ IgM antibodies in 350 psychiatric disord-
ers

Disorder Category Clinical Diagnosis Patients studied Patients with an- Patients with anti-
ti-T. gondii IgG+ T. gondii IgM+
Personality disorders Personality disorder 6 (1.71) 3 (0.85) 0
Anxiety disorders Posttraumatic Stress Disorder 15 (4.28) 4 (1.14) 0
Developmental disorders Mental retardation 6 (1.71) 2 (0.85) 0
Psychotic disorders Schizoaffective 24 (6.9) 10 (2.85) 1 (0.28)
Psychotic disorders Schizophrenia 162 (46.28) 65 (18.57) 9 (2.56)
Psychotic disorders Delusional Disorder 8 (2.28) 4 (1.14) 0
Developmental disorders Mental disorder 24 (6.85) 8 (2.28) 1 (0.28)
Mood disorders Bipolar Affective Disorder 70 (20) 33 (9.42) 5 (1.42)
Mood disorders Major Depressive Disorder 35 (10) 18 (5.13) 1 (0.28)
Total 350 (100) 147 (42) 17 (4.85)

Table 3: Seroprevalence of anti-T. gondii IgG antibodies in schizophrenic patients according to age groups

Age groups (yr) Schizophrenic patients

No. Tested Positive No. %
10-20 10 2 20
21-30 50 23 46
31-40 56 21 37.5
41-50 31 13 41.3
51-60 12 5 41.6
61-70 3 1 33.3
Total 162 65 40.1

Discussion 26) and some reports in the world (27-31).

However, some of them are in contrast (12, 15,
Toxoplasma gondii is one of the most wide- 25, 32-35). This difference could be due to our
spread protozoan parasites of humans (9), al- method for selection of population study. Fur-
though, prevalence between different popula- thermore, the healthy individuals in our con-
tions varies according to different geographi- trol group were the relatives of the patients’
cal regions. In a previous study on HIV pa- group revealed that the higher prevalence of
tients in Mashhad, the IgG and IgM anti- toxoplasmosis in psychiatric and schizophren-
Toxoplasma antibodies were estimated 38.01% ic patients showed associations between T.
and 2.5%, respectively (21). gondii infection and schizophrenia as other re-
In the present study, the prevalence of T. searchers have reported (1, 12-14). Patients
gondii infection was 46.85% and 34.28% in with schizophrenia have insufficient hygiene
psychiatric inpatients and control individuals, and self-care skills, and they have a greater
respectively. The present results correspond tendency to pica and coprophagia. The preva-
with the result of the other places of Iran (22- lence of anti- T. gondii IgM antibody was not

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 Iran J Parasitol: Vol. 12, No. 1, Jan-Mar 2017, pp.117-122

significantly high in patients in comparison to in a low Toxoplasma seroprevalence Mexican

the control group. population. Parasitol Int. 2011; 60(2): 151-5.
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tify either of infection acquired as early as High prevalence of the hepatitis C virus
birth time or months/yr later. This is because infection among the inpatients of schizophrenia
anti-schizophrenia and bipolar disorder drugs and psychoactive substance abuse in Japan. Prog
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In addition, environmental exposures have 28(3): 591-7.
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The authors appreciate financial support re- behavior. Schizophr Bull. 2007; 33(3): 757-60.
ceived through a research grant No. 87-300 12. Hamidinejat H, Ghorbanpoor M, Hosseini H,
approved by Deputy of Research, Mashhad Alavi SM, Nabavi L, Jalali MH, et al. Toxoplasma
University of Medical Sciences, Mashhad, Iran. gondii infection in first-episode and inpatient
The authors are grateful to nursing staffs of individuals with schizophrenia. Int J Infect Dis.
Avicenna Psychiatric hospital in Mashhad for 2010; 14(11): e978-81.
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their kind cooperation in preparing the serum
Roberts CW. Neuropsychiatric disease and
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