Investigating the prevalence of Toxoplasmosis and Cytomegalovirus infection among pregnant women in Iraq.

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Chapter four result and discussion

In a prospective study conducted in Karbala governorate and include240 pregnant women that attending to gynecological hospital and obstetric for detection seroprevalence of Toxoplasmosis and Cytomegalovirus infection by using minividas technique .the results revealed that the prevalence rate with Toxoplasmosis was (29.1)and (92.88) with Cytomegalovirus infection .these rate distributed as (28.3%) for chronic Toxoplasmosis (IgG), and (0.8%) for acute Toxoplasmosis (IgM).while results for Cytomegalovirus (CMV) revealed that (92.08% ) positive for chronic CMV (IgG) and (0.8%) positive for acute CMV(IgM) as shown in table (4-1).

Table(4-1): The seroprevalence rate anti-T. gondii and anti-CMV anti-bodies among the study samples .

N0

%

Anti-T.gondii antibodies

IgG IgG

Positive

68

28.3

Negative

172

71.7

Total

240

100.0

IgM

Positive

2

.8

Negative

238

99.2

Total

240

100.0

Anti- CMV antibodies

IgG

Positive

221

92.08

Negative

19

7.92

Total

240

100.0

IgM

Positive

2

0.8

Negative

238

99.2

Total

240

100.0

The current study is one of few studies in Iraq to explore the prevalence of T.gondii and CMV infection among pregnant women. In our study, we also detected CMV as co-infections accompanying withT.gondiiinfections. The prevalence of anti- T. gondii antibody observed in this study was agreement with seroprevalence data from previous studies conducted in Salah – Aden governorate by (ADdory, 2011)[108] who found that seropositivity Anti- T.gondii (IgG) was (26.1%) of cases while seropositivity for ( IgM) antibody was (3.1%) of cases and both was (29.2%). close to be similar results were mentioned by Raad Abas and Haytham AL-awadi (2012)[109] in Babylon province Who recorded (29.64%). Nijem and Al-Amleh (2009), among pregnant women in Hebron district ,Palestine, was found (27.9%) for IgG by using ELISA technique[105] . Also , seropositivity rate in this study consistent with the result of Al-Harthi et al. (2006) in Makah, Saudi Arabia when he was determined seroprevalence of T. gondi infection using 197 pregnant women and showed that the seroprevalence of anti- T. gondii (IgG) was (29.4%), whereas IgM seropositvity was (5.6%)[241] .another study nearly similar to our study in Turkey between (2004 and 2011) were mentioned by(I Akyar) who found seropositivity T. gondii(IgM) and (IgG) were 1.34 and 24.6, respectively[242] . This similarity may belong to availability of the same appropriate conditions including temperature, humidity ,hygienic level and other risk factor that allow to the longer infectivity and viability of the oocysts which considered as a main source for infection spread in these cities .

the seropsitive rate in this study was lower than study recorded by Al-Jebouri, M. et al., (2013) which he was found the high prevalence of toxoplasmosis among the investigated high risk women at Al-Hawija and at Al-Baiji was (42%)[111] , Almosawi (2012)in Babylon province who found seroprevalence of anti- T. gondii antibodies was (65.8%)[110] . Aziz and Drueish (2011) found seroprevalence of anti- T. gondii antibodies was51(41.8%) among 122 aborted women[243] . also in Sudan 34.1% [244] , in Jordan 47.1% [106] and in Zanjan, Northwest of Iran 38.6% (IgM and IgG were positive in 1.4% and 37.2% respectively) [245] .

while the seropsitivity cases in this study was roughly higher in the present study than that recorded by Hussein Aqeelyet al.,(2014),which was demonstrated that seropsitivity rate (24.1%)amongst Pregnant Women in Jazan Province, Saudi Arabia[107], recent study reported in London were found seropsitivity rate was (17.32%) among antenatal women[246] .

This may be due to the difference in the availability of optimum environmental conditions among countries and different socio-demographic regions in the same country for survive and spread the parasite in addition to the presence of more than one risk factor influencing the occurrence of toxoplasmosis as the habits of people and the sanitary conditions and variation in the sensitivity of different immunoassays. This may explain the variation in seropositivity [247] .

Figure (4-1)

The seroprevalence rate Toxoplasma gondii(IgM) anti-body among the study samples .

Figure (4-2)

The seroprevalence rate Toxoplasma gondii(IgG) anti-body among the study samples

while prevalence CMV infection in current study was (92.08), (0.8%)for (IgG) and (IgM) respectively as mentioned previously , All research work from different parts of the world had proven that almost all people have had CMV infection during their life from early childhood and become persistent[204 and 248] , also its incidence has been estimated to be between 0.2-2.2% of all live births in different parts of the world [205] . The highest percentage rates of CMV (IgG) seropositivity as observed in the current study may indicate the previous exposure of the tested women and now they are immune against CMV, especially when they were IgM-negative. similar conclusions were reported in (2006) who noticed that most of the tested women were had immune against primary CMV infection and these results suggested that latent CMV infection predisposes to adverse pregnancy outcomes[249] . Also this results agreement with observations recorded by Ali and his colleagues in 1992 in Mousil whose noticed that the seropositivity rates of CMV(IgG) and (IgM) among pregnant women were (90%) and (2.5%) respectively [250] .Al- Jebori, M. J. (2005) reported presence of anti CMV (IgG) in Baghdad among women serum was (93.3%)[251] . also ,close to be similar were mentioned by Salih Ahmed et al.,(2013)in Sulaimani city (Iraq) who recorded seropsitivity for (IgG) was (90.2%)[214] , Haniet al.,(2002)among Pregnant Saudi Women, who recorded that overall seropositivity IgG was (92.1%)[252] .

in this current study were observed pregnant women who afflicted with CMV infection were high percentages in many studies that reflected high prevalence rate among Iraq pregnant women because different modes of CMV transmission from person to person particularly between children who is shedding CMV in their all bodily fluids . Poor socioeconomic conditions that are characterized by overcrowding and a lack of hand hygiene, and placing children in daycare facilities, transmission from mother to infant by breastfeeding that promote CMV transmission [253] .

this current study inconsistent with other studies recorded by Aljumaili ZKM,et al.,(2013) in Kirkuk (Iraq)who found slightly higher comparison to my results was(96.6%) for (IgG) and (7.2%) for IgM[254] . also, Tabatabaee et al.,(2009) among pregnant Iran women ,who found That overall of seropositivity was ( 97.69%)[255] .

while the seropsitivity rate in this study was slightly higher in the present study than that recorded by Sheevani,(2005),which demonstrated that seropositivity rate was (87.4%)[256] . the variation between this study and another studies attributed multifactor's , different in socioeconomic conditions in the same and different country ,crowding index , sanitary level , children in daycare center and child feeding , also different in samples size .This may be an explanation variation in results.

Figure (4-3)

The seroprevalence rate CMV ( IgM) anti-body among the study samples .

Figure (4-4)

The seroprevalence rate CMV ( IgG) anti-body among the study samples .

Table( 4-2): The distribution of anti -T.gondii (IgG) antibodies according to the age groups.

Age groups

Anti-T.gondii (IgG)

Positive

Negative

Total

N0

%

N0

%

N0

%

<20

7

10.29

27

15.70

34

14.17

20-29

43

63.24

92

53.49

135

56.25

30-39

13

19.12

45

26.16

58

24.17

40-49

5

7.35

8

4.65

13

5.42

Total

68

100.00

172

100.00

240

100.00

χ2=3.485 df=3 p= 0.323

In table(4-2) illustrated the distribution of Toxoplasmosis among the age groups. Were showed the highest number of the seropositivity cases was (43) among age group ≤20 to 29 years, while the lowest number of these cases (5) was among age group 40 to 49 years. And when compared to negative cases the association was found to be statistically not significant relationship between toxoplasmosis and age groups( p= 0.323).

Our results in table(4-2) indicated the great risk group of pregnant women with toxoplasmosis at the age group between 20 – 29 year was (64.24%) of cases than other age, this results agreement to other Iraqi studies carried out in other cities and is nearly similar to results which recorded in Kirkuk by Aljumaili ZKM,et al (2013),was found 312 than 538of pregnant women in the age group < 30 years[254] , ADdory, A.Z.R.(2011) in AL- Muthana province / Iraq was found that the largest age group between (20-29)year[108] . Kadihm, M. A.( 2006) who showed main age group of seropositivity were toxoplasmosis between (20-30) [257] .This finding may reflect that age group is consider most marriage age for Iraqi female and in this age optimum activity regarding reproduction and fertility in additionally that age are active working adult age group and so have more chance of contact with (raw meat through cooking and soil through gardening).

But this result was inconsistent with the result recorded by Another studies by Kareem, S. S. (2008.)was showed the highest percentage of toxoplasmosis occurred at the age group (11-20) and (15-19) year respectively[258] . Whereas a previous study by Jasim, et al,(1979) was indicated that the incidence of toxoplasmosis increase with age but no more 50 years [259] .but Williamset et al.,(2005) was found the incidence increase with age but to a peak of 34 years[259] . Other results recorded by Fernands et al ., (2010) was showed no significant difference with age but the highest infection rate occurred in age group (31-35) years[260] . Hussein Aqeely.et al.,(2014)was found highest seropositivity of Anti- T.gondii (IgG) was found to be(13.1%) among pregnant women in the age group (35–39)[107] .