Remington JS, McLeod R, Thulliez P, Desmonts G, 2001. Toxoplasmosis. Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant. Fifth edition. Philadelphia, PA: Saunders, 205–346.
Jones JL, Dargelas V, Roberts J, Press C, Remington JS, Montoya JG, 2009. Risk factors for Toxoplasma gondii infection in the United States. Clin Infect Dis 49: 878–884.
Schmidt DR, Hogh B, Andersen O, Fuchs J, Fledelius H, Petersen E, 2006. The national neonatal screening program for congenital toxoplasmosis in Denmark: results from the initial four years, 1999–2002. Arch Dis Child 91: 661–665.
Fernandes RC, Vasconcellos VP, Araújo LC, Medina-Acosta E, 2009. Vertical transmission of HIV and Toxoplasma by reactivation in a chronically infected woman. Braz J Infect Dis 13: 70–71.
Nabnien K, 1979. Seroepidemiological Study of Toxoplasmosis in the Central Part of Thailand [master's thesis]. Bangkok: Mahidol University.
Morakote N, Thamasonthi W, Charuchinda K, Khamboonruang C, 1984. Prevalence of Toxoplasma antibodies in Chiang Mai population. Southeast Asian J Trop Med Public Health 15: 80–85.
Chintana T, Sukthana Y, Bunyakai B, Lekkla A, 1998. Toxoplasma gondii antibody in pregnant women with and without HIV infection. Southeast Asian J Trop Med Public Health 29: 383–386.
Wanachiwanawin D, Sutthent R, Chokephaibulkit K, Mahakittikun V, Ongrotchanakun J, Monkong N, 2001. Toxoplasma gondii antibodies in HIV and non-HIV infected Thai pregnant women. Asian Pac J Allergy Immunol 19: 291–293.
Chintana T, 1991. Pattern of antibodies in toxoplasmosis of pregnant women and their children in Thailand. Southeast Asian J Trop Med Public Health 22: 107–110.
Sukthana Y, 1999. Difference of Toxoplasma gondii antibodies between Thai and Austrian pregnant women. Southeast Asian J Trop Med Public Health 30: 38–41.
Tantivanich S, Amarapal P, Suphadtanaphongs W, Siripanth C, Sawatmongkonkun W, 2001. Prevalence of congenital cytomegalovirus and Toxoplasma antibodies in Thailand. Southeast Asian J Trop Med Public Health 32: 466–469.
Maleewong W, Lulitanond V, Pipitgool V, Auwijitaroon Y, Kuttsarejariya S, Morakote N, 1989. Prevalence of Toxoplasma antibodies in blood donors and pregnant women in Khon Kaen Province. J Med Assoc Thai 72: 256–259.
Daenseekaew W, Maleewong W, Luevisadpaibul V, Molagool S, Rajanuwong A, 1992. Seroprevalence of Toxoplasma gondii in pregnant women in Ubon Ratchathani province. J Med Assoc Thai 75: 609–610.
Han K, Shin DW, Lee TY, Lee YH, 2008. Seroprevalence of Toxoplasma gondii infection and risk factors associated with seropositivity of pregnant women in Korea. J Parasitol 94: 963–965.
Buchy P, Follézou JY, Lien TX, An TT, Tram LT, Tri DV, Cuong NM, Glaziou P, Chien BT, 2003. Serological study of toxoplasmosis in Vietnam in a population of drug users (Ho Chi Minh city) and pregnant women (Nha Trang). Bull Soc Pathol Exot 96: 46–47.
Liu Q, Wei F, Gao S, Jiang L, Lian H, Yuan B, Yuan Z, Xia Z, Liu B, Xu X, Zhu XQ, 2009. Toxoplasma gondii infection in pregnant women in China. Trans R Soc Trop Med Hyg 103: 162–166.
Wong A, Tan KH, Tee CS, Yeo GS, 2000. Seroprevalence of cytomegalovirus, Toxoplasma and parvovirus in pregnancy. Singapore Med J 41: 151–155.
Akinbami AA, Adewunmi AA, Rabiu KA, Wright KO, Dosunmu AO, Dada MO, Adeyemo TA, 2010. Seroprevalence of Toxoplasma gondii antibodies amongst pregnant women at the Lagos State University Teaching Hospital, Nigeria. Niger Postgrad Med J 17: 164–167.
Maggi P, Volpe A, Carito V, Schinaia N, Bino S, Basho M, Dentico P, 2009. Surveillance of toxoplasmosis in pregnant women in Albania. New Microbiol 32: 89–92.
Nissapatorn V, Noor Azmi MA, Cho SM, Fong MY, Init I, Rohela M, Khairul Anuar A, Quek KF, Latt HM, 2003. Toxoplasmosis: prevalence and risk factors. J Obstet Gynaecol 23: 618–624.
Sroka S, Bartelheimer N, Winter A, Heukelbach J, Ariza L, Ribeiro H, Oliveira FA, Queiroz AJ, Alencar C Jr, Liesenfeld O, 2010. Prevalence and risk factors of toxoplasmosis among pregnant women in Fortaleza, northeastern Brazil. Am J Trop Med Hyg 83: 528–533.
Montoya JG, 2002. Laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis. J Infect Dis 185: S73–S82.
Remington JS, Thulliez P, Montoya JG, 2004. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 42: 941–945.
Cruz ML, Cardoso CA, Saavedra MC, Santos ED, Melino T, 2007. Congenital toxoplasmosis infection in an infant born to an HIV-1-infected mother. Braz J Infect Dis 11: 610–611.
Spalding SM, Amendoeira MR, Klein CH, Ribeiro LC, 2005. Serological screening and toxoplasmosis exposure factors among pregnant women in South of Brazil. Rev Soc Bras Med Trop 38: 173–177.
Lopes FM, Mitsuka-Breganó R, Gonçalves DD, Freire RL, Karigyo CJ, Wedy GF, Matsuo T, Reiche EM, Morimoto HK, Capobiango JD, Inoue IT, Garcia JL, Navarro IT, 2009. Factors associated with seropositivity for anti-Toxoplasma gondii antibodies in pregnant women of Londrina, Paraná, Brazil. Mem Inst Oswaldo Cruz 104: 378–382.
Mohammad HI, Amin TT, Balaha MH, Moghannum MS, 2010. Toxoplasmosis among the pregnant women attending a Saudi maternity hospital: seroprevalence and possible risk factors. Ann Trop Med Parasitol 104: 493–504.
Ertug S, Okyay P, Turkmen M, Yuksel H, 2005. Seroprevalence and risk factors for Toxoplasma infection among pregnant women in Aydin province, Turkey. BMC Public Health 5: 66.
Alvarado-Esquivel C, Alanis-Quiñones OP, Arreola-Valenzuela MA, Rodríguez-Briones A, Piedra-Nevarez LJ, Duran-Morales E, Estrada-Martínez S, Martínez-García SA, Liesenfeld O, 2006. Seroepidemiology of Toxoplasma gondii infection in psychiatric inpatients in a northern Mexican city. BMC Infect Dis 6: 178.
Nijem KI, Al-Amleh S, 2009. Seroprevalence and associated risk factors of toxoplasmosis in pregnant women in Hebron district, Palestine. East Mediterr Health J 15: 1278–1284.
Kapperud G, Jenum PA, Stray-Pedersen B, Melby KK, Eskild A, Eng J, 1996. Risk factors for Toxoplasma gondii infection in pregnancy. Results of a prospective case-control study in Norway. Am J Epidemiol 144: 405–412.
Jenum PA, Kapperud G, Stray-Pedersen B, Melby KK, Eskild A, Eng J, 1998. Prevalence of Toxoplasma gondii specific immunoglobulin G antibodies among pregnant women in Norway. Epidemiol Infect 120: 87–92.
Qublan HS, Jumaian N, Abu-Salem A, Hamadelil FY, Mashagbeh M, Abdel-Ghani F, 2002. Toxoplasmosis and habitual abortion. J Obstet Gynaecol 22: 296–298.
Avelino MM, Campos D Jr, Parada JB, Castro AM, 2004. Risk factors for Toxoplasma gondii infection in women of childbearing age. Braz J Infect Dis 8: 164–174.
Ayi I, Edu SA, Apea-Kubi KA, Boamah D, Bosompem KM, Edoh D, 2009. Sero-epidemiology of toxoplasmosis amongst pregnant women in the greater accra region of Ghana. Ghana Med J 43: 107–114.
Dabritz HA, Conrad PA, 2010. Cats and Toxoplasma: implications for public health. Zoonoses Public Health 57: 34–52.
López-Castillo CA, Díaz-Ramirez J, Gómez-Marín JE, 2005. Risk factors for Toxoplasma gondii infection in pregnant women in Armenia, Colombia. Rev Salud Publica (Bogota) 7: 180–190.
Asthana SP, Macpherson CN, Weiss SH, Stephens R, Denny TN, Sharma RN, Dubey JP, 2006. Seroprevalence of Toxoplasma gondii in pregnant women and cats in Grenada, West Indies. J Parasitol 92: 644–645.
Hung CC, Fan CK, Su KE, Sung FC, Chiou HY, Gil V, da Conceicao dos Reis Ferreira M, de Carvalho JM, Cruz C, Lin YK, Tseng LF, Sao KY, Chang WC, Lan HS, Chou SH, 2007. Serological screening and toxoplasmosis exposure factors among pregnant women in the Democratic Republic of Sao Tome and Principe. Trans R Soc Trop Med Hyg 101: 134–139.
Lin YL, Liao YS, Liao LR, Chen FN, Kuo HM, He S, 2008. Seroprevalence and sources of Toxoplasma infection among indigenous and immigrant pregnant women in Taiwan. Parasitol Res 103: 67–74.
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Toxoplasma gondii is an important parasite in pregnant women. This case-controlled study assessed the seroprevalence of toxoplasmosis in 640 pregnant women in southern Thailand and identified their associated risk factors. The overall seroprevalence of toxoplasmosis was 181 (28.3%). Of this, 138 (21.6%) were positive for only anti-Toxoplasma immunoglobulin G (IgG) antibody, 43 (6.7%) were positive for both IgG and IgM antibodies, and none were positive for IgM antibody. Multivariate analysis revealed that increasing age (adjusted odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.01–2.67), living outside Songkhla province (adjusted OR = 1.56, 95% CI = 1.08–2.24), parity (adjusted OR = 1.65, 95% CI = 1.01–2.68), contact with cats (adjusted OR = 1.70, 95% CI = 1.20–2.43), and drinking of unclean water (adjusted OR = 1.70, 95% CI = 1.08–2.68) were factors associated with Toxoplasma seroprevalence. On the basis of the results obtained, a health surveillance program should be initiated as a primary preventive measure for congenital toxoplasmosis and focus on educating women of the child-bearing age group to avoid contact with cats and to strictly practice personal hygiene.
Financial support: This study was supported by the University of Malaya Research Grant (UMRG 094/09HTM), Kuala Lumpur, Malaysia and Faculty of Medicine Research Foundation (no.: 01/2553), Prince of Songkla University, Songkhla province, Thailand.
Disclosure: This work was presented in part at the XIIth International Congress on Parasitology (ICOPA XII), Melbourne, Australia, 15–20 August 2010.
Authors' addresses: Veeranoot Nissapatorn and Lau Yee Ling, Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, E-mails: veeranoot@um.edu.my and lauyeeling@um.edu.my. Chitkasaem Suwanrath and Verapol Chandeying, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand, E-mails: schitkas@yahoo.co.uk and verapol.c@psu.ac.th. Nongyao Sawangjaroen, Department of Microbiology, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, Thailand, E-mail: nongyao.s@psu.ac.th.
Remington JS, McLeod R, Thulliez P, Desmonts G, 2001. Toxoplasmosis. Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infant. Fifth edition. Philadelphia, PA: Saunders, 205–346.
Jones JL, Dargelas V, Roberts J, Press C, Remington JS, Montoya JG, 2009. Risk factors for Toxoplasma gondii infection in the United States. Clin Infect Dis 49: 878–884.
Schmidt DR, Hogh B, Andersen O, Fuchs J, Fledelius H, Petersen E, 2006. The national neonatal screening program for congenital toxoplasmosis in Denmark: results from the initial four years, 1999–2002. Arch Dis Child 91: 661–665.
Fernandes RC, Vasconcellos VP, Araújo LC, Medina-Acosta E, 2009. Vertical transmission of HIV and Toxoplasma by reactivation in a chronically infected woman. Braz J Infect Dis 13: 70–71.
Nabnien K, 1979. Seroepidemiological Study of Toxoplasmosis in the Central Part of Thailand [master's thesis]. Bangkok: Mahidol University.
Morakote N, Thamasonthi W, Charuchinda K, Khamboonruang C, 1984. Prevalence of Toxoplasma antibodies in Chiang Mai population. Southeast Asian J Trop Med Public Health 15: 80–85.
Chintana T, Sukthana Y, Bunyakai B, Lekkla A, 1998. Toxoplasma gondii antibody in pregnant women with and without HIV infection. Southeast Asian J Trop Med Public Health 29: 383–386.
Wanachiwanawin D, Sutthent R, Chokephaibulkit K, Mahakittikun V, Ongrotchanakun J, Monkong N, 2001. Toxoplasma gondii antibodies in HIV and non-HIV infected Thai pregnant women. Asian Pac J Allergy Immunol 19: 291–293.
Chintana T, 1991. Pattern of antibodies in toxoplasmosis of pregnant women and their children in Thailand. Southeast Asian J Trop Med Public Health 22: 107–110.
Sukthana Y, 1999. Difference of Toxoplasma gondii antibodies between Thai and Austrian pregnant women. Southeast Asian J Trop Med Public Health 30: 38–41.
Tantivanich S, Amarapal P, Suphadtanaphongs W, Siripanth C, Sawatmongkonkun W, 2001. Prevalence of congenital cytomegalovirus and Toxoplasma antibodies in Thailand. Southeast Asian J Trop Med Public Health 32: 466–469.
Maleewong W, Lulitanond V, Pipitgool V, Auwijitaroon Y, Kuttsarejariya S, Morakote N, 1989. Prevalence of Toxoplasma antibodies in blood donors and pregnant women in Khon Kaen Province. J Med Assoc Thai 72: 256–259.
Daenseekaew W, Maleewong W, Luevisadpaibul V, Molagool S, Rajanuwong A, 1992. Seroprevalence of Toxoplasma gondii in pregnant women in Ubon Ratchathani province. J Med Assoc Thai 75: 609–610.
Han K, Shin DW, Lee TY, Lee YH, 2008. Seroprevalence of Toxoplasma gondii infection and risk factors associated with seropositivity of pregnant women in Korea. J Parasitol 94: 963–965.
Buchy P, Follézou JY, Lien TX, An TT, Tram LT, Tri DV, Cuong NM, Glaziou P, Chien BT, 2003. Serological study of toxoplasmosis in Vietnam in a population of drug users (Ho Chi Minh city) and pregnant women (Nha Trang). Bull Soc Pathol Exot 96: 46–47.
Liu Q, Wei F, Gao S, Jiang L, Lian H, Yuan B, Yuan Z, Xia Z, Liu B, Xu X, Zhu XQ, 2009. Toxoplasma gondii infection in pregnant women in China. Trans R Soc Trop Med Hyg 103: 162–166.
Wong A, Tan KH, Tee CS, Yeo GS, 2000. Seroprevalence of cytomegalovirus, Toxoplasma and parvovirus in pregnancy. Singapore Med J 41: 151–155.
Akinbami AA, Adewunmi AA, Rabiu KA, Wright KO, Dosunmu AO, Dada MO, Adeyemo TA, 2010. Seroprevalence of Toxoplasma gondii antibodies amongst pregnant women at the Lagos State University Teaching Hospital, Nigeria. Niger Postgrad Med J 17: 164–167.
Maggi P, Volpe A, Carito V, Schinaia N, Bino S, Basho M, Dentico P, 2009. Surveillance of toxoplasmosis in pregnant women in Albania. New Microbiol 32: 89–92.
Nissapatorn V, Noor Azmi MA, Cho SM, Fong MY, Init I, Rohela M, Khairul Anuar A, Quek KF, Latt HM, 2003. Toxoplasmosis: prevalence and risk factors. J Obstet Gynaecol 23: 618–624.
Sroka S, Bartelheimer N, Winter A, Heukelbach J, Ariza L, Ribeiro H, Oliveira FA, Queiroz AJ, Alencar C Jr, Liesenfeld O, 2010. Prevalence and risk factors of toxoplasmosis among pregnant women in Fortaleza, northeastern Brazil. Am J Trop Med Hyg 83: 528–533.
Montoya JG, 2002. Laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis. J Infect Dis 185: S73–S82.
Remington JS, Thulliez P, Montoya JG, 2004. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 42: 941–945.
Cruz ML, Cardoso CA, Saavedra MC, Santos ED, Melino T, 2007. Congenital toxoplasmosis infection in an infant born to an HIV-1-infected mother. Braz J Infect Dis 11: 610–611.
Spalding SM, Amendoeira MR, Klein CH, Ribeiro LC, 2005. Serological screening and toxoplasmosis exposure factors among pregnant women in South of Brazil. Rev Soc Bras Med Trop 38: 173–177.
Lopes FM, Mitsuka-Breganó R, Gonçalves DD, Freire RL, Karigyo CJ, Wedy GF, Matsuo T, Reiche EM, Morimoto HK, Capobiango JD, Inoue IT, Garcia JL, Navarro IT, 2009. Factors associated with seropositivity for anti-Toxoplasma gondii antibodies in pregnant women of Londrina, Paraná, Brazil. Mem Inst Oswaldo Cruz 104: 378–382.
Mohammad HI, Amin TT, Balaha MH, Moghannum MS, 2010. Toxoplasmosis among the pregnant women attending a Saudi maternity hospital: seroprevalence and possible risk factors. Ann Trop Med Parasitol 104: 493–504.
Ertug S, Okyay P, Turkmen M, Yuksel H, 2005. Seroprevalence and risk factors for Toxoplasma infection among pregnant women in Aydin province, Turkey. BMC Public Health 5: 66.
Alvarado-Esquivel C, Alanis-Quiñones OP, Arreola-Valenzuela MA, Rodríguez-Briones A, Piedra-Nevarez LJ, Duran-Morales E, Estrada-Martínez S, Martínez-García SA, Liesenfeld O, 2006. Seroepidemiology of Toxoplasma gondii infection in psychiatric inpatients in a northern Mexican city. BMC Infect Dis 6: 178.
Nijem KI, Al-Amleh S, 2009. Seroprevalence and associated risk factors of toxoplasmosis in pregnant women in Hebron district, Palestine. East Mediterr Health J 15: 1278–1284.
Kapperud G, Jenum PA, Stray-Pedersen B, Melby KK, Eskild A, Eng J, 1996. Risk factors for Toxoplasma gondii infection in pregnancy. Results of a prospective case-control study in Norway. Am J Epidemiol 144: 405–412.
Jenum PA, Kapperud G, Stray-Pedersen B, Melby KK, Eskild A, Eng J, 1998. Prevalence of Toxoplasma gondii specific immunoglobulin G antibodies among pregnant women in Norway. Epidemiol Infect 120: 87–92.
Qublan HS, Jumaian N, Abu-Salem A, Hamadelil FY, Mashagbeh M, Abdel-Ghani F, 2002. Toxoplasmosis and habitual abortion. J Obstet Gynaecol 22: 296–298.
Avelino MM, Campos D Jr, Parada JB, Castro AM, 2004. Risk factors for Toxoplasma gondii infection in women of childbearing age. Braz J Infect Dis 8: 164–174.
Ayi I, Edu SA, Apea-Kubi KA, Boamah D, Bosompem KM, Edoh D, 2009. Sero-epidemiology of toxoplasmosis amongst pregnant women in the greater accra region of Ghana. Ghana Med J 43: 107–114.
Dabritz HA, Conrad PA, 2010. Cats and Toxoplasma: implications for public health. Zoonoses Public Health 57: 34–52.
López-Castillo CA, Díaz-Ramirez J, Gómez-Marín JE, 2005. Risk factors for Toxoplasma gondii infection in pregnant women in Armenia, Colombia. Rev Salud Publica (Bogota) 7: 180–190.
Asthana SP, Macpherson CN, Weiss SH, Stephens R, Denny TN, Sharma RN, Dubey JP, 2006. Seroprevalence of Toxoplasma gondii in pregnant women and cats in Grenada, West Indies. J Parasitol 92: 644–645.
Hung CC, Fan CK, Su KE, Sung FC, Chiou HY, Gil V, da Conceicao dos Reis Ferreira M, de Carvalho JM, Cruz C, Lin YK, Tseng LF, Sao KY, Chang WC, Lan HS, Chou SH, 2007. Serological screening and toxoplasmosis exposure factors among pregnant women in the Democratic Republic of Sao Tome and Principe. Trans R Soc Trop Med Hyg 101: 134–139.
Lin YL, Liao YS, Liao LR, Chen FN, Kuo HM, He S, 2008. Seroprevalence and sources of Toxoplasma infection among indigenous and immigrant pregnant women in Taiwan. Parasitol Res 103: 67–74.
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