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Seroprevalence of Toxoplasmosis in Antenatal Women with Bad Obstetric History

The Causes of bad obstetric history (BOH) may be genetic, hormonal, abnormal maternal immune response and maternal infections (Turbadkar et al., 2003). Infection caused by TORCH (Toxoplasma gondii, Rubella virus, Cytomegalovirus and Herpes SimplexVirus) are one of the major causes for bad obstetrichistory (BOH) (Mc cabe, 1988). These are a group of viral, bacterial and protozoan infections that gain access to the fetal blood stream transplacentally via the chorionic villi. The pathogens usually cause only asymptomatic or mild infections in mother, but can cause much more serious consequences in fetus (Kaur et al., 1999). Toxoplasmosis is caused by an obligate International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 3 (2017) pp. 732-741 Journal homepage: http://www.ijcmas.com


Introduction
Bad Obstetric History (BOH) implies previous unfavourable fetal outcome in terms of two or more consecutive spontaneous abortions, history of intra uterine fetal death, intra uterine growth retardation, still birth, early neonatal death or congenital anomalies (Kumari et al., 2011).
The Causes of bad obstetric history (BOH) may be genetic, hormonal, abnormal maternal immune response and maternal infections . Infection caused by TORCH (Toxoplasma gondii, Rubella virus, Cytomegalovirus and Herpes SimplexVirus) are one of the major causes for bad obstetrichistory (BOH) (Mc cabe, 1988). These are a group of viral, bacterial and protozoan infections that gain access to the fetal blood stream transplacentally via the chorionic villi. The pathogens usually cause only asymptomatic or mild infections in mother, but can cause much more serious consequences in fetus (Kaur et al., 1999). Toxoplasmosis is caused by an obligate Toxoplasmosis is a zoonosis caused by Toxoplasma gondii, an obligate intracellular parasite. It can cause significant morbidity and mortality in the developing fetus if the pregnant women get acute infection during pregnancy. The aim of the study was to assess the seroprevalence of Toxoplasmosis in antenatal women with bad obstetric history. The seropositivity was analysed according to age, bad obstetric history, socioeconomic and literacy status. A total of 160 antenatal women with BOH and 24 antenatal women with previous normal delivery as control group attending to Govt. General Hospital, Guntur. The serum samples were collected and tested for presence of specific IgM antibodies using a commercial ELISA kit. The seroprevalence of IgM antibodies was 26 (16.25%) in antenatal women with BOH and 0 among the control group. Abortion (53.85%) was the commonest form of BOH followed by still births (19.23%).Various risk factors such as people living in rural areas, low socioeconomic status & illiteracy had greater association of risk of toxoplasmosis than urban population, high socioeconomic status and literacy. This study concluded that there is correlation between toxoplasma infection and Bad obstetric history and abortion is the major cause of fetal loss in pregnant women with bad obstetric history. A previous history of pregnancy wastage & the serological reaction for toxoplasmosis during current pregnancy must be considered while managing BOH cases so as to reduce the adverse outcome.  (Parija, 2008). It is one of the most common parasitic infections of humans and other warm-blooded animals. Approximately one-third of the population is exposed to this parasite. Infection in an immunocompetent adult human is usually asymptomatic. Toxoplasma is most dangerous for immunocompromised patients and the fetus whose mother is infected during pregnancy (Pinard et al., 2003).

K e y w o r d s
Transmission of the infection to the fetus usually occurs when primary infection is acquired by an immunologically normal mother during gestation. Infected pregnant are often asymptomatic or many have only mild symptoms, making the diagnosis difficult. Infection may be transmitted to the fetus transplacentally (McLeod et al., 2000). The risk of congenital toxoplasmosis depends on the timing of the mother's acute infection. The disease usually severe when acquired in the first trimester, and the severity decreases as the gestational age advances, leading to a mild or an in apparent disease at birth. The different rates of transmission and outcomes are most likely related to placental blood flow, the virulence and amount of T. gondii acquired, and the immunologic ability of the mother to restrict parasitaemia.
The overall rate of transmission of maternal infection to the fetus is about 45%, of these 60% are subclinical infections, 9% resulting in deaths of the fetus, and 30% have severe damage (Singh, 2003).
The clinical implications of infections due to Toxoplasma in pregnant patients are manifold.
Such patients may have spontaneous abortions, still births, intra uterine growth retardation, preterm deliveries or foetal anomalies (Zargar et al., 1998). Various manifestations of congenital infections may occur in the perinatal period.
These range from relatively mild signs, such as prematurity, peripheral retinal scars, sensory deficits, developmental delay, impaired psychomotor performance, and maternal retardation to the classic triad of signs consisting of hydrocephalus, intracerebral calcification and choriretinits.
Toxoplasmosis is usually by serological tests Toxoplasma-specific IgM and IgG antibodies. A positive IgG titre is sufficient to establish that a patient has been infected with T. gondii but a negative IgM result virtually ruleout a recently acquired infection, unless sera tested so early when an antibody response has not yet developed or is undectable.
The present study was conducted to determine the seropositivity of toxoplasmosis is antenatal women with bad obstetric history (BOH) and to compare it with that in antenatal women having previous normal obstetric history attending the antenatal OPD of tertiary care hospital in Guntur, Guntur medical college.

Materials and Methods
A total number of 184 blood samples were collected from antenatal women who attended Govt. General Hospital, Guntur during the period April2013 -April 2014.out of the 184 samples, 160 samples were included in the study group from patients with previous BOH, and 24 were included in the control group from antenatal women with previous normal delivery.
Pregnant women without bad obstetric history were excluded. All the samples were analysed for anti Toxoplasma specific IgM antibodies by using RD-Ratio Diagnostics, kits (manufactured by Germany) following instruction details as per kit insert in the Department of Microbiology, Guntur Medical College, Guntur.

Results and Discussion
Among 160 B.O.H cases, 26 (16.25%) were seropositive for Toxoplasma specific IgM antibodies and 134 (83.75%) were seronegative for IgM antibodies. In the control group, none of the samples were positive for IgM antibodies to T. gondii (Table 1).
Out of 26 seropositive cases, 15 cases are observed in 20-24 years age group which is high incidence. Also, 7 cases are observed in 25-29 years of age group. 1 case is observed in 15-19 years of age group and 3 cases are observed in 30-34 years of age group. Among total 26 seropositive cases, 14 cases were observed in first trimester, 10 cases in second Trimester and 2 cases are in third Trimester (Table 3). Majority of cases are observed in low-socio economic status i.e. 22 (84.62%) cases out of total 26 seropositive cases. And only 4(15.38%) cases were observed in middle-socio economic status.
The observation on distribution of seropositivity according to their residential area status, out of 26 cases, 18 (69.23%) cases are observed in rural areas and 8 (30.77%) cases in urban area. Out of 26 positive cases, 14 (53.84%) antenatal women are illiterates, 10 (38.46%) cases belong to 5th to graduation and 2 cases are up to 5 th standard.
Maternal infection play a critical role in pregnancy wastage and its prevalence in patients with BOH or complicated pregnancy is a significant risk factor.
Toxoplasmosis is a zoonotic disease with worldwide distribution. Most Toxoplasma associated infections among people occur by ingesting tissue cysts from infected meat or oocysts from soil or by congenital transmission through the placenta. The seropositivity levels vary widely in different regions of the globe. The rates of prevalence change according to the nutritional factors, sociocultural habits, geographical factors, climate, transmission route and typically rise with age (Coelho et al., 2003).
In conclusion, 1. Based on this study, the information obtained about the prevalence of Toxoplasmosis in this area (16.25%), could help to estimate the real magnitude of the problem and investigative measures should be taken to undertake a multi-centric study as well as compulsory screening for antenatal check-up. 2. A previous history of pregnancy wastage and the seropositivity of Toxoplasmosis during the current pregnancy must be considered while managing BOH cases so as to reduce the adverse fetal outcome. 3. All pregnant women should be screened for Toxoplasmosis and educated on predisposing risk factors during their antenatal visits. 4. The education of pregnant women about transmission route and measures seems to be the only effective way to protect seronegative women from Toxoplasmosis.