Sero-Prevalence of Toxoplasma Gondii and Risk Factors Associated with Pregnant Women of District Dir Lower, Pakistan

Imdad Ullah; Muhammad Naeem; Kausar Masoom; Saira Bano; Syed Ehsanullah; Rahim Ullah

doi:10.70749/ijbr.v3i5.1457

Authors

Imdad Ullah Department of Microbiology, Hazara University Mansehra, KP, Pakistan.
Muhammad Naeem College of Life Sciences, Northwest Agriculture and Forestry University, China.
Kausar Masoom MCH Centre, Department of Gynae, PIMS, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan.
Saira Bano Department of Microbiology, Jinnah University for Women, Pakistan.
Syed Ehsanullah Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan.
Rahim Ullah Department of Microbiology, Hazara University Mansehra, KP, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.1457

Keywords:

Sero-Prevalence, Toxoplasma Gondii, Risk Factors

Abstract

Toxoplasmosis is worldwіde distributed zoonotic disease that infects about 20% to 90% adult population of the world. The parasite is usually found all around the globe which infects all warm-blooded creatures including human beings. Therefore, the current study was conducted to determine the seroprevalence of Toxoplasma gondii and risk factors associated with pregnant women of District Dir Lower, Pakistan. Blood samples from 200 pregnant women were collected and their corresponding serums were tested for anti-toxoplasma IgM, IgG antibodies. During serological analysis, two various tests were used to screen the collected serum i.e. Rapid Diagnostic Test (RDT) and ELISA. All the samples were screened through RDT for target etiological agent and the positive cases were then confirmed using ELISA. A self-design questionnaire was used to collect the socio-demographic information of the patient. Out of total 200 samples, 34 samples were seropositive and 166 samples were seronegative for etiological agent by Rapid Diagnostic Test. Among 34 positive samples, 30 were seropositive for IgG antibody and 4 were seropositive for IgM antibody. None of the pregnant women were reactive to both T. gondii IgM and IgG antibodies. The overall seroprevalence of the infection was 17%. All the positive samples were also screened by mean of ELISA for both IgG and IgM antibodies. Of the 34 positive samples, 27 specimens were sero-positive for T. gondii IgG antibody and 3 specimens were sero-positive for T. gondii IgM antibody. The current study concluded that the infection of Toxoplasma gondii is relatively high. Having contact with domestic animals, drinking pipe water (general network) source and consumption of raw fruits/vegetables were recognized as probable risk factors associated with the infection of T. gondii. Moreover, the burden of disease was found to be high in the second trimester of pregnancy.

Downloads

Download data is not yet available.

References

Abamecha, F., & Awel, H. (2016). Seroprevalence and risk factors of Toxoplasma gondii infection in pregnant women following antenatal care at Mizan Aman General Hospital, bench Maji zone (BMZ), Ethiopia. BMC Infectious Diseases, 16(1).

https://doi.org/10.1186/s12879-016-1806-6

Abu-Madi, M. A., Behnke, J. M., & Dabritz, H. A. (2010). Toxoplasma gondii seropositivity and co-infection with TORCH pathogens in high-risk patients from Qatar. The American journal of tropical medicine and hygiene, 82(4), 626.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2844547/

Agmas, B., Tesfaye, R., & Koye, D. N. (2015). Seroprevalence of Toxoplasma gondii infection and associated risk factors among pregnant women in Debre Tabor, northwest Ethiopia. BMC Research Notes, 8(1).

https://doi.org/10.1186/s13104-015-1083-2

Ahmadpour, E., Daryani, A., Sharif, M., Sarvi, S., Aarabi, M., Mizani, A., Rahimi, M. T., & Shokri, A. (2014). Toxoplasmosis in immunocompromised patients in Iran: A systematic review and meta-analysis. The Journal of Infection in Developing Countries, 8(12), 1503-1510.

https://doi.org/10.3855/jidc.4796

Al Amleh, S., & Nijem, K. I. (2009). Seroprevalence and associated risk factors of Toxoplasmosis among pregnant women in Hebron district, Palestine.

https://dspace.hebron.edu:80/xmlui/handle/123456789/249

Alanazi, F., Hassan, T., & Alanazi, W. (2017). Seroprevalence of Toxoplasma gondii among pregnant Saudi woman in Arar, northern borders province, Saudi Arabia. Kasr Al Ainy Medical Journal, 23(2), 104.

https://doi.org/10.4103/kamj.kamj_13_17

Al-Eryani, S. M., Al-Mekhlafi, A. M., Al-Shibani, L. A., Mahdy, M. M., & Azazy, A. A. (2016). Toxoplasma gondii infection among pregnant women in Yemen: Factors associated with high seroprevalence. The Journal of Infection in Developing Countries, 10(06), 667-672.

https://doi.org/10.3855/jidc.6638

Alghamdi, J., Elamin, M. H., & Alhabib, S. (2016). Prevalence and genotyping of Toxoplasma gondii among Saudi pregnant women in Saudi Arabia. Saudi Pharmaceutical Journal, 24(6), 645-651.

https://doi.org/10.1016/j.jsps.2015.05.001

Aqeely, H., El-Gayar, E. K., Perveen Khan, D., Najmi, A., Alvi, A., Bani, I., Mahfouz, M. S., Abdalla, S. E., & Elhassan, I. M. (2014). Seroepidemiology ofToxoplasma gondiiamongst pregnant women in Jazan province, Saudi Arabia. Journal of Tropical Medicine, 2014, 1-6.

https://doi.org/10.1155/2014/913950

Avelar, J. B., Silva, M. G., Rezende, H. H., Storchilo, H. R., Amaral, W. N., Xavier, I. R., Avelino, M. M., & Castro, A. M. (2018). Epidemiological factors associated with Toxoplasma gondii infection in postpartum women treated in the public healthcare system of Goiânia, state of Goiás, Brazil. Revista da Sociedade Brasileira de Medicina Tropical, 51(1), 57-62.

https://doi.org/10.1590/0037-8682-0112-2017

Avelino, M. M., Campos Júnior, D., Parada, J. B., & Castro, A. M. (2004). Risk factors for Toxoplasma gondii infection in women of childbearing age. Brazilian Journal of Infectious Diseases, 8(2).

https://doi.org/10.1590/s1413-86702004000200007

Babaie, J., Amiri, S., Mostafavi, E., Hassan, N., Lotfi, P., Esmaeili Rastaghi, A. R., & Golkar, M. (2013). Seroprevalence and risk factors for Toxoplasma gondii infection among pregnant women in Northeast Iran. Clinical and Vaccine Immunology, 20(11), 1771-1773.

https://doi.org/10.1128/cvi.00125-13

Bamba, S., Cissé, M., Sangaré, I., Zida, A., Ouattara, S., & Guiguemdé, R. T. (2017). Seroprevalence and risk factors of Toxoplasma gondii infection in pregnant women from Bobo Dioulasso, Burkina Faso. BMC Infectious Diseases, 17(1).

https://doi.org/10.1186/s12879-017-2583-6

Breugelmans, M., Naessens, A., & Foulon, W. (2004). Prevention of toxoplasmosis during pregnancy - an epidemiologic survey over 22 consecutive years. Journal of Perinatal Medicine, 32(3).

https://doi.org/10.1515/jpm.2004.039

Cademartori, B. G., Farias, N. A. D. R., & Brod, C. S. (2008). Soroprevalência e fatores de risco à infecção por Toxoplasma gondii em gestantes de Pelotas, sul do Brasil. Rev. panam. infectol, 30-35.

https://pesquisa.bvsalud.org/portal/resource/pt/lil-544932

Carter, F., & Fleck, D. (1966). The incidence of toxoplasma antibodies in the sudanese. Transactions of the Royal Society of Tropical Medicine and Hygiene, 60(4), 539-543.

https://doi.org/10.1016/0035-9203(66)90281-1

Doudou, Y., Renaud, P., Coralie, L., Jacqueline, F., Hypolite, S., Hypolite, M., Patrick, M., Andreia, I. D., Van Sprundel, M., Marleen, B., Van Geertruyden, J., & Pascal, L. (2014). Toxoplasmosis among pregnant women: High seroprevalence and risk factors in Kinshasa, Democratic Republic of Congo. Asian Pacific Journal of Tropical Biomedicine, 4(1), 69-74.

https://doi.org/10.1016/s2221-1691(14)60211-2

DUBEY, J. P. (2008). The history ofToxoplasma gondii-The first 100 years. Journal of Eukaryotic Microbiology, 55(6), 467-475.

https://doi.org/10.1111/j.1550-7408.2008.00345.x

Elmore, S. A., Jones, J. L., Conrad, P. A., Patton, S., Lindsay, D. S., & Dubey, J. (2010). Toxoplasma gondii: Epidemiology, feline clinical aspects, and prevention. Trends in Parasitology, 26(4), 190-196.

https://doi.org/10.1016/j.pt.2010.01.009

Elnahas, A., Gerais, A. S., Elbashir, M. I., Eldien, E. S., & Adam, I. (2003). Toxoplasmosis in pregnant Sudanese women. Saudi medical journal, 24(8), 868-870.

https://europepmc.org/article/med/12939674

Elsaid, M., Azbedah, A., Dia Eddin, E. & Alkout, A. (2014). The prevalence of Toxoplasma gondii infection in psychiatric patients in Tripoli, Libya. Journal of American Science, 10.

Elsheikha, H. (2008). Congenital toxoplasmosis: Priorities for further health promotion action. Public Health, 122(4), 335-353.

https://doi.org/10.1016/j.puhe.2007.08.009

Endris, M., Belyhun, Y., Moges, F., Adefiris, M., Tekeste, Z., Mulu, A. & Kassu, A. (2014). Seroprevalence and associated risk factors of Toxoplasma gondii in pregnant women attending in Northwest Ethiopia. Iranian journal of parasitology, 9, 407.

Ertug, S., Okyay, P., Turkmen, M., & Yuksel, H. (2005). Seroprevalence and risk factors for toxoplasmainfection among pregnant women in Aydin province, Turkey. BMC Public Health, 5(1).

https://doi.org/10.1186/1471-2458-5-66

Eshratkhah Mohammadnejad, A., Eslami, G., Shamsi, F., Pirnejad, A., Samie, A., Safabakhsh, J., Sakhavand, A., & Elloumi, M. (2018). Prevalence of food-borne Toxoplasma in pregnant women population of Urmia, Iran. Journal of Food Quality and Hazards Conrol, 5(1), 17-23.

https://doi.org/10.29252/jfqhc.5.1.17

Faisal, I. A., Khan, A. U., Waqar, M., Ahmad, T., Shah, T., Khan, M. I., ... & Javid, U. (2014). Distribution of Toxoplasma gondii in the pregnant women of district Swabi Khyber Pakhtunkhwa Pakistan. World Applied Sciences Journal, 29(1), 77-79.

https://doi.org/10.5829/idosi.wasj.2014.29.01.826

Fallahi, S., Rostami, A., Nourollahpour Shiadeh, M., Behniafar, H., & Paktinat, S. (2018). An updated literature review on maternal-fetal and reproductive disorders of Toxoplasma gondii infection. Journal of Gynecology Obstetrics and Human Reproduction, 47(3), 133-140.

https://doi.org/10.1016/j.jogoh.2017.12.003

Findal, G., Barlinn, R., Sandven, I., Stray?Pedersen, B., Nordbø, S. A., Samdal, H. H., Vainio, K., Dudman, S. G., & Jenum, P. A. (2015). Toxoplasma prevalence among pregnant women in Norway: A cross?sectional study. APMIS, 123(4), 321-325.

https://doi.org/10.1111/apm.12354

Flatt, A., & Shetty, N. (2012). Seroprevalence and risk factors for toxoplasmosis among antenatal women in London: A re-examination of risk in an ethnically diverse population. The European Journal of Public Health, 23(4), 648-652.

https://doi.org/10.1093/eurpub/cks075

Foulon, W., Villena, I., Stray-Pedersen, B., Decoster, A., Lappalainen, M., Pinon, J., Jenum, P. A., Hedman, K., & Naessens, A. (1999). Treatment of toxoplasmosis during pregnancy: A multicenter study of impact on fetal transmission and children's sequelae at age 1 year. American Journal of Obstetrics and Gynecology, 180(2), 410-415.

https://doi.org/10.1016/s0002-9378(99)70224-3

Frimpong, C., Makasa, M., Sitali, L., & Michelo, C. (2017). Seroprevalence and determinants of toxoplasmosis in pregnant women attending antenatal clinic at the university teaching hospital, Lusaka, Zambia. BMC Infectious Diseases, 17(1).

https://doi.org/10.1186/s12879-016-2133-7

Gelaye, W., Kebede, T., & Hailu, A. (2015). High prevalence of anti-toxoplasma antibodies and absence of Toxoplasma gondii infection risk factors among pregnant women attending routine antenatal care in two hospitals of Addis Ababa, Ethiopia. International Journal of Infectious Diseases, 34, 41-45.

https://doi.org/10.1016/j.ijid.2015.03.005

Gencer, M., Cevizci, S., Sacar, S., Vural, A., Cakir Gungor, A. N., Uysal, A., Ozden Hacivelioglu, S., Celik, M., Duru, E., & Cosar, E. (2014). Evaluation of anti-toxoplasma gondii antibody distribution and risk factors among pregnant women admitted to obstetrics polyclinic of Canakkale Onsekiz mart University hospital. Turkish Journal of Parasitology, 38(2), 76-80.

https://doi.org/10.5152/tpd.2014.3355

Hafez Hass, N. A., Shaapan, R. M., & Hafez Hass, M. A. (2018). Associated antenatal health risk factors with incidence of toxoplasmosis in Egyptian pregnant women. Pakistan Journal of Biological Sciences, 21(9), 463-468.

https://doi.org/10.3923/pjbs.2018.463.468

Hiramoto, R., Mayrbaurl-Borges, M., Galisteo Jr, A., Meireles, L., Macre, M., & Andrade Jr, H. (2001). Infectivity of cysts of the ME-49 Toxoplasma gondii strain in bovine milk and homemade cheese. Revista de Saúde Pública, 35(2), 113-118.

https://doi.org/10.1590/s0034-89102001000200002

HOGAN, M. J., YONEDA, C., FEENEY, L., ZWEIGART, P., & LEWIS, A. (1960). Morphology and culture of Toxoplasma. Archives of Ophthalmology, 64(5), 655-667.

https://doi.org/10.1001/archopht.1960.01840010657006

Hotez, P. J., & Kamath, A. (2009). Neglected tropical diseases in sub-Saharan Africa: Review of their prevalence, distribution, and disease burden. PLoS Neglected Tropical Diseases, 3(8), e412.

https://doi.org/10.1371/journal.pntd.0000412

Hung, C., Su, H., Lee, Y., Weng, H., Wang, Y., Naito, T., Tsubouchi, A., Wang, G., & Fan, C. (2015). Seroprevalence, seroconversion, and risk factors for toxoplasmosis among pregnant women in Taipei, Taiwan. Japanese Journal of Infectious Diseases, 68(4), 312-317.

https://doi.org/10.7883/yoken.jjid.2014.263

Iddawela, D., Vithana, S. M., & Ratnayake, C. (2017). Seroprevalence of toxoplasmosis and risk factors of Toxoplasma gondii infection among pregnant women in Sri Lanka: A cross sectional study. BMC Public Health, 17(1).

https://doi.org/10.1186/s12889-017-4941-0

Ishaku, B. S., Ajogi, I., Umoh, J. U., Lawal, I., & Randawa, A. J. (2009). Seroprevalence and risk factors for Toxoplasma gondii infection among antenatal women in Zaria, Nigeria. Res J Med Med Sci, 4(2), 483-488.

Jiang, R., Ma, L., Ma, Z., Hou, G., Zhao, Q., & Wu, X. (2018). Seroprevalence and associated risk factors of Toxoplasma gondii among Manchu pregnant women in northeastern China. Microbial Pathogenesis, 123, 398-401.

https://doi.org/10.1016/j.micpath.2018.07.041

Jones, J., Lopez, A. & Wilson, M. (2003). Congenital toxoplasmosis. American family physician, 67, 21312146.

Jones, J. L., Krueger, A., Schulkin, J., & Schantz, P. M. (2010). Toxoplasmosis prevention and testing in pregnancy, survey of obstetrician-gynaecologists. Zoonoses and Public Health, 57(1), 27-33.

https://doi.org/10.1111/j.1863-2378.2009.01277.x

Jones, J. L., Parise, M. E., & Fiore, A. E. (2014). Neglected parasitic infections in the United States: Toxoplasmosis. The American Society of Tropical Medicine and Hygiene, 90(5), 794-799.

https://doi.org/10.4269/ajtmh.13-0722

Jula, J., Girones, G., Edao, B., Deme, C., Cebrian, J., Butrón, L., ... & Ramos, J. M. (2018). Seroprevalence of Toxoplasma gondii infection in pregnant women attending antenatal care in southern Ethiopia. Revista Española de Quimioterapia, 31(4), 363.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6172689/

Kamal, A. M., Ahmed, A. K., Abdellatif, M. Z., Tawfik, M., & Hassan, E. E. (2015). Seropositivity of toxoplasmosis in pregnant women by ELISA at Minia University hospital, Egypt. The Korean Journal of Parasitology, 53(5), 605-610.

https://doi.org/10.3347/kjp.2015.53.5.605

Khan, S. N., Khan, S., Ayaz, S., Jan, A. H., Jehangir, S., Attaullah, S., ... & Shams, S. (2011). Seroprevalance and risk factors of toxoplasmosis among pregnant women in District Kohat, Khyber Pakhtunkhwa, Pakistan. World Appl Sci J, 14(7), 1032-1036.

https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=6bf1aZUVUGHjzuFd9wQGfqSwsX7anbrYg9Q8ced

Kijlstra, A., & Jongert, E. (2009). Toxoplasma-safe meat: Close to reality? Trends in Parasitology, 25(1), 18-22.

https://doi.org/10.1016/j.pt.2008.09.008

Krueger, W. S., Hilborn, E. D., Converse, R. R., & Wade, T. J. (2014). Drinking water source and human Toxoplasma gondii infection in the United States: A cross-sectional analysis of NHANES data. BMC Public Health, 14(1).

https://doi.org/10.1186/1471-2458-14-711

Lindström, I., Kaddu-Mulindwa, D. H., Kironde, F., & Lindh, J. (2006). Prevalence of latent and reactivated Toxoplasma gondii parasites in HIV-patients from Uganda. Acta Tropica, 100(3), 218-222.

https://doi.org/10.1016/j.actatropica.2006.11.002

Lopes-Mori, F. M., Mitsuka-Breganó, R., Bittencourt, L. H., Dias, R. C., Gonçalves, D. D., Capobiango, J. D., Reiche, E. M., Morimoto, H. K., Freire, R. L., & Navarro, I. T. (2013). Gestational toxoplasmosis in parana state, Brazil: Prevalence of IgG antibodies and associated risk factors. The Brazilian Journal of Infectious Diseases, 17(4), 405-409.

https://doi.org/10.1016/j.bjid.2012.12.003

Mareze, M., Benitez, A. D., Brandão, A. P., Pinto-Ferreira, F., Miura, A. C., Martins, F. D., Caldart, E. T., Biondo, A. W., Freire, R. L., Mitsuka-Breganó, R., & Navarro, I. T. (2019). Socioeconomic vulnerability associated to Toxoplasma gondii exposure in southern Brazil. PLOS ONE, 14(2), e0212375.

https://doi.org/10.1371/journal.pone.0212375

Mazigo, H. D., Morona, D., Kweka, E. J., Waihenya, R., Mnyone, L., & Heukelbach, J. (2013). Epilepsy and tropical parasitic infections in sub-Saharan Africa: A review. Tanzania Journal of Health Research, 15(2).

https://doi.org/10.4314/thrb.v15i2.5

Minkoff, H., Remington, J. S., Holman, S., Ramirezc, R., Goodwin, S., & Landesman, S. (1997). Vertical transmission of toxoplasma by human immunodeficiency virus-infected women. American Journal of Obstetrics and Gynecology, 176(3), 555-559.

https://doi.org/10.1016/s0002-9378(97)70547-7

Mohaghegh, M. A., Kalani, H., Hashemi, M., Hashemi, S., Yazdnezhad, S. K., Hejazi, S. H., & Hashemi, N. (2016). Toxoplasmosis-related risk factors in pregnant women in the North Khorasan province, Iran. International Journal of Medical Research & Health Sciences, 5(8), 370-374.

Morris, A., & Croxson, M. (2004). Serological evidence of Toxoplasma gondii infection among pregnant women in Auckland. New Zealand Medical Journal, 117(1189), 1-6.

http://www.nzma.org.nz/journal/117-1189/770/

Mwambe, B., Mshana, S. E., Kidenya, B. R., Massinde, A. N., Mazigo, H. D., Michael, D., Majinge, C., & Groß, U. (2013). Sero-prevalence and factors associated with Toxoplasma gondii infection among pregnant women attending antenatal care in Mwanza, Tanzania. Parasites & Vectors, 6(1).

https://doi.org/10.1186/1756-3305-6-222

Nissapatorn, V. (2011). Toxoplasmosis in HIV/AIDS patients - A living legacy. Microbes, Viruses and Parasites in AIDS Process.

https://doi.org/10.5772/19580

Olusi, T. A., Salawu, S. A., & Oniya, M. O. (2023). Seroprevalence and risk factors associated with Toxoplasma gondii infection among pregnant women in ile Ife, southwestern Nigeria. Journal of Infectious Diseases and Immunity, 15(2), 33-40.

https://doi.org/10.5897/jidi2022.0219

Paquet, C., Yudin, M. H., Yudin, M. H., Allen, V. M., Bouchard, C., Boucher, M., Caddy, S., Castillo, E., Money, D. M., Murphy, K. E., Ogilvie, G., Paquet, C., Van Schalkwyk, J., & Senikas, V. (2013). Toxoplasmosis in pregnancy: Prevention, screening, and treatment. Journal of Obstetrics and Gynaecology Canada, 35(1), 78-79.

https://doi.org/10.1016/s1701-2163(15)31053-7

Paul, E. & Chilongola, J. (2017). SERO-PREVALENCE AND RISK FACTORS FOR TOXOPLASMA GONDII INFECTION AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT KILIMANJARO CHRISTIAN MEDICAL CENTRE IN NORTHERN TANZANIA BY ELIAKIMU PAUL A Dissertation submitted in partial fulfillment of the requirements for Degree of Master of Science in Clinical Research (MSc. CR) of Tumaini.

Peyron, F., Mc Leod, R., Ajzenberg, D., Contopoulos-Ioannidis, D., Kieffer, F., Mandelbrot, L., Sibley, L. D., Pelloux, H., Villena, I., Wallon, M., & Montoya, J. G. (2017). Congenital toxoplasmosis in France and the United States: One parasite, two diverging approaches. PLOS Neglected Tropical Diseases, 11(2), e0005222.

https://doi.org/10.1371/journal.pntd.0005222

Qublan, H. S., Jumaian, N., Abu-Salem, A., Hamadelil, F. Y., Mashagbeh, M., & Abdel-Ghani, F. (2002). Toxoplasmosis and habitual abortion. Journal of Obstetrics and Gynaecology, 22(3), 296-298.

https://doi.org/10.1080/01443610220130616

Remington, J. S., Thulliez, P., & Montoya, J. G. (2004). Recent developments for diagnosis of toxoplasmosis. Journal of clinical microbiology, 42(3), 941-945.

https://doi.org/10.1128/jcm.42.3.941-945.2004

Retmanasari, A., Widartono, B. S., Wijayanti, M. A., & Artama, W. T. (2016). Prevalence and risk factors for toxoplasmosis in middle Java, Indonesia. EcoHealth, 14(1), 162-170.

https://doi.org/10.1007/s10393-016-1198-5

Robert-Gangneux, F., & Dardé, M. (2012). Epidemiology of and diagnostic strategies for toxoplasmosis. Clinical Microbiology Reviews, 25(2), 264-296.

https://doi.org/10.1128/cmr.05013-11

Rostami, A., Riahi, S. M., Fakhri, Y., Saber, V., Hanifehpour, H., Valizadeh, S., Gholizadeh, M., Pouya, R. H., & Gamble, H. (2017). The global seroprevalence of Toxoplasma gondii among wild boars: A systematic review and meta-analysis. Veterinary Parasitology, 244, 12-20.

https://doi.org/10.1016/j.vetpar.2017.07.013

Saadatnia, G., & Golkar, M. (2012). A review on human toxoplasmosis. Scandinavian Journal of Infectious Diseases, 44(11), 805-814.

https://doi.org/10.3109/00365548.2012.693197

Sacks, J. J. (1982). Toxoplasmosis infection associated with raw goat's milk. JAMA: The Journal of the American Medical Association, 248(14), 1728.

https://doi.org/10.1001/jama.1982.03330140038029

Saif, N., Al-Ameeri, G., Alhweesh, M., Alkadasi, M., & Zaid, A. A. (2014). Sero prevalence of toxoplasmosis in pregnant women in Taiz-Yemen. Int J Curr Microbiol App Sci, 3, 680-90.

https://www.cabidigitallibrary.org/doi/full/10.5555/20143271536

Saki, J., Mohammadpour, N., Moramezi, F., & Khademvatan, S. (2015). Seroprevalence of Toxoplasma gondii in women who have aborted in comparison with the women with normal delivery in Ahvaz, southwest of Iran. The Scientific World Journal, 2015(1).

https://doi.org/10.1155/2015/764369

Scallan, E., Hoekstra, R. M., Angulo, F. J., Tauxe, R. V., Widdowson, M., Roy, S. L., Jones, J. L., & Griffin, P. M. (2011). Foodborne illness acquired in the United States-Major pathogens. Emerging Infectious Diseases, 17(1), 7-15.

https://doi.org/10.3201/eid1701.09-1101p1

Simpore, J., Savadogo, A., Ilboudo, D., Nadambega, M. C., Esposito, M., Yara, J., Pignatelli, S., Pietra, V., & Musumeci, S. (2006). Toxoplasma gondii, HCV, and HBV seroprevalence and Co?infection among HIV?positive and ?negative pregnant women in Burkina Faso. Journal of Medical Virology, 78(6), 730-733.

https://doi.org/10.1002/jmv.20615

Singh, S. (2003). Mother-to-child transmission and diagnosis of toxoplasma gondii infection during pregnancy. Indian Journal of Medical Microbiology, 21(2), 69-76.

https://doi.org/10.1016/s0255-0857(21)03124-8

Sukthana, Y. (2006). Toxoplasmosis: Beyond animals to humans. Trends in Parasitology, 22(3), 137-142.

https://doi.org/10.1016/j.pt.2006.01.007

Tekkesin, N. (2012). Diagnosis of toxoplasmosis in pregnancy: a review. HOAJ Biology, 1(1), 9.

Tenter, A. M., Heckeroth, A. R., & Weiss, L. M. (2000). Toxoplasma gondii: From animals to humans. International Journal for Parasitology, 30(12-13), 1217-1258.

https://doi.org/10.1016/s0020-7519(00)00124-7

Varella, I. S., Canti, I. C., Santos, B. R., Coppini, A. Z., Argondizzo, L. C., Tonin, C., & Wagner, M. B. (2009). Prevalence of acute toxoplasmosis infection among 41,112 pregnant women and the mother-to-child transmission rate in a public hospital in south Brazil. Memórias do Instituto Oswaldo Cruz, 104(2), 383-388.

https://doi.org/10.1590/s0074-02762009000200037

Weiss, L. M. & Kim, K. (2011). Toxoplasma gondii: the model apicomplexan. Perspectives and methods, Elsevier.

Wong, A., Tan, K. H., Tee, C. S., & Yeo, G. S. H. (2000). Seroprevalence of cytomegalovirus, toxoplasma and parvovirus in pregnancy. Singapore medical journal, 41(4), 151-155.

https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=0ac33eb8ef81d1d3d642ba81531e6c25998bf586

Wong, S., & Remington, J. S. (1994). Toxoplasmosis in pregnancy. Clinical Infectious Diseases, 18(6), 853-862.

https://doi.org/10.1093/clinids/18.6.853

Yusuf, A., Yahaya, S. & Azeez-Akande, O. (2016). Seroprevalence and risk factors of toxoplasma gondii infection (toxoplasmosis) among hiv seropositive pregnant women in a tertiary healthcare centre, Kano, Northern Nigeria. International Research Journal of Medicine and Medical Sciences, 07(01).

https://doi.org/10.14303/jmms.2016.017

Zemene, E., Yewhalaw, D., Abera, S., Belay, T., Samuel, A., & Zeynudin, A. (2012). Seroprevalence of Toxoplasma gondiiand associated risk factors among pregnant women in Jimma town, southwestern Ethiopia. BMC Infectious Diseases, 12(1).

https://doi.org/10.1186/1471-2334-12-337