Abstract
Although human toxoplasmosis is a notifiable disease in Taiwan since 2007, little is known about its risk factors. This study aimed to investigate the risk factors for acute Toxoplasma gondii diseases in Taiwan. We conducted a nationwide population-based case-control study. Cases of acute human toxoplasmosis notified to the Taiwan Centers for Diseases Control (Taipei, Taiwan) during 2008–2013 were compared with controls that were randomly selected from healthy T. gondii-seronegative blood donors who participated in a nationwide T. gondii seroepidemiologic study during 2009–2010. Cases and controls were matched according to age, gender and residency at an 1∶8 ratio. Structured questionnaires were used to gather information regarding risk factors. A total of 30 laboratory-confirmed acute T. gondii disease cases and 224 controls were enrolled. The most common clinical manifestation of the cases was flu-like symptoms (n = 20), followed by central nervous system disease (n = 4), ocular diseases (n = 3), abortion (n = 2), and congenital infection (n = 1). Multivariate conditional logistic regression showed that raw clam consumption (adjusted odds ratio [OR] = 3.7; 95% confidence interval [CI] = 1.4–9.9) and having a cat in the household (adjusted OR = 2.9; 95% CI = 1.1–7.9) were two independent risk factors for acute T. gondii disease. We conclude that raw shellfish consumption and domestic cat exposure were risk factors for acquiring acute T. gondii diseases in Taiwan. This finding may guide future research and control policies.
Highlights
Toxoplasma gondii, a zoonotic protozoan pathogen, infects nearly one-third of the world’s human population [1,2,3]
Laboratory-confirmed cases of acute human toxoplasmosis reported to the Taiwan Centers for Diseases Control (CDC) (Taipei, Taiwan) during 2008–2013 were compared with controls randomly selected from the T. gondii-seronegative healthy blood donors who participated in our previous nationwide seroepidemiologic study, which occurred during 2009–2010 [11]
The results indicated that household cat exposure and raw clam consumption were two independent risk factors for acquiring acute T. gondii diseases in Taiwan
Summary
Toxoplasma gondii, a zoonotic protozoan pathogen, infects nearly one-third of the world’s human population [1,2,3]. T. gondii can be transmitted through blood transfusion or organ transplantation from infected donors [5,6,7]. Acute toxoplasmosis in immunocompetent persons is usually self-limited [2,4]. Ocular disease (chorioretinitis) with impaired vision can occur in immunocompetent persons [2,4], either sporadically or in the context of an outbreak [8]. Congenital toxoplasmosis can cause intracranial and ocular lesions in newborns, which may lead to subsequent mental retardation or blindness [9]. Encephalitis is the most common clinical manifestation, but chorioretinitis, pneumonia, or multi-organ involvements can be observed [2,4]. The T. gondii disease burden [9] and its potential to cause outbreaks [8,10] highlight the importance of identifying the risk factors related to this neglected disease
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