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      The association between Toxoplasma infection and mortality: the NHANES epidemiologic follow-up study

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          Abstract

          Background

          Toxoplasma gondii has been reported to be associated with higher mortality in patients with schizophrenia. This study aimed to explore the relationship between T. gondii infection and 25-year mortality based on data from the Third National Health and Nutrition Examination Survey (NHANES III) database.

          Methods

          Cases with serum T. gondii antibody test results were included in this study and the corresponding mortality dataset was obtained from the US National Center for Health Statistics (NCHS). Propensity score matching (PSM) was used to match age and sex between groups. The Cox proportional hazards model was used to evaluate the effect of T. gondii infection on mortality.

          Results

          A total of 14,181 cases were included in the analysis, of which 3831 (27.0%) were seropositive for T. gondii antibody. The median follow-up time of the whole cohort was 22.5 (interquartile range 16.3, 24.5) years. A total of 5082 deaths were observed in this cohort, a mortality rate of 35.8%. All-cause mortality was significantly higher in the seropositive group than in the seronegative group (50.0% vs 30.6%, P < 0.001). Kaplan–Meier analysis showed a significant difference in the survival time between two groups before and after PSM. Multivariate analysis showed that T. gondii infection was independently associated with higher all-cause mortality after adjusting for potential confounders.

          Conclusions

          Toxoplasma gondii infection is associated with higher mortality in general population.

          Graphical Abstract

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13071-022-05398-1.

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          Most cited references21

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          Chronic inflammation in the etiology of disease across the life span

          David Furman, Judith Campisi, Eric Verdin … (2019)
          Although intermittent increases in inflammation are critical for survival during physical injury and infection, recent research has revealed that certain social, environmental and lifestyle factors can promote systemic chronic inflammation (SCI) that can, in turn, lead to several diseases that collectively represent the leading causes of disability and mortality worldwide, such as cardiovascular disease, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease and autoimmune and neurodegenerative disorders. In the present Perspective we describe the multi-level mechanisms underlying SCI and several risk factors that promote this health-damaging phenotype, including infections, physical inactivity, poor diet, environmental and industrial toxicants and psychological stress. Furthermore, we suggest potential strategies for advancing the early diagnosis, prevention and treatment of SCI.
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            Toxoplasmosis.

            JG Montoya, O. Liesenfeld (2004)
            Toxoplasma gondii is a protozoan parasite that infects up to a third of the world's population. Infection is mainly acquired by ingestion of food or water that is contaminated with oocysts shed by cats or by eating undercooked or raw meat containing tissue cysts. Primary infection is usually subclinical but in some patients cervical lymphadenopathy or ocular disease can be present. Infection acquired during pregnancy may cause severe damage to the fetus. In immunocompromised patients, reactivation of latent disease can cause life-threatening encephalitis. Diagnosis of toxoplasmosis can be established by direct detection of the parasite or by serological techniques. The most commonly used therapeutic regimen, and probably the most effective, is the combination of pyrimethamine with sulfadiazine and folinic acid. This Seminar provides an overview and update on management of patients with acute infection, pregnant women who acquire infection during gestation, fetuses or infants who are congenitally infected, those with ocular disease, and immunocompromised individuals. Controversy about the effectiveness of primary and secondary prevention in pregnant women is discussed. Important topics of current and future research are presented.
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              Toxoplasmosis – A Global Threat. Correlation of Latent Toxoplasmosis with Specific Disease Burden in a Set of 88 Countries

              Jaroslav Flegr, Joseph Prandota, Michaela Sovičková … (2014)
              Background Toxoplasmosis is becoming a global health hazard as it infects 30–50% of the world human population. Clinically, the life-long presence of the parasite in tissues of a majority of infected individuals is usually considered asymptomatic. However, a number of studies show that this ‘asymptomatic infection’ may also lead to development of other human pathologies. Aims of the Study The purpose of the study was to collect available geoepidemiological data on seroprevalence of toxoplasmosis and search for its relationship with mortality and disability rates in different countries. Methods and Findings Prevalence data published between 1995–2008 for women in child-bearing age were collected for 88 countries (29 European). The association between prevalence of toxoplasmosis and specific disease burden estimated with age-standardized Disability Adjusted Life Year (DALY) or with mortality, was calculated using General Linear Method with Gross Domestic Product per capita (GDP), geolatitude and humidity as covariates, and also using nonparametric partial Kendall correlation test with GDP as a covariate. The prevalence of toxoplasmosis correlated with specific disease burden in particular countries explaining 23% of variability in disease burden in Europe. The analyses revealed that for example, DALY of 23 of 128 analyzed diseases and disease categories on the WHO list showed correlations (18 positive, 5 negative) with prevalence of toxoplasmosis and another 12 diseases showed positive trends (p<0.1). For several obtained significant correlations between the seroprevalence of toxoplasmosis and specific diseases/clinical entities, possible pathophysiological, biochemical and molecular explanations are presented. Conclusions The seroprevalence of toxoplasmosis correlated with various disease burden. Statistical associations does not necessarily mean causality. The precautionary principle suggests however that possible role of toxoplasmosis as a triggering factor responsible for development of several clinical entities deserves much more attention and financial support both in everyday medical practice and future clinical research.
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                Author and article information

                Contributors
                Jiaofeng Huang: huangjiaofeng@fjmu.edu.cn
                Jiaolong Zheng: 893806824@qq.com
                Bang Liu: liubang617@126.com
                Lingling Lu: 384130051@qq.com
                Haicong Wu: 847614051@qq.com
                Su Lin: sumer5129@fjmu.edu.cn
                Dongliang Li: ldliang900@163.com
                Journal
                Journal ID (nlm-ta): Parasit Vectors
                Journal ID (iso-abbrev): Parasit Vectors
                Title: Parasites & Vectors
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1756-3305
                Publication date (Electronic): 6 August 2022
                Publication date PMC-release: 6 August 2022
                Publication date Collection: 2022
                Volume: 15
                Electronic Location Identifier: 284
                Affiliations
                [1 ]GRID grid.256112.3, ISNI 0000 0004 1797 9307, Department of Hepatobiliary Disease, , Fuzong Clinical Medical College of Fujian Medical University, ; Fuzhou, China
                [2 ]Department of Hepatobiliary Disease, The 900th Hospital of Joint Logistics Support Force, Fuzhou, China
                [3 ]GRID grid.412683.a, ISNI 0000 0004 1758 0400, Department of Hepatology, Hepatology Research Institute, , The First Affiliated Hospital of Fujian Medical University, ; Fuzhou, China
                Article
                Publisher ID: 5398
                DOI: 10.1186/s13071-022-05398-1
                PMC ID: 9357320
                PubMed ID: 35933421
                SO-VID: 4326de0a-d3a4-4ebc-82ce-b2c30253ff9f
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 27 April 2022
                Date accepted : 13 July 2022
                Funding
                Funded by: Startup Fund for scientific research of Fujian Medical University
                Award ID: 2019QH1285
                Award Recipient :
                Funded by: Natural Science Foundation of Fujian Province
                Award ID: 2021J011263
                Award Recipient :
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Parasitology
                Keywords: toxoplasma gondii,toxoplasmosis,mortality,nhanes
                Data availability:
                ScienceOpen disciplines: Parasitology
                Keywords: toxoplasma gondii, toxoplasmosis, mortality, nhanes

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