Serological Evaluation of Anti-Toxoplasma gondii Antibodies in Patients with Acute Leukemia and Lymphoma through Chemotherapy
Background: Toxoplasma gondii is a protozoan parasite that belongs to the family Coccidae. We aimed to evaluate IgG avidity and the changes of anti-Toxoplasma immunoglobulins M (IgM) and G (IgG) in patients with acute leukemia and lymphoma.
Methods: Ninety eight patients with Acute myeloid leukemia (AML), Acute Lymphoblastic Leukemia (ALL) and lymphoma, selected from patients referring to Imam Reza Hospital of Tabriz (38°04′N 46°18′E), in terms of the presence of anti-Toxoplasma IgM, IgG, IgG avidity antibodies and the major risk factors were evaluated.
Results: The results of pre-chemotherapy evaluation showed that of the examined patients, only two cases, one patient with ALL and another patient with lymphoma, had a positive IgM titer. Overall, 46 cases had positive IgG titers, including 20 patients with AML, 15 patients with ALL and 11 patients with lymphoma. Three (3.06%) patients were positive for anti-T. gondii IgM and one of them was with new infection of toxoplasmosis in lymphoma patients. The post-chemotherapy IgG titer evaluation showed 46 [46.9% (95% CI 37.4–56.7)] positive IgG cases that this result was similar to the result of pre-treatment phase. One [1% (95% CI 0.2–5.6)] positive IgG avidity case was detected using ELISA method, in a patient with lymphoma whose IgM was also positive. There was no significant difference between the type of leukemia and the history of contact with cat.
Conclusion: Performing specialized tests to diagnose toxoplasma infection before starting treatment, in immunodeficiency patients who undergo chemotherapy, is necessary; therefore, these tests should be considered in therapeutic protocols.
2. Edrisian Gh RM, Ghorbani M, Keshavarz H, et al. Medical Protozoology. 2nd ed. Tehran: Idenovin Publication; 2015.
3. Rostami A, Keshavarz H, Shojaee S, et al. Frequency of Toxoplasma gondii in HIV positive patients from West of Iran by ELISA and PCR. Iran J Parasitol. 2014;9(4):474-481.
4. Oskouei MM, Hamidi F, Talebi M, et al. The correlation between Toxoplasma gondii infection and Parkinson’s disease: a case-control study. J Parasit Dis. 2016;40(3):872-6.
5. Bahhaj R, Ahmadpour E, Mahami-Oskouei M, et al. Toxoplasma gondii Infection and Related Risk Factors among Blood Donors in Northwest Iran. Arch. Clin. Infect. Dis. 2017 ;12(2).
6. Di Guardo G. Commentary: Toxoplasma depends on lysosomal consumption of autophagosomes for persistent infection. Front Microbiol. 2017;8:1876.
7. Ikebe T, Sasaki H, Takata H, et al. Toxoplasmic Encephalitis with Untreated Hairy Cell Leukemia Variant. Intern Med. 2016;55(21):3175-80.
8. Wang Z-D, Liu H-H, Ma Z-X, et al. Toxoplasma gondii infection in immunocompromised patients: a systematic review and meta-analysis. Front Microbiol. 2017;8:389.
9. Armitage JO. Early-stage Hodgkin's lymphoma. N Engl J Med. 2010;363(7):653-62.
10. Chintakuntlawar A, Kidd M, Al-Kali A, et al. Toxoplasmosis in patients with hematologic malignancies. Leuk Lymphoma. 2015; 56(2):536-8.
11. Hoffbrand AV, Moss PAH. Hoffbrand's Essential Haematology: Wiley;2015
12. Fielding AK. Current treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia. Haematologica. 2010; 95(1): 8–12.
13. M.Al-Mukhtar Sama-NA. Detection of anti-Toxoplasma antibodies among patients with acute Leukemia or Lymphoma using latex agglutination and ELISA tests. The Medical Journal of Basrah University. 2009; 2(27):95-8.
14. Willemze R, Jaffe ES, Burg G, et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005;105(10):3768-85.
15. Huang Y, Huang Y, Chang A, et al. Is Toxoplasma gondii Infection a Risk Factor for Leukemia? An Evidence-Based Meta-Analysis. Med Sci Monit. 2016;22:1547-1552.
16. Nelson J, Kauffmann D, Ciavarella D, et al. Acquired toxoplasmic retinochoroiditis after platelet transfusions. Ann Ophthalmol. 1989;21(7):253-4.
17. Ngobeni R, Samie A. prevalence of Toxoplasma gondii IgG and IgM and associated risk factors among hiv-positive and hiv-negative patients in vhembe district of south africa. Afr J Infect Dis. (2017);11(2):1-9.
18. Kim YH, Hoo Lee J, Kyu Ahn S, et al. Seroprevalence of Toxoplasmosis with ELISA and Rapid Diagnostic Test among Residents in Gyodong-do, Inchon city, Korea: A Four-Year Follow-up. Korean J Parasitol. 2017;55(3):247-254.
19. Hedman K, Lappalainen M, Seppäiä I, et al. Recent primary Toxoplasma infection indicated by a low avidity of specific IgG. Int J Infect Dis; 1989,159(4):736-40.
20. Candolfi E, Pastor R, Huber R, et al. IgG avidity assay firms up the diagnosis of acute toxoplasmosis on the first serum sample in immunocompetent pregnant women. Diagn Microbiol Infect Dis. 2007;58(1):83-8.
21. Tanyuksel M, Guney C, Araz E, et al. Performance of the immunoglobulin G avidity and enzyme immunoassay IgG/IgM screening tests for differentiation of the clinical spectrum of toxoplasmosis. J Microbiol. 2004;42(3):211-5.
22. Pedram M, Maraghi S, Shirazi AS, et al. A Report of Two Cases of Cerebral Toxoplasmosis in Leukemia Patients. Jundishapur J. Microbiol. 2013;6(10).
23. Fallahi S, Kazemi B, Bandehpour M, et al. Comparison of the RE and B1 gene for detection of Toxoplasma gondii infection in children with cancer. Parasitol Int 2014; 63(1): 37-41.
24. Hanifehpour H, Samsam Shariat SK, Ghafari MS, et al. Serological and Molecular Diagnosis of Toxoplasma gondii Infections in Thalassemia Patients. Iran J Parasitol. 2019; 14(1): 20–28.
25. Ocak S, Duran N, Eskiocak AF, et al. Anti-Toxoplasma gondii antibodies in hemodialysis patients receiving long-term hemodialysis therapy in Turkey. Saudi Med J. 2005; 26(9): 1378-82.
26. Hassanzadeh M, Rasti S, Hooshyar H, et al. Seroepidemiology of Toxoplasma gondii infection in immunodeficiency patients in Kashan and Qom during 2014-2015. Feyz. 2017; 21(5): 483-9.
27. Yazar S, Yaman O, Eser B, et al. Investigation of anti-Toxoplasma gondii antibodies in patients with neoplasia. J Med Microbio. 2004; 53(12):1183-6.
28. Gharavi MJ, Jalali S, Khademvatan S, et al. Serological evaluation of anti-Toxoplasma IgM and IgG antibodies in renal transplant recipient's before and after transplant by ELFA, ELISA and ISAGA methods. Koomesh. 2012;13(2):177-82.
29. Yuan Z, Gao S, Liu Q, et al. Toxoplasma gondii antibodies in cancer patients. Cancer Lett. 2007;254(1):71-4.
30. Iqbal J, Nampoory M, Johnv K, et al. Determination of antibodies to Toxoplasma gondii and CMV in renal transplant recipients. Transplant Proc. 2003; 35(7):2703-5.
31. Horváth KN, Szénási Z, Danka J, et al. Value of the IgG avidity in the diagnosis of recent toxoplasmosis: A comparative study of four commercially available anti-Toxoplasma gondii IgG avidity assays. Acta Parasitologica. 2005;50(3):255-60.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.