Original Article

Seroepidemiology and Risk Factors of Toxoplasma gondii in Iranian COVID-19 Patients: A Case-Control Study

Abstract

Background: Theoretically, there is a possible association between emerging SARS‑CoV‑2 infection and parasites such as Toxoplasma gondii. We aimed to evaluate the seroepidemiology of T. gondii in COVID-19 patients and the control group as well as its correlation with risk factors.
Methods: Totally, 450 sera samples were taken from COVID-19 positive patients and controls from the Tehran, Karaj, and Shiraz cities, Iran. Anti-T. gondii IgG and IgM were evaluated using the ELISA technique. After two months, the participants were followed for recovery or non-recovery and even death. The association between seroprevalence and severity of viral infection as well as other risk factors was statistically estimated.
Results: IgG prevalence in patients and healthy individuals was 59.11% and 61.77%, respectively; these values were estimated at 2.22% and 0% for IgM, respectively. There was no significant association between the prevalence of IgG with COVID-19 infection, while this association was statistically significant for IgM prevalence. The Karaj had the highest prevalence, and a significant association was observed between the seroprevalence and some variables.
Conclusion: Despite the non-significant association between the chronic phase of T. gondii (sero) prevalence and COVID-19 symptomatic forms, the parasite prevalence was estimated remarkable and the viral infection and parasite-related acute phase antibodies relationship was estimated to be statistically significant. Due to immunosuppressive therapies for this viral inflammatory infection, it makes it more difficult to interpret the results, and because of the vulnerability of the immune system of these individuals, toxoplasmosis is likely to be hazardous in them; therefore, screening for this parasitic complication seems necessary.

1. Ciotti M, Ciccozzi M, Terrinoni A, Jiang W-C, Wang C-B, Bernardini S. The covid-19 pandemic. Crit Rev Clin Lab Sci. 2020;57:365-388.
2. Daniel SJ. Education and the covid-19 pandemic. Prospects (Paris). 2020;49:91-96.
3. https://www.worldometers.info/coronavirus/
4. Alimohamadi Y, Sepandi M, Taghdir M, Hosamirudsari H. Determine the most common clinical symptoms in covid-19 patients: A systematic review and meta-analysis. J Prev Med Hyg. 2020; 61(3):E304-E312.
5. Nile SH, Nile A, Qiu J, et al. Covid-19: Pathogenesis, cytokine storm and therapeutic potential of interferons. Cytokine Growth Factor Rev. 2020; 53:66-70.
6. Yong SJ. Long covid or post-covid-19 syndrome: Putative pathophysiology, risk factors, and treatments. Infect Dis (Lond). 2021; 53:737-754.
7. Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with covid-19: A systematic review and meta-analysis. J Infect. 2020;81:266-275.
8. Zargaran FN, Rostamian M, Kooti S, Madanchi H, Ghadiri K. Co-infection of covid-19 and parasitic diseases: A systematic review. Parasit Epidemiol Control. 2023; 21:e00299.
9. Brown SP, Grenfell BT. An unlikely partnership: Parasites, concomitant immunity and host defence. Proc Biol Sci. 2001;268:2543-2549.
10. Khan IA, Moretto M. Immune responses to Toxoplasma gondii. Curr Opin Immunol. 2022;77:102226.
11. Kochanowsky JA, Koshy AA. Toxoplasma gondii. Curr Biol. 2018;28:R770-R771.
12. Saadatnia G, Golkar M. A review on human toxoplasmosis. Scand J Infect Dis. 2012;44:805-814.
13. Ahmed M, Sood A, Gupta J. Toxoplasmosis in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2020; 255:44-50.
14. Fisch D, Clough B, Frickel E-M. Human immunity to Toxoplasma gondii. PLoS Pathog. 2019;15:e1008097.
15. Maizels RM, McSorley HJ. Regulation of the host immune system by helminth parasites. J Allergy Clin Immunol. 2016; 138:666-675.
16. Wakelin D. Immunity to parasites: How parasitic infections are controlled. Cambridge University Press; 1996.
17. Zhou Y, Fu B, Zheng X, et al. Pathogenic t-cells and inflammatory monocytes incite inflammatory storms in severe covid-19 patients. Natl Sci Rev. 2020;7:998-1002.
18. Sharaf-El-Deen SA. Toxoplasma gondii as a possible risk factor for covid-19 severity: A case-control study. Egyptian Journal of Medical Microbiology. 2021;30:125-132.
19. Roe K. The symptoms and clinical manifestations observed in covid-19 patients/long covid-19 symptoms that parallel Toxoplasma gondii infections. J Neuroimmune Pharmacol. 2021;16:513-516.
20. Meira CS, Pereira-Chioccola VL, Vidal JE, et al. Cerebral and ocular toxoplasmosis related with ifn-γ, tnf-α, and il-10 levels. Front Microbiol. 2014;5:492.
21. Mahmoudzadeh S, Nozad Charoudeh H, Marques CS, Bahadory S, Ahmadpour E. The role of il-12 in stimulating nk cells against Toxoplasma gondii infection: A mini-review. Parasitol Res. 2021;120:2303-2309.
22. Ghosh D, Walton JL, Roepe PD, Sinai AP. Autophagy is a cell death mechanism in Toxoplasma gondii. Cell Microbiol. 2012;14:589-607.
23. Seabra SH, de Souza W, DaMatta RA. Toxoplasma gondii partially inhibits nitric oxide production of activated murine macrophages. Exp Parasitol. 2002;100:62-70.
24. MacRae JI, Sheiner L, Nahid A, et al. Mitochondrial metabolism of glucose and glutamine is required for intracellular growth of Toxoplasma gondii. Cell Host Microbe. 2012;12:682-692.
25. Jafari MM, Tabrizi ZA, Dayer MS, et al. Immune system roles in pathogenesis, prognosis, control, and treatment of Toxoplasma gondii infection. Int Immunopharmacol. 2023;124 (Pt A):110872.
26. Tay MZ, Poh CM, Rénia L, et al. The trinity of covid-19: Immunity, inflammation and intervention. Nat Rev Immunol. 2020;20:363-374.
27. Roe K. The link between Toxoplasma gondii infections and higher mortality in covid-19 patients having schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2022;272:167-168.
28. Montazeri M, Nakhaei M, Fakhar M, et al. Exploring the association between latent Toxoplasma gondii infection and covid-19 in hospitalized patients: First registry-based study. Acta Parasitol. 2022;67:1172-1179.
29. Gibson PG, Qin L, Puah SH. Covid‐19 acute respiratory distress syndrome (ards): Clinical features and differences from typical pre‐covid‐19 ards. Med J Aust. 2020;213:54-56.e1.
30. Butcher BA, Denkers EY. Mechanism of entry determines the ability of Toxoplasma gondii to inhibit macrophage proinflammatory cytokine production. Infect Immun. 2002;70:5216-5224.
31. Heidari A, Hezarosi M, Nasserkhail E, et al. The parasitic contamination of edible raw vegetables in karaj, iran in 2017. Iran J Public Health. 2020;49:2435-2437.
32. Dalimi A, Abdoli A. Latent toxoplasmosis and human. Iran J Parasitol. 2012; 7(1):1-17.
33. Araujo F, Remington J. Toxoplasmosis in immunocompromised patients. Eur J Clin Microbiol. 1987; 6(1):1-2.
34. Ghaffari S, Kalantari N, Gorgani-Firouzjaee T, et al. Is covid-19 associated with latent toxoplasmosis? Environ Sci Pollut Res Int. 2021;28:67886-67890.
35. Yazdanbakhsh M, Matricardi PM. Parasites and the hygiene hypothesis: Regulating the immune system? Clin Rev Allergy Immunol. 2004;26:15-24.
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IssueVol 20 No 1 (2025) QRcode
SectionOriginal Article(s)
Keywords
Toxoplasma gondii COVID-19 Risk factors Iran

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How to Cite
1.
Haghparast Z, Ghaffarifar F, Sharifi Z, Bahadory S. Seroepidemiology and Risk Factors of Toxoplasma gondii in Iranian COVID-19 Patients: A Case-Control Study. Iran J Parasitol. 2025;20(1):140-147.