Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medial Sciences, Tehran, Iran.
Parasitology. 2019 Nov;146(13):1683-1689. doi: 10.1017/S0031182019001033. Epub 2019 Aug 14.
Infection is a significant cause of morbidity and mortality in patients with chronic kidney disease, especially who were under dialysis due to their depressed immunity. Toxoplasma gondii is a ubiquitous parasite that causes severe manifestations in immunocompromised patients. This case-control study was conducted to the immunodiagnosis and molecular validation of T. gondii infection among patients with end-stage renal disease undergoing haemodialysis. The study population consisted of 260 haemodialysis patients and 259 healthy controls referred to the main dialysis centres of Tehran, Iran during 2016. Anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies were assessed using enzyme-linked immunosorbent assay. As well, the T. gondii genomic DNA in whole blood samples of IgM-positive patients and healthy controls was evaluated using GRA6-polymerase chain reaction (PCR) and SAG1-loop-mediated isothermal amplification (LAMP) assays. The anti-T. gondii IgG and IgM antibodies were detected in 175 (67.3%) and 18 (7%) of haemodialysis patients and 122 (47%) and 4 (1.5%) of controls, respectively. Two of the 18 blood samples from IgM-positive patients and none of the IgM-positive control subjects were positive by GRA6-PCR. Whereas, nine and two blood samples of IgM-positive patients and controls were positive for Toxoplasma DNA by a SAG1-LAMP technique respectively. The seropositivity of the Toxoplasma IgM antibody was significantly different between haemodialysis patients and healthy controls which was confirmed by PCR and LAMP. The higher prevalence of T. gondii infection in haemodialysis patients compared with the controls proposes that these patients can be a group at risk for toxoplasmosis and screening for toxoplasmosis before dialysis is necessary for the patients.
在慢性肾脏病患者中，感染是发病率和死亡率的重要原因，尤其是那些因免疫力低下而接受透析治疗的患者。刚地弓形虫是一种普遍存在的寄生虫，在免疫功能低下的患者中会引起严重的临床表现。本病例对照研究旨在对接受血液透析的终末期肾病患者进行弓形虫感染的免疫诊断和分子验证。研究人群包括 2016 年期间在伊朗德黑兰主要透析中心就诊的 260 名血液透析患者和 259 名健康对照者。采用酶联免疫吸附试验检测抗弓形虫免疫球蛋白 G（IgG）和免疫球蛋白 M（IgM）抗体。此外，采用 GRA6-聚合酶链反应（PCR）和 SAG1-环介导等温扩增（LAMP）检测 IgM 阳性患者和健康对照者全血样本中的弓形虫基因组 DNA。在血液透析患者中，175 例（67.3%）和 18 例（7%）检测到抗弓形虫 IgG 和 IgM 抗体，而在对照组中，122 例（47%）和 4 例（1.5%）检测到抗弓形虫 IgG 和 IgM 抗体。18 例 IgM 阳性患者的 2 份血样和 0 份 IgM 阳性对照血样通过 GRA6-PCR 检测呈阳性，而 9 份和 2 份 IgM 阳性患者和对照血样通过 SAG1-LAMP 技术检测到弓形虫 DNA 阳性。血液透析患者和健康对照组之间弓形虫 IgM 抗体的血清阳性率存在显著差异，PCR 和 LAMP 检测结果均证实了这一点。与对照组相比，血液透析患者弓形虫感染的患病率较高，这表明这些患者可能是弓形虫病的高危人群，在透析前对患者进行弓形虫病筛查是必要的。
