Toxoplasma gondii seropositivity in renal patients: rate, pattern, predictors and related morbidity.

Infection is a significant cause of morbidity and mortality in patients with chronic kidney disease (CKD) due to their depressed immunity. T. gondii is a ubiquitous parasite that causes severe manifestations in immunocomprmised patients. The present study investigated rate, pattern, predictors and related morbidity of T. gondii seropositivity in CKD patients. The study included four groups: i- patients on maintenance hemodialysis (HD; n = 60); ii- patients with systemic lupus erythematosus on immunosuppressive therapy for lupus nephritis (SLE; n = 30) iii-Renal transplant recipients (RTR; n = 30) and iv- healthy controls (HC; n = 30). Anti-Toxoplasma IgG, IgM & IgG avidity were determined using enzyme immunoassays. Patients' medical data and information on plausible risk factors for toxoplasmosis were recorded. Results revealed that T. gondii seropositivity rates in HD, SLE and RTR groups (61.7, 60 & 70% respectively) were significantly high compared to HC (30 %). Among seropositive patients, 79% of those with negative IgM displayed high IgG avidity confirming past infection. None of IgM positive patients had low IgG avidity. The latter was detected in some IgM negative patients. Multivariate analysis showed that seropositivity was significantly associated with undercooked meat consumption (adjusted OR = 6.256, CI = 2.167-18.056) and blood transfusion (adjusted OR = 5.953, CI = 2.987-11.864). No significant association could be found between T. gondii seropositivity and the clinical manifestations of CKD patients.