Insights into the interplay of latent toxoplasmosis, testosterone, cortisol and oxidative stress in screened schizophrenic patients in Egypt

Background: Toxoplasma gondii is a wide-spread infection. Most cases are asymptomatic latent toxoplasmosis and its link with schizophrenia is of wide interest. Toxoplasmosis induces immunopathological and neuroendocrine alterations that induce activation of hypothalamic pituitary-adrenal axis resulting in higher glucocorticoid and testosterone levels. Oxidative stress also has a role since antioxidants as glutathione (GSH) were found to be reduced. Objective: To assess seroprevalence/serointensity of toxoplasmosis in schizophrenic patients in relation to the levels of testosterone, cortisol and GSH activity in order to evaluate these factors in the etiopathogenesis of schizophrenic patients harboring latent toxoplasmosis. Subjects and Methods: In this cross sectional case control study, 120 schizophrenic inpatients were compared with 120 individuals attending the outpatients’ clinics in the same age range, and after exclusion of schizophrenia. Schizophrenia was confirmed or excluded using positive and negative syndrome scale (PANSS). Levels of Toxoplasma IgG, free testosterone, cortisol and GSH were determined in both groups. Results: Statistical analysis revealed no differences between cases and controls as regard age, gender, contact with pets, and Toxoplasma IgG seroprevalence. Toxoplasma IgG seroprevalence was higher in males compared to females and in rural areas than in urban areas. In Toxoplasma-positive patients, testosterone was higher in both genders and glutathione was lower, while no significant difference was documented in relation to PANSS, treatment with electroconvulsive-therapy (ECT) or cortisol level. Schizophrenic patients showed higher Toxoplasma antibody titer, cortisol, free testosterone levels in both genders and lower GSH than control. Male schizophrenic patients particularly showed lower GSH level and higher Toxoplasma antibody titer. Free testosterone level was significantly higher in male patients who had received ECT. Conclusion: Latent toxoplasmosis may be involved in the etiology of schizophrenia. Screening and treatment of toxoplasmosis is advisable to prevent schizophrenia. Also, screening of schizophrenic patients for chronic toxoplasmosis and the fore mentioned parameters is recommended for prediction of complications and presents a promising approach for prevention and management.