Trends of seropositivity and clinical spectra of Toxoplasmosis- A two-year observational study from a tertiary care centre in North India

Background: Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is highly prevalent in man and other warm-blooded animals. Most of the affected adults do not manifest any serious illness, but it can cause mental retardation and blindness in congenitally infected children and serious illness in immunocompromised individuals. We aimed to study the disease burden and clinical manifestations of Toxoplasma seropositive patients in the hilly region of North India. Methods: This is a hospital based retrospective cross-sectional study conducted between January-2018 and December-2019.Sera of suspected cases of toxoplasmosis were examined for presence of anti-Toxoplasma antibodies (IgG and IgM) by enzyme-linked immunosorbent assay. Antibody index of >1.1 was interpreted as positive. Clinical data were retrieved from medical records maintained in the department. Result: Out of 174 included cases, 70 (40.22%) cases showed positivity to both IgG and IgM antibodies. Most of the suspected cases were sent from the Pediatrics department followed by Departments of Obstetrics and Gynecology, Ophthalmology and General Medicine. Majority of the patients (45.7%) presented with mild non-specific symptoms like fever, malaise and generalized weakness and lymphadenopathy in 25.7%. Ocular and neurological manifestations were observed in 21.4% and 20% respectively. Other rare presentations were hepatic, cutaneous, pulmonary and endocrine diseases. More than one clinical feature could be found in one patient. Co-infection with HIV and Tuberculosis was found in 8.6% and 5.7% respectively. 20% cases were associated with congenital anomalies; while 18.6% cases were detected in routine anti-natal screening. Conclusion: Toxoplasmosis is highly prevalent in this hilly region showing wide variety of clinical manifestations. Therefore, prevention and control policies mainly targeting the anti-natal cases are the need of the hour.