Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Seroprevalence of Toxoplasma Gondii and Toxocara Spp in Children with Cryptogenic Epilepsy

Nora Labeeb El-Tantawy*, Hala Ahmed El-Nahas, Doaa Abdel-Badie Salem, Nanees Abdel-Badie Salem, Bothina M. Hasaneen

Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Abstract: Cryptogenic epilepsy is a group of epilepsy syndromes where aetiology is unknown but an underlying brain disease is suspected. Increased seropositivity for Toxocara and Toxoplasma gondii have been observed in epileptic patients with sparse data about their seropositivity in cryptogenic epileptic patients. Therefore, we investigated the probable relationship between seropositivity against T. gondii and Toxocara with cryptogenic epilepsy. We examined patients who had cryptogenic epilepsy and healthy non epileptic controls for seropositivity for Toxocara and T. gondii antibodies by ELISA. Out of 132 cryptogenic epileptic patients, 80 (60.6 %) and 64 (48.5%) were seropositive for T. gondii and Toxocara immunoglobulin G (IgG) antibodies respectively. The seropositivity in the control group was 26 (43.3%) and 28 (46.7%) for T. gondii and Toxocara IgG respectively. We found a significant association between chronic T. gondii infection and cryptogenic epilepsy while the association between Toxocara infection and cryptogenic epilepsy was insignificant. Our findings indicate that toxoplasmosis may be a cause of cryptogenic epilepsy. We recommended both promoting health education to prevent such infection and screening children for toxoplasmosis which would help early treatment and so decreasing the incidence of epilepsy.

Keywords: Toxoplasma, Toxocara, cryptogenic epilepsy, ELISA

Received September 14, 2013; Revised October 15, 2013; Accepted October 23, 2013

Citation: Nora Labeeb El-Tantawy, Hala Ahmed El-Nahas, Doaa Abdel-Badie Salem, Nanees Abdel-Badie Salem, Bothina M. Hasaneen, Seroprevalence of Toxoplasma Gondii and Toxocara Spp in Children with Cryptogenic Epilepsy. American Journal of Infectious Diseases and Microbiology, 1 (5). 92-95. January 2013. doi:10.12691/ajidm-1-5-3

1. Introduction

Epilepsy is a chronic neurological disorder that affects approximately 70 million people of all ages worldwide [1]. Nearly 80% of people with epilepsy are found in developing countries, where it remains a major public health problem, not only because of its health implications but also for its social, cultural, psychological and economic connotations [2]. According to the Commission on Classification and Terminology of the International League Against Epilepsy in 1985-1989 [3], cryptogenic epilepsies are defined as epilepsy syndromes for which an aetiology is unknown, but an underlying brain disease is suspected affecting approximately 20% of all patients with epilepsy [4].

Parasitic infections are considered as serious public health problems in many developing countries [5] affecting various tissues including the brain leading to neurological dysfunction and constitute important risk factors for epilepsies [6]. Simultaneously, these infections represent a controllable risk as they can be prevented through immunization or treatment. Among these parasitic infections, toxoplasmosis and toxocariasis have been suggested as an important risk factor for epilepsy needing confirmation [7,8].

Toxoplasmosis is caused by Toxoplasma gondii, a protozoan and is estimated to infect one-third of the world’s human population [9,10]. Toxoplasma is an obligate intracellular parasite founded in two forms in humans. The actively proliferating trophozoites are usually seen in the early phases of the infection while the resting forms or tissue cysts are primarily found in muscle and brain [11]. Cerebral toxoplasmosis has been reported to cause seizures in about 25% of infected cases [12] by producing diffuse encephalitis or localized lesions [13].

Toxocariasis is a zoonosis caused by Toxocara canis and T. catis, the nematode parasites of dogs and cats, respectively [14]. The principal source of infection is eggs which are released from the feces of dogs and result in contamination of the soil [15,16]. Children are more susceptible to this infection because they handle (playing habits) contaminated soil [17]. When infective eggs containing larvae are ingested by human, the larvae become free in the intestine and pass through the intestinal wall to migrate through tissues provoking inflammatory tissue reactions with multisystem involvement leading to the clinical syndrome referred to as visceral larva migrans [18]. The larvae can locate in the central nervous system leading to a variety of neurological disorders [19]. Seizures have been reported as the initial CNS manifestation of toxocariasis in quite a number of patients [20]. A possible association between Toxocara infection and epilepsy has been hypothesized and toxocariasis has been suggested as a cofactor for epilepsy [21].

Both Toxoplasma and Toxocara infections are implicated to have an association with epilepsy either as a cause or a potential risk factor for its occurrence. There has been long-standing interest in investigating this possible association. But, yet the evidence for such a relationship is far from conclusive. So, our study was aimed to investigate the relationship between Toxoplasma and Toxocara seropostivity in children with cryptogenic epilepsy.

2. Subjects and Methods

The present case-control seroprevalence study was carried out with a total of 132 consecutive pediatric age patients with cryptogenic epilepsy who were evaluated and followed up in the Neurology Unit at Mansoura University Children’s Hospital, Mansoura, Egypt. This prospective study was conducted in the period from April 2012 to June 2013. Diagnosis of cryptogenic epilepsy was based on: a negative family history of epilepsy, no history of head trauma, previous meningitis/encephalitis or brain surgery and normal magnetic resonance imaging (MRI) study and electroencephalogram (EEG). All patients were subjected to full history taking and complete physical examination. The demographic and life style information was obtained through a survey questionnaire. The epileptic patients were classified into three age groups; group I (≤ 5 years), group II (> 5 years to ≤ 10 years), and group III (> 10 years to ≤ 14 years).

The control group consisted of 60 age matched volunteers with informed consent from parient/guardian from children attending out-patient clinic for other causes without any personal or family history of seizures. The study was approved by Ethics Committee of Pediatric department at Mansoura University Children’s Hospital-Mansoura University.

2.1. Sample Collection

Three ml of venous blood was drawn aseptically from each subject included in the study. Serum was separated by centrifugation and each sample is divided into two tubes and stored at −20°C until tested.

2.2. Serological Investigation

Serum samples were tested for both anti-Toxocara IgG antibodies detection using RIDASCREEN Toxocara-IgG ELISA (R-Biopharm AG, Germany) kit which detects antibodies against the excretory/secretory antigen of the Toxocara larvae. For anti-Toxoplasma IgG antibodies detection, (Adaltis, Italy) kit was used. According to the manufacturer’s recommendations, serum samples were diluted and used for testing; each serum sample was tested in triplicates. Positive and negative controls were included in the kit.

2.3. Statistical Analysis

Collected epidemiological, clinical and laboratory data were computerized and statistically analyzed using SPSS 16.0 (SPSS Inc., Chicago, IL.). Results were presented as frequencies [n (%)]. Chi-squared test was used in comparing the results. A p value of < 0.05 was considered significant.

3. Results

Of the 132 cryptogenic epilepsy patients included in the study, 62 (47%) were females and 70 (53%) were males; their age range was between 1-14 years (8.7 ± 3.9). The control group consisted of 60 subjects, 34 (56.7%) were males and 26 (43.3%) were females; their age range was between 1-14 years of age (9.9 ± 3.7). The epileptic patients and controls groups were quite similar regarding age groups and sex (p > 0.05). The overall seroprevalence of both Toxoplasma and Toxocara antibodies in both groups were 55.02 % and 47.91% respectively.

As regard T. gondii seroprevalence results, 80 epilepsy patients (60.6%) had statistically significant T. gondii seropositive rates, as compared to 26 (43.3%) seropositive controls (P = 0.026) (Table 1). Among T. gondii seropositive patients, there was male predominance (57.8%). Children residing in rural areas have higher T. gondii seropostivity than children residing urban areas (45 vs. 38).

Table 1. Seropositivity rates for both T. gondii and Toxocara spp

As regard Toxocara results, 64 (48.5%) of children with cryptogenic epilepsy have positive anti-Toxocara antibodies in comparison to control ones 28 (46.7%). There is no significant association between epilepsy and Toxocara seropostivity (p= 0.815) (Table 1).

Table 2. Demographic characteristics of cases and control subjects

4. Discussion

Cryptogenic epilepsies are a group of epilepsy syndromes for which the etiology is hidden or occult [22] and it comprises about 20% of all epilepsy syndromes [23]. Epidemiological links suggest an association between Helminth infection and epilepsy, particularly in the poorer areas of the world [24].

Toxoplasma gondii can form asymptomatic dormant cysts in the brain and could have the potential to cause epilepsy [7]. Also, the migrating Toxocara larvae can be found in the human brain causing an epileptic focus [25]. There is no precise report from both anti-Toxocara and anti-Toxoplasma antibodies in cryptogenic epileptic patients in our region. Our study screened the cryptogenic epileptic patients and the controls for T. gondii and Toxocara to investigate the possible correlation between these infections and cryptogenic epilepsy.

We found a statistically significant association between T. gondii infection and cryptogenic epilepsy was detected but no significant association between Toxocariasis and cryptogenic epilepsy. This significant correlation can be explained by either (i) dormant T. gondii cysts containing bradyzoites may cause epileptic foci and cryptogenic epilepsy in animal models it is proposed that some tissue cysts rupture and in doing so causes marked inflammation of that area and hence triggers microglial formation which may represent the ‘tombstones’ of Toxoplamsa cysts and lead to scar tissue formation [26]; or (ii) The cryptogenic epilepsy patients could be more susceptible to this infections [27].

Regarding the association between Toxoplasma infection and cryptogenic epilepsy, our results are consistent with that of Yazar et al. [28] who have reported that the level of T. gondii IgG showed a statistically significantly high value in a study of cryptogenic epilepsy. And also with Stommel et al. [7] who suggested that chronic T. gondii infection with brain cysts may be a cause of cryptogenic epilepsy. On the other hand, Akyol et al. [29] reported no relationship between cryptogenic epilepsy and positive T. gondii serology in his study which was carried on 100 cryptogenic epileptic patients and 50 healthy volunteers that had no history of epilepsy in their first degree relatives.

However, we found no significant association between Toxocara infection and cryptogenic epilepsy. To our knowledge, there is no previous data about this relation except a study from Turkey which also did not find any association between cryptogenic epilepsy and seropositivity to Toxocara [29]. Also, there is less data about the association between Toxocara species and epilepsy. Most of them describe a significant association in the United States [29], Italy [21,30] and Iran [31]. In these studies, increased Toxocara seropostivity may be due to increased susceptibility to helminth infection.

Our findings demonstrated that the seropositivity to Toxocara and Toxoplasma cases were in the age group 5-10 years, the age where rate of infection is high and seropostivity were more in males than females as males are more frequently infected than females in most endemic areas [32]. As contact with cats and dogs is important risk factor of Toxocara infection [33,34]. We also asked about contact with animals in our cases but we found no significant relationship between animal contact and Toxocara-Toxoplasma seropostivity rates. We found that there was a significant relationship in antibody positivity against Toxoplasma and Toxocara and rural areas. This in accordance with that of [21,35,36] who have found that the risk for developing Toxocara and Toxoplasma infection is higher in rural areas than in urban areas.

5. Conclusion

The study results have indicated that there was a statistically significant association between Toxoplasma gondii seropostivity and cryptogenic epilepsy and no significant association between Toxocara spp seropostivity and cryptogenic epilepsy. This correlation should be further evaluated. The results of the current study reemphasize the importance/significance of public health measures to prevent and control exposure of pediatric age/susceptible population to such parasitic infections.

References

[1]   | Ngugi, A.K., Bottomley, C., Kleinschmidt, I., Sander, J.W., Newton, C.R, "Estimation of the burden of active and life-time epilepsy: a meta-analytic approach", Epilepsia, 51(5):883-890, 2010.
[2]   | World Health Organization (WHO), Epilepsy: aetiology, epidemiology and prognosis, Fact Sheet, No. 999, 2009.
[3]   | Commision on the Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of the epilepsies and epileptic syndromes. Epilepsia,30:389-99, 1989.
[4]   | Manford, M., Hart, Y.M., Sander, J.W.A.S. and Shorvon, S.D, "The National General Practice Study of Epilepsy: the syndromic classification of the International League against Epilepsy applied to epilepsy in a general population", Arch Neurol , 49:801-8, 1992.
[5]   | Stephenson, L.S., Latham, M.C., Ottesen, E.A, "Malnutrition and parasitic helminth infections", Parasitology, 121: SupplS23-S38,2000.

[6]  
Nkouawa, A., Sako, Y., Itoh, S., Kouojip-Mabou, A., Nganou, C.N., Saijo, Y., Knapp, J., Yamasaki, H., Nakao, M., Nakaya ,K., Moyou-Somo, R., Ito, A, "Serological studies of neurologic helminthic infections in rural areas of southwest cameroon: toxocariasis, cysticercosis and paragonimiasis", PLoS Negl Trop Dis, 6;4(7), 2010.

[7]   | Stommel, E.W., Seguin, R., Thadani, V.M., Schwartzman, J.D., Gilbert, K., Ryan K.A., Tosteson, T.D., Kaspe, L.H, "Cryptogenic epilepsy: an infectious aetiology?", Epilepsia, 42 (3):436-438, 2001.

[8]  
Nicoletti ,A., Bartoloni, A., Reggio, A., Bartalesi, F., Roselli, M., Sofia, V., Rosado Chavez, J., Gamboa Barahona, H., Paradisi, F., Cancrini ,G., Tsang, V.C., Hall, A.J, "Epilepsy, cysticercosis, and toxocariasis: a population-based case-control study in rural Bolivia", Neurology, 23;58(8):1256-61, 2002.

[9]   | Tenter, A.M., Heckeroth, A.R., Weiss, L.M. "Toxoplasma gondii: from animals to humans", Int J Parasitol, 30:1217-1258, 2000.
[10]   | Dubey, J.P., Jones, J.L. "Toxoplasma gondii infection in humans and animals in the United States", Int J Parasitol, 38:1257-1278, 2008.
[11]   | Garcia, S. L. and Bruckner, A. D. "Tissue protozoa (Toxoplasma gondii). In: Diagnostic Medical Parasitology, 3rd ed. Washington, D.C., American Society for Microbiology, pp. 111-121. 1997.
[12]   | Senanayake, N., Roman GC. "Aetiologic factors of epilepsy in the tropics", J Trop Geogr Neurol, 1: 69-80, 1991.
[13]   | Neto, M.C., De Bittencourt, P.R.M, "Infections and post-infective causes". In: Wallace S, ed. Epilepsy in children. Madras: Chapman & Hall, 79-86. 1996.
[14]   | Cypess, R.H., Karol, M.H., Zidian, J.L., Glickman, L.T., Gitlin, D, "Larva specific antibodies in patients with visceral larva migrans", J.Infect Dis, 135:633-40,1977.
[15]   | Uga, S., Kataoka, N, "Measures to control Toxocara egg contamination in sandpits of public parks", Am J Trop Med Hyg, 52:21-24, 1995.
[16]   | Roddie G., Holland, C., Stafford, P., Wolfe, A, "Contamination of fox hair with eggs of Toxocara canis", J Helminthol, 82(4):293-6, 2008.
[17]   | Figueiredo, S.D., Taddei, J.A., Menezes, J.J., Novo, N.F., Silva, E.O., Cristóvão, H.L., Cury ,MC, "Clinical-epidemiological study of toxocariasis in a pediatric population", J Pediatr, 81 (2):126-32, 2005.
[18]   | Magnaval, J.F., Glickman, L.T., Dorchies, P., Morassin, B, "Highlights of human toxocariasis", Korean J Parasitol,39(1):1-11, 2001.
[19]   | Schantz, P.M., Glickman, L.T, "Toxocaral visceral larva migrans", N Engl J Med. 23;298(8):436-9,1978.
[20]   | Bächli, H., Minet, J.C., Gratzl, O, "Cerebral toxocariasis: a possible cause of epileptic seizure in children", Childs Nerv Syst, 20(7):468-72, 2004.
[21]   | Arpino, C., Gattinara, G.C., Piergili, D., Curatolo, P, "Toxocara infection and epilepsy in children: a case-control study", Epilepsia 31:33-36,1990.

[22]  
Berg, A.T., Berkovic, S.F., Brodie, M.J., Buchhalter, J., Cross, J.H., van Emde Boas, W., Engel, J., French, J., Glauser, T.A., Mathern, G.W., Moshé, S.L., Nordli, D., Plouin, P., Scheffer, I.E, "Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009", Epilepsia, 51(4):676-85, 2010.

[23]   | Manford, M., Hart, Y.M., Sander, J.W., Shorvon, S.D, "National General Practice Study of Epilepsy (NGPSE): partial seizure patterns in a general population", Neurology, 42(10):1911-7, 1992.
[24]   | Wagner, R.G., Newton, C.R, "Do helminths cause epilepsy?", Parasite Immunol, 31(11):697-705, 2009.
[25]   | Despommier, D, "Toxocariasis: clinical aspects, epidemiology, medical ecology, and molecular aspects", Clinical Microbiology, 16(2) 265-272, 2003.
[26]   | Frenkel, J.K., Escajadillo, A, "Cyst rupture as a pathogenic mechanism of toxoplasmic encephalitis", Am J Trop Med Hyg, 36(3):517-22,1987.
[27]   | Woodruff, A.W., Bisseru, B., Bowe, J.C, "Infection with animal helminths as a factor in causing poliomyelitis and epilepsy", Br Med J, 1: 1576–1579, 1966.
[28]   | Yazar, S., Arman, F., Yalcin, S., Demirtas, F., Yaman, O., Sahin, I, "Investigation of probable relationship between Toxoplasma gondii and cryptogenic epilepsy", Seizure, 2003;12:107-9,2003.
[29]   | Akyol, A., Bicerol, B., Ertug, S., Ertabaklar, H., Kiylioglu, N, "Epilepsy and seropositivity rates of Toxocara canis and Toxoplasma gondii", Seizure, 16(3):233-7., 2007.
[30]   | Nicoletti, A., Sofia, V., Mantella, A., Vitale, G., Contrafatto, D., Sorbello, V., Biondi, R., Preux, P.M., Garcia, H.H., Zappia, M., Bartoloni, A, "Epilepsy and toxocariasis: a case-control study in Italy", Epilepsia, 49(4):594-9, 2008.
[31]   | Zibaei, M., Firoozeh, F., Bahrami, P., Sadjjadi, S.M, "Investigation of anti-Toxocara antibodies in epileptic patients and comparison of two methods: ELISA and Western blotting", Epilepsy Res Treat, Apr 22, 2013
[32]   | Kaiser, C., Pion, S.D., Boussinesq,M, "Case-control studies on the relationship between onchocerciasis and epilepsy: systematic review and meta-analysis", PLoS Negl Trop Dis, 7(3), 2013.
[33]   | Magnaval, J.F., Michault, A., Calon, N., Charlet, J.P, " Epidemiology of human toxocariasis in La R´eunion", Transactions of the Royal Society of Tropical Medicine and Hygiene, 88:531-533, 1994.
[34]   | Mendonça, L.R., Figueired, C.A., Esquivel, R., Fiaccone, R.L., Pontes-de-Carvalho, L., Cooper, P., Barreto, M.L., Alcantara-Neve, N.M, "Seroprevalence and risk factors for Toxocara infection in children from an urban large setting in Northeast Brazil", Acta Trop, Jul 8, 2013.
[35]   | Glickman, L.T., Cypess, R.H., Crumrine, P.K., Gitlin, D.A, "Toxocara infection and epilepsy in children", J Pediatr, 94:75-8, 1979
[36]   | Hill, I.R., Denham, D.A., Scholtz, C.L, "Toxocara canis larvae in the brain of a British child", Trans R Soc Trop Med Hyg, 79:351-4, 1985.