title: Is toxoplasmosis a potential risk factor for liver cirrhosis?
abstract: OBJECTIVE
  To document Toxoplasma gondii (T. gondii) antibody status in patients with liver disease, blood samples were taken from 180 hepatic patients and 180 healthy controls.
  
  
  METHODS
  Toxoplasma IgG antibody was detected using enzyme-linked immunosorbent assay and histopathological assessment of liver biopsy METAVIR score was applied.
  
  
  RESULTS
  Anti-T. gondii IgG antibodies were found in 32.8% of patients and in 22.2% of controls (P = 0.02). Toxoplasma seropositivity was significantly associated with lymphadenopathy, history of blood transfusion and reflex impairment in patients. Chronic hepatitis C virus (HCV) and chronic HCV-related cirrhosis groups compared to chronic HBV and chronic HBV-related cirrhosis groups expressed significantly higher prevalence of T. gondii seropositivity (odds ratio (OR) = 4; 95% confidence interval (CI): 1.3-12.6; P = 0.013, OR = 4.8; 95% CI: 1.5-14.9; P = 0.006, respectively). Within the chronic HCV group, T. gondii seropositivity significantly associated disease evolution as regards to METAVIR histopathological system for fibrosis and inflammation (OR = 19.4; 95% CI: 2.3-165.2; P = 0.0008, OR = 0.29; 95% CI: 0.1-0.8; P = 0.01, respectively). Albumin, international normalized ratio (INR) and platelets count were the laboratory parameters significantly altered in Toxoplasma-positive chronic HCV patients (P = 0.001, 0.03, 0.04, respectively). Child-Pugh scoring for cirrhosis in chronic HCV group placed the majority of seropositive patient in class C with significant statistical difference compared to Child A reference group (OR = 0.08; 95% CI: 0.01-0.5; P = 0.003).
  
  
  CONCLUSIONS
  Toxoplasma seropositivity was high in patients with cirrhosis and associated higher grades of inflammation and necrosis signifying disease evolution, suggesting that cirrhotic patients may thus form a risk group for toxoplasmosis.
authors.affiliation: Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Abeer
authors.initials: A
authors.lastname: Abd El-Rehim El-Henawy
authors.affiliation: Department of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdel-Razik
authors.affiliation: Department of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Sahar
authors.initials: S
authors.lastname: Zakaria
authors.affiliation: Department of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Dina
authors.initials: D
authors.lastname: Elhammady
authors.affiliation: Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Niveen
authors.initials: N
authors.lastname: Saudy
authors.affiliation: Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt. Electronic address: manaryym@yahoo.com.
authors.forename: Manar Sobh
authors.initials: MS
authors.lastname: Azab
keywords: Child-Pugh score; HBV; HCV; Liver cirrhosis; METAVIR score; Toxoplasma gondii