title: Toxoplasma infection in individuals in central Italy: does a gender-linked risk exist?
abstract: An accurate estimate of the impact of toxoplasmosis on the population in Italy is not available. We performed a cross-sectional study on individuals living in Italy to assess: (1) differences in access to Toxo testing and in the prevalence of recent and past Toxoplasma gondii infection according to gender and age, and (2) the clinical impact of disease burden on the male patient subset. Reason for testing, condition of in- or outpatient and clinical data were analysed. Between-gender differences were observed in access to the test. Immunoglobulin M (IgM) prevalence was increased in males in the age range 5-34 years [odds ratio (OR) = 2.03, 95% confidence interval (CI) 1.18-3.49, p = 0.01), with a peak at 25-34 years. In females, it decreased in the age range 20-39 years (OR = 0.49, 95% CI 0.32-0.74, p = 0.0008). The attack rate of recent infection was twice as high for males than for females. Estimates pointed out 3.3 and 1.7 events in 1000 at-risk person-years in the male and female cohorts, respectively. Most IgM-positive subjects did not experience severe forms of toxoplasmosis, with 35% having lymphadenopathy. Chorioretinitis, systemic and neurological manifestations were also observed. Our findings suggest that the acute phase of toxoplasmosis is largely unapparent or clinically mild in this area. It is also possible that the disease burden for Toxoplasma infection in Italy is underestimated. Further study should focus on information acquisition and Toxo test access in hospital units for a better estimation of the real burden of mild and severe forms of the disease.
authors.affiliation: Department of Translational Research, New Technologies in Medicine and Surgery (NTMS), Università di Pisa, via Roma, 55-56126, Pisa, Italy. barbara.pinto@dps.unipi.it.
authors.forename: B
authors.identifier: http://orcid.org/0000-0003-2447-7500
authors.initials: B
authors.lastname: Pinto
authors.affiliation: Chemical, Clinical and Microbiological Laboratory, USL Toscana Nord Ovest, Lucca, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Mattei
authors.affiliation: Department of Laboratory Medicine, Pisa University Cisanello Hospital, Pisa, Italy.
authors.forename: G A
authors.initials: GA
authors.lastname: Moscato
authors.affiliation: Medical Direction, Azienda Ospedaliero, Universitaria Pisana, Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cristofano
authors.affiliation: Medical Direction, Azienda Ospedaliero, Universitaria Pisana, Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Giraldi
authors.affiliation: Unit of Genetic & Microbiology, Department of Biology, Università di Pisa, Pisa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Scarpato
authors.affiliation: Department of Pediatrics, University Hospital Federico II, Naples, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Buffolano
authors.affiliation: Department of Translational Research, New Technologies in Medicine and Surgery (NTMS), Università di Pisa, via Roma, 55-56126, Pisa, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bruschi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000913:Antibodies, Protozoan / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D014123:Toxoplasmosis / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D007075:Immunoglobulin M