ORIGINAL ARTICLE


https://doi.org/10.5005/jp-journals-11001-0075
Eastern Journal of Psychiatry
Volume 24 | Issue 1 | Year 2024

Association in Toxoplasma gondii and Related Psychotic Disorders: A Primary Report


Dina Raja1, Shyamanta Das2, Chimanjita Phukan3, Simanta Talukdar4, Samrat S Bhandari5, Sanjay Singh6

1Department of Microbiology, Dhubri Medical College and Hospital, Dhubri, Assam, India

2Department of Psychiatry, Dhubri Medical College and Hospital, Dhubri, Assam, India

3Department of Microbiology, Assam Medical College and Hospital, Dibrugarh, Assam, India

4Department of Psychiatry, Nalbari Medical College and Hospital, Nalbari, Assam, India

5Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India

6Department of Psychiatry, Hayat Hospital, Guwahati, Assam, India

Corresponding Author: Shyamanta Das, Department of Psychiatry, Dhubri Medical College and Hospital, Dhubri, Assam, India, Phone: 9864501214, e-mail: dr.shyamantadas@gmail.com

Received: 02 May 2024; Accepted: 28 May 2024; Published on: 08 June 2024

ABSTRACT

Background: Implication of infection in etiology of psychotic disorders is an area of interest.

Aim: We aimed to explore the relationship between Toxoplasma gondii and psychotic disorders in a preliminary study.

Materials and methods: T. gondii immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies were measured in a sample of patients with psychotic disorders, first-degree relatives (FDR), and healthy volunteers (HV) and compared. Data were analyzed by descriptive statistics in the forms of frequency and percentage using Statistical Package for the Social Sciences (SPSS).

Results: Sample size was 10. Men and women were equal. All were from rural background. One patient with psychotic disorder out of the four had anti-T. gondii IgG antibodies in comparison to none among the three each of the FDR and HV. The patient with positive Toxoplasma IgG antibody status had the diagnosis of acute and transient psychotic disorder (ATPD).

Conclusion: This pioneering pilot project from this part of the globe highlights a pertinent area for further work in the future in order to have a newer understanding in proper management of psychotic disorder.

How to cite this article: Raja D, Das S, Phukan C, et al. Association in Toxoplasma gondii and Related Psychotic Disorders: A Primary Report. East J Psychiatry 2024;24(1):22–23.

Source of support: This research project is funded by the Srimanta Sankaradeva University of Health Sciences (SSUHS), Assam, India.

Conflict of interest: Dr Samrat S bhandari is associated as the Editorial board members of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of the Editorial board members and his research group.

Keywords: Enzyme-linked fluorescent assay, Neuropsychiatric disorders, Schizophrenia.

INTRODUCTION

The role of infection in the causation of schizophrenia is gaining ground. One such infectious agent is Toxoplasma gondii.1 Can we find a relation of Toxoplasma with schizophrenia and related disorders? Such a relation helps us not only in our knowledge of these neuropsychiatric disorders but also in their treatment. The study protocol of this work is already published.2

AIMS AND OBJECTIVES

MATERIALS AND METHODS

In this cross-sectional hospital-based study, four patients diagnosed with schizophrenia (two) and acute and transient psychotic disorder (ATPD) (two) along with three each of “FDR and healthy controls/volunteers,” a total of 10 subjects were examined in the Department of Psychiatry, Gauhati Medical College and Hospital (GMCH), Guwahati, Assam, India.

Subsequently procuring informed patient consent, approximately 5 mL of blood was taken under aseptic conditions by way of venipuncture. Patient blood samples were maintained in similar conditions, centrifuged for 5 minutes at 3000 rotations per minute, and the sera were refrigerated at –20°C until serological examination.2

The extracted serum samples of patient subjects and were further screened for anti-Toxoplasma IgG and IgM antibodies in the Department of Microbiology, GMCH using the enzyme-linked fluorescent assay (ELFA) in the mini VIDAS system (bioMérieux) strictly following the manufacturer’s instructions.2

The study was approved by the Institutional Ethics Committee of GMCH.2

Descriptive statistics was used to analyze the data.

RESULTS

Both the sexes are equally distributed (Table 1). All came from rural background. Schizophrenia and ATPD were the diagnoses. Three each were FDR and HV. All had negative IgM status while one had positive IgG status to T. gondii.

Table 1: Characteristics of the sample
Characteristics N %
Sex
 Women 5 50.0
 Men 5 50.0
Locality
 Rural 10 100.0
 Urban 0 0.0
Diagnosis
 Schizophrenia 2 20.0
 ATPD 2 20.0
 None 6 60.0
Participant distribution
 Patient 4 40.0
 FDR 3 30.0
 HV 3 30.0
IgM status
 Negative 10 100
IgG status
 Negative 7 70.0
 Positive 1 10.0
 Equivocal 2 20.0

Tables 2 and 3 demonstrate positive serological markers of anti-T. gondii antibodies in various participants and groups, respectively.

Table 2: Seroprevalence of anti-T. gondii IgG antibodies in different participants
IgG status
IgG-negative IgG-positive IgG-equivocal
Participants N % N % N %
Patient 3 30.0 1 10.0 0 0.0
FDR 2 20.0 0 0.0 1 10.0
HV 2 20.0 0 0.0 1 10.0
Total 7 70.0 1 10.0 2 20.0

HV, healthy volunteer; FDR, first-degree relative

Table 3: Seroprevalence of anti-T. gondii IgG antibodies in different groups
IgG-positive IgG-negative IgG-equivocal Total
Groups N % N % N % N %
Schizophrenia 2 100.0 0 0.0 0 0.0 2 100.0
ATPD 1 50.0 1 50.0 0 0.0 2 100.0
None* 4 66.7 0 0.0 2 33.3 6 100.0
Total 7 70.0 1 10.0 2 20.0 10 100.0

*The “none” group constitutes of FDR and HV; ATPD, acute and transient psychotic disorder

DISCUSSION

In the present study of the 10 participants, “T. gondii/IgG antibodies noted in one out of four patient subjects” in comparison to none among the six controls [FDR (three) and HV (three)]. Two individuals from the control group (one each of FDR and HV) have shown equivocal IgG status. None of the patients tested positive for IgM. The patient with IgG-positive status had the diagnosis of ATPD.

“Looking at antagonistic results on the aspects of T. gondii infection in schizophrenia,” Alvarado-Esquivel et al.3 determined their association in Mexico. “T. gondii IgM and IgG antibodies were investigated by employing enzyme-linked immunoassays in respective 50 patient subject samples for schizophrenia and 150 controls. Schizophrenia-linked patient subjects with displayed elevated levels of serological titers of T. gondii IgG antibodies when compared to control/HV subjects respectively.”

Cysts formed in chronic T. gondii infection have their location in multiple anatomical sites including the brain. Two aromatic amino acid hydroxylases found in the T. gondii genome can affect the synthesis of dopamine and serotonin.4

In a systematic review, Daryani et al.5 show that in the Iranian population, Toxoplasma has around 40% seroprevalence rate. Men and women exhibit no differences. Prevalence increases with age. High seroprevalence was observed “in groups who have explicit point of contact with cat/felines, eating raw/uncooked meat and raw fruits or vegetables, in demographic social groups of farmers, housewife, individuals having lesser awareness/education, and mainly thriving in rural households.”

CONCLUSION

The seroprevalence of IgG anti-T. gondii antibodies in psychotic group in relation to controls indicates the potential for further work in this field. A major breakthrough can be achieved by establishing the role of Toxoplasma in psychotic disorders that can pave way for not only a brain-based diagnostic system but also novel therapeutic approaches having disease modifying effect.

ACKNOWLEDGMENT

India-US Fogarty Training in Chronic Noncommunicable Disorders and Diseases Across the Lifespan Grant #1D43TW009120 (SS Bhandari, Fellow; LB Cottler, PI).

REFERENCES

1. Torrey EF, Yolken RH. Toxoplasma gondii and schizophrenia. Emerg Infect Dis 2003;9:1375–1380. DOI: 10.3201/eid0911.030143

2. Raja D, Das S, Phukan C, et al. Relationship between Toxoplasma gondii and psychotic disorders with implications toward a brain-based diagnostic system and novel treatment approaches: a study protocol. J Adv Med Med Res 2021;33:82–88. DOI: 10.9734/JAMMR/2021/v33i1330958

3. Alvarado-Esquivel C, Urbina-Álvarez JD, Estrada-Martínez S, et al. Toxoplasma gondii infection and schizophrenia: a case control study in a low Toxoplasma seroprevalence Mexican population. Parasitol Int 2011;60:151–155. DOI: 10.1016/j.parint.2010.12.003

4. Henriquez SA, Brett R, Alexander J, et al. Neuropsychiatric disease and Toxoplasma gondii infection. Neuroimmunomodulation 2009;16:122–133. DOI: 10.1159/000180267

5. Daryani A, Sarvi S, Aarabi M, et al. Seroprevalence of Toxoplasma gondii in the Iranian general population: a systematic review and meta-analysis. Acta Trop 2014;137:185–194. DOI: 10.1016/j.actatropica.2014.05.015

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