Document Type: Original Article


1 Department of Medical Parasitology, Faculty of Medical Sciences, Tarbiat Modaress University, Tehran, Iran

2 Department of Nursing, Faculty of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran

3 Assistant Professor, Department of Environmental Sciences, Faculty of Fisheries and Environmental Sciences, University of Agricultural Sciences and Natural Resources, Gorgan, Iran


Background and aims: Toxoplasmosis is a very common disease in the world and has two types,
including chronic and acute toxoplasmosis. In the chronic toxoplasmosis, the abnormality of tissue
function is negligible, but in acute toxoplasmosis, the function of the reticuloendothelial system is
interrupted and the assessment of Toxoplasma antibody with tissue enzymes is very essential in this
stage. In addition, in some conditions, serum ferritin increases in the acute phase of the infectious
disease. In congenital toxoplasmosis, the evaluation of biochemical factors and IgG avidity test is
important for detecting the acute congenital toxoplasmosis in pregnant women. Based on the
above-mentioned explanations, the present study aimed to evaluate the biochemical factors in
patients with acute toxoplasmosis (congenital toxoplasmosis) among the Iranian population using
electrochemiluminescence and IgG ELISA avidity.
Methods: The study was based on a comparative abundance study and was conducted from March to
June 2017. Material included 980 serum and amniotic fluid samples collected from human blood with
a high level of IgG antibody against Toxoplasma gondii in Rajaie Center, Tehran, Iran. The standard and
the main tests included the ELISA assay and the measurement of the liver transaminases (i.e., SGOT
and SGPT), along with/namely bilirubin and ferritin used to detect IgG antibodies and to evaluate the
acute toxoplasmosis, respectively. Finally, the results were analyzed by SPSS software.
Results: The results showed that the level of liver transaminases, namely, serum bilirubin and ferritin
increase in some patients with a high level of IgG avidity antibody against Toxoplasma gondii. For
example, the mean serum levels of SGOT was 108 IU/L in 120 patients with acute toxoplasmosis and
the mean serum bilirubin was about 5 mg/dL in 80 patients.
Conclusion: Overall, in acute congenital toxoplasmosis, the evaluation of IgG AVIDITY is regarded as
the first step and then the measurement of biochemical factors such as serum transaminases, serum
bilirubin, and serum ferritin is important.


Main Subjects

1. Chiang TY, Kuo MC, Chen CH, Yang JY, Kao CF, Ji DD, et
al. Risk factors for acute Toxoplasma gondii diseases in
Taiwan: a population-based case-control study. PLoS One.
2014;9(3):e90880. doi: 10.1371/journal.pone.0090880.
2. Jones JL, Dargelas V, Roberts J, Press C, Remington JS,
Montoya JG. Risk factors for Toxoplasma gondii infection in
the United States. Clin Infect Dis. 2009;49(6):878-84. doi:
3. Alvarado-Esquivel C, Torres-Berumen JL, Estrada-Martinez
S, Liesenfeld O, Mercado-Suarez MF. Toxoplasma gondii
infection and liver disease: a case-control study in a northern
Mexican population. Parasit Vectors. 2011;4:75. doi:
4. McAuley JB. Congenital toxoplasmosis. J Pediatric Infect Dis
Soc. 2014;3 Suppl 1:S30-5. doi: 10.1093/jpids/piu077.
5. Prusa AR, Kasper DC, Pollak A, Gleiss A, Waldhoer T, Hayde
M. The Austrian toxoplasmosis register, 1992-2008. Clin Infect
Dis. 2015;60(2):e4-e10. doi: 10.1093/cid/ciu724.
6. Tomasoni LR, Meroni V, Bonfanti C, Bollani L, Lanzarini
P, Frusca T, et al. Multidisciplinary approach to congenital
Toxoplasma infection: an Italian nationwide survey. New
Microbiol. 2014;37(3):347-54.
7. Sato S, Nishida M, Nasu K, Narahara H, Norose K, Aosai
F. Congenital toxoplasmosis from a mother with type 2
diabetes mellitus: a case report. J Obstet Gynaecol Res.
2014;40(11):2158-61. doi: 10.1111/jog.12477.
8. Kavari A, Nowzari N, Moazeni Jula G, Moazeni Jula F,
Hashemzadeh H. A Serological and Molecular study on
Toxoplasma gondii infection in sheep and goat in Tabriz.
Archives of Razi Institute. 2013;68(1):29-35. doi: 10.7508/
ari.2013.01.005. [Persian].
9. Yad Yad MJ, Jomehzadeh N, Jafar Sameri M, Noorshahi N.
Seroprevalence of Anti-Toxoplasma gondii antibodies among
pregnant woman in South Khuzestan, Iran. Jundishapur J
Microbiol. 2014;7(5):e9998. doi: 10.5812/jjm.9998.
10. Zhang YP, Song RH. [Investigation on pregnancy outcomes
and risk factors in pregnant women infected with Toxoplasma
gondii]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi.
11. Davami MH, Pourahamd M, Jahromi AR, Tadayon SM.
Toxoplasma seroepidemiology in women who intend to marry
in Jahrom, Islamic Republic of Iran. East Mediterr Health J.
2014;19 Suppl 3:S71-5.
12. Park YH, Nam HW. Clinical features and treatment of ocular
toxoplasmosis. Korean J Parasitol. 2013;51(4):393-9. doi:
13. Andiappan H, Nissapatorn V, Sawangjaroen N, Khaing SL,
Salibay CC, Cheung MM, et al. Knowledge and practice on
Toxoplasma infection in pregnant women from Malaysia,
Philippines, and Thailand. Front Microbiol. 2014;5:291. doi:
14. Rodrigues IM, Costa TL, Avelar JB, Amaral WN, Castro AM,
Avelino MM. Assessment of laboratory methods used in the
diagnosis of congenital toxoplasmosis after maternal treatment
with spiramycin in pregnancy. BMC Infect Dis. 2014;14:349.
doi: 10.1186/1471-2334-14-349.
15. Marangoni A, Capretti MG, De Angelis M, Nardini P,
Compri M, Foschi C, et al. Evaluation of a new protocol for
retrospective diagnosis of congenital toxoplasmosis by use
of Guthrie cards. J Clin Microbiol. 2014;52(8):2963-70. doi:
16. Andiappan H, Nissapatorn V, Sawangjaroen N, Chemoh W,
Lau YL, Kumar T, et al. Toxoplasma infection in pregnant
women: a current status in Songklanagarind hospital, southern
Thailand. Parasit Vectors. 2014;7:239. doi: 10.1186/1756-
17. El-Shahawy IS, Khalil MI, Bahnass MM. Seroprevalence of
Toxoplasma gondii in women in Najran City, Saudi Arabia.
Saudi Med J. 2014;35(9):1143-6.
18. Drapala D, Holec-Gasior L, Kur J, Ferra B, Hiszczynska-
Sawicka E, Lautenbach D. A new human IgG avidity test, using
mixtures of recombinant antigens (rROP1, rSAG2, rGRA6), for
the diagnosis of difficult-to-identify phases of toxoplasmosis.
Diagn Microbiol Infect Dis. 2014;79(3):342-6. doi: 10.1016/j.
19. Puccio G, Cajozzo C, Canduscio LA, Cino L, Romano A,
Schimmenti MG, et al. Epidemiology of Toxoplasma and CMV
serology and of GBS colonization in pregnancy and neonatal
outcome in a Sicilian population. Ital J Pediatr. 2014;40:23.
doi: 10.1186/1824-7288-40-23.
20. Chemoh W, Sawangjaroen N, Nissapatorn V, Suwanrath C,
Chandeying V, Hortiwakul T, et al. Toxoplasma gondii infection:
What is the real situation? Exp Parasitol. 2013;135(4):685-9.
doi: 10.1016/j.exppara.2013.10.001.
21. Dlugonska H. Toxoplasma gondii and the host cells. Ann
Parasitol. 2014;60(2):83-8.
22. Krueger WS, Hilborn ED, Converse RR, Wade TJ. Drinking
water source and human Toxoplasma gondii infection in the
United States: a cross-sectional analysis of NHANES data.
BMC Public Health. 2014;14:711. doi: 10.1186/1471-2458-
23. Tomasoni LR, Meroni V, Bonfanti C, Bollani L, Lanzarini
P, Frusca T, et al. Multidisciplinary approach to congenital
Toxoplasma infection: an Italian nationwide survey. New 

Microbiol. 2014;37(3):347-54.
24. Li ZH, Guo FY, Wang ZQ, Cui J. Intracranial inflammatory
granuloma caused by toxoplasmosis. Pathog Glob Health.
2014;108(5):255-9. doi: 10.1179/2047773214y.0000000147.
25. Bilal JA, Alsammani MA, Ahmed MI. Acute Toxoplasma gondii
infection in children with reactive hyperplasia of the cervical
lymph nodes. Saudi Med J. 2014;35(7):699-703.
26. Andiappan H, Nissapatorn V, Sawangjaroen N, Khaing SL,
Salibay CC, Cheung MM, et al. Knowledge and practice on
Toxoplasma infection in pregnant women from Malaysia,
Philippines, and Thailand. Front Microbiol. 2014;5:291. doi:
27. Elahian Firouz Z, Kaboosi H, Faghih Nasiri A, Tabatabaie SS,
Golhasani-Keshtan F, Zaboli F. A comparative serological
study of toxoplasmosis in pregnant women by CLIA and
ELISA methods in Chalus City Iran. Iran Red Crescent Med J.
2014;16(4):e15115. doi: 10.5812/ircmj.15115.
28. Mumcuoglu I, Toyran A, Cetin F, Coskun FA, Baran I, Aksu
N, et al. [Evaluation of the toxoplasmosis seroprevalence
in pregnant women and creating a diagnostic algorithm].
Mikrobiyol Bul. 2014;48(2):283-91.
29. Capobiango JD, Bregano RM, Navarro IT, Rezende Neto CP,
Casella AM, Mori FM, et al. Congenital toxoplasmosis in a
reference center of Parana, Southern Brazil. Braz J Infect Dis.
2014;18(4):364-71. doi: 10.1016/j.bjid.2013.11.009.
30. Jerant PV, Milosevic V, Hrnjakovic Cvjetkovic I, Patic A, Stefan
Mikic S, Ristic M. [Toxoplasma gondii infection in pregnant
women]. Med Pregl. 2013;66(11-12):459-63.
31. Murat JB, Hidalgo HF, Brenier-Pinchart MP, Pelloux H. Human
toxoplasmosis: which biological diagnostic tests are best
suited to which clinical situations? Expert Rev Anti Infect Ther.
2013;11(9):943-56. doi: 10.1586/14787210.2013.825441.
32. Geleneky M. [Toxoplasmosis in pregnancy - questions in
clinical practice]. Klin Mikrobiol Infekc Lek. 2013;19(2):48-
33. Schmidt M, Sonneville R, Schnell D, Bige N, Hamidfar R,
Mongardon N, et al. Clinical features and outcomes in patients
with disseminated toxoplasmosis admitted to intensive care: a
multicenter study. Clin Infect Dis. 2013;57(11):1535-41. doi: