Seroprevalence of Toxoplasma gondii among hemodialysis patients: A possible link to main T-lymphocyte subsets levels and dialysis adequacy

Abstract

Background: A high prevalence of Toxoplasma gondii infection has been reported in patients with hemodialysis (HD). However, a lack of data exists on the relationship between T lymphocyte subsets and dialysis adequacy. This study aimed to investigate the seroprevalence of Toxoplasma gondii infection among HD patients and its relation to T lymphocyte cells subsets, CD3+, CD4+, CD8+, CD4+/CD8+ ratio, and HD adequacy.

Methods: This cross-sectional comparative study was conducted on 92 subjects. Of them, 42 HD patients and 50 were control participants. Anti-Toxoplasma gondii IgG, IgM antibodies, the T lymphocyte cells subset CD3+, CD4+, CD8+, CD4+/CD8+ ratio, and adequacy of dialysis via calculation of Kt/V were detected for all subjects.

Results: The seropositivity for anti-Toxoplasma gondii IgG antibodies was significantly higher in HD patients 66.7% (28/42) compared to 34% in controls (17/50), (p = 0.0003). The main T lymphocyte subsets was significantly lower in HD compared to controls (p < 0.05). Seropositive HD patients exhibited statistically significantly lower T lymphocyte cell subsets and CD4+/CD8+ ratio compared to seronegative patients (p < 0.05). There was a negative correlation between anti-Toxoplasma gondii IgG level and T lymphocyte subsets and the CD4/CD8+ ratio. Binary logistic regression showed that CD4+ T cell significantly predicts Toxoplasma gondii susceptibility among HD patients (p = 0.03). The mean Kt/V index is significantly lower among seropositive HD patients compared to seronegative HD patients (1.05 ± 0.46, 1.41 ± 0.53, respectively, p = 0.03) with a significant negative correlation with anti-Toxoplasma gondii IgG level (p < 0.05). ROC curve analysis showed the CD4+ T cell % had the highest AUC value among HD patients (AUC= 0.88, p < 0.001). The Kt/V value of ≤ 0.8 significantly predicted susceptibility to Toxoplasma gondii infection among HD patients (AUC = 0.68, p = 0.03).

Conclusion: The current study reinforces previous reports of a high prevalence of Toxoplasma gondii infection among HD patients. CD4+ T cell and Kt/V showed a good diagnostic performance in predicting susceptibility for Toxoplasma gondii infection in HD patients. Considering the clinical consequences caused by Toxoplasma gondii infection in these patients, regular screening and adequate HD are recommended.

Keywords: CD3+; CD4+; CD8+; Hemodialysis; IgG antibody; IgM antibody; Kt/V; T lymphocyte; Toxoplasmosis.