Tuberculosis/toxoplasmosis co-infection in Egyptian patients: A reciprocal impact.

OBJECTIVE: To assess the concurrent toxoplasmosis infection in Egyptian TB patients and the impact of each infection on the other in terms of increased severity of TB or reactivation of latent Toxoplasma infection.

METHODS: Three hundred suspected pulmonary TB cases were initially screened for TB using direct Ziehl Neelsen staining and Lowenstein Jensen culture of their sputa. Rifampicin resistance was detected by Xpert MTB/RIF assay. Control group of 30 age and sex-matched healthy individuals negative for TB was included for comparison. All subjects were further assessed for serum levels of anti-Toxoplasma IgG antibodies and malondialdehyde (MDA).

RESULTS: Forty three confirmed TB-infected patients including 10 (23.3%) rifampicin-resistant patients were detected. Associated toxoplasmosis was found to be significantly higher among TB patients (OR = 2.709; 95% CI: 1.034-7.099; P<0.05) and among rifampicin sensitive than rifampicin resistant TB patients (OR=0.213; 95% CI: 0.048-0.951; P < 0.05). Serum levels of anti-Toxoplasma IgG antibodies and MDA were significantly higher among TB patients than the control group. Furthermore, serum level of MDA was significantly higher among TB/Toxoplasma co-infected patients as compared to toxoplasmosis free-TB patients. Strong positive correlation was detected between serum levels of anti-Toxoplasma IgG and MDA in TB patients (r = 0.75, P = 0.001).

CONCLUSIONS: Among pulmonary TB Egyptian patients, there is a considerable prevalence of toxoplasmosis. Severity of pulmonary tuberculosis could be increased by Toxoplasma co-infection.