A contemporary insight into the sero-epidemiology of Toxoplasma gondii infection in the foot-hills of Himalayas: A cross-sectional study from a tertiary care center in Northern India

Background: Toxoplasma gondii infects 30-50% of the world's population with high diversity in the geo-epidemiology and seroprevalence. The burden of toxoplasmosis and its determinants from remote and vulnerable regions of India is unknown. Therefore, this study aim to evaluate the prevalence of toxoplasma antibodies and factors associated with seropositivity among individuals from Uttarakhand and adjoining areas. Methods: Serum samples from 442 cases were tested for anti-Toxoplasma IgG and IgM antibodies by Enzyme-linked Immunosorbent Assay. Association of seropositivity of toxoplasmosis with age, gender, place of residence, dietary habits, and comorbidities were analyzed using binary logistic regression analysis. Results: The overall Toxoplasma seropositivity was found to be 36.88% [95% Confidence Interval (CI)=30.40-39.28]. While anti-T. gondii IgG was present in 34.84% [95% CI=30.40-39.28], anti-IgM was detected in 6.33% [95% CI=4.06-8.61]. The overall and IgG seroprevalence increased with age in both the genders and there was a sharp increase in the seropositivity after the age of 40 years [adjusted Odds Ratio (aOR)=2.98, p-value=0.030]. The seropositivity rate was significantly higher in individuals from Uttarakhand in both the hilly region (aOR=5.61; 95%CI:[2.14-14.68]) and plains (aOR=5.14; 95%CI:[2.2-12.02]). Multivariable logistic regression analysis also showed that being rural residents (aOR=3.23; 95%CI:[1.67-6.23]) and presence of comorbidities (aOR=8.64; 95%CI:[4.62-16.18]) were potential risk factors of Toxoplasmosis. On the other hand, consumption of vegetarian diet was found to have a protective effect (aOR=0.46; 95%CI:[0.28-0.75]). Conclusion: Seroprevalence of T. gondii antibodies was relatively high in Uttarakhand, particularly in rural and hilly terrain, indicating a necessity for the implementation of integrated public health strategies to prevent and control toxoplasmosis in this region.