, May 2014
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Keskes and Muhie, African Journal of Applied Microbiology Research, 3(1): 1-11, May 2014 Available online at http://scienceparkjournals.com/ajamr (ISSN 2315-5396) 2014 Science Park Journals Full Length Research Paper TOXOPLASMOSIS: EMERGING AND RE-EMERGING ZOONOSIS Yibeltal Muhie1, 2 and Simenew Keskes 1, 3* 1 College of Veterinary Medicine and Agriculture, Addis Ababa University, Debre Zeit, Ethiopia 2 College of Veterinary medicine, Jigjiga University, Jigjiga, Ethiopia 3 College of Agriculture and Natural Resources, Dilla University, Dilla, Ethiopia Accepted 18 April 2014 Abstract: Comprehended review was done to discuss about toxoplasmosis in animals and human. Toxoplasmosis is a zoonotic disease with potential transmission to people from livestock and vic-versa. Consumption of undercooked meat is one of the principal risk factors for Toxoplasma infection. Encephalitis is the most important manifestation of toxoplasmosis in immunosuppressed patients as it causes the most severe damage to the patients. The socio-economic impact of toxoplasmosis in humans suffering and the cost care of sick children, especially those with mental retardation and blindness are enormous. The clinical disease usually occurs sporadically and has low levels of incidence. However, occasionally there are small epidemics attributed to the consumption of infected meat or contaminated water. Collaborative and focused control strategies should be implemented for this serious disease. Key Words: Toxoplasmosis, Veterinary and public health, immune compromised individuals, production and productivity INTRODUCTION Worldwide infectious and parasitic diseases still cause untold suffering and enormous physical, economic and social toll on human existence, causing 33% of deaths worldwide, with more than half of the victims under the age 5 years. But the figure is much higher in developing countries. For example, in Africa it is estimated that 68% of all deaths are as the result of infectious diseases (Zowghi, 2008). In 1992, "new, reemerging or drug-resistant infections whose incidence has been increased within the past two decades or whose incidence threatens to increase in the near future" were defined as "Emerging Infections". Previously, zoonoses were defined as "diseases and infections which are naturally transmitted between ________________________________________________________________ *Correspondence: Email: drsimenew@yahoo.com, simenew.keskes@aau.edu.et 2 Afr. J. App. Microbiol. Res. vertebrate animals and man". Thereafter, WHO noted zoonotic diseases caused either by totally new or partially new agents, or by microorganismsm previously known (Zowghi, 2008). The majority of infectious diseases that affect humans are zoonoses and they constitute as much as 70 % of the emerging diseases (Jones et al., 2008). Environments where wild animals, domestic animals and humans live in close proximity with no or small boundaries in the ecological system favor the emergence of new or already known diseases, as it also favors the transmission of diseases between animals and humans (Elwing, 2013). The above described situation is more common in low income countries where humans and animals live in high density and zoonoses are generally more common. These diseases do not only constitute a threat to human and animal health, but also reduce the production capacity of livestock and contribute further to sustained poverty (Magnusson, 2009). The zoonotic diseases also constitute a possible global health problem due to their pandemic potential to spread over the world. Regarding pandemic and emerging zoonotic diseases, there is a strong consensus that these are most efficiently fought at the origin of the epidemic, i.e. mostly in low income countries (Jones et al., 2008). Zoonotic diseases make up 26 % of the infectious disease burden in low income countries in terms of lost disability adjusted life years (DALYs) (Grace et al., 2012). DALY is the present value of future years lost due to premature death or being alive with poor health. Among high income countries, zoonoses are responsible for just 0.7 % of the infectious disease burden (Elwing, 2013). Toxoplasmosis is a cosmopolitan zoonotic disease caused by the coccidian protozoan Toxoplasma gondii, an obligatory intracellular parasite capable of infecting all warm-blooded animals including mammals, birds and humans. The parasite has a worldwide distribution and it is mainly transmitted by food contaminated with oocysts dispersed by cats and other felines, definitive hosts, undercooked meat containing tachyzoites stages, and transplacentally (Clementino et al., 2007). All forms of toxoplasmosis that occur in normal individuals may also occur in immunocompromised patients. People who have previously acquired toxoplasmosis, with or without manifestation of the disease may suffer a devastating relapse if their immune defenses, particularly cell-mediated immunity are impaired as in the case of Acquired Immuno Deficiency Syndrome (AIDS) (Negash et al., 2008). Toxoplasmosis is a major public health problem, with a high socioeconomic impact in terms of human suffering including the cost of caring sick, mentally retarded and blind children. The parasite is an extremely successful pathogen, responsive for significant morbidity and mortality, especially in congenitally infected and immuno-compromised individuals, although some subjects experience infection without overt disease or with mild symptoms (Molawi et al., 2008). In animals, the infection not only results in significant reproductive and economic losses, but also has implications for public health, since consumption of infected meat or milk can facilitate zoonotic transmission (Clementino et al., 2007). Toxoplasma gondii-specific IgM plus detection of Toxoplasma gondii DNA by PCR in CSF or aqueous humor correlates well with clinical disease (Lappin, 2000). Considering its public health and veterinary importance, the objective of this paper is therefore to make an insight review on toxoplasmosis by consulting relevant sources around the world. Etiology The organisms were first isolated in 1908 by Nicole and Manceaux from desert rodents which were maintained in the Pasteur institute. The rodents are called Gondi. Hence the name of organisms is Toxopalsma gondii (Mandal, 2006). The causative agent Toxoplasma gondii is a protozoan and a member of the sub order Eimeria. It is specific parasite of the definitive host members of the Felidae family, but has a wide range of intermediate hosts (Blood and Radostits, 1989). Keskes and Muhie 3 Life Cycle Toxoplasma gondii can complete its evolutionary cycle in the intestine of the cat and other felines, which are the definitive hosts. In addition it can, and usually does, take advantage of an intermediate host, which may be any of some 200 species of vertebrates. The fact that man is an intermediate host makes it medically important (Acha and Szyfres, 2003). When the parasites are ingested by a cat, they invade the feline intestinal cells and multiply asexually by merogony for several generations. They can multiply sexually by gametogony and produce immature oocysts that cause the host cells to rupture, after which they are eventually evacuated in the feces. Outside the host the oocysts mature 1-5 days, depending on the temperature and humidity of the environment, at which point they form sporulated oocysts (Acha and Szyfres, 2003). Extra intestinal cycles occurs in the intermediate host only but in this regard there is also variation. This cycle may occur in the definitive host simultaneously. In the extra intestinal cycles two types of multiplicative stages are formed (Mandal, 2006). Bradyzoites (resting stage) are slowly multiplying organisms contained in tissue cysts usually localized to muscle and brain. They live in the host cells for months to years. Once ingested, gastric enzymes degrade the cyst wall liberating viable bradyzoites takes place. Tachyzoites (tachy mean fast) are rapidly dividing organisms found in tissues during the acute phase of infection. The tachyzoites are the forms responsible for tissue destruction. Multiplication continues until either cyst formation or host cell destruction occurs. After cell death, the free tachyzoites invade other cells and resume rapid multiplication (Hakeen, 2010). EPIDEMIOLOGY Distribution Occurrence in Animals Epidemiological investigation in the US and elsewhere indicates that 60% cats are serologically positive to Toxoplasma antigen, the majority acquiring infection by predation (Urquhart et al., 2001). In Europe, parasitism rates in excess of 50% have been found in the meat of sheep and swine slaughtered in abattoirs. In Canada, the infection was found in 3.5% to 13.2% of pigs that underwent federal inspection, while in Japan, the rates are much lower. Cattle, on other hand, are more resistant to the infection; they have low, brief serological titers, and parasites are isolated from them only rarely (Acha and Szyfres, 2003). Occurrence in Humans Toxoplasma gondii has a worldwide distribution in human population infecting up to one third of the global population and wide range of other mammalian and avian species. The prevalence rate is usually higher at lower elevations and in older persons. In most animals and people, primary infection results in detectable antibody titer for the life of the host, therefore, sero-prevalence increases with age (Acha and Szyfres, 2003). Serologic prevalence data indicate that toxoplasmosis is one of the most common of human infections throughout the world. High prevalence of infection in France has been related to a preference for eating raw or under cooked meat, while prevalence in Central America has been related to the frequency of stray cat in a climate favoring survival of oocyst and soil exposure. The overall seroprevalence in the US among adolescents and adults, as determined with specimens collected by the NHANES III between 1988 and 1994, was found to be 22.5%, with the Seroprevalence woman of child bearing age (15-44 years) of 15% (Jenkins, 2009). A study in Malaysia shown that, the Seroprevalence of 4 Afr. J. App. Microbiol. Res. toxoplasmosis in HIV/AIDS patients and HBD were 21% (21/100) and 28.1% (57/203) respectively as indicated in Table 1. Studies have shown that between 16% and 40% of the population in the US and Great Britain and from 50% to 80% of people in continental Europe and Latin America have antibodies to the parasite, indicating that they have been infected at some time. Bossi et al., (1998) found that 399 (24.5%) of 1,628 AIDS patients had encephalitis caused by Toxoplasma, which is rare in immunocompitent persons; 97% of patients had antibodies to the parasite, 30% had relapses, and 84% died during the course of study. A study in Thailand revealed an infection rate of 30.1% in pregnant woman who were HIV negative and 21.1% in woman who were HIV positive (Acha and Szyfres, 2003). Sources of Infection and Methods of Transmission It appears that cats are significant factor in the contamination of parasites, because single infected cat produces millions of oocysts, which survive in the ground for almost a year as long as they are protected from the sun and from drying out (Acha and Szyfres, 2003). Contamination of water sources and soil with the feces of wild or domestic cats is more difficult to control and can lead to infection following ingestion of oocysts on unwashed, uncooked vegetables or in contaminated water. Cockroaches and coprophagic flies may also serve as mechanical vectors of Toxoplasma, resulting in infectious oocysts with contamination of food, water and utensils. Contact with contaminated soil or sand, such as in a garden or sand box, may also be associated with toxoplasma infection (Weese, 2008). Most cats become by ingesting Toxoplasma infected animals, usually rodents, whose tissues contain tachyzoites or bradyzoites, although direct transmission of oocysts between the cats also occur. The ingestion of mature bradyzoites is the most routes and results in the shedding of higher numbers of oocysts than when infection is acquired from other stages (Urquhart et al., 2001). Evidence has recently been presented indicating that fecal transmission of Toxoplasma gondii is possible with Toxocara cati as the vector and Tsunoda in Japan has observed transmission Toxoplasma from swine to swine via lung worms (Schwarble, 1969). The common of spread in ruminants is the ingestion of feed contaminated by cat feces which contain infective oocysts. This is well established as the means of transmission in sheep. In sheep, a high rate of infection has been shown to be related to a high rainfall which allows longer survival of oocysts on pasture. There is the interesting observation that sheep raised in cat free populations have almost no toxoplasmosis whereas sheep raised in similar environments with cats have an infection rate as high as 32% (Blood and Radostits, 1989). The major modes of transmission in intermediate hosts include consumption of undercooked meat containing toxoplasma cysts, fecal-oral transfer of Toxoplasma oocysts from cat feces (either directly or in contaminated food, water or soil), and vertical transmission from mother to fetus if primary infection occurs during pregnancy (Weese, 2008). Congenital transmission is infrequent in all animals except sheep and goats. It occurs in lambs only when the ewe is infected during pregnancy. When the fetus is infected between days 45 and 55 of gestation, it usually does; if infection is acquired in the third month of pregnancy, the lambs are born but they are sick; if it occurs after four months, the lambs may be born with the infection but they are asymptomatic. Congenitally infected lambs lack muscular coordination, they are physically weak, and they are unable to feed themselves. Some authors have defended the use of sheep rather than mice as animal models for the human infection, because the clinical characteristics of ovine congenital toxoplasmosis are similar to those seen in man as indicate in figure 1 below (Acha and Szyfres, 2003). Keskes and Muhie 5 PUBLIC HEALTH SIGNIFICANCE Modes of Transmission Transmission of Toxoplasma gondii to humans occurs through accidental ingestion of sporulated oocysts or the consumption of raw or undercooked meat. Among meat producing animals pigs, sheep and goats relatively often harbor Toxoplasma gondii cysts in edible tissue and therefore raw or undercooked meat from this animal constitutes major risk to humans. In area where goat milk is utilized, unpasteurized milk from acutely diseased goats is also an important source of infection to children, Toxoplasma gondii can also be transplacentally transmitted from the mother to offspring if the infection is contracted during pregnancy (Negash et al., 2008). Recent studies have suggested that coprophilic flies and cockroaches may act as transport host carry cat’s fecal oocysts to human feed, which would account infection in vegetarians. Contamination of the soil with oocyst from wild feline would account for infections contracted by indigenous people living alone the bank of Xingu River in Brazil, who do not keep domestic cat and who do not eat raw meat (Acha and Szyfres, 2003). Consumption of undercooked meat is one the principal risk factor for Toxoplasma infection and people who handle raw meat, such as abattoir workers may also be commonly exposed to parasite. The importance of this varies factors likely varies, considerably between ethnic groups due to differences in cultural habits regarding exposure to undercooked meat, soil and cats (Weese, 2008). Infection Risk for Humans Most infections in humans are asymptomatic, but at times the parasite can produce devastating disease. Infection may be congenitally or postnatal acquired. Congenital infection occurs only when a woman st becomes infected during pregnancy. Congenital infections acquired during the 1 trimester are severe nd rd than those acquired in the 2 or 3 trimester while the mother rarely has symptoms of infection, she does have a temporary parasitemia. Focal lesions develop in the placenta and the fetus may become infected. st At the 1 trimester there is generalized infection in the fetus. Later, infection is cleared from the visceral tissues and may localize in the central nervous system. The socioeconomic impact of Toxoplasmosis in humans suffering and the cost of care of sick children, especially those with mental retardation and blindness are enormous (Lawley et al., 2006). Under normal circumstances, a female that has been exposed to Toxoplasma 4-6 months prior to pregnancy will develop sufficient immunity to protect herself and the fetus for the rest of her life. However, if the immune response is suppressed by drug therapy or disease such as HIV/ AIDS in the humans, both the mother and fetus may become susceptible to infection again (Weese, 2008). In toxoplasmosis both humeral and cell-mediated components appear to be involved in the immune response. However, the relative importance of their roles remains to be ascertained, although it is generally believed that antibody formation by the host leads to a cessation in the production of tachyzoites and to the development of the latent bradyzoite cyst. It is believed that recrudescence of tachyzoites activity may occur if the host becomes immunosuppressed as a consequence of therapy or some other disease (Schwarble, 1969). Postnatal acquired infection may be localized or generalized. Oocyst-transmitted infections may be more severe than tissue induced infections. Enlarged lymph nodes are the most frequently observed clinical form of toxoplasmosis in humans. Lymphadenopathy may be associated with fever, fatigue, muscle pain, sore throat, and headache. Toxoplasmosis ranks high on the list of diseases which lead to death of patient with AIDS. Although in AIDS patients any organ may be 6 Afr. J. App. Microbiol. Res. involved, including the testis, dermis, and the spinal cord, infection of the brain is most frequently reported (Lawley et al., 2006). Clinical Manifestations The symptoms of congenital toxoplasmosis are highly varied. Early infection can cause pre-natal or postnatal death or severe damage to the fetus. Later infection can cause generalized disease in utero, subsequent infection of the nervous system, and the birth of children with sequel such as hydrocephaly, chorioretinitis, or cerebral calcification. When the infection occurs shortly before the delivery, the child may be born with an in apparent infection; or with fever, eruptions, hepatomegally, spleenomegally, or pneumonia; or with generalized infection that compromises the hematopoietic, reticuloendothelial, or pulmonary systems. Ocular toxoplasmosis deserves special mention. The most common manifestations are retinochoroiditis, but there can be other lesions, and alterations, such as strabismus, nystagmus, and microphtalmia. Ocular lesions are common in new born infants is with toxoplasmosis, and they are almost bilateral. Later manifestations of the lesions tend to be unilateral (Acha and Szyfres, 2003). Encephalitis is the most important manifestation of toxoplasmosis in immunosuppresed patients as it causes the most severe damage to the patients. Infection may occur in any organ and patients may have headache, disorientation, drowsiness, hemi paresis, reflex changes and convulsions, and may become comatose. Most AIDS patients suffering from toxoplasmosis have bilateral, severe and persistent headache which responds poorly to analgesics. As the disease progresses, the headache may give way to a condition characterized by confusion, lethargy, ataxia, and coma (Lawley et al., 2006). TOXOPLASMOSIS IN ETHIOPIA In human a study conducted to assess the seroprevalence of Toxoplasma gondii and associated risk factors among pregnant women in Jimma town, Southwestern Ethiopia showed that 83.6% (Zemene et al., 2012). The study revealed that anti- T. gondii IgG antibodies were detected in 81.4% of the samples of which 78.4% were positive for only IgG and 3.06% positive for both IgG and IgM antibodies (Gebremedhin et al., 2013). There is also a report on isolation of viable Toxoplasma gondii from tissues and feces of cats from addis ababa, ethiopia. In total, viable T. gondii was isolated from 27 of the 36 cats, and these isolates were designated TgCatEt1 to TgCatEt27 and this is the first report of isolation of viable T. gondii from any host in Ethiopia (Dubey et al., 2013a). In addition to this there is Four genotypes were recognized, including ToxoDB #1 (Type II clonal, nine isolates), ToxoDB #2 (Type III, five isolates), Toxo DB #3 (Type II variant, ten isolates), and ToxoDB #20 (nine isolates) study conducted from tissues and feces of 27 cats from Ethiopia (Dubey, 2013b). There are some studies on the prevalence of toxoplasmosis in animals and human in different parts of the country as indicated in the above table (Table 1). ECONOMIC SIGNIFICANCE OF TOXOPLASMOSIS Its effects are particularly important in sheep and goats because it causes abortions and disease in newborns, resulting in serious economic losses, especially in Australia, Great Britain, and Newzealand. In Tasmania, Australia, T.gondii was believed to have been the etiology in 46% of the outbreaks of abortion and neonatal mortality in sheep between 1962 and 1968. Congenitally infected lambs lack muscular coordination, they are physically weak, and they are unable to feed themselves (Acha and Szyfres, 2003). In most countries, toxoplasmosis comes as the second in prevalence after chlamydial abortion. Prenatal mortality rates (including ovine abortion and neonatal mortality due to T. gondii) in affected flocks can be Keskes and Muhie 7 as high as 50% and in non-clinical cases may result in low losses. Therefore, the infection has an economic and clinical significance in many sheep and goat producing countries (Radostits et al., 1994). DIAGNOSIS OF TOXOPLASMOSIS General Examination of the fecal sample for detection of the oocysts of T.gondii is done. The oocysts are very typical having two sporocysts. Each sporocyst has four sporozoites. The organisms are also isolated from the infected animal, and then the organisms are inoculated in the mice. The organisms are detected in the infected mice after considerable period. Furthermore, the cysts remain packed up with bradyzoites and these cysts are clearly visible under the dissecting or stereoscopic microscope or emulsifying the muscle in saline (Mandal, 2006). Serological Tests Immunologic testing via IFA and ELISA for IgM and IgG antibodies can be performed on serum, CSF, or aqueous humor. Serum antibodies document exposure to T.gondii but do not diagnose disease caused by T. gondii because clinically normal animals may have positive Ab titers. IgM Abs correlate best with clinical disease, but failure to detect IgM Abs does not exclude toxoplasmosis as cause of disease. IgG Abs persist for years because the host rarely clears infections completely (Morgan et al., 2003). A fourfold rise in titers suggests recent infection. T. gondii-specific IgM plus detection of T.gondii DNA by PCR in CSF or aqueous humor correlates well with clinical disease (Lappin, 2000). IFA and ELISA are particularly appropriate for this purpose because they make it possible to determine the presence of IgM antibodies, which appear and disappear before the IgG Abs. Because IgM does not cross the placenta, the presence this Abs in the serum of newborns is reliable evidence that the fetus developed them inutero and that the infant was born with the infection. Another procedure used for determining the presence of acute infection is the evolution of IgG Abs titers and if the titers increase after more than three dilutions, it may be speculated that the patient’s immune system is responding actively to the parasite and therefore he or she must be in the active phase of the infection (Acha and Szyfres, 2003). Persons should be initially tested for the presence of Toxoplasma-specific IgG Abs to determine their immune status. A positive IgG titer indicates infection with the organism at sometime. If more precise knowledge of the time of infection is necessary, then an IgG positive person should have an IgM test performed by a procedure with minimal none specific reactions, such as IgM-capture ELISA. A negative IgM test essentially excludes recent infection, but a positive IgM test is difficult to interpret between Toxoplasma specific IgM Abs may be detected by ELISA for as long as 18 months after acute acquired infection (Jenkins, 2009). Antibodies to Toxoplasma gondii where determined by the modified direct agglutination by using a commercially available kit and the test employs intact tachyzoites as antigen as, hence antibodies IgG to surface antigens are detected. The advantage of MDAT is that it is easy to perform, can be used on any species since specific conjugates are not used and the results obtained strongly correlated with other serological test (Negash et al., 2008). PCR is used to detect Toxoplasma gondii DNA in body fluids and tissues. It has been successfully used to diagnose congenital, ocular, cerebral and disseminated toxoplasmosis. PCR performed on amniotic fluid has revolutioned the diagnosis of fetal Toxoplasma gondii infection by enabling early diagnosis to be made, thereby avoiding the use of more invasive procedure on the fetus (Montoya et al., 2011). 8 Afr. J. App. Microbiol. Res. TREATMENT Most healthy people recover from toxoplasmosis without treatment persons with ill can be treated with a combination of drugs such Pyrimethamine and Sulfadiazine, plus Folinic acid. Pregnant women, newborns and infants can be treated, although the parasite is not eliminated completely spiramycine is an antibiotic used most for pregnant women to prevent the infection of their child. Persons with compromised immune systems need to be treated until they are improvement in their condition. For AIDS patients, continuation of medication for the rest of their life may be necessary, or for as long as they are immuno suppressed (Jenkins, 2009). In people with latent toxoplasmosis, the cysts are immune to this treatment, as the antibiotics do not reach the bradyzoites in sufficient concentration. Atovaquone is an antibiotic that have been used to kill toxoplasma cysts inside AIDS patients. Clindamycin is an antibiotic which, in combination with Atovaquone, seemed to optimally killed mice patients (Djurković-Djaković et al., 2002). Monensin and Decoquinate have also been administered to ewes in mid pregnancy in attempt to control abortion due to toxoplasmosis (Urquhart et al., 2001). PREVENTION AND CONTROL In Humans To prevent infection of human beings with Toxoplasma gondii especially pregnant women, children, and immuno compromised individuals, contact with cats, soil, and raw meat should be avoided and people should be made aware of the dangers of toxoplasmosis. Toxoplasma gondii organism in meat can be killed by exposure to extreme heat or cold. Tissue cysts in meat are killed by heating the meat through o o out to 67 c or by cooling to -13 c (William, 2001). Pregnant women and immune deficient individuals should not perform tasks that expose them potentially contaminated soil with the oocyst of Toxoplasma unless they should use water proof gloves and wash their hands carefully afterward. Flies and cockroaches should be controlled to prevent them from serving that transport hosts for the fecal oocysts of cats. It would appear that an effective in means of infection in newborns is to identify pregnant women with acute infection and treat them. At present there is no vaccine to prevent infection in humans (Acha and Szyfres, 2003). In Animals Cats should be kept indoors and fed canned, cooked, or previously frozen food to keep them from hunting and catching infected rodents and birds and thus becoming infected. It has been shown in the laboratory that the addition of monensin to dry cat food can suppress the excretion of oocysts in feces (Acha and Szyfres, 2003). For some years, work has been under way to develop vaccines against toxoplasmosis for cats, sheep, and swine. So far, the only successfully effort has been a modified live parasite vaccine for sheep, which is administered before impregnation to prevent congenital infections. This live vaccine consisting of tachyzoites attenuated by repeated passage in mice (Urquhart et al., 2001). CONCLUSION The socio-economic impact of toxoplasmosis in humans suffering and the cost care of sick children, especially those with mental retardation and blindness are enormous. The clinical disease usually occurs sporadically and has low levels of incidence. However, occasionally there are small epidemics attributed to the consumption of infected meat or contaminated water among human beings and animals. Keskes and Muhie 9 Authors' contributions Both authors contributed equally in making critical reviewing of this manuscript. Table 1: Prevalence of T. gondii in Ethiopia Study area Prevalence (%) of different study Test subjects References used Cattl Shee Goa Cat Human e p t Central Ethiopia 6.6 11.9 22.9 - - MDAT Bekele and Kasali (1989) Debre Birhan - 35 34 - - MDAT Tilaye and Getachew (2002) Nazareth 52.6 East and West 24 - 19.7 MDAT Negash et al. (2004) ELISA Zewdu et al. (2012) Shewa Zones Nazareth 60 Addis Ababa 90 South Omo, Negash et al. (2008) ELISA Teshale et al. (2009) Teshale et al. (2007) 74.9 North Omo and East Shewa Zones Jimma town 83.6 ELISA Zemene et al. (2012) Centeral Ethiopia 81.4 ELISA Gebremedhin et al. (2013) 10 Afr. J. App. Microbiol. Res. Figure 1: Life cycle and mode of transmission of Toxoplasma gondii in different species of animals Source: Keith, 2010 REFERENCES 1. Acha PN, Szyfres B (2003). 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