认识不足但具有临床相关性：印度比哈尔邦一项基于医院的刚地弓形虫血清阳性率研究

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中文摘要

刚地弓形虫是一种全球流行的原生动物寄生虫，其血清阳性率和临床表现存在显著地域差异，但来自印度东部，尤其是比哈尔邦的数据仍然匮乏。这项回顾性横断面研究利用2021年9月至2025年7月期间巴特那一家三级医疗中心的实验室和临床数据，评估了临床疑似患者的血清学阳性率以及比哈尔邦弓形虫病的临床谱。共使用化学发光免疫分析法检测了2014份血清样本的弓形虫IgM和IgG抗体，并将血清学结果与人口学、地理和临床信息进行关联。临床疑似患者的总体血清学阳性率为4.86%，其中IgG反应性病例占3.62%，IgM反应性病例占1.1%，IgM-IgG双阳性占0.14%。血清阳性率随年龄增长而升高，且男性更为常见。地理分布图显示明显异质性，巴特那占所有血清阳性病例的45.9%，其次是布克萨尔、加雅和萨马斯蒂普尔的小型聚集。转诊主要来自儿科和眼科（各占31.6%），其次是妇产科、耳鼻喉科和内科。在有可用临床数据的血清阳性患者中，眼弓形虫病是最常见的表现（29.3%），主要表现为白内障和青光眼。感音神经性听力损失占病例的24.4%，而不良产科结局占19.5%。中枢神经系统受累包括脑膜脑炎、脑积水、癫痫痉挛和颅神经麻痹。还观察到肝脏和肺部表现，包括肝脓肿和肺炎，反映出广泛且非典型的临床谱。这些发现表明，尽管血清阳性率较低，但临床异质性显著，强调在流行地区需要进行有针对性的诊断警惕。

英文摘要

Toxoplasma gondii is a globally prevalent protozoan parasite with marked regional variation in seroprevalence and clinical expression, yet data from eastern India, particularly Bihar, remain scarce. This retrospective cross-sectional study evaluated the serological positivity among clinically suspected patients and clinical spectrum of toxoplasmosis in Bihar using laboratory and clinical data from a tertiary-care centre in Patna between September 2021 and July 2025. A total of 2014 serum samples were tested for T. gondii IgM and IgG antibodies using chemiluminescent immunoassay, and serological results were correlated with demographic, geographic, and clinical information. Overall serological positivity among clinically suspected patients was 4.86%, comprising 3.62% IgG-reactive cases, 1.1% IgM-reactive cases, and 0.14% with dual IgM-IgG positivity. Seropositivity increased with age and was more common in males. Geographic mapping demonstrated marked heterogeneity, with Patna contributing 45.9% of all seropositive cases, followed by smaller clusters in Buxar, Gaya, and Samastipur. Referrals originated predominantly from Pediatrics and Ophthalmology (31.6% each), followed by Obstetrics and Gynaecology, ENT, and Medicine. Among seropositive patients with available clinical data, ocular toxoplasmosis was the most frequent presentation (29.3%), largely manifesting as cataract and glaucoma. Sensorineural hearing loss accounted for 24.4% of cases, while adverse obstetric outcomes comprised 19.5%. Central nervous system involvement included meningoencephalitis, hydrocephalus, epileptic spasms, and cranial nerve palsies. Hepatic and pulmonary manifestations, including liver abscess and pneumonia, were also observed, reflecting a wide and atypical clinical spectrum. These findings demonstrate substantial clinical heterogeneity despite low seropositivity, underscoring the need for targeted diagnostic vigilance in endemic settings.