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Schizophrenia Bulletin Advance Access published online on March 26, 2007
Schizophrenia Bulletin, doi:10.1093/schbul/sbm010
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© The Author 2007. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

A Controlled Prospective Study of Toxoplasma gondii Infection in Individuals With Schizophrenia: Beyond Seroprevalence

Dunja Hinze-Selch1,2, Walter Däubener3, Lena Eggert2, Sükran Erdag2, Renate Stoltenberg3 and Sibylle Wilms2
2 The Center for Integrative Psychiatry, Department of Psychiatry and Psychotherapy, Christian-Albrechts-University, Niemannsweg 147, D-24105 Kiel, Germany
3 Institute for Medical Microbiology and Hospital Hygiene, Heinrich-Heine University, Düsseldorf

1 To whom correspondence should be addressed; tel: +49-431-9900-2554, fax: +49-431-9900-2568, e-mail: d.hinze-selch{at}zip-kiel.de.

Toxoplasma gondii (TG) infection has been reported to be more frequent in schizophrenia. The interaction of the lifelong persisting parasite with the host's immune system involves T-cell/interferon-gamma–induced degradation of tryptophan and provides a challenge to the host well beyond a possible role in the etiology of schizophrenia. The hypothesis we tested in this study was that TG infection may be more frequent (serofrequency) and/or more intense (serointensity) in patients with schizophrenia or major depression compared with psychiatrically healthy controls. In addition, these measures are associated with the clinical course. We did a cross-sectional, prospective investigation of individuals with schizophrenia (n = 277) and major depression (n = 465) admitted to our department (2002–2005) and of healthy controls (n = 214), with all groups adjusted for age and geographic home region. Serofrequency was comparable between the groups, but serointensity was significantly higher in the patients. In individuals with schizophrenia, serointensity was significantly positively associated with C-reactive protein levels and leukocyte counts, and first-episode patients yielded significantly higher serotiters. Immunomodulatory medication was associated with decreased serotiters. In addition, the route of infection appears to differ between patients and controls. Thus, our results support increased host responses to TG infection in the patients, as well as increased titers in first-episode patients with schizophrenia; this may relate to the shifted T-helper 1/2 status described in these patients. Therefore, we suggest that TG infection, particularly in individuals with schizophrenia, is an important environmental factor in the interaction between psychiatric vulnerability, genetic background, immunomodulation, and the neurotransmitter systems.

Keywords: infection / immunity / tryptophan / Toxoplasma gondii, psychosis / depression


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