Infection by the parasite Toxoplasma, which affects about 33% of world population, is associated with an increased risk of several mental health disorders, the most strongly with schizophrenia. It is unknown whether schizophrenia is associated with this infection the most strongly, or whether this association has just been the most intensively studied for historical reasons. We used the data from 6,367 subjects tested for toxoplasmosis who took part in an internet survey to search for associations of these infections with 24 mental health disorders and evidence of otherwise impaired mental health. The typical symptom associated with toxoplasmosis was anxiety, and the typical toxoplasmosis-associated disorders were autism (OR = 4.78), schizophrenia (OR = 3.33), attention deficit hyperactivity disorder (OR = 2.50), obsessive compulsive disorder (OR = 1.86), antisocial personality disorder (OR = 1.63), learning disabilities (OR = 1.59), and anxiety disorder (OR = 1.48). Toxoplasmosis could play a substantial role in the etiopathogenesis of mental health disorders and its association with schizophrenia is the second strongest association, after autism.

Applied Neurosciences and Brain Imagination National Institute of Mental Health Klecany Czechia

Division of Biology Faculty of Science Charles University Prague Prague Czechia

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Flegr J, Escudero DQ. Impaired health status and increased incidence of diseases in Toxoplasma-seropositive subjects - an explorative cross-sectional study. Parasitology (2016) 143:1974–89. 10.1017/S0031182016001785 PubMed DOI

Flegr J, Prandota J, Sovickova M, Israili ZH. Toxoplasmosis - A global threat. Correlation of latent toxoplasmosis with specific disease burden in a set of 88 countries. PLoS One (2014) 9(3):9. 10.1371/journal.pone.0090203 PubMed DOI PMC

Torrey EF, Bartko JJ, Yolken RH. Toxoplasma gondii and other risk factors for schizophrenia: an update. Schizophr Bull (2012) 38:642–7. 10.1093/schbul/sbs043 PubMed DOI PMC

Sutterland AL, Fond G, Kuin A, Koeter MW, Lutter R, Van Gool T, et al. Beyond the association. Toxoplasma gondii in schizophrenia, bipolar disorder, and addiction: systematic review and meta-analysis. Acta Psychiatr Scand (2015) 132:161–79. 10.1111/acps.12423 PubMed DOI

Niebuhr DW, Cowan DN, Millikan AM, Yolken R, Li Y, Weber N. Risk of schizophrenia and antibodies to Toxoplasma gondii among U.S. military personnel. Schizophr Bull (2007) 33:243–4.

Horáček J, Flegr J, Tintera J, Verebova K, Spaniel F, Novak T, et al. Latent toxoplasmosis reduces gray matter density in schizophrenia but not in controls: voxel-based-morphometry (VBM) study. World J Biol Psychiatry (2012) 13:501–9. 10.3109/15622975.2011.573809 PubMed DOI

Wang HL, Wang GH, Li QY, Shu C, Jiang MS, Guo Y. Prevalence of Toxoplasma infection in first-episode schizophrenia and comparison between Toxoplasma-seropositive and Toxoplasma-seronegative schizophrenia. Acta Psychiatr Scand (2006) 114:40–8. 10.1111/j.1600-0447.2006.00780.x PubMed DOI

Holub D, Flegr J, Dragomirecka E, Rodriguez M, Preiss M, Novak T, et al. Differences in onset of disease and severity of psychopathology between toxoplasmosis-related and toxoplasmosis-unrelated schizophrenia. Acta Psychiatr Scand (2013) 127:227–38. 10.1111/acps.12031 PubMed DOI

Celik T, Kartalci S, Aytas O, Akarsu GA, Gozukara H, Unal S. Association between latent toxoplasmosis and clinical course of schizophrenia - continuous course of the disease is characteristic for Toxoplasma gondii-infected patients. Folia Parasitol (2015) 62. 10.14411/fp.2015.015 PubMed DOI

Flegr J. Neurological and neuropsychiatric consequences of chronic Toxoplasma infection. Clin Microbiol Rep (2015) 2. 10.1007/s40588-015-0024-0 DOI

Flegr J, Kuba R. The relation of Toxoplasma infection and sexual attraction to fear, danger, pain, and submissiveness. Evol Psychol (2016) 14. 10.1177/1474704916659746 DOI

Kankova S, Flegr J, Calda P. The influence of latent toxoplasmosis on women's reproductive function: four cross-sectional studies. Folia Parasitol (2015) 62. 10.14411/fp.2015.041 PubMed DOI

Flegr J, Horáček J. Toxoplasmosis, but not borreliosis, is associated with psychiatric disorders and symptoms. Schizophr Res (2018) 197:603–4. 10.1016/j.schres.2018.02.008 PubMed DOI

Benjamini Y, Hochberg Y. Controlling the false discovery rate: A practical and powerful approach to multiple testing. J Roy Stat Soc B Met (1995) 57:289–300. 10.1111/j.2517-6161.1995.tb02031.x DOI

Miman O, Mutlu EA, Ozcan O, Atambay M, Karlidag R, Unal S. Is there any role of Toxoplasma gondii in the etiology of obsessive-compulsive disorder? Psychiatry Res (2010) 177:263–5. 10.1016/j.psychres.2009.12.013 PubMed DOI

Xiao Y, Yin JG, Jiang N, Xiang M, Hao LL, Lu HJ, et al. Seroepidemiology of human Toxoplasma gondii infection in China. BMC Infect Dis (2010) 4:165. 10.1186/1471-2334-10-4 PubMed DOI PMC

Flegr J, Horáček J. Toxoplasma-infected subjects report an obsessive-compulsive disorder diagnosis more often and score higher in obsessive-compulsive inventory. Eur Psychiat (2017. a) 40:82–7. 10.1016/j.eurpsy.2016.09.001 PubMed DOI

Gale SD, Brown BL, Berrett A, Erickson LD, Hedges DW. Association between latent toxoplasmosis and major depression, generalised anxiety disorder and panic disorder in human adults. Folia Parasitol (2014) 61:285–92. 10.14411/fp.2014.038 PubMed DOI

Prandota J, Elleboudy NAF, Ismail KA, Zaki OK, Shehata HH. Increased seroprevalence of chronic toxoplasmosis in autistic children: Special reference to the pathophysiology of IFN-gama and NO overproduction. Int J Neurol Res (2015) 1:102–22. 10.17554/j.issn.2313-5611.2015.01.30 DOI

Flegr J, Hodny Z. Cat scratches, not bites, are associated with unipolar depression - cross-sectional study. Parasit (2016) Vectors 9. 10.1186/s13071-015-1290-7 PubMed DOI PMC

Silva NM, Rodrigues CV, Santoro MM, Reis LF, Alvarez-Leite JI, Gazzinelli RT. Expression of indoleamine 2, 3-dioxygenase, tryptophan degradation, and kynurenine formation during in vivo infection with Toxoplasma gondii: induction by endogenous gamma interferon and requirement of interferon regulatory factor 1. Infect Immun (2002) 70:859–68. 10.1128/IAI.70.2.859-868.2002 PubMed DOI PMC

Hunt NH, Too LK, Khaw LT, Guo J, Hee L, Mitchell AJ, et al. The kynurenine pathway and parasitic infections that affect CNS function. Neuropharmacology (2017) 112:389–98. 10.1016/j.neuropharm.2016.02.029 PubMed DOI

Elsheikha HM, Busselberg D, Zhu XQ. The known and missing links between Toxoplasma gondii and schizophrenia. Metab Brain Dis (2016) 31:749–59. 10.1007/s11011-016-9822-1 PubMed DOI

Krause DL, Muller N. The relationship between Tourette's syndrome and infections. Open Neurol J (2012) 6:124–8. 10.2174/1874205X01206010124 PubMed DOI PMC

Badescu GM, Filfan M, Sandu RE, Surugiu R, Ciobanu O, Popa-Wagner A. Molecular mechanisms underlying neurodevelopmental disorders, ADHD and autism. Rom J Morphol Embryol (2016) 57:361–6. PubMed

Cotrin JC, Fontenelle LF, Kohlrausch FB. Association analyses reveal gender-specific associations of DAT1 40-bp VNTR and -839C/T polymorphisms with obsessive-compulsive disorder and obsessive-compulsive symptoms. Mol Biol Rep (2019) 46:5155–62. 10.1007/s11033-019-04971-9 PubMed DOI

Qayyum A, Zai CC, Hirata Y, Tiwari AK, Cheema S, Nowrouzi B, et al. The role of the catechol-o-methyltransferase (COMT) GeneVal158Met in aggressive behavior, a review of genetic studies. Curr Neuropharmacol (2015) 13:802–14. 10.2174/1570159X13666150612225836 PubMed DOI PMC

Zarrindast MR, Khakpai F. The modulatory role of dopamine in anxiety-like behavior. Arch Iran Med (2015) 18:591–603. 0151809/AIM.009 PubMed

Nestler EJ, Carlezon WA., Jr. The mesolimbic dopamine reward circuit in depression. Biol Psychiatry (2006) 59:1151–9. 10.1016/j.biopsych.2005.09.018 PubMed DOI

Grace AA. Dysregulation of the dopamine system in the pathophysiology of schizophrenia and depression. Nat Rev Neurosci (2016) 17:524–32. 10.1038/nrn.2016.57 PubMed DOI PMC

Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jonsson B, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol (2011) 21:655–79. 10.1016/j.euroneuro.2011.07.018 PubMed DOI

Flegr J. Predictors of Toxoplasma gondii infection in Czech and Slovak populations: the possible role of cat-related injuries and risky sexual behavior in the parasite transmission. Epidemiol Infect (2017) 145:1351–62. 10.1017/S095026881700019X PubMed DOI PMC

Šebánková B, Flegr J. Physical and mental health status in Toxoplasma-infected women before and three years after they learn about their infection: manipulation or side-effects of impaired health? Front Ecol Evol (2017) 5:144. 10.3389/fevo.2017.00144 DOI

Flegr J. Heterozygote advantage probably maintains Rhesus factor blood group polymorphism: ecological regression study. PLoS One (2016) 11. 10.1371/journal.pone.0147955 PubMed DOI PMC

Flegr J, Hoffmann R, Dammann M. Worse health status and higher incidence of health disorders in Rhesus negative subjects. PLoS One (2015) 10. 10.1371/journal.pone.0141362 PubMed DOI PMC

Flegr J, Preiss M. Friends with malefit. The effects of keeping dogs and cats, sustaining animal-related injuries and Toxoplasma infection on health and quality of life. PLoS One (2019) 14. 10.1371/journal.pone.0221988 PubMed DOI PMC

Flegr J, Horáček J. Toxoplasmosis, but not borreliosis, is associated with psychiatric disorders: a cross-sectional survey on 46 thousand of subjects. BioRxiv (2017. b). 10.1101/231803 DOI

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