Name: Date:

Course Code and Section: Course Degree and Year:

CONCEPTUAL LITERATURE SECTION EXERCISE 1

Directions: Identify the techniques used in organizing ideas of the following Conceptual Literature section
by surrounding each sub-section with brackets and extending each of the brackets with arrows leading to the
writing of their specific techniques on the margins.

2.1 Epidemiology
Epidemiology is conventionally defined as the study focusing on the distribution and the
determinants of problems regarding health and is classified as either descriptive or analytic (Szklo &
Nieto, 2014). It is a way of describing factors as to why people in a defined area are getting ill. This
includes several parameters such as frequency, the causative agent, and may involve measure taken
by the community to combat the disease.
In studying epidemiology, factors involved with the disease are confined to a specific
population which is at risk. These people at risk may be healthy or have already contracted the
disease. Having a defined population will facilitate a more efficient way of gathering data and will help
generate more valid conclusions. Moreover, having a definite population aids in having defined
systematic samples. Regarding this, observations in epidemiology are fundamentally concomitant with
groups of people and not just individuals.
As mentioned, epidemiologic studies are classified as either descriptive or analytic. In
descriptive epidemiology, previously gathered data are utilized to determine variations in rates of the
disease based on demographic variables (Szklo & Nieto, 2014). These variables would include time,
place, and person. According to the Centers for Disease Control and Prevention (CDC, 2012),
compilation and analysis of data by time, place, and person is favorable due to several reasons. One
is that the epidemiologist can familiarize himself with the data, allowing him to determine what the
data can report based on the mentioned variables. It also helps the epidemiologist to diagnose the
pattern and the expanse of the disease being considered. Using descriptive epidemiology helps in
creating an extensive description of the health status of a specific population, which can be easily
shown in several visual aids such as graphs, tables, and maps.
Analytical epidemiology, on the other hand, assesses hypotheses of associations on exposure
to suspected risk factor and their effect on the health of the population (Szklo & Nieto, 2014). The
CDC (2012) mentioned that a key feature of analytical epidemiology is the presence of a comparison
group. This comparison group helps determine what risk factors or characteristics may have an
association with the disease taken into consideration. These characteristics may be demographic
factors such as age, race or sex, immunity, and behaviors such as smoking or excessive alcohol
intake.

2.2 Toxoplasma gondii Life Cycle

One of the major concerns about Toxoplasma gondii (T. gondii) is its ability to infect humans
and animals, which are part of its life cycle. The life cycle of T. gondii was fully described when
oocysts of the parasite were discovered in cat feces (Burrells, 2014). At first, it was thought that felids
are the only known definitive host of the parasite. However, it was later discovered that other animals
are used by the parasite as its reservoir host ensuring continuation of its life cycle. According to
Herrmann (2012), the life stages of T. gondii can be divided into four groups, namely, the sexual
stages, oocysts, tachyzoites, and bradyzoite.
The sexual stages of T. gondii occur in felids (Herrmann, 2012). Inside the cat host,
microgametocytes (male form) from the adult parasites fertilize the macrogametocytes (female form).
Burrells (2014) explained that fusion of the two gametocytes result to the formation of a zygote, which
then becomes an oocyst. This oocyst, which is unsporulated and contains two sporoblasts, is
excreted in the feces of infected felids (Burrells, 2014; Herrmann, 2012). Herrmann (2012) added that
one adaptation of oocysts is that they are highly resistant to environmental stresses and they
described them as having subspherical to ellipsoidal shape. The sporoblasts in the oocysts then begin
to sporulate through endodyogeny once the oocysts are out in the environment and form sporozoites
(Burrells, 2014; Herrmann, 2012). Burrells (2014) mentioned that ingestion of the oocysts by an
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Name: Date:
Course Code and Section: Course Degree and Year:

CONCEPTUAL LITERATURE SECTION EXERCISE 1

Directions: Identify the techniques used in organizing ideas of the following Conceptual Literature section
by surrounding each sub-section with brackets and extending each of the brackets with arrows leading to the
writing of their specific techniques on the margins.

intermediate host such as animals and humans release the sporozoites into the intestinal lumen,
where they transform into tachyzoites. She also added that these tachyzoites undergo asexual
reproduction through endodyogeny, and they are carried into the bloodstream. Moreover, bradyzoites
form from the tachyzoite stage and undergo tissue cyst formation particularly infecting the muscle and
nervous tissues (Burrells, 2014). Hundreds of bradyzoites are contained within the tissue cysts.

Figure 2.1 General Life Cycle of Toxoplasma gondii (Franco, 2014)

As shown in Figure 2.1 (Franco, 2014) the life cycle of T. gondii is complex but it helps in the
propagation of the species. This ensures the persistence of the parasite for a very long time and
eradication is still a problem unanswered. This is also the reason why Herrmann (2012) regarded T.
gondii as one of the most successful and most prevalent parasites in the globe.

2.3 Toxoplasma gondii Infection/Toxoplasmosis

T. gondii is an obligate protozoan parasite that is present in around 33% of the human
population (Sugden et al., 2016). Symptoms are usually subclinical or only show mild signs of
infection, yet it is the third most common parasitic infection caused by contaminated food which
require hospitalization overall (Pappas, Roussos & Falagas, 2009). The infection caused by T. gondii
is called toxoplasmosis, affecting both humans and animals causing many pathologies in both host
groups (Szabo & Finney, 2017).
One of the most researched pathology of T. gondii is congenital toxoplasmosis. Many
researches are being conducted to determine the adverse effects of toxoplasmosis in infants. T.
gondii are known to exhibit transplacental transmission, which means that it can be transferred from
the mother to the fetus. According to Calderaro et al. (2009), during pregnancy, infections acquired
from T. gondii may cause severe damage to the fetus inside the mother’s womb. They mentioned that
fetal infection may cause cervical lymphadenopathy. Furthermore, Fallahi et al. (2017) explained that

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Name: Date:
Course Code and Section: Course Degree and Year:

CONCEPTUAL LITERATURE SECTION EXERCISE 1

Directions: Identify the techniques used in organizing ideas of the following Conceptual Literature section
by surrounding each sub-section with brackets and extending each of the brackets with arrows leading to the
writing of their specific techniques on the margins.

transmission of T. gondii can lead to adverse consequences for the development of the fetus causing
abnormalities. According to the same authors, these abnormalities may include deafness and
psychomotor retardation, along with abortion and still-birth. Due to these reasons, Ander et al. (2017)
mentioned that congenital toxoplasmosis should be taken into serious consideration because of its
association with miscarriage and birth defects.
Neurological defects are also associated with toxoplasmosis. Primary infection of T. gondii
may cause ocular diseases as explained by Calderaro et al. (2009) and Pappas et al. (2009). Figure
2.3 shows the difference between a normal retina and a retina with congenital toxoplasmosis scar
(Toxoplasmosis, 2016). Calderaro et al. (2009) added that the reactivation of latent toxoplasmosis in
patients with compromised immune systems may lead to life-threatening encephalitis. Moreover,
Fallahi et al. (2017) claimed that transplacental transmission of T. gondii may lead to hydrocephalus
or microcephaly.

Figure 2.3 Image of a Normal Retina (left) and a Retina with Congenital Toxoplasmosis Scar (right)
(Toxoplasmosis, 2016)

Since eradication is still not possible, knowing the effects of toxoplasmosis on the health of
humans would help control and prevent the spread of the infection. Due to the fact that many
diseases would show similar symptoms, proper determination of the real cause would help in
providing the right medications for the diseased patient.

2.4 Incidence and Prevalence

According to Szklo and Nieto (2014), incidence refers to the occurrence or rate of a disease in
the context of cohort or population studies. They also added that the number of events that occurred
in a distinct population over a particular amount of time determines the basic structure of incidence.
CDC (2012) explained that in epidemiologic studies, two types of incidence are commonly used,
namely incidence proportion and incidence rate. Incidence proportion refers to the fraction of a
population which are initially free from the disease contracts the it during a specific amount of time.
Thus, it involves only new cases that are reported in the duration of time chosen by the
epidemiologist. In incidence proportion, the numerator is the number of those who develop the
disease and the denominator is the number of the entire population being considered. On the other
hand, incidence rate considers follow-up studies from long-term cohorts, in which the respondents are
monitored during a specific duration and new cases of the disease is recorded. However, unlike the
incidence proportion, the denominator of incidence rate includes the time variable. It is the sum of the
time each individual respondent was monitored. The incidence rate is therefore the fraction of the
number of cases over the time the population being observed is at risk of the disease.
In a certain population, the frequency of existing cases of a particular disease at a specified
period of time indicates the prevalence of the disease (Szklo & Nieto, 2014). It is different from
incidence in the sense that it involves both new and preexisting cases in the population unlike
3
Name: Date:
Course Code and Section: Course Degree and Year:

CONCEPTUAL LITERATURE SECTION EXERCISE 1

Directions: Identify the techniques used in organizing ideas of the following Conceptual Literature section
by surrounding each sub-section with brackets and extending each of the brackets with arrows leading to the
writing of their specific techniques on the margins.

incidence which includes only the new cases. Szklo and Nieto (2014) mentioned that prevalence can
be classified into two types, the point prevalence and period prevalence. They explained that point
prevalence refers to the frequency of the disease at a specific point in time while period prevalence
looks at the frequency of the disease during a specified time interval. Thus, the observation time for
period prevalence is much longer compared to that of the point prevalence.

2.5 Risk Factor

According to Australian Institute of Health and Welfare (AIHW, 2017), risk factors are attributes
or characteristics that increase the chance of a person of being infected with a disease or disorder.
Risk factors may be classified into two types, the behavioral and the biomedical risk factors.
Behavioral risk factors are those that can be modified by the individual such as the use of tobacco,
excessive alcohol intake, and physical inactivity. Biomedical risk factors on the other hand are states
of the body that are affected by behavioral risk factors (AIHW, 2017). This would include high body
mass index (BMI) and high blood pressure.
Risk factors are important in prediction and prevention of a disease. Knowing the
characteristics of an individual which may have a positive or negative association to a disease would
help determine ways or measures to prevent the acquisition of the disease being considered.