Toxoplasma gondii: Challenges and perspectives in interpreting longitudinal seroprevalence data for a chronic parasitic infection

Toxoplasma gondii—the causative agent of toxoplasmosis—is a zoonotic pathogen of warm-blooded hosts. Infection causes mild-to-severe symptoms, including lethargy, fever, muscle pain, abortion, ocular disease, and encephalitis. Toxoplasma affects many vertebrate species, although felids are the only known definitive hosts. Seroprevalence in wildlife is often assessed using cross-sectional data, but few studies have tracked individual-level infections through time. We present a 4-yr dataset from white-tailed deer (Odocoileus virginianus) with repeated sampling of individuals that highlights challenges associated with assigning serostatus to individuals. Using a modified agglutination test, we observed seroconversion from seronegative to seropositive within individuals, as expected. Although toxoplasmosis is known to be a chronic disease, we also found reversion from seropositive to seronegative. Accurate assignment of serostatus is necessary for evaluating effects of infection on behavioral and physiologic outcomes. However, longitudinal data from individuals whose titers oscillate around the positive threshold present novel challenges. Therefore, we discuss the implications for assigning serostatus for chronic toxoplasmosis infection for three proposed approaches: 1) ever positive, always positive; 2) negative until positive and then always positive; and 3) status by sampling period. Clarifying which approach is used to assign serostatus when analyzing longitudinal T. gondii data may enable more meaningful comparisons across systems and studies.