Advances in serological, imaging techniques and molecular diagnosis of Toxoplasma gondii infection

A systematic review and meta-analysis of the validation of serological methods for detecting anti-Toxoplasma gondii antibodies in humans and animals

Toxoplasma gondii is a paradigmatic zoonotic parasite from the One Health perspective, since it is broadly distributed and virtually infects all warm-blooded species. A wide variety of serological techniques have been developed to detect T. gondii infection in humans and animals. Our aim was to describe and compare the main characteristics of these serological tests and validation processes and to critically analyze whether these tests meet the standards required to ensure an accurate serological diagnosis. The current systematic review and meta-analysis included 134 studies that were published from 2013 to 2023. QUADAS 2 tool was used to evaluate the quality of the included studies. A total of 52 variables related to the characteristics of the techniques and analytical and diagnostic validation parameters were studied. A wider panel of tests was developed for humans, including techniques exclusively developed for humans that involve costly equipment and the measurement of different Ig isotypes that are considered biomarkers of congenital toxoplasmosis. Studies conducted in humans frequently employed commercial techniques as reference tests, measured different immunoglobulin isotypes with a predominance for IgG (>50%) and discriminated between acute and chronic infections. In animals, the most commonly used reference techniques were in-house tests, which almost exclusively detected IgG. Common limitations identified in a large number of studies were some misunderstandings of the terms "gold standard" and "reference test" and the absence of information about the negative and positive control sera used or the exact cutoff employed, which were independent of the quality of the study. There is a lack of analytical validation, with few evaluations of cross-reactivity with other pathogens. Diagnostic odds ratio values showed that indirect ELISA based on native or chimeric antigens performed better than other tests. The reproducibility of serological test results in both humans and animals is not guaranteed due to a lack of relevant information and analytical validation. Thus, several key issues should be considered in the future, including interlaboratory ring trials.

Seroprevalence of Toxoplasma gondii, Neospora caninum and Trichinella spp. in Pigs from Cairo, Egypt

Pork production is a niche economy in Egypt, and pigs are typically raised as backyard animals with no sanitary control, potentially exposing them to various pathogens. Commercially available ELISAs were used to detect specific antibodies to the food-borne zoonotic parasites Toxoplasma gondii and Trichinella spp., as well as to Neospora caninum, in serum samples of pigs slaughtered at Egypt's only licensed pig abattoir, the El-Bassatin abattoir in Cairo. Among the tested sera (n = 332), seroreactivity for T. gondii was 45.8% (95% confidence interval: 40.4-51.3), N. caninum was 28.0% (95% CI: 23.3-33.2), and Trichinella spp. was 1.2% (95% CI: 0.4-3.3). Mixed infection was only detected for T. gondii and N. caninum (18.7%; 95% CI: 14.7-23.4). The seroprevalence of T. gondii was significantly higher (p = 0.0003) in animals collected from southern Cairo (15 May city slum) than in eastern Cairo (Ezbet El Nakhl slum). Seroprevalence for N. caninum was higher in western (Manshiyat Naser slum; p = 0.0003) and southern Cairo (15 May city slum; p = 0.0003) than in that of eastern Cairo (Ezbet El Nakhl slum; p = 0.0003). Moreover, female pigs exhibited a higher rate of N. caninum antibodies than male ones (p < 0.0001). This study provides the first seroprevalence data for N. caninum in pigs in Egypt, and updates the prevalence of the zoonotic parasites Trichinella spp. and T. gondii.

The detection of Toxoplasma gondii ME49 infections in BALB/c mice using various techniques

Toxoplasma gondii infections are primarily diagnosed by serological assays, whereas molecular and fluorescence-based techniques are garnering attention for their high sensitivity in detecting these infections. Nevertheless, each detection method has its limitations. The toxoplasmosis detection capabilities of most of the currently available methods have not been evaluated under identical experimental conditions. This study aimed to assess the diagnostic potential of enzyme-linked immunosorbent assay (ELISA), real-time polymerase chain reaction (RT-PCR), immunohistochemistry (IHC), and immunofluorescence (IF) in BALB/c mice experimentally infected with various doses of T. gondii ME49. The detection of toxoplasmosis from sera and brain tissues was markedly enhanced in mice subjected to high infection doses (200 and 300 cysts) compared to those subjected to lower doses (10 and 50 cysts) for all the detection methods. Additionally, increased B1 gene expression levels and cyst sizes were observed in the brain tissues of the mice. Importantly, IHC, IF, and ELISA, but not RT-PCR, successfully detected T. gondii infections at the lowest infection dose (10 cysts) in the brain. These findings may prove beneficial while designing experimental methodologies for detecting T. gondii infections in mice.

Quercetin inhibits Toxoplasma gondii tachyzoite proliferation and acts synergically with azithromycin

Quercetin (QUE) is a natural polyphenol known to have numerous pharmacological properties against infectious and non-infectious diseases. Azithromycin (AZ) is an antibiotic that belongs to the azalide class of antimicrobials and an antiparasitic that is known to be effective in combination with clindamycin against pyrimethamine/sulfadiazine-resistant Toxoplasma gondii tachyzoites in clinical settings. Both compounds are known to target protein synthesis and have anti-inflammatory properties. However, little is known about QUE and AZ synergistic interaction against T. gondii growth. Here, we report for the first time the effects of the combination of QUE and AZ on T. gondii growth. The 50% inhibitory concentration (IC50) for QUE at 72 h of interaction was determined to be 0.50 µM, whereas AZ gave an IC50 value of 0.66 µM at 72 h of interaction with parasites. Combination testing of QUE and AZ in a ratio of 2:1 (QUE:AZ) showed an IC50 value of 0.081 µM. Interestingly, a fractional inhibitory index value of 0.28 was observed, indicating a strong synergy. QUE was also found to upregulate the generation of reactive oxygen species and cause dysfunction of the mitochondria membrane of both intracellular and extracellular T. gondii tachyzoites. Overall, the results indicate that QUE is a novel lead capable of synergizing with AZ for inhibiting T. gondii growth and may merit future investigation in vivo for possible combination drug development.

Detection of chronic toxoplasmosis in the brain of mice using loop-mediated isothermal amplification (LAMP) and conventional PCR

BACKGROUND

Toxoplasma gondii is a common protozoan parasite that infects approximately one-third of the world's population. It is a disease with multiple manifestations. In immunocompetent individuals, symptoms are mild and flu-like, whereas, in immunocompromised patients, it often results in severe morbidity and mortality. Thus, studies for developing a simple, rapid diagnostic tool for early detection of Toxoplasma are emerging. Molecular diagnosis is highly accurate and helpful in congenitally infected and immunocompromised patients. The loop-mediated isothermal amplification (LAMP) technique was invented to improve nucleic acid amplification efficacy in terms of sensitivity and specificity.

AIM OF THE STUDY

The study aimed to validate a LAMP protocol for detecting Toxoplasma DNA in the brain homogenates from mice experimentally infected with Toxoplasma's ME-49 (cyst-forming type II) strain in comparison to PCR.

METHODS

In this study, the target DNA fragment was the Toxoplasma 529-bp, repeated 200-300 copies/genome. The sensitivity of both LAMP and conventional PCR techniques was estimated in brain homogenates in experimental mice at eight weeks post-infection and compared to the histopathology data.

RESULTS

The LAMP reaction showed positive results in 18 of the 26 examined samples of brain homogenates. PCR showed the characteristic 529-bp band in 15 of the 26 examined samples.

CONCLUSION

The LAMP showed a higher sensitivity over PCR in detecting Toxoplasma infection in brain homogenates of infected mice.

Toward waterborne protozoa detection using sensing technologies

Drought and limited sufficient water resources will be the main challenges for humankind during the coming years. The lack of water resources for washing, bathing, and drinking increases the use of contaminated water and the risk of waterborne diseases. A considerable number of waterborne outbreaks are due to protozoan parasites that may remain active/alive in harsh environmental conditions. Therefore, a regular monitoring program of water resources using sensitive techniques is needed to decrease the risk of waterborne outbreaks. Wellorganized point-of-care (POC) systems with enough sensitivity and specificity is the holy grail of research for monitoring platforms. In this review, we comprehensively gathered and discussed rapid, selective, and easy-to-use biosensor and nanobiosensor technologies, developed for the early detection of common waterborne protozoa.

Advances and Challenges in Diagnostics of Toxoplasmosis in HIV-Infected Patients

Toxoplasma gondii is a worldwide distributed protozoan parasite. This apicomplexan parasite infects one-third of the population worldwide, causing toxoplasmosis, considered one of the neglected parasitic infections. In healthy humans, most infections are asymptomatic. However, in immunocompromised patients, the course of the disease can be life-threatening. Human immunodeficiency virus (HIV)-infected patients have a very high burden of Toxoplasma gondii co-infection. Thus, it is essential to use modern, sensitive, and specific methods to properly monitor the course of toxoplasmosis in immunodeficient patients.

Recombinant AMA1 Virus-like Particle Antigen for Serodiagnosis of Toxoplasma gondii Infection

Toxoplasmosis diagnosis predominantly relies on serology testing via enzyme-linked immunosorbent assay (ELISA), but these results are highly variable. Consequently, various antigens are being evaluated to improve the sensitivity and specificity of toxoplasmosis serological diagnosis. Here, we generated Toxoplasma gondii virus-like particles displaying AMA1 of T. gondii and evaluated their diagnostic potential. We found that AMA1 VLPs were highly sensitive and reacted with the sera acquired from mice infected with either T. gondii ME49 or RH strains. The overall IgG and IgM antibody responses elicited by AMA1 VLPs were substantially higher than those induced by the conventionally used T. gondii lysate antigen (TLA). Importantly, AMA1 VLPs were capable of detecting parasitic infection with T. gondii RH and ME49 as early as 1 week post-infection, even when mice were exposed to low infectious doses (5 × 10³ and 10 cysts, respectively). AMA1 VLPs also did not cross-react with the immune sera acquired from Plasmodium berghei-infected mice. Compared to TLA, stronger antibody responses were induced by AMA1 VLPs when tested using T. gondii-infected human sera. The sensitivities and specificities of the two antigens were substantially different, with AMA1 VLPs demonstrating over 90% sensitivity and specificity, whereas these values were in the 70% range for the TLA. These results indicated that AMA1 VLPs can detect infections of both T. gondii ME49 and RH at an early stage of infection caused by very low infection doses in mice, and these could be used for serological diagnosis of human toxoplasmosis.

From Fetal to Neonatal Neuroimaging in TORCH Infections: A Pictorial Review

Congenital infections represent a challenging and varied clinical scenario in which the brain is frequently involved. Therefore, fetal and neonatal neuro-imaging plays a pivotal role in reaching an accurate diagnosis and in predicting the clinical outcome. Congenital brain infections are characterized by various clinical manifestations, ranging from nearly asymptomatic diseases to syndromic disorders, often associated with severe neurological symptoms. Brain damage results from the complex interaction among the infectious agent, its specific cellular tropism, and the stage of development of the central nervous system at the time of the maternal infection. Therefore, neuroradiological findings vary widely and are the result of complex events. An early detection is essential to establishing a proper diagnosis and prognosis, and to guarantee an optimal and prompt therapeutic perinatal management. Recently, emerging infective agents (i.e., Zika virus and SARS-CoV2) have been related to possible pre- and perinatal brain damage, thus expanding the spectrum of congenital brain infections. The purpose of this pictorial review is to provide an overview of the current knowledge on fetal and neonatal brain neuroimaging patterns in congenital brain infections used in clinical practice.

Toxoplasma gondii in African Wildlife: A Systematic Review

Toxoplasma gondii (T. gondii) is a protozoan parasite, which infects a wide variety of mammals and bird species globally. In large parts of the world, this parasite is relatively well documented in wildlife species, however, this topic is poorly documented in Africa. The current review systematically explores the presence and distribution of T. gondii in African wildlife species through a key word search in PubMed, Web of Science and CAB Direct. A total of 66 records were identified and included in the qualitative analysis, of which 19 records were retained for the quantitative synthesis. The presence of T. gondii was reported in a wide range of wildlife species, found in twelve countries, spread over the African continent. The retained records report a prevalence range of 6–100% in herbivores, 8–100% in omnivores and 14–100% in carnivores. In wild felines (cheetahs, leopards, and lions) a prevalence range of 33–100% was found. Reports from South Africa, and on the presence of T. gondii in lion were most common. Overall, the results indicate the scarcity of information on T. gondii in Africa and its circulation in wildlife. The lack of knowledge on the parasite in Africa, especially in areas at the human-livestock-wildlife interface, prevents us from understanding how prevalent it is on the continent, what strains are circulating in wildlife and what the most common routes of transmission are in the different habitats in Africa.

Development of an Immunochromatographic Test Based on Rhoptry Protein 14 for Serological Detection of Toxoplasma gondii Infection in Swine

Toxoplasma gondii, a worldwide distributed apicomplexan protozoan, can infect almost all warm-blooded animals and may cause toxoplasmosis. In order to provide a point-of-care detection method for T. gondii infection, an immunochromatographic test (ICT) was established. The proposed test uses recombinant T. gondii rhoptry protein 14 (ROP14) conjugated with 20 nm gold particles, recombinant protein A as the detection line and monoclonal antibody TgROP14-5D5 as the control line. The specificity, sensitivity, positive predictive value, negative predictive value and stability of this new ICT were evaluated. rTgROP14 was specifically recognized by positive serum of T. gondii but not negative serum. mAb TgROP14-5D5 showed higher specific recognition of T. gondii antigens and was therefore selected for subsequent colloidal gold strip construction. The new ICT based on TgROP14 exhibited good diagnostic performance with high specificity (86.9%) and sensitivity (90.9%) using IHA as a “reference standard”. Among 436 field porcine sera, ICT and IHA detected 134 (30.7%) and 99 (22.7%) positive samples, respectively. The relative agreement was 87.8%. These data indicate that this new ICT based on TgROP14 is a suitable candidate for routine testing of T. gondii in the field.

Standardization of the PCR Technique for the Detection of the Toxoplasma gondii B1 Gene in Meat and Water Samples and Cloning of the Product for Use as Control

INTRODUCTION

Toxoplasmosis is caused by the parasite Toxoplasma gondii. The infection is generally asymptomatic and the most severe cases occur in immunosuppressed patients. The main route of transmission is the ingestion of water or food contaminated with cysts of the parasite. The objective of this work was the standardization of the PCR for the detection of the T. gondii B1 gene in meat and water samples and cloning of the product for use as a control.

METHODS

The optimal reaction conditions of the different components of the PCR were determined and the technique was used to detect DNA from meat and water samples. Bands were purified and cloned into a pGEM-T-Easy vector and used as a control in the PCR.

RESULTS

Optimal PCR conditions were; 100 µM dNTP, 0.4 µM primers, and 0.5 U Taq polymerase. The product obtained from the PCR was cloned with a simple cloning strategy with efficient results. With the standardized PCR and using the cloned DNA as a control, T. gondii DNA was detected in 90% of the positives samples of meat and water and there was no amplification in the negative samples.

CONCLUSIONS

The PCR assay standardized in this study was demonstrated to be an effective technique to detect T. gondii DNA in meat and water samples. The cloning of PCR product and its application as a control in molecular diagnosis of toxoplasmosis might improve the reproducibility of this method and avoid the use of patient samples or cultures, which present several limitations.

A systematic literature review and meta-analysis of Toxoplasma gondii seroprevalence in goats

The aim of this study was evaluate to seroprevalence of Toxoplasma gondii in goats worldwide and the main risk factors associated from 2000 to 2020, through meta-analysis with 55,317 goats from 75 reports published in seven electronic databases of major global importance. A global seroprevalence detected was 27.49% (95% CI 24.15-30.95; I2 = 99%), with the lowest percentage in Asia (20.74%; 95% CI 16.45-25.39) and highest in Central America (62.15%; 95% CI 57.28-66.90) and Europe (31.53%; 95% CI 21.71-42.26). The seropositivity in Africa and South America were (29.41%; 95% CI 19.11-40.89) and (29.76%; 95% CI 25.84-33.83), respectively. The seroprevalence was associated with presence of cats (OR 2.22; 95% CI 1.30-3.82), goats older than one year (OR 1.77; 95% CI 1, 37-2.29), females (OR 1.43; 95% CI 1.23-1.65), rearing system (extensive vs. intensive) (OR 4.82; 95% CI 1.96-11, 84) and rearing system (semi-intensive vs. intensive) (OR 1.48; 95% CI 1.48-6.13). The heterogeneity was evidenced in most world regions and the risk factors may play roles in varying the seroprevalence.

A novel rapid visual detection assay for Toxoplasma gondii combining recombinase-aided amplification and lateral flow dipstick coupled with CRISPR-Cas13a fluorescence (RAA-Cas13a-LFD)

Toxoplasmosis, a parasitic disease resulting from Toxoplasma gondii infection, remains prevalent worldwide, and causes great harm to immunodepressed patients, pregnant women and newborns. Although various molecular approaches to detect T. gondii infection are available, they are either costly or technically complex. This study aimed at developing a rapid visual detection assay using recombinase-aided amplification (RAA) and lateral flow dipstick (LFD) coupled with CRISPR-Cas13a fluorescence (RAA-Cas13a-LFD) to detect T. gondii. The RAA-Cas13a-LFD assay was performed in an incubator block at 37 °C within 2 h, and the amplification results were visualized and determined through LFD by the naked eye. The detection limit was 1 × 10^-6 ng/μL by our developed RAA-Cas13a-LFD protocol, 100-fold higher than that by qPCR assay (1 × 10^-8 ng/μL). No cross-reaction occurred either with the DNA of human blood or Ascaris lumbricoides, Digramma interrupta, Entamoeba coli, Fasciola gigantica, Plasmodium vivax, Schistosoma japonicum, Taenia solium, and Trichinella spiralis, and the positive rate by RAA-Cas13a-LFD assay was identical to that by qPCR assay (1.50% vs. 1.50%) in detecting T. gondii infection in the unknown blood samples obtained from clinical settings. Our findings demonstrate that this RAA-Cas13a-LFD assay is not only rapid, sensitive, and specific and allows direct visualization by the naked eye, but also eliminates sophisticated and costly equipment. More importantly, this technique can be applied to on-site surveillance of T. gondii.

Rapid diagnosis of Toxoplasma gondii using loop-mediated isothermal amplification assay in camels and small ruminants

Background

This study was conducted to detect the presence of T. gondii in milk and blood samples using three different assays: enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR), and loop-mediated isothermal amplification assay (LAMP). Whole blood, serum, and milk samples were collected from goats (n = 156), sheep (n = 261), and camels (n = 108) in different governorates in Egypt from December 2019 to February 2021 and screened by ELISA for anti-Toxoplasma IgG antibodies before DNA extraction. The target T. gondii DNA gene was detected and evaluated using the LAMP assay compared to PCR.

Results

T. gondii antibodies were found in milk and serum samples at the rates of (29.26%) and (36.58%) in camels, (34.18%) and (35.89%) in sheep, and (33.7%) and (36.36%) in goats, respectively. Similar to PCR, the percentages of LAMP tests for the detection of the T. gondii DNA gene in milk and blood samples of camels, sheep, and goats were (4.8, 14.63), (6.83, 7.69), and (7.79, 9.09), respectively. LAMP's sensitivity for detecting T. gondii in milk and blood samples, which was identical to that of PCR, was 100%.

Conclusions

The findings clearly demonstrated that there were no variations in T. gondii detection capabilities in milk and blood samples from various animals using both PCR and LAMP tests. It provides a quick, precise, and sensitive method of detecting T. gondii in a variety of samples that may be used both in the field and in laboratory diagnosis.

Prevalence of Batrachochytrium dendrobatidis in Amphibians From 2000 to 2021: A Global Systematic Review and Meta-Analysis

Chytridiomycosis is an amphibian fungal disease caused by Batrachochytrium dendrobatidis (Bd), which has caused large-scale death and population declines on several continents around the world. To determine the current status of Bd infection in amphibians, we conducted a global meta-analysis. Using PubMed, ScienceDirect, SpringerLink, China National Knowledge Infrastructure (CNKI) and Wanfang database searches, we retrieved a total of 111 articles from 2000 to 2021. Based on these, we estimated the Bd prevalence to be 18.54% (95% CI: 13.76–20.52) in current extent amphibians. Among these populations, the prevalence of Bd in Asia was the lowest at 7.88% (95% CI: 1.92–8.71). Further, no Bd infection was found in Vietnam. However, the prevalence of Bd in Oceania was the highest at 36.34% (95% CI: 11.31–46.52). The Bd prevalence in Venezuela was as high as 49.77% (95% CI: 45.92–53.62). After 2009, the global Bd prevalence decreased to 18.91% (95% CI: 13.23–21.56). The prevalence of Bd in epizootic populations was significantly higher than enzootic populations. The highest prevalence of Bd was detected with real-time PCR at 20.11% (95% CI: 13.12–21.38). The prevalence of Bd in frogs was the highest at 20.04% (95% CI: 13.52–21.71), and this different host was statistically significant (P < 0.05). At the same time, we analyzed the geographic factors (longitude, latitude, elevation, rainfall and temperature) that impacted the fungal prevalence in amphibians. Our meta-analysis revealed that factors including region, disease dynamic, detection method, host and climate may be sources of the observed heterogeneity. These results indicate that chytridiomycosis was a consistent threat to amphibians from 2000 to 2021. Based on different habitat types and geographical conditions, we recommend formulating corresponding control plans and adopting reasonable and efficient biological or chemical methods to reduce the severity of such diseases.

Congenital Toxoplasmosis: The State of the Art

Infection with the protozoan parasite Toxoplasma gondii occurs worldwide and usually causes no symptoms. However, a primary infection of pregnant women, may infect the fetus by transplacental transmission. The risk of mother-to-child transmission depends on week of pregnancy at the time of maternal infection: it is low in the first trimester, may reach 90% in the last days of pregnancy. Inversely, however, fetal disease is more severe when infection occurs early in pregnancy than later. Systematic serologic testing in pregnant women who have no antibodies at the beginning of pregnancy, can accurately reveal active maternal infection. Therefore, the risk of fetal infection should be assessed and preventive treatment with spiramycin must be introduced as soon as possible to reduce the risk of mother-to-child transmission, and the severity of fetal infection. When maternal infection is confirmed, prenatal diagnosis with Polymerase Chain Reaction (PCR) on amniotic fluid is recommended. If fetal infection is certain, the maternal treatment is changed to a combination of pyrimethamine-sulfonamide and folinic acid. Congenitally infected newborns are usually asymptomatic at birth, but at risk for tardive sequelae, such as blindness. When congenital infection is evident, disease include retinochoroiditis, cerebral calcifications, hydrocephalus, neurocognitive impairment. The diagnosis of congenital infection must be confirmed at birth and management, specific therapy, and follow-up with multidisciplinary counseling, must be guaranteed.

Molecular detection and genetic characterization of Toxoplasma gondii in pork from Chongqing, southwest China

Raw or undercooked meat is an important source of Toxoplasma gondii infection in China, but there is little research data on these infections in Chongqing. This study determined the prevalence of T. gondii, and its genotypes, in pork. A total of 1,223 diaphragm muscle samples were collected from eight slaughterhouses and 79 markets and detected by PCR amplification of the ITS gene. All of the positive samples were used for genotype identification by PCR-RFLP with 11 genetic markers. The total positive rate of T. gondii in Chongqing pork was 8.7%, and differences in T. gondii infection rates were found between different districts (0%-23.3%), seasons (e.g., 4.3% from Spring, 7.3% from Summer, 11.4% from Autumn, 12.0% from Winter) and years (2.7%-14.3%). Six samples were successfully genotyped, of which one was identified as ToxoDB#9 and five were ToxoDB#9-like. This was the first continuous study about the prevalence of T. gondii in pork in Chongqing for several years. Slaughterhouses in different districts, pork source, farm scale, season and year were potential risk factors for T. gondii contamination by the univariate logistic regression, and using multivariate logistic regression districts, pork source and year were the independent risk factor. These data may help reducing the levels of toxoplasmosis in pigs and humans in Chongqing.

Toxoplasma infection and risk of epilepsy: A case-control study of incident patients

We performed an age matched case-control study of incident epileptic patients to assess the relationship between Toxoplasma gondii seropositivity and epilepsy. Cases were 94 newly diagnosed patients (mean age, 36.7 ± 15.9) with unprovoked convulsive epilepsy of unknown etiology and controls were 88 healthy individuals (mean age, 37.5 ± 17.1) with no history of epilepsy or neurological disorders. Sera of all subjects were examined for anti-Toxoplasma IgG antibodies using commercially enzyme-linked immunoassays. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using univariate analysis and logistic regression, adjusted for potential confounders. The prevalence of anti-Toxoplasma IgG antibodies in epileptic patients (68.1%; 95%CI, 57.6-77.3%) was significantly higher than healthy controls (47.7%; 95%CI, 36.9-58.6%), indicating a significant relationship between Toxoplasma infection seropositivity and epilepsy (adjusted OR, 2.58; 95%CI, 1.16-5.72; P value < 0.05). The univariate analyses showed more than two-fold higher Toxoplasma seropositivity in patients with focal (OR, 2.31; 95%CI, 0.94-5.67) and generalized (OR, 2.35; 95%CI, 1.215-4.57) seizures versus healthy controls. Our findings support hypothesis that Toxoplasma infection/exposure may play an important role in development of epilepsy. Preventive measures to control of Toxoplasma infection especially in north of Iran and early treatment might be effective to reduce the occurrence of epilepsy in this region.

Diagnostic methods and protocols used in investigating Toxoplasma gondii in humans: A review

Toxoplasmosis, a zoonotic disease, is a parasitic infection caused by a coccidian protozoan Toxoplasma gondii. In immunocompetent people, the infection is asymptomatic, while it can produce serious signs in immunocompromised people and in developing fetuses. Accurate diagnosis is dependent, mainly, on the clinical features. However, in immunocompromised patients, the diagnosis is very difficult and may lead to misdiagnosis and improper treatment. Today, molecular diagnosis and serotyping are widely used for the diagnosis of T. gondii in many countries. The aim of the present short review is to highlight the current diagnostic methods and protocols that are used for the diagnosis of T. gondii in humans.

Geo-climatic factors and prevalence of chronic toxoplasmosis in pregnant women: A meta-analysis and meta-regression

In this study, we evaluated the effects of geo-climatic parameters and other potential risk factors on the prevalence of chronic toxoplasmosis (CT) in pregnant women. We searched PubMed/MEDLINE, Web of Science, EMBASE, Scopus, and SciELO databases for seroepidemiological studies published between January 1988, and February 2021. We performed meta-analysis and meta-regression by using a random effect model to synthesize data. A total of 360 eligible datasets, including 1,289,605 pregnant women from 94 countries, were included in this study. The highest and lowest prevalence rates were estimated for latitudes of 0-10° (49.4%) and ≥50° (26.8%); and for the longitude of 80-90° (44.2%) and 110-120° (7.8%), respectively. Concerning climatic parameters, the highest and lowest prevalence rates were estimated in regions with the mean relative humidities of >80% (46.6%) and <40% (27.0); annual precipitation between 1000 and 1500 mm (39.2%) and 250-500 mm (26.8%); and mean annual temperature of 20-30 °C (36.5%), and <7 °C (24.9%), respectively. Meta-regression analyses indicated significant increasing trends in prevalence of CT in pregnant women with decrease in geographical latitude (coefficient, = -0.0035), and geographical longitudes (C = -0.0017). While it was positively associated (P < 0.01) with the mean environmental temperature (C = 0.0047), annual precipitation (C = 0.000064), and mean relative humidity (C = 0.002). Our results highlighted various effects of environmental parameters on the prevalence of CT. Therefore, different regions in the world may benefit from different types of interventions, and thus, novel preventive measures in a region should be developed according to local climate, agricultural activities and people culture.

Seroprevalence Estimates of Latent and Acute Toxoplasma Infections in HIV+ People-Call for Action in Underprivileged Communities

We undertook a comprehensive, systematic review of observational studies to estimate respective seroprevalences of latent and acute Toxoplasma gondii infections in HIV⁺ people at the global, regional and country levels; related seroprevalence to socio-economic variables and CD4+ cell counts; and assessed temporal changes in prevalence and risk factors for this group. We systematically searched international databases for seroepidemiological surveys between 1 January 1980 and 31 July 2020. We used a random effects model to calculate pooled seroprevalences with 95% confidence intervals (CI), and estimated the numbers of HIV⁺ people inferred to harbour latent and acute T. gondii infections (LT or AT). We grouped seroprevalence data according to the geographic regions defined by the World Health Organization (WHO) and conducted subgroup and meta-regression analyses of the data. Of a total of 4024 studies identified, 150 and 65 of them met the inclusion criteria for LT and AT in HIV⁺ people, respectively. The overall, pooled seroprevalences of LT and AT were 37.4% (95% CI, 33.4–41.4) and 1.3% (95% CI, 0.9–1.8%), equating to ~14.2 and 0.5 million HIV⁺ people, respectively. Most HIV⁺ people with T. gondii infections originated from Africa, and the highest seroprevalences were in low-income countries with low human development indices. Significant risk factors for toxoplasmosis in HIV⁺ patients included the consumption of raw/undercooked meat, frequent contact with soil, a low CD4+ T lymphocyte number (<200 cells per μL) and age. Overall, the finding of high seroprevalences of particularly latent T. gondii infection in HIV⁺ people in underprivileged regions of the world, such as parts of Africa, calls for preventative action. Programs that include routine serological monitoring, counselling, care, animal control and/or prophylactic treatment measures are needed to prevent severe toxoplasmosis from developing in people living with HIV infection. Our study highlights the potential importance of parasite chemoprophylaxis in resource-poor settings, particularly in low-income countries.

Characterization and evaluation of a recombinant multiepitope peptide antigen MAG in the serological diagnosis of Toxoplasma gondii infection in pigs

Background

Toxoplasmosis caused by Toxoplasma gondii is a serious disease threatening human and animal health. People can be infected with T. gondii by ingesting raw pork contaminated with cysts or oocysts. Serological test is a sensitive and specific method usually used for large-scale diagnosis of T. gondii infection in humans and animals (such as pigs). Commercial pig Toxoplasma antibody ELISA diagnostic kits are expensive, which limits their use; moreover, the wide antigen composition used in these diagnostic kits is still unclear and difficult to standardize. The multiepitope peptide antigen is a novel diagnostic marker, and it has potential to be developed into more accurate and inexpensive diagnostic kits.

Methods

The synthetic multiepitope antigen (MAG) cDNA encoding a protein with epitopes from five T. gondii-dominant antigens (SAG1, GRA1, ROP2, GRA4, and MIC3) was designed, synthesized, and expressed in Escherichia coli BL21 (DE3) strain. The recombinant protein was detected through western blot with pig anti-T. gondii-positive and -negative serum, and then IgG enzyme-linked immunosorbent assay (ELISA) named MAG-ELISA was designed. The MAG-ELISA was evaluated in terms of specificity, sensitivity, and stability. The MAG-ELISA was also compared with a commercial PrioCHECK^®Toxoplasma Ab porcine ELISA (PrioCHECK ELISA). Finally, the trend of pig anti-T. gondii IgG levels after artificial infection with RH tachyzoites was evaluated using MAG-ELISA and two other ELISA methods (rMIC3-ELISA and PrioCHECK ELISA).

Results

MAG antigen could be specifically recognized by pig anti-T. gondii-positive but not -negative serum. MAG-ELISA showed high diagnostic performance in terms of specificity (88.6%) and sensitivity (79.1%). MAG-ELISA could be used for detecting anti-T. gondii IgG in the early stage of T. gondii infection in pigs (at least 7 days after artificial infection).

Conclusions

Our results suggest that MAG antigen can be applied to specifically recognize anti-T. gondii IgG in pig, and MAG-ELISA has the potential for large-scale screening tests of T. gondii infection in pig farms and intensive industries.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-021-04917-w.

Assessment of an In-House Enzyme-Linked Immunosorbent Assay and IgG Avidity Test Based on SAG1 and GRA7 Proteins for Discriminating between Acute and Chronic Toxoplasmosis in Humans

To improve serodiagnostic methods for diagnosis of acute from chronic toxoplasmosis, an economical in-house enzyme-linked immunosorbent assay (ELISA) for measuring Toxoplasma-specific IgG, IgM, and IgG avidity has been developed and assessed based on use of various Toxoplasma gondii antigens, including SAG1, GRA7, and a combination of SAG1 and GRA7 (SAG1+GRA7), as well as Toxoplasma lysate antigens (TLAs). Performances of in-house IgM, IgG, and IgG avidity assays were compared to those of ELISA commercial kits and VIDAS Toxo IgG avidity. A set of 138 sera from patients with acquired T. gondii infection and seronegative people were assessed. Receiver operating characteristic (ROC) analysis revealed an area under curve (AUC) of 0.98, 0.97, 0.99, and 0.99 for IgM-TLAs, IgM-SAG1, IgM-GRA7, and IgM-SAG1+GRA7, respectively. Furthermore, AUC was calculated as 0.99, 0.99, 0.98, and 0.99 for IgG-TLAs, IgG-SAG1, IgG-GRA7, and IgG-SAG1+GRA7, respectively. The current study showed that GRA7 included 100% sensitivity for the detection of Toxo IgM, while SAG1 included 89.7% sensitivity. Furthermore, the highest specificity (97.2%) to detect Toxo IgM was achieved using SAG1+GRA7 antigen. For the detection of Toxo IgG, the highest sensitivity (100%) was recorded for SAG1+GRA7, followed by TLAs (97.9%). The SAG1+GRA7 showed the greatest potential for assessing avidity of IgG antibodies, with 97.1% sensitivity and 96.6% specificity compared to those of VIDAS Toxo IgG avidity. The preliminary results have promised better discriminations between acute and chronic infections using a combination of SAG1 and GRA7 recombinant antigens compared to those using TLAs.

A peptide originated from Toxoplasma gondii microneme 8 displaying serological evidence to differentiate recent from chronic human infection

Toxoplasmosis is able to cause death and/or sequelae in foetuses from pregnant women and immunocompromised individuals. The early diagnosis, able to differentiate acute from chronic phases, is essential to define the treatment against this disease and minimize the risk of complications. Here we describe a peptide derived from microneme 8 (pMIC8) protein of Toxoplasma gondii, able to distinguish the phase of infection. By using human and mice serum samples with different infection times, we assessed the ability of pMIC8 to interact with antibodies present in early of infection, and compared the results obtained with soluble antigen of T. gondii (STAg). The results showed that pMIC8 was recognized more precisely with antibodies present in serum samples from individuals with time of infection below 3 months, followed by those between 4 and 6 months of infection. Based on these results, it is possible to conclude that the association of immunoassays using STAg and pMIC8 as antigen preparations can be used to distinguish acute from chronic infections.

A novel loop-mediated isothermal amplification-lateral-flow-dipstick (LAMP-LFD) device for rapid detection of Toxoplasma gondii in the blood of stray cats and dogs

Toxoplasma gondii is an obligate intracellular protozoan parasite that causes toxoplasmosis and threatens warm-blooded animal and human health worldwide. Simple and applicable diagnostic methods are urgently needed to guide development of effective approaches for prevention of toxoplasmosis. Most molecular diagnostic tools for T. gondii infection require high technical skills, sophisticated equipment, and a controlled lab environment. In this study, we developed a loop-mediated isothermal amplification-lateral-flow-dipstick (LAMP-LFD) assay that specifically targets the 529 bp for detecting T. gondii infection. This novel portable device is universal, fast, user-friendly, and guarantees experimental sensitivity as well as low risk of aerosol contamination. Our LAMP-LFD assay has a detection limit of 1 fg of T. gondii DNA, and shows no cross-reaction with other parasitic pathogens, including Cryptosporidium parvum, Leishmania donovani, and Plasmodium vivax. We validated the developed assay by detecting T. gondii in DNA extracted from blood samples collected from 318 stray cats and dogs sampled from Deqing, Wenzhou, Yiwu, Lishui and Zhoushan cities across Zhejiang province, Eastern China. The LAMP-LFD device detected T. gondii DNA in 4.76 and 4.69% of stray cats and dogs, respectively. In conclusion, the developed LAMP-LFD assay is efficient, minimizes aerosol contamination, and is therefore suitable for detecting T. gondii across basic medical institutions and field settings.

Cerebral Toxoplasmosis, CMV and Bacterial Pneumonia with Decreasing CD4+ T-Cell Count as Results of Antiretroviral Therapy Discontinuation-A Case Report

Cerebral toxoplasmosis occurs mainly in immunocompromised hosts as a reactivation of latent Toxoplasma gondii infection. In the diagnostic process, magnetic resonance imaging (MRI), serum testing, and biopsy are used. We describe a case of a 43-year-old HIV-positive patient presenting with altered levels of consciousness, aphasia, and hemiparesis. The patient had a history of antiretroviral therapy discontinuation for about 3 years. MRI revealed lesions, suggesting cerebral toxoplasmosis and subacute hemorrhage, serum tests for Toxoplasma gondii were positive. Antiparasitics and glycocorticosteroids were administered. A decline in viral load and clinical improvement were observed, however CD4+ T-cell count continued to decrease. The patient’s state worsened, he developed CMV and bacterial pneumonia, which led to his death. What is crucial in the management of an HIV-infected patient is effective and continuous antiretroviral therapy. Discontinuation of the treatment may result in AIDS and lead to poor recovery of the CD4+ T-cell population, even after reimplementation of antiretroviral therapy and a decrease in viral load.

Seroepidemiology of Toxoplasma gondii infection in people with alcohol consumption in Durango, Mexico

The seroepidemiology of infection with Toxoplasma gondii (T. gondii) in alcohol consumers is largely undeveloped. In light of this, we sought to determine the seroprevalence of T. gondii infection in alcohol consumers in Durango, Mexico, and the association of T. gondii seroprevalence with characteristics of the population studied. Anti-T. gondii IgG and IgM antibodies were searched in sera of participants using commercially available enzyme immunoassays. Bivariate and logistic regression analyses were then used to determine the association between T. gondii infection and the characteristics of the population studied. Of the 1544 people studied (mean age: 39.4±14.0 years), 173 (11.2%) tested positive for anti-T. gondii IgG antibodies. We were able to test 167 of the 173 anti-T. gondii IgG positive sera for anti-T. gondii IgM antibodies. Fifty-five (32.9%) of these 167 serum samples were positive for anti-T. gondii IgM antibodies. Bivariate analysis showed that visual impairment, history of surgery, and hepatitis were negatively associated with T. gondii IgG seropositivity (P<0.05). In women, seropositivity to T. gondii was positively associated with a history of pregnancy (P<0.05). Logistic regression analysis showed that T. gondii seropositivity was associated with the variables consumption of armadillo meat (OR = 2.33; 95% CI: 1.04–5.22; P = 0.03), and the use of latrines for elimination of excretes (OR = 2.27; 95% CI: 1.07–4.80; P = 0.03); and high (>150 IU/ml) anti-T. gondii IgG antibodies were associated with consumption of both armadillo meat (OR = 2.25; 95% CI: 1.01–5.02; P = 0.04) and crowding at home (OR = 1.63; 95% CI: 1.02–2.61; P = 0.03). We found a distinct T. gondii seroprevalence in people with alcohol consumption from those previously found in population groups in the region. This is the first study that illustrates the association between high anti-T. gondii antibodies and crowding in Mexico, and the second study on the association between T. gondii infection and consumption of armadillo meat and the use of latrines in this country. We conclude that epidemiology of T. gondii infection in people with alcohol consumption deserves further investigation.

Seroprevalence and risk factors of Toxoplasma gondii infection in goats in China from 2010 to 2020: A systematic review and meta-analysis

Toxoplasma gondii is a widely distributed protozoan parasite that can infect a variety of warm-blooded animals including humans and goats. This is the first meta-analysis to assess the overall seroprevalence and potential risk factors of T. gondii infection among goats in China. Databases including the VIP Chinese Journal Databases (VIP), the China National Knowledge Infrastructure (CNKI) database, WanFang, ScienceDirect, and PubMed were searched comprehensively for relevant studies published from 2010 to date. A random-effects model was used to calculate pooled seroprevalence estimates with 95 % confidence intervals (CI) and data were analyzed from 13 provinces in China. The pooled T. gondii seroprevalence in goats was estimated as 9.9 %. Goats T. gondii had the highest seroprevalence in Southwestern China (13.3 %) and the lowest in Northeastern China (7.3 %). The seroprevalence in the sub-group before 2012 (8.0 %) was lower than that in 2012-2015 (15.2 %) and 2016 or later (9.2 %). Goats aged > 12-months had a higher seroprevalence (11.7 %) than ≤ 12-months (10.7 %). The seroprevalence in female goats was 12.5 % and 12.2 % in male goats. In season subgroups, the seroprevalence was lowest in autumn (6.1 %). Naturally grazed goats had a seroprevalence of 8.1 % of infection and 7.8 % in intensively fed goats. We also evaluated the effects of geographical and climate variables on the pooled seroprevalence of T. gondii in goats in China. The results indicated that toxoplasmosis is widely distributed in goats in China. In the context of ensuring animal welfare, we suggest the continued promotion of the transition from natural grazing to intensive agriculture to strengthen disease prevention. Prevention would be better carried out in areas suitable for the survival and reproduction of T. gondii. Breeders need to regularly disinfect the feeding areas and pens or other areas of goat activity thoroughly to reduce the impact of environmental factors responses on the infection of goats to T. gondii.

The Main Molecular and Serological Methods for Diagnosing COVID-19: An Overview Based on the Literature

Diagnostic tests have been considered as the main alternative for the control of coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as a correct diagnosis allows for decision making when facing the disease, particularly as there is a lack of effective therapeutic protocols and vaccines. Thus, in this review, we summarized the main diagnostic approaches currently available for the diagnosis of SARS-CoV-2 infection in humans based on studies available in article databases. The tests can be organized into two main categories: nucleic acid-based tests, recommended for the initial detection of the virus, and serological tests, recommended for assessing the disease progression. The studies have shown that the performance of diagnostic methods depends on different factors, such as the type of samples and the characteristics of each assay. It was identified that the positivity of the tests is mainly related to the onset of symptoms. We also observed that point-of-care diagnoses are considered as one of the main trends in this area, due to the low-cost and simplicity of the assay; however, the analytical performance must be critically analyzed. Thus, the COVID-19 pandemic has highlighted the critical role of diagnostic technologies in the control of infectious diseases.

The global prevalence and risk factors of Toxoplasma gondii among foxes: A systematic review and meta-analysis

Toxoplasma gondii is one of the most successful intracellular protozoan parasites in the world, which can infect most warm-blooded animals including foxes in the world and cause toxoplasmosis. This is the first meta-analysis to assess the overall prevalence and potential risk factors of T. gondii among foxes in the world. Relevant studies were comprehensively collected from ScienceDirect, Springer-Link, PubMed, VIP Chinese Journal Databases (VIP), WanFang, and China National Knowledge Infrastructure (CNKI) databases. The random-effect model was used to calculate pooled prevalence with 95% confidence intervals (CI) and analyzed data were from 20 countries. The pooled T. gondii prevalence in foxes was estimated to be 39.6%. T. gondii has the highest prevalence in North America (51.2%), and lowest in Asia (8.3%). The prevalence in the sub-group after 2006 (44.7%) was lower than 2006 or before (48.5%). The prevalence in female foxes was 46.1%, which was higher than that in male foxes (19.7%). In species subgroup, red fox has the highest prevalence (46.8%). Wild foxes have a higher rate of infection (40.8%) than captive foxes (8.4%). Genotype Ⅱ of T. gondii is the most prevalent in foxes. We also evaluated the effects of geographical and climate variables on pooled prevalence of T. gondii in foxes. Our research indicated that toxoplasmosis widely existed in the world. The investigation of T. gondii infection in wild animals can provide an estimate of environmental pollution and T. gondii circulation in the ecosystem. It is essential for us to prevent and control T. gondii infection in foxes in order to reduce the risk of human infection.

A loop-mediated isothermal amplification (LAMP) assay for detection of Toxoplasma gondii infection in women with spontaneous abortion

The present study aimed to use the loop-mediated isothermal amplification (LAMP) technique in comparison with serological tests to determine the rate of T. gondii infection in women suffering from spontaneous abortion (SA). A total of 140 women suffering from their first SA were included in this study. The collected aborted fetal remains and blood samples from each patient were examined in sterilized conditions using the LAMP technique and ELISA. Of the 140 women, 80 (57.1%) tested seropositive for anti-Toxoplasma antibodies by ELISA, 72 (51.4%) women tested seropositive for the IgG antibody, 8 (5.7%) tested seropositive for the IgM antibody. Among the eight women who'd had their first SA who tested seropositive for IgM antibody by ELISA, only five cases (62.5%) reported positively to the LAMP test. The difference in the frequency distribution of the LAMP results for measuring the Toxoplasma infection in pregnant women under study was statistically significant (P < 0.001) from the results of the serological test (ELISA). Although there was a significant difference between age and positivity in the LAMP test (P = 0.017), no significant difference was observed between positivity in the LAMP test and other variables. The findings of the present investigation suggest that LAMP is a preferred method for determining Toxoplasma infection in pregnant women suffering from SA compared with other routine serological tests. Even in a field with limited facilities and equipment, this technique can be effective and efficient in accurately and specifically diagnosing Toxoplasma infections in women at high risk of SA.

The prevalence of latent and acute toxoplasmosis in HIV-infected pregnant women: A systematic review and meta-analysis

OBJECTIVE

HIV in pregnancy is not only important for mother-to-child HIV transmission, but also it assumes additional importance because HIV increases susceptibility to opportunistic infections, leading to increased morbidity and mortality in mothers and neonates. Toxoplasmosis is one of the most important opportunistic infections in HIV-infected pregnant women. The present study was undertaken to assess the prevalence of latent toxoplasmosis (LT) and acute toxoplasmosis (AT) infection in HIV-infected pregnant women.

METHODS

PubMed/MEDLINE, Scopus, Web of Science, EMBASE and SciELO were searched to identify relevant studies. A random-effects model was used to estimate the overall and subgroup-pooled prevalences across studies. Heterogeneity between studies was assessed via the I² test.

RESULTS

A total of 14 articles that included 3256 subjects in nine countries met the inclusion criteria. The overall prevalence rates of LT and AT in HIV-infected pregnant women were 45.7% (95% CI, 32.3-59.7%) and 1.1% (95% CI, 0.4-3.2%), respectively. The findings indicate that, worldwide, approximately 559,000 and 13,450 HIV-infected pregnant women are affected by LT and AT, respectively. From this review, it is estimated that approximately 3432 babies annually could be born with congenital toxoplasmosis (CT) from HIV-infected pregnant mothers.

CONCLUSIONS

The present study indicates that a large number of HIV-infected mothers are affected by LT and AT. This can lead to adverse complications such toxoplasmic encephalitis in mothers and CT in neonates. Our results suggest a need for screening programs using well-validated diagnostic platforms for both LT and AT for all HIV-infected pregnant women.

Evaluation of toxoplasmosis in pregnant women using dot-immunogold-silver staining with recombinant Toxoplasma gondii peroxiredoxin protein

BACKGROUND

Toxoplasma gondii infection endangers human health and affects animal husbandry. Serological detection is the main method used for epidemiological investigations and diagnosis of toxoplasmosis. The key to effective diagnosis of toxoplasmosis is the use of a standardized antigen and a specific and sensitive detection method. Peroxiredoxin is an antigenic protein and vaccine candidate antigen of T. gondii that has not yet been exploited for diagnostic application.

METHODS

In this study, recombinant T. gondii peroxiredoxin protein (rTgPrx) was prepared and used in dot-immunogold-silver staining (Dot-IGSS) to detect IgG antibodies in serum from mice and pregnant women. The rTgPrx-Dot-IGSS method was established and optimized using mouse serum. Furthermore, serum samples from pregnant women were analyzed by rTgPrx-Dot-IGSS.

RESULTS

Forty serum samples from mice infected with T. gondii and twenty negative serum samples were analyzed. The sensitivity and specificity of rTgPrx-Dot-IGSS were 97.5 and 100%, respectively, equivalent to those of a commercial ELISA kit for anti-Toxoplasma IgG antibody. Furthermore, 540 serum samples from pregnant women were screened with a commercial ELISA kit. Eighty-three positive and 60 negative serum samples were analyzed by rTgPrx-Dot-IGSS. The positive rate was 95.18%, comparable to that obtained with the commercial ELISA kit.

CONCLUSIONS

The Dot-IGSS method with rTgPrx as an antigen might be useful for diagnosing T. gondii infection in individuals.

Characterization of prenatal healthcare for implementation of congenital toxoplasmosis surveillance program: cross-sectional study

BACKGROUND

Prenatal toxoplasmosis remains a neglected disease worldwide and few government programs focusing on its prevention are available. Success in these programs has been extensively reported in the literature, yet the strategies used for their implementation, as a model for such actions in different communities, have not been described.

OBJECTIVE

To describe the aspects of prenatal care strategies in 13 municipalities within the regional healthcare unit of Araçatuba, in the northwestern region of the state of São Paulo in 2017, focusing on congenital toxoplasmosis.

DESIGN AND SETTING

Descriptive study on prenatal healthcare within the Brazilian National Health System, in 13 participating municipalities.

METHODS

Data on serological tests, referral clinics, notifications, healthcare strategies, health education and drugs for infected children were requested through a questionnaire that was sent via e-mail to people responsible for healthcare services in these municipalities.

RESULTS

Major differences relating to diagnoses, reference outpatient clinics, notifications, health education and healthcare and drugs for infected children were reported among the prenatal strategies of these 13 municipal healthcare services.

CONCLUSION

The lack of standardized prenatal strategy in the study area may compromise the prevention of infection. However, our identification of each aspect of prenatal care corroborates the need to implement a healthcare surveillance program relating to congenital toxoplasmosis.

Toxoplasma gondii Recombinant Antigens in the Serodiagnosis of Toxoplasmosis in Domestic and Farm Animals

Simple Summary

The very common parasite infections in animals are caused by members of Apicomplexa, including Toxoplasma gondii, Neospora sp., and Sarcocystis sp. These parasites pose serious veterinary problems. For example, the development of unambiguous diagnostic algorithms and determining the correct diagnosis are hindered by the similar antigenic structure of these parasites, as well as the multitude of similar disease symptoms presented in an infected animal. The intracellular parasite, T. gondii, infects a wide range of warm-blooded animals, including humans. This parasite is widespread among different animal populations, contributes to the loss of reproductive and malformations in young individuals, and can become a serious economic concern for farmers. Additionally, the consumption of undercooked or raw meat and the consumption of improperly processed milk product derived from farm animals are the main parasite transmission routes in humans. This work reviews potential improvements to diagnostic techniques that use recombinant antigens for serodiagnosis of toxoplasmosis in various species of animals.

Abstract

Toxoplasmosis is caused by an intracellular protozoan, Toxoplasma gondii, and is a parasitic disease that occurs in all warm-blooded animals, including humans. Toxoplasmosis is one of the most common parasitic diseases of animals and results in reproductive losses. Toxoplasmosis in humans is usually caused by eating raw or undercooked meat or consuming dairy products containing the parasite. Diagnosis of toxoplasmosis is currently based on serological assays using native antigens to detect specific anti-T. gondii antibodies. Due to the high price, the available commercial agglutination assays are not suited to test a large number of animal serum samples. The recent development of proteomics elucidated the antigenic structure of T. gondii and enabled the development of various recombinant antigens that can be used in new, cheaper, and more effective diagnostic tools. Continuous development of scientific disciplines, such as molecular biology and genetic engineering, allows for the production of new recombinant antigens and provides the basis for new diagnostic tests for the detection of anti-T. gondii antibodies in animal serum samples.

Challenging TaqMan probe-based real-time PCR and loop-mediated isothermal amplification (LAMP): the two sensitive molecular techniques for the detection of toxoplasmosis, a potentially dangerous opportunistic infection in immunocompromised patients

Due to defects and drawbacks of most conventional diagnostic methods including serology for the diagnosis of toxoplasmosis as a dangerous opportunistic infection in immunocompromised individuals, the accurate, rapid, and sensitive detection of infection in such patients is essential. In this study, the TaqMan probe-based real-time PCR and, a relatively new nucleic acid amplification method, the loop-mediated isothermal amplification (LAMP) technique was compared based on the repetitive elements (RE) sequence to detect Toxoplasma gondii (T. gondii) DNA in blood samples of immunocompromised individuals. During this study, 119 blood samples from immunocompromised cancer patients with renal failure, undergoing dialysis were studied. After DNA extraction from blood samples using the salt extraction method, the molecular techniques of TaqMan probe-based real-time PCR and LAMP were used to investigate the contamination of the samples with T. gondii, based on the 529 bp (RE) sequence of T. gondii. The analytical sensitivity of LAMP and real-time PCR was evaluated by duplicating the five-step serial dilutions of T. gondii tachyzoites from 0.25 to 5×10⁵ spiked tachyzoites per milliliter of the Toxoplasma seronegative blood sample. The extracted DNA from other parasites and human chromosomal DNA were used to determine the specificity of the molecular methods. The obtained results were analyzed using Kappa statistical test and SPSS22 software. Out of 119 studied samples, 7 (5.8%) and 5 (4.2%) samples were positive for Toxoplasma by TaqMan probe-based real-time PCR and LAMP, respectively. The limits of detection of TaqMan probe-based real-time PCR and RE-LAMP in negative serum samples were one and five tachyzoites (CT 38), respectively. Both real-time PCR and LAMP methods were 100% specific for Toxoplasma detection. Positive results were obtained only with T. gondii DNA, while other DNA samples were negative. The TaqMan probe-based real-time PCR based on the RE sequence showed higher sensitivity to T. gondii DNA detection in blood samples of cancer patients and serial dilutions of parasitic tachyzoites. The results show that TaqMan probe-based real-time PRC is a sensitive and specific method for the detection of toxoplasmosis in immunocompromised individuals, as well as the LAMP assay, which can be used as a suitable alternative diagnostic method for the detection of toxoplasmosis in such patients, without need the for any expensive equipment.

Toxoplasma gondii-specific IgG avidity testing in pregnant women

BACKGROUND

The parasite Toxoplasma gondii can cause congenital toxoplasmosis following primary infection in a pregnant woman. It is therefore important to distinguish between recent and past infection when both T. gondii-specific IgM and IgG are detected in a single serum in pregnant women. Toxoplasma gondii-specific IgG avidity testing is an essential tool to help to date the infection. However, interpretation of its results can be complex.

OBJECTIVES

To review the benefits and limitations of T. gondii-specific avidity testing in pregnant women, to help practitioners to interpret the results and adapt the patient management.

SOURCES

PubMed search with the keywords avidity, toxoplasmosis and Toxoplasma gondii for articles published from 1989 to 2019.

CONTENT

Toxoplasma gondii-specific IgG avidity testing remains a key tool for dating a T. gondii infection in immunocompetent pregnant women. Several commercial assays are available and display comparable performances. A high avidity result obtained on a first-trimester serum sample is indicative of a past infection, which occurred before pregnancy. To date, a low avidity result must still be considered as non-informative to date the infection, although some authors suggest that very low avidity results are highly suggestive of recent infections depending on the assay. Interpretation of low or grey zone avidity results on a first-trimester serum sample, as well as any avidity result on a second-trimester or third-trimester serum sample, is more complex and requires recourse to expert toxoplasmosis laboratories.

IMPLICATIONS

Although used for about 30 years, T. gondii-specific avidity testing has scarcely evolved. The same difficulties in interpretation have persisted over the years. Some authors have proposed additional thresholds to exclude an infection of <9 months, or in contrast to confirm a recent infection. Such thresholds would be of great interest to adapt management of pregnant women and avoid unnecessary treatment; however, they need confirmation and further studies.

Seroprevalence and risk factors associated with Toxoplasma gondii infection in sheep of Veracruz State, southeast Mexico

Toxoplasma gondii is widely prevalent in sheep and their products pose a risk to public health. The aim of this study was to identify the seroprevalence and risk factors associated with T. gondii infection in sheep in Veracruz State, Mexico. The study was cross-sectional and it was carried out in thirteen municipalities distributed in three regions of Veracruz State. A total of 414 blood samples were collected from four districts of Veracruz State and analyzed for T. gondii antibodies using enzyme-linked immunosorbent assay. Total seroprevalence was 35.90% (149/414; 95.00% CI = 31.40-40.80). Seroprevalence by the municipality was 10.50% to 85.70% and for the district was 28.80% to 47.80%, respectively. Age, breed and productive status were identified as risk factors associated with T. gondii infection significantly. The infection by T. gondii is widely present in the districts of the Veracruz State with a high seroprevalence and risk factors associated with infection.

In vitro Evaluation of Mannosylated Paromomycin-Loaded Solid Lipid Nanoparticles on Acute Toxoplasmosis

Toxoplasma gondii is a zoonotic intracellular protozoan with worldwide distribution. Acute and severe toxoplasmosis are commonly reported in patients who suffer from acquired/congenital immune deficiency. This study aimed to synthesize mannosylated paromomycin-loaded solid lipid nanoparticles (PM-SLN-M) and to evaluate them on acute toxoplasmosis. SLN was synthesized and then loaded by 7 mg/mL paromomycin sodium. Mannose coating was performed, and after washing, the size, zeta potential, and loading percentage were calculated. To evaluate the cell toxicity, an MTT assay was performed on Vero cells by different concentrations (log 10^-1) of SLN, PM-SLN-M, and PM-SLN. In addition, the anti-Toxoplasma effects were also evaluated using trypan-blue staining and scanning electron microscopy (SEM). An MTT assay was also employed to evaluate the effects of PM and PM-SLN-M on intracellular Toxoplasma. A 6-month stability test of PM-SLN and PM-SLN-M represented that the characteristics all remained constant. The cell viability assay demonstrated that PM-SLN-M had lower cell toxicity (<20%) compared to PM-SLN (<30%) and PM (<40%). Statistical analysis showed that PM-SLN-M significantly killed ~97.555 ± 0.629 (95% CI: 91.901 to 103.209; P < 0.05) of T. gondii tachyzoites. More than 50% of Toxoplasma-infected Vero cells remained viable in concentrations more than 0.07 μg/mL and 7 μg/mL of PM and PM-SLN-M, respectively. SEM analysis showed that T. gondii tachyzoites were changed in both size and morphology facing with PM-SLN-M. Our findings indicated that synthesized PM-SLN-M had anti-Toxoplasma activity without significant host cell toxicity at the highest concentration. Our study demonstrated that PM was able to kill intracellular Toxoplasma in lower concentration in comparison to PM-SLN-M, although PM-SLN-M showed lower cytotoxic effects on Vero cells.

Serological diagnosis of Toxoplasma gondii: analysis of false-positive IgG results and implications

BACKGROUND

Primary infection by Toxoplasma gondii in pregnant women can result in serious outcomes for the foetus. A false-positive IgG result during pregnancy can lead to a misdiagnosis of past infection and to stopping preventive measures. We collected 189 sera with positive Architect^® Toxo IgG assay (Abbott Laboratories) and negative IgG results with at least two other serological tests, in order to find an explanation for the suspected false-positive IgG results. We used the recomLine Toxoplasma IgG^® immunoblot (Mikrogen Diagnostik) to search for specific antigenic reactivities of the sera, and the LDBio Toxo II IgG^® immunoblot (LDBio Diagnostics) as a confirmatory test.

RESULTS

The bands GRA8 and/or GRA7 were positive for 148 samples (78.3%). GRA8 was the most frequent band, appearing in 133 patterns (70.4%), whereas GRA7 was present for 49 samples (25.9%). Of the 81 samples tested with LDBio^®, 23 (28.4%) turned out to be positive. Of the 58 negative LDBio^® tests (71.6%) (real false-positive Architect^® IgG), 23 samples (39.6%) did not show either a GRA8 or p30 band by recomLine^®. Their false positivity with Architect^® remains unexplained since Abbott uses these two recombinant antigens for their assay.

CONCLUSIONS

The Architect^® IgG false positivity for T. gondii seems to be due to reactivity against GRA8 for the majority of the sera and GRA7 to a lesser extent. The hypothesis of past contact with parasites genetically close to T. gondii such as Hammondia hammondi or Neospora caninum seems promising and should be assessed further.

Toxoplasma gondii Recombinant antigen AMA1: Diagnostic Utility of Protein Fragments for the Detection of IgG and IgM Antibodies

Toxoplasma gondii is an important zoonotic protozoan that infects a wide variety of vertebrates as intermediate hosts. For this reason, the diagnosis of this disease is very important and requires continuous improvement. One possibility is to use recombinant antigens in serological tests. Apical membrane antigen 1 (AMA1), a protein located in specific secretory organelles (micronemes) of T. gondii, is very interesting in regard to its potential diagnostic utility. In the present study, we attempted to identify a fragment of the AMA1 protein with a high sensitivity and specificity for the serological diagnosis of human toxoplasmosis. The full-length AMA1 and two different fragments (AMA1N and AMA1C) were produced using an Escherichia coli expression system. After purification by metal affinity chromatography, recombinant proteins were tested for their utility as antigens in enzyme-linked immunosorbent assays (ELISAs) for the detection of IgG and IgM anti-T. gondii antibodies in human and mouse immune sera. Our data demonstrate that the full-length AMA1 recombinant antigen (corresponding to amino acid residues 67–569 of the native protein) has a better diagnostic potential than its N- or C-terminal fragments. This recombinant protein strongly interacts with specific anti-T. gondii IgG (99.4%) and IgM (80.0%) antibodies, and may be used for developing new tools for diagnostics of toxoplasmosis.

Comparison of the RE-529 sequence and B1 gene for Toxoplasma gondii detection in blood samples of the at-risk seropositive cases using uracil DNA glycosylase supplemented loop-mediated isothermal amplification (UDG-LAMP) assay

Diagnosis of toxoplasmosis is an important issue, especially in at-risk patients. The molecular methods showed a promising future for such diagnosis; however, the method itself and the target sequence to be detected is an important part of accurate detection of the infection. The aim of the present study was to evaluate the RE-529 sequence and B1 gene for Toxoplasma gondii detection in blood samples of the at-risk seropositive cases using uracil DNA glycosylase supplemented loop-mediated isothermal amplification (UDG-LAMP) assay. In this study, 110 T. gondii seropositive at-risk individuals (pregnant women and immunocompromised patients) and 110 seronegative controls were enrolled. The two most studied sequences (RE-529 and B1) were used and compared for accurate and reliable detection of T. gondii in blood samples using UDG-LAMP assay and compared with real-time PCR method. The detection limit, accuracy, and reliability of UDG-LAMP for the parasite's DNA were also studied. Among 110 studied cases, 39 (35.45%) and 36 (32.7%) were positive for T. gondii DNA with the RE-LAMP and B1-LAMP, respectively. The seronegative cases remained negative for T. gondii DNA with the studied genes, however, there were few false negatives compared with real-time PCR method. The detection limit of the UDG-LAMP for both DNA targets was 0.16 tachyzoite's DNA per reaction tube. Based on the results of this study, the RE-529 sequence has a better detection rate compared to the B1 gene for toxoplasmosis among at-risk people. UDG-LAMP is a highly sensitive, accurate, and reliable method with no false-positive results for the diagnosis of T. gondii infection in blood specimens, however few cases may be missed.

Evaluation of a PCR assay for diagnosis of toxoplasmosis in serum and peripheral blood mononuclear cell among HIV/AIDS patients

Cerebral toxoplasmosis is one of the neurological infections with high morbidity and mortality in patients with AIDS, so the accurate method for diagnosis of cerebral toxoplasmosis seems necessary. In this study, nested PCR assay using B1 gene was evaluated in diagnosis of toxoplasmosis in serum and peripheral blood mononuclear cell (PBMC) among HIV/AIDS patients. One hundred eight blood samples from HIV/AIDS patients, including four patients with cerebral toxoplasmosis and 104 HIV/AIDS patients without cerebral toxoplasmosis were evaluated for the Toxoplasma gondii antibodies using Enzyme Linked immunosorbent Assay. DNA of serum and PBMC of these patients were extracted and nested-PCR was carried out. Of 108 participants, 95 cases (88%) were positive for Toxoplasma IgG antibodies and one patient was found positive for Toxoplasma IgM antibody. In general, four patients, including three patients with cerebral toxoplasmosis, who were positive for Toxoplasma IgG antibodies and one patient without cerebral toxoplasmosis who was positive for Toxoplasma IgM antibody were found to be PCR positive. DNA of T. gondii was detected in both serum and PBMC in two cerebral toxoplasmosis patients; however DNA was detected in only PBMC in other cerebral toxoplasmosis patient. All cases with cerebral toxoplasmosis were also diagnosed by clinical and radiological manifestations. The results of this study showed that the numbers of positive samples by PCR in PBMC were higher than serum specimens for diagnosis of toxoplasmosis. If molecular method and immunological assay are complemented with magnetic resonance imaging, the results can be useful for diagnosis of cerebral toxoplasmosis.

Immediate versus deferred antiretroviral therapy in HIV-infected patients presenting with acute AIDS-defining events (toxoplasmosis, Pneumocystis jirovecii-pneumonia): a prospective, randomized, open-label multicenter study (IDEAL-study)

BACKGROUND

To evaluate clinical outcomes after either immediate or deferred initiation of antiretroviral therapy in HIV-1-infected patients, presenting late with pneumocystis pneumonia (PCP) or toxoplasma encephalitis (TE).

METHODS

Phase IV, multicenter, prospective, randomized open-label clinical trial. Patients were randomized into an immediate therapy arm (starting antiretroviral therapy (ART) within 7 days after initiation of OI treatment) versus a deferred arm (starting ART after completing the OI-therapy). All patients were followed for 24 weeks. The rates of clinical progression (death, new or relapsing opportunistic infections (OI) and other grade 4 clinical endpoints) were compared, using a combined primary endpoint. Secondary endpoints were hospitalization rates after completion of OI treatment, incidence of immune reconstitution inflammatory syndrome (IRIS), virologic and immunological outcome, adherence to proteinase-inhibitor based antiretroviral therapy (ART) protocol and quality of life.

RESULTS

61 patients (11 patients suffering TE, 50 with PCP) were enrolled. No differences between the two therapy groups in all examined primary and secondary endpoints could be identified: immunological and virologic outcome was similar in both groups, there was no significant difference in the incidence of IRIS (11 and 10 cases), furthermore 9 events (combined endpoint of death, new/relapsing OI and grade 4 events) occurred in each group.

CONCLUSIONS

In summary, this study supports the notion that immediate initiation of ART with a ritonavir-boosted proteinase-inhibitor and two nucleoside reverse transcriptase inhibitors is safe and has no negative effects on incidence of disease progression or IRIS, nor on immunological and virologic outcomes or on quality of life.

Prevalence of Toxoplasma gondii parasite in captive Mexican jaguars determined by recombinant surface antigens (SAG1) and dense granular antigens (GRA1 and GRA7) in ELISA-based serodiagnosis

Toxoplasma gondii is an obligate intracellular protozoan parasite that infects almost all warm-blooded animals, including humans, causing serious public health problems. In this study, the seroprevalence of T. gondii in captive jaguars in 10 Mexican zoos was determined using single and mixtures of recombinant surface antigens (SAG1) and dense granular antigens (GRA1 and GRA7) in immunoglobulin G (IgG) enzyme-linked immunosorbent assays (ELISAs). Their efficacy was compared with the tachyzoite lysate antigen. All recombinant antigens were characterised by high sensitivity (92.5-97.5%); the specificity of the IgG ELISAs was variable (83.3-91.6%). Mixtures of the two recombinant proteins were generally more reactive than single antigens. GRA7 + SAG1 showed the highest sensitivity (97.5%) and specificity (91.6%), almost perfect agreement (96.2%), and a kappa value of 0.89. An area under the curve value of 0.998 represented a highly accurate test with a cutoff value of 0.8. The seroprevalence of anti-T. gondii IgG antibodies in the single and mixed recombinant antigen ELISAs was 75.0-76.9%. This study shows that GRA7 + SAG1 can be successfully used to diagnose T. gondii infection in jaguars for effective monitoring of prevalence and for devising control methods and prevention strategies against toxoplasmosis.

Diagnosis of Candida albicans: conventional diagnostic methods compared to the loop-mediated isothermal amplification (LAMP) assay

Candida species cause a wide range of opportunistic infections in humans and animals. The detection of Candida species by conventional diagnosis methods is costly and time consuming. This study was conducted for the first time to evaluate and compare a relatively new molecular assay and the loop-mediated isothermal amplification (LAMP) technique with conventional methods for detection of Candida albicans. In this study, 70 different species of Candida identified by conventional methods were cultured on Sabouraud chloramphenicol agar medium and then the genomic DNA was extracted. The LAMP technique was performed using specific primers targeting the ITS2 gene of C. albicans. The analytical sensitivity and specificity of LAMP were measured using a tenfold serial dilution prepared from extracted DNA from standard C. albicans strain from 1 ng to 1 fg and the DNA samples of other clinical Candida species and three non-Candida yeast. Out of 70 yeast samples analyzed by LAMP technique, 24 samples (34.3%) were positive for C. albicans. Comparison of the results showed that the CHROMagar Candida and germ tube production methods are quite consistent with the LAMP technique, while the agreement amount between the results of carbohydrate assimilation and chlamydoconidia generation assays and LAMP technique was 98.5% and 72.8%, respectively. The detection limits of the LAMP assay were 10 fg of the DNA from the standard C. albicans strain. No amplification was observed in the DNA samples of other yeast species and only the DNA sample of standard C. albicans strain was amplified. Based on the results, it can be concluded that the LAMP method is as specific and precise as common diagnostic methods, but is faster, easier deployable or more sensitive. Therefore, this method can be used as a suitable complementary assay for Candida diagnosis in medical diagnostic laboratories and field conditions.