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Pollak A. 40 years neonatology : An academic life. Wien Klin Wochenschr 2024:10.1007/s00508-024-02360-2. [PMID: 38634910 DOI: 10.1007/s00508-024-02360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND A complete review of the development of neonatology in the last 40 years would probably require a compendium with several volumes, to bring to view the remarkable improvements in survival rates and neurodevelopmental outcomes of ill babies in Austria, most industrial countries and to some extent worldwide. The challenge I had to solve here was to integrate my own contributions to the field of neonatology during this period and particularly the contributions of my team from the Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescence Medicine, Medical University Vienna where I was working first as an intern and resident and later had the privilege to become head of department. AIM This very personal review was conceived to showcase the milestones of neonatology where, in my opinion, our department made some meaningful contributions in research and clinical practice during the past 40 years. METHODS A total of 10 areas of interest were selected which most likely influenced survival rates of preterm infants born at increasingly younger gestational ages and ameliorated long-term clinical and neurodevelopmental outcomes, including: 1) Construction and continuous modernization of neonatal intensive care units (NICUs). 2) Installation of the "Regionalization Program for NICUs in Vienna". 3) Treatment of respiratory distress syndrome (RDS) of premature babies. 4) Fine tuning of glucose metabolism for growth and outcome. 5) Neurodevelopmental care. 6) Neonatal hematology. 7) Infection control. 8) The toxoplasma screening program. 9) The newborn screening program. 10) Quality control: the Vermont Oxford Neonatal Network (VONN). RESULTS Over the past four decades advancements in research and technology have allowed a transformative development of neonatal medicine. Survival rates without increased morbidity for very premature infants with gestational ages reaching to what we consider nowadays the border of viability have constantly increased. In my professional life as a neonatologist in Austria I have had the possibility to support and shape some of these developments together with my team. CONCLUSION As we look ahead it is imperative to build upon the progress made, harnessing the power of science and technology to further improve the survival and quality of life for preterm infants in Austria and worldwide. At the same time, neonatology must continue to prioritize ethical reflection and education, fostering a culture of integrity, interdisciplinary collaboration, and the development of guidelines and protocols that uphold ethical standards while addressing the evolving needs and complexities of neonatal medicine.
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Affiliation(s)
- Arnold Pollak
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Vienna, Austria.
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Arkhis S, Rouges C, Dahane N, Guegan H, Yéra H, Robert-Gangneux F. Could PLATELIA Toxo IgM be the new gold standard for the serological diagnosis of congenital toxoplasmosis: a French multicenter study. J Clin Microbiol 2024; 62:e0122223. [PMID: 38259072 PMCID: PMC10865801 DOI: 10.1128/jcm.01222-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024] Open
Abstract
To assess the performance of PLATELIA Toxo IgM (Bio-Rad) and Toxo ISAGA (BioMérieux) to detect anti-Toxoplasma IgM in infants at risk of congenital toxoplasmosis, a retrospective multicenter study was conducted comparing serological results obtained in the framework of routine diagnosis work-up for congenital toxoplasmosis. All infants born to mothers infected with T. gondii during pregnancy from 2010 to 2020 with at least 6 months of serological follow-up were included (n = 1,010). One thousand ten cases were included, of which 250 infants (24.75%) had congenital toxoplasmosis. A total of 1039 sera were included. The concordance between the two techniques was 96%, with kappa coefficient of 0.87, showing an almost perfect agreement between ISAGA and PLATELIA. Cumulative sensitivity and specificity were 73.2% and 99.5.% and 74.8% and 100% for ISAGA and PLATELIA, respectively. The mean time to detect IgM using ISAGA and PLATELIA tests was 6.9 ± 20.1 days and 5.6 ± 14.7 days, respectively not significant (ns). Finally, the sensitivity of ISAGA and PLATELIA to detect IgM antibodies in infected neonates at 5 days of life was 62% and 64%, respectively. Performances of PLATELIA Toxo IgM assay were comparable to the gold standard ISAGA. This enzyme-linked immunosorbent assay is suitable for routine serology for the diagnosis of congenital toxoplasmosis in newborns. IMPORTANCE This study will help clinical microbiologists to chose an alternative serological method for the neonatal diagnosis of congenital toxoplasmosis, once the gold standard technique ISAGA will be withdrawn next year.
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Affiliation(s)
- Safya Arkhis
- Laboratory of Parasitology and Mycology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Celia Rouges
- Department of Parasitology and Mycology, Cochin University Hospital, AP-HP, Paris, France
| | - Naïma Dahane
- Department of Parasitology and Mycology, Cochin University Hospital, AP-HP, Paris, France
| | - Hélène Guegan
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), Rennes, France
| | - Hélène Yéra
- Department of Parasitology and Mycology, Cochin University Hospital, AP-HP, Paris, France
- Department of Parasitology and Mycology, Dupuytren University Hospital, Limoges, France
| | - Florence Robert-Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), Rennes, France
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Khalil A, Sotiriadis A, Chaoui R, da Silva Costa F, D'Antonio F, Heath PT, Jones C, Malinger G, Odibo A, Prefumo F, Salomon LJ, Wood S, Ville Y. ISUOG Practice Guidelines: role of ultrasound in congenital infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:128-151. [PMID: 32400006 DOI: 10.1002/uog.21991] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - F da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
| | - P T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's University of London and St George's University Hospitals NHS Trust, London, UK
| | - C Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Malinger
- Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Odibo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - F Prefumo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | | | - Y Ville
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
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Picone O, Fuchs F, Benoist G, Binquet C, Kieffer F, Wallon M, Wehbe K, Mandelbrot L, Villena I. Toxoplasmosis screening during pregnancy in France: Opinion of an expert panel for the CNGOF. J Gynecol Obstet Hum Reprod 2020; 49:101814. [PMID: 32428782 DOI: 10.1016/j.jogoh.2020.101814] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 11/15/2022]
Abstract
Prenatal screening to prevent congenital toxoplasmosis as performed in France for several decades has been questioned in view of the decreasing incidence of this infection and the cost of testing. The French College of Obstetrics and Gynecology mandated a multidisciplinary panel of experts to perform a reassessment of the screening program in accordance with international good practice. In France, about 70% of pregnant women are not immune to T. gondii, and 0.2-0.25% become infected during pregnancy. The risk of maternal-fetal transmission of infection is on average 25-29% and depends greatly on the gestational age at seroconversion. In case of fetal transmission, the outcome is livebirth in 95% of cases, with latent congenital toxoplasmosis in 90% of cases and symptomatic forms in 10% of cases, of which 1/3 are severe and 2/3 moderate. Biological techniques have satisfactory performance regarding serologies for the diagnosis of maternal infections and PCR on amniotic fluid for the prenatal diagnosis of congenital toxoplasmosis. Primary prevention of toxoplasmosis is based on hygiene measures that are relatively simple, but poorly implemented. In case of maternal seroconversion, there is a strong case for prenatal prophylactic treatment as soon as possible (ideally within 3 weeks of seroconversion), spiramycin before 14 weeks of gestation (WG), and with a tendency to superiority of the pyrimethamine/sulfadiazine association over spiramycin beyond 14 W G, in order to reduce the risk of symptomatic congenital toxoplasmosis. In case of congenital toxoplasmosis, prompt initiation of treatment reduces the occurrence of cerebral signs and symptoms, as well as retinal lesions. Several medico-economic evaluations of the French toxoplasmosis screening program have been conducted including an individual cost-effectiveness approach with decision analysis which concluded on the profitability of prenatal screening as carried out in France (monthly surveillance of seronegative women, prenatal treatment in case of seroconversion, termination of pregnancy in severe forms). Though most international societies do not recommend systematic screening for mainly financial reasons, if congenital toxoplasmosis appears benign in France today, it is probably thanks to screening and the possibility of early treatment of fetuses and/or newborns. Thus, the panel recommends continuing for now the program in France for prevention of congenital toxoplasmosis.
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Affiliation(s)
- Olivier Picone
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris; Inserm IAME-U1137, Paris, France; FHU PREMA; Groupe de Recherche sur les Infections pendant la grossesse (GRIG)
| | - Florent Fuchs
- Service de Gynécologie Obstétrique CHU de Montpellier, Hopital Arnaud de Villeneuve, Montpellier, France; Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018, Reproduction et Développement de l'enfant, 94807 Villejuif, France; EA2415: Aide à la décision médicale Personnalisée, Axe B: Méthode en épidémiologie Clinique, Université de Montpellier
| | | | - Christine Binquet
- Inserm, CIC1432, module Epidémiologie Clinique, Dijon, France; CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Epidémiologie Clinique/Essais Cliniques, Dijon, France
| | - François Kieffer
- Assistance Publique-Hôpitaux de Paris, Service de néonatologie, Hôpital Armand Trousseau, Paris, France
| | - Martine Wallon
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Parasitologie - Mycologie Médicale, Lyon, France; Université Lyon-1, Equipe Waking, Physiologie Intégrée du Système d'éveil, Centre de Recherche en Neurosciences de Lyon (INSERM U1028 - CNRS UMR 5292), Bron, France
| | - Karl Wehbe
- Centre Hospitalier Universitaire de Strasbourg, Service de Gynécologie-Obstétrique, Strasbourg, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris; Inserm IAME-U1137, Paris, France; FHU PREMA; Groupe de Recherche sur les Infections pendant la grossesse (GRIG)
| | - Isabelle Villena
- Université Reims Champagne -Ardenne, EA7510 et Centre National de Référence de la Toxoplasmose, Centre de Ressources Biologiques Toxoplasma, Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Reims, Reims, France
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Paquet C, Yudin MH. No. 285-Toxoplasmosis in Pregnancy: Prevention, Screening, and Treatment. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:e687-e693. [PMID: 30103893 DOI: 10.1016/j.jogc.2018.05.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND One of the major consequences of pregnant women becoming infected by Toxoplasma gondii is vertical transmission to the fetus. Although rare, congenital toxoplasmosis can cause severe neurological or ocular disease (leading to blindness), as well as cardiac and cerebral anomalies. Prenatal care must include education about prevention of toxoplasmosis. The low prevalence of the disease in the Canadian population and limitations in diagnosis and therapy limit the effectiveness of screening strategies. Therefore, routine screening is not currently recommended. OBJECTIVE To review the prevention, diagnosis, and management of toxoplasmosis in pregnancy. OUTCOMES Outcomes evaluated include the effect of screening on diagnosis of congenital toxoplasmosis and the efficacy of prophylaxis and treatment. EVIDENCE The Cochrane Library and Medline were searched for articles published in English from 1990 to the present related to toxoplasmosis and pregnancy. Additional articles were identified through references of these articles. VALUES The quality of evidence is rated and recommendations made according to guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS Guideline implementation should assist the practitioner in developing an approach to screening for and treatment of toxoplasmosis in pregnancy. Patients will benefit from appropriate management of this condition. SPONSOR The Society of Obstetricians and Gynaecologists of Canada. RECOMMENDATIONS
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Konstantinovic N, Guegan H, Stäjner T, Belaz S, Robert-Gangneux F. Treatment of toxoplasmosis: Current options and future perspectives. Food Waterborne Parasitol 2019; 15:e00036. [PMID: 32095610 PMCID: PMC7033996 DOI: 10.1016/j.fawpar.2019.e00036] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 02/08/2023] Open
Abstract
Toxoplasmosis is a worldwide parasitic disease infecting about one third of humans, with possible severe outcomes in neonates and immunocompromised patients. Despite continuous and successful efforts to improve diagnosis, therapeutic schemes have barely evolved since many years. This article aims at reviewing the main clinical trials and current treatment practices, and at addressing future perspectives in the light of ongoing researches.
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Affiliation(s)
- Neda Konstantinovic
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, 11129 Belgrade, Serbia
| | - Hélène Guegan
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset - UMR_S 1085, F-35000 Rennes, France
| | - Tijana Stäjner
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, 11129 Belgrade, Serbia
| | - Sorya Belaz
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset - UMR_S 1085, F-35000 Rennes, France
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Treatment of Toxoplasmosis: Historical Perspective, Animal Models, and Current Clinical Practice. Clin Microbiol Rev 2018; 31:31/4/e00057-17. [PMID: 30209035 DOI: 10.1128/cmr.00057-17] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Primary Toxoplasma gondii infection is usually subclinical, but cervical lymphadenopathy or ocular disease can be present in some patients. Active infection is characterized by tachyzoites, while tissue cysts characterize latent disease. Infection in the fetus and in immunocompromised patients can cause devastating disease. The combination of pyrimethamine and sulfadiazine (pyr-sulf), targeting the active stage of the infection, is the current gold standard for treating toxoplasmosis, but failure rates remain significant. Although other regimens are available, including pyrimethamine in combination with clindamycin, atovaquone, clarithromycin, or azithromycin or monotherapy with trimethoprim-sulfamethoxazole (TMP-SMX) or atovaquone, none have been found to be superior to pyr-sulf, and no regimen is active against the latent stage of the infection. Furthermore, the efficacy of these regimens against ocular disease remains uncertain. In multiple studies, systematic screening for Toxoplasma infection during gestation, followed by treatment with spiramycin for acute maternal infections and with pyr-sulf for those with established fetal infection, has been shown to be effective at preventing vertical transmission and minimizing the severity of congenital toxoplasmosis (CT). Despite significant progress in treating human disease, there is a strong impetus to develop novel therapeutics for both the acute and latent forms of the infection. Here we present an overview of toxoplasmosis treatment in humans and in animal models. Additional research is needed to identify novel drugs by use of innovative high-throughput screening technologies and to improve experimental models to reflect human disease. Such advances will pave the way for lead candidates to be tested in thoroughly designed clinical trials in defined patient populations.
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Paquet C, Yudin MH. No 285 - Toxoplasmose pendant la grossesse : Prévention, dépistage et traitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e694-e702. [DOI: 10.1016/j.jogc.2018.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Evaluation of serological and molecular tests used to identify Toxoplasma gondii infection in pregnant women attended in a public health service in São Paulo state, Brazil. Diagn Microbiol Infect Dis 2017; 89:13-19. [PMID: 28689893 DOI: 10.1016/j.diagmicrobio.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 11/23/2022]
Abstract
Toxoplasmosis during pregnancy can have severe consequences. The use of sensitive and specific serological and molecular methods is extremely important for the correct diagnosis of the disease. We compared the ELISA and ELFA serological methods, conventional PCR (cPCR), Nested PCR and quantitative PCR (qPCR) in the diagnosis of Toxoplasma gondii infection in pregnant women without clinical suspicion of toxoplasmosis (G1=94) and with clinical suspicion of toxoplasmosis (G2=53). The results were compared using the Kappa index, and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. The results of the serological methods showed concordance between the ELISA and ELFA methods even though ELFA identified more positive cases than ELISA. Molecular methods were discrepant with cPCR using B22/23 primers having greater sensitivity and lower specificity compared to the other molecular methods.
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Toxoplasmose pendant la grossesse : Prévention, dépistage et traitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S189-S196. [PMID: 28063534 DOI: 10.1016/j.jogc.2016.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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de Oliveira Azevedo CT, do Brasil PEAA, Guida L, Lopes Moreira ME. Performance of Polymerase Chain Reaction Analysis of the Amniotic Fluid of Pregnant Women for Diagnosis of Congenital Toxoplasmosis: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0149938. [PMID: 27055272 PMCID: PMC4824461 DOI: 10.1371/journal.pone.0149938] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 02/07/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Congenital infection caused by Toxoplasma gondii can cause serious damage that can be diagnosed in utero or at birth, although most infants are asymptomatic at birth. Prenatal diagnosis of congenital toxoplasmosis considerably improves the prognosis and outcome for infected infants. For this reason, an assay for the quick, sensitive, and safe diagnosis of fetal toxoplasmosis is desirable. Goal To systematically review the performance of polymerase chain reaction (PCR) analysis of the amniotic fluid of pregnant women with recent serological toxoplasmosis diagnoses for the diagnosis of fetal toxoplasmosis. Method A systematic literature review was conducted via a search of electronic databases; the literature included primary studies of the diagnostic accuracy of PCR analysis of amniotic fluid from pregnant women who seroconverted during pregnancy. The PCR test was compared to a gold standard for diagnosis. Results A total of 1.269 summaries were obtained from the electronic database and reviewed, and 20 studies, comprising 4.171 samples, met the established inclusion criteria and were included in the review. The following results were obtained: studies about PCR assays for fetal toxoplasmosis are generally susceptible to bias; reports of the tests’ use lack critical information; the protocols varied among studies; the heterogeneity among studies was concentrated in the tests’ sensitivity; there was evidence that the sensitivity of the tests increases with time, as represented by the trimester; and there was more heterogeneity among studies in which there was more time between maternal diagnosis and fetal testing. The sensitivity of the method, if performed up to five weeks after maternal diagnosis, was 87% and specificity was 99%. Conclusion The global sensitivity heterogeneity of the PCR test in this review was 66.5% (I2). The tests show low evidence of heterogeneity with a sensitivity of 87% and specificity of 99% when performed up to five weeks after maternal diagnosis. The test has a known performance and could be recommended for use up to five weeks after maternal diagnosis, when there is suspicion of fetal toxoplasmosis.
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Affiliation(s)
| | | | - Letícia Guida
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/Fiocruz)
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Abstract
There are several infections in adults that warrant special consideration in pregnant women given the potential fetal consequences. Among these are toxoplasmosis, parvovirus B19, and cytomegalovirus. These infections have an important impact on the developing fetus, depending on the timing of infection. This article reviews the modes of transmission as well as maternal and neonatal effects of each of these infections. In addition, the article outlines recommended testing, fetal surveillance, and treatment where indicated.
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Affiliation(s)
- Deborah M Feldman
- Division of Maternal Fetal Medicine, Prenatal Testing Center, Hartford Hospital, University of Connecticut School of Medicine, 85 Jefferson Street, #625, Farmington, CT 06102, USA.
| | - Rebecca Keller
- Maternal Fetal Medicine, Obstetrics and Gynecology, UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Adam F Borgida
- Division of Maternal Fetal Medicine, Prenatal Testing Center, Hartford Hospital, University of Connecticut School of Medicine, 85 Jefferson Street, #625, Farmington, CT 06102, USA
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Stajner T, Bobic B, Klun I, Nikolic A, Srbljanovic J, Uzelac A, Rajnpreht I, Djurkovic-Djakovic O. Prenatal and Early Postnatal Diagnosis of Congenital Toxoplasmosis in a Setting With No Systematic Screening in Pregnancy. Medicine (Baltimore) 2016; 95:e2979. [PMID: 26945416 PMCID: PMC4782900 DOI: 10.1097/md.0000000000002979] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the risk of congenital toxoplasmosis (CT) and provide early (pre- or postnatal) identification of cases of CT in the absence of systematic screening in pregnancy.I n the presented cross-sectional study, serological criteria were used to date Toxoplasma gondii infection versus conception in 80 pregnant women with fetal abnormalities or referred to as suspected of acute infection, and in 16 women after delivery of symptomatic neonates. A combination of serological, molecular (qPCR), and biological (bioassay) methods was used for prenatal and/or postnatal diagnosis of CT. Most (77.5%) pregnant women were examined in advanced pregnancy. Of all the examined seropositive women (n = 90), infection could not be ruled out to have occurred during pregnancy in 93.3%, of which the majority (69%) was dated to the periconceptual period. CT was diagnosed in 25 cases, of which 17 prenatally and 8 postnatally. Molecular diagnosis proved superior, but the diagnosis of CT based on bioassay in 7 instances and by Western blot in 2 neonates shows that other methods remain indispensable. In the absence of systematic screening in pregnancy, maternal infection is often diagnosed late, or even only when fetal/neonatal infection is suspected. In such situations, use of a complex algorithm involving a combination of serological, biological, and molecular methods allows for prenatal and/or early postnatal diagnosis of CT, but lacks the preventive capacity provided by early maternal treatment.
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Affiliation(s)
- Tijana Stajner
- From the National Reference Laboratory for Toxoplasmosis, Center of Excellence for Food- and Vector-Borne Zoonoses, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
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Di Mario S, Basevi V, Gagliotti C, Spettoli D, Gori G, D'Amico R, Magrini N. Prenatal education for congenital toxoplasmosis. Cochrane Database Syst Rev 2015; 2015:CD006171. [PMID: 26493047 PMCID: PMC9272404 DOI: 10.1002/14651858.cd006171.pub4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Congenital toxoplasmosis is considered a rare but potentially severe infection. Prenatal education about congenital toxoplasmosis could be the most efficient and least harmful intervention, yet its effectiveness is uncertain. OBJECTIVES To assess the effects of prenatal education for preventing congenital toxoplasmosis. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015), and reference lists of relevant papers, reviews and websites. SELECTION CRITERIA Randomized and quasi-randomized controlled trials of all types of prenatal education on toxoplasmosis infection during pregnancy. Cluster-randomized trials were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS Two cluster-randomized controlled trials (RCTs) (involving a total of 5455 women) met the inclusion criteria. The two included trials measured the effectiveness of the intervention in different ways, which meant that meta-analysis of the results was not possible. The overall quality of the two studies, as assessed using the GRADE approach, was low, with high risk of detection and attrition bias in both included trials.One trial (432 women enrolled) conducted in Canada was judged of low methodological quality. This trial did not report on any of the review's pre-specified primary outcomes and the secondary outcomes reported results only as P values. Moreover, losses to follow-up were high (34%, 147 out of 432 women initially enrolled). The authors concluded that prenatal education can effectively change pregnant women's behavior as it increased pet, personal and food hygiene. The second trial conducted in France was also judged of low methodological quality. Losses to follow-up were also high (44.5%, 2233 out of 5023 women initially enrolled) and differential (40% in the intervention group and 52% in the control group). The authors concluded that prenatal education for congenital toxoplasmoses has a significant effect on improving women's knowledge, whereas it has no effect on changing women's behavior. In this trial 17/3949 pregnant women seroconverted for toxoplasmosis: 13/2591 (0.5%) in the intervention group and 4/1358 (0.3%) in the control group. The rate of seroconversion detected during the study did not differ between groups (risk ratio (RR) 1.70, 95% confidence interval (CI) 0.56 to 5.21; participants = 3949; studies = one, low quality evidence). The number of events was too small to reach conclusions about the effect of prenatal education on seroconversion rate during pregnancy.No other randomized trials on the effect of prenatal education on congenital toxoplasmosis rate, or toxoplasmosis seroconversion rate during pregnancy were detected. AUTHORS' CONCLUSIONS Even though primary prevention of congenital toxoplasmosis is considered a desirable intervention, given the lack of related risks compared to secondary and tertiary prevention, its effectiveness has not been adequately evaluated. There is very little evidence from RCTs that prenatal education is effective in reducing congenital toxoplasmosis even though evidence from observational studies suggests it is. Given the lack of good evidence supporting prenatal education for congenital toxoplasmosis prevention, further RCTs are needed to confirm any potential benefits and to further quantify the impact of different sets of educational intervention.
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Affiliation(s)
- Simona Di Mario
- Regional health authority of Emilia‐RomagnaSaPeRiDoc, Primary health care, general medicine, planning and development of health servicesBolognaItaly
| | - Vittorio Basevi
- Emilia‐Romagna Regional health authoritySaPeRiDoc, Primary health care, general medicine, planning and development of health servicesBolognaItaly
| | - Carlo Gagliotti
- Regional agency for health and social care of Emilia‐RomagnaControl of infectious disease UnitBolognaItaly
| | - Daniela Spettoli
- Regional health authority of Emilia‐RomagnaSaPeRiDoc, Primary health care, general medicine, planning and development of health servicesBolognaItaly
| | - Gianfranco Gori
- Regional health authority of Emilia‐RomagnaSaPeRiDoc, Primary health care, general medicine, planning and development of health servicesBolognaItaly
| | - Roberto D'Amico
- University of Modena and Reggio EmiliaItalian Cochrane Centre, Department of Diagnostic, Clinical and Public Health MedicineVia del Pozzo 71ModenaItaly41124
| | - Nicola Magrini
- World Health OrganisationPolicy, Access and Use (PAU), Department of Essential Medicines and Health ProductsAvenue Appia 20GenevaSwitzerland1211 GENEVA 27
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Nasir IA, Aderinsayo AH, Mele HU, Aliyu MM. Prevalence and Associated Risk Factors of Toxoplasma gondii Antibodies among Pregnant Women Attending Maiduguri Teaching Hospital, Nigeria. JOURNAL OF MEDICAL SCIENCES 2015. [DOI: 10.3923/jms.2015.147.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Schlüter D, Däubener W, Schares G, Groß U, Pleyer U, Lüder C. Animals are key to human toxoplasmosis. Int J Med Microbiol 2014; 304:917-29. [PMID: 25240467 DOI: 10.1016/j.ijmm.2014.09.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Toxoplasma gondii is an extremely sucessfull protozoal parasite which infects almost all mamalian species including humans. Approximately 30% of the human population worldwide is chronically infected with T. gondii. In general, human infection is asymptomatic but the parasite may induce severe disease in fetuses and immunocompromised patients. In addition, T. gondii may cause sight-threatening posterior uveitis in immunocompetent patients. Apart from few exceptions, humans acquire T. gondii from animals. Both, the oral uptake of T. gondii oocysts released by specific hosts, i.e. felidae, and of cysts persisting in muscle cells of animals result in human toxoplasmosis. In the present review, we discuss recent new data on the cell biology of T. gondii and parasite diversity in animals. In addition, we focus on the impact of these various parasite strains and their different virulence on the clinical outcome of human congenital toxoplasmosis and T. gondii uveitis.
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Affiliation(s)
- Dirk Schlüter
- Institute of Medical Microbiology, Infection Control and Prevention, Otto-von-Guericke-University, Magdeburg, Germany; Helmholtz Centre for Infection Research, Braunschweig, Germany.
| | - Walter Däubener
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gereon Schares
- Institute of Epidemiology, Friedrich-Loeffler-Institute, Greifswald-Insel Riems, Germany
| | - Uwe Groß
- Institute for Medical Microbiology, University Medical Center, Göttingen, Germany
| | - Uwe Pleyer
- Eye Clinic, Charité Universitätsmedizin, Berlin, Germany
| | - Carsten Lüder
- Institute for Medical Microbiology, University Medical Center, Göttingen, Germany
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Karacan M, Batukan M, Cebi Z, Berberoglugil M, Levent S, Kır M, Baksu A, Ozel E, Camlıbel T. Screening cytomegalovirus, rubella and toxoplasma infections in pregnant women with unknown pre-pregnancy serological status. Arch Gynecol Obstet 2014; 290:1115-20. [PMID: 25027818 DOI: 10.1007/s00404-014-3340-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the prevalence of acute cytomegalovirus (CMV), rubella and T. gondii infections among pregnant women who had no serological status tested for these microorganisms prior to pregnancy in a metropolitan area. METHODS A cross-sectional study was undertaken between January 2009 and January 2013 in 1,258 women presenting for their first antenatal visit (between 6 and 11 weeks of gestation). All women were tested for IgG and IgM antibodies. Subsequently, avidity test was utilized for inconclusive results. They were followed until delivery and all newborns were examined by a pediatrician. RESULTS Presence of IgM antibody positivity alone was not detected in any women. Avidity test excluded primary infection in 15 out of 16 (93.7 %) women who were positive for both IgG and IgM antibodies. Amniocentesis was performed in one case with borderline IgG avidity for T. gondii. No primary infections were detected in any newborn for the infections screened. The prevalences of IgG antibodies were 95 % for rubella, 84.1 % for CMV and 23.1 % for T. gondii. CONCLUSIONS Assessment of IgG and IgM antibodies followed by IgG avidity testing for inconclusive results may be an acceptable approach in pregnant women with unknown serological status prior to pregnancy. Utilization of IgG avidity as a supplemental test prevented unnecessary intervention in IgG and IgM antibodies positive patients. No primary infection was detected for CMV, rubella and T. gondii infections in the urban population screened.
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Affiliation(s)
- Meric Karacan
- Obstetrics and Gynecology Department, Ota-Jinemed Hospital, Istanbul, Turkey,
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18
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Li XL, Wei HX, Zhang H, Peng HJ, Lindsay DS. A meta analysis on risks of adverse pregnancy outcomes in Toxoplasma gondii infection. PLoS One 2014; 9:e97775. [PMID: 24830795 PMCID: PMC4022675 DOI: 10.1371/journal.pone.0097775] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/22/2014] [Indexed: 11/26/2022] Open
Abstract
Objective Quantified risks of congenital Toxoplasma gondii infection and abnormal pregnancy outcomes following primary maternal infection were evaluated with meta- analysis based on published studies. Methods The related literatures were searched in multiple literature databases regardless of languages. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the risks of vertical transmission of Toxoplasma gondii and abnormal pregnancy outcomes following primary maternal infection with meta-analysis. Results 53 of the 2632 searched literatures were included in our analysis. The incidence of abnormal pregnancy outcomes in T. gondii infected pregnant women (infected group) was significantly higher than that in the uninfected pregnant women (control group) (OR = 5.10; 95% CI, 3.85–6.75). Toxoplasma gondii infection rate in the abnormal-pregnancy-outcome group was significantly higher than in the normal-pregnancy group (OR = 3.71; 95% CI, 3.31–4.15). The pooled rate of vertical transmission was 20% (95% CI, 15%–26%) in maternal infection of T. gondii. The incidences of vertical transmission in women who were infected in the first, second or third trimester of pregnancy were 5% (95%CI, 2%–16%), 13% (95%CI, 7%–23%), and 32% (95%CI, 24%–41%), respectively. The rates of vertical transmission in women who were treated with spiramycin-only, PSF (pyrimethamine + sulfadiazine + folinic acid) or PS (pyrimethamine + sulfadiazine) combined with spiramycin, or other untypical treatments were 13% (95%CI, 7%–22%), 13%(95%CI, 7%–25%), and 24%(95%CI, 18%–32%), respectively. Conclusions Toxoplasma gondii infection can result in adverse pregnancy outcomes in pregnant women. The pooled rate of vertical transmission was 20% in maternal infection and the incidences of vertical transmission increased in the first, second or third trimester of pregnancy. The pooled rates of transmission in groups treated with spiramycin-only, PSF or PS combined with spiramycin, or other untypical treatments were not significantly different.
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Affiliation(s)
- Xue-Lan Li
- Department of Pathogen Biology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, the People's Republic of China
| | - Hai-Xia Wei
- Department of Pathogen Biology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, the People's Republic of China
| | - Hao Zhang
- Department of Pathogen Biology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, the People's Republic of China
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital attached to Southern Medical University, Guangzhou, Guangdong, and the People's Republic of China,
| | - Hong-Juan Peng
- Department of Pathogen Biology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, the People's Republic of China
- * E-mail: (HP); (DL)
| | - David S. Lindsay
- Department of Biomedical Sciences & Pathobiology, VA-MD Regional College of Veterinary Medicine, Virginia Tech, Duck Pond Drive, Blacksburg, Virginia, United States of America
- * E-mail: (HP); (DL)
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Gunel T, Kalelioglu I, Ermis H, Has R, Aydinli K. Large Scale Pre-Diagnosis ofToxoplasma GondiiDNA Genotyping by Real-Time PCR on Amniotic Fluid. BIOTECHNOL BIOTEC EQ 2014. [DOI: 10.5504/bbeq.2011.0106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tuba Gunel
- Istanbul University, Faculty of Science, Istanbul, Turkey
| | | | - Hayri Ermis
- Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Recep Has
- Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Kilic Aydinli
- Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Avelino MM, Amaral WN, Rodrigues IMX, Rassi AR, Gomes MBF, Costa TL, Castro AM. Congenital toxoplasmosis and prenatal care state programs. BMC Infect Dis 2014; 14:33. [PMID: 24438336 PMCID: PMC3918215 DOI: 10.1186/1471-2334-14-33] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 01/08/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Control programs have been executed in an attempt to reduce vertical transmission and the severity of congenital infection in regions with a high incidence of toxoplasmosis in pregnant women. We aimed to evaluate whether treatment of pregnant women with spiramycin associated with a lack of monitoring for toxoplasmosis seroconversion affects the prognosis of patients. METHODS We performed a prospective cohort study with 246 newborns (NB) at risk for congenital toxoplasmosis in Goiânia (Brazil) between October 2003 and October 2011. We analyzed the efficacy of maternal treatment with spiramycin. RESULTS A total of 40.7% (66/162) of the neonates were born seriously infected. Vertical transmission associated with reactivation during pregnancy occurred in 5.5% (9/162) of the NB, with one showing severe infection (systemic). The presence of specific immunoglobulins (fetal IgM and NB IgA) suggested the worst prognosis. Treatment of pregnant women by spiramycin resulted in reduced vertical transmission. When infected pregnant women did not undergo proper treatment, the risk of severe infection (neural-optical) in NB was significantly increased. Fetal IgM was associated with ocular impairment in 48.0% (12/25) of the fetuses and neonatal IgA-specific was related to the neuro-ophthalmologic and systemic forms of the disease. When acute toxoplasmosis was identified in the postpartum period, a lack of monitoring of seronegative pregnant women resulted in a higher risk of severe congenital infection. CONCLUSION Treatment of pregnant women with spiramycin reduces the possibility of transmission of infection to the fetus. However, a lack of proper treatment is associated with the onset of the neural-optical form of congenital infection. Primary preventive measures should be increased for all pregnant women during the prenatal period and secondary prophylaxis through surveillance of seroconversion in seronegative pregnant woman should be introduced to reduce the severity of congenital infection in the environment.
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Affiliation(s)
- Mariza M Avelino
- Pediatrics and Childcare Department of the Medical School of Federal University of Goiás (UFG), Goiânia, Brazil
- Department of Pediatrics and Puericulture MS/UFG and the Postgraduate Program from IPTSP/UFG, Rua 235 esq com 1a. Av. s/n Setor Leste Universitário, Goiânia-GO, Brazil
| | - Waldemar N Amaral
- Department of Gynecology and Obstetrics of the Medical School of Federal University of Goiás (UFG), Goiânia, Brazil
| | | | - Alan R Rassi
- Department of Ophthalmology of the Medical School (UFG), Goiânia, Brazil
| | | | - Tatiane L Costa
- Clinical Analyses Laboratory - Clinical Hospital of UFG, Goiânia, Brazil
| | - Ana M Castro
- Laboratory studies of the host-parasite relationship at the Institute for Tropical Pathology and Public Health (IPTSP) of the Federal University of Goiás (UFG), - LAERPH/IPTSP/UFG, Goiânia, Brazil
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Moncada PA, Montoya JG. Toxoplasmosis in the fetus and newborn: an update on prevalence, diagnosis and treatment. Expert Rev Anti Infect Ther 2014; 10:815-28. [DOI: 10.1586/eri.12.58] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Wang Y, Wang G, Zhang D, Yin H, Wang M. Detection of acute toxoplasmosis in pigs using loop-mediated isothermal amplification and quantitative PCR. THE KOREAN JOURNAL OF PARASITOLOGY 2013; 51:573-7. [PMID: 24327785 PMCID: PMC3857507 DOI: 10.3347/kjp.2013.51.5.573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/10/2013] [Accepted: 07/14/2013] [Indexed: 11/23/2022]
Abstract
A loop-mediated isothermal amplification (LAMP) assay allows rapid diagnosis of Toxoplasma gondii infection. In the present study, the LAMP assay was evaluated using blood from both naturally and experimentally infected pigs. The sensitivity of the LAMP assay was compared with that of Q-PCR. Both assays detected T. gondii in the blood of experimentally infected pigs, with 100% agreement. In infected blood samples, the parasite was detected as early as 2 days post-infection and reached a peak in 3-5 days. In 216 field serum samples, the detection rates of LAMP and Q-PCR assays were 6.9% and 7.8%, respectively. This result indicates that the sensitivity of the LAMP assay was slightly lower than that of the Q-PCR assay. However, the LAMP may be an attractive diagnostic method in conditions where sophisticated and expensive equipment is unavailable. This assay could be a powerful supplement to current diagnostic methods.
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Affiliation(s)
- Yanhua Wang
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou 730046, China
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Di Mario S, Basevi V, Gagliotti C, Spettoli D, Gori G, D'Amico R, Magrini N. Prenatal education for congenital toxoplasmosis. Cochrane Database Syst Rev 2013:CD006171. [PMID: 23450566 DOI: 10.1002/14651858.cd006171.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Congenital toxoplasmosis is considered a rare but potentially severe infection. Prenatal education about congenital toxoplasmosis could be the most efficient and least harmful intervention, yet its effectiveness is uncertain. OBJECTIVES To assess the effects of prenatal education for preventing congenital toxoplasmosis. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 January 2012), PubMed (1966 to 15 January 2012), EMBASE (1980 to 15 January 2012), CINAHL (1982 to 15 January 2012), LILACS (1982 to 15 January 2012), IMEMR (1984 to 15 January 2012), and reference lists of relevant papers, reviews and websites. SELECTION CRITERIA Randomized and quasi-randomized controlled trials (RCTs) of all types of prenatal education on toxoplasmosis infection during pregnancy. Cluster-randomized trials were included. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and study quality. Two review authors extracted data. Data were checked for accuracy. MAIN RESULTS Two cluster-randomized controlled trials (involving a total of 5455 women) met the inclusion criteria. The two included trials measured the effectiveness of the intervention in different ways which meant that meta-analysis of the results was not possible One trial (432 women enrolled) conducted in Canada was judged of low methodological quality. The authors did not report measure of association but only provided P values (P less than 0.05) for all outcomes. Moreover, losses to follow-up were high (34%, 147 out of 432 women initially enrolled). The authors concluded that prenatal education can effectively change pregnant women's behavior as it increased pet, personal and food hygiene. The second trial conducted in France was also judged of low methodological quality. Losses to follow-up were high (44.5%, 2233 out of 5023 women initially enrolled) and differential (40% in the intervention group and 52% in the control group). The authors concluded that prenatal education for congenital toxoplasmoses has a significant effect on improving women's knowledge whereas it has no effect on changing women's behavior. In this trial 17/3949 pregnant women seroconverted for toxoplasmosis: 13/2591 (0.5%) in the intervention group and 4/1358 (0.3%) in the control group. The number of events was too small to reach conclusions about the effect of prenatal education on seroconversion rate during pregnancy.No other randomized trials on the effect of prenatal education on congenital toxoplasmosis rate, or toxoplasmosis seroconversion rate during pregnancy were detected. AUTHORS' CONCLUSIONS Even though primary prevention of congenital toxoplasmosis is considered a desirable intervention, given the lack of related risks compared to secondary and tertiary prevention, its effectiveness has not been adequately evaluated. There is very little evidence from RCTs that prenatal education is effective in reducing congenital toxoplasmosis even though evidence from observational studies suggests it is. Given the lack of good evidence supporting prenatal education for congenital toxoplasmosis prevention, further RCTs are needed to confirm any potential benefits and to further quantify the impact of different sets of educational intervention.
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Affiliation(s)
- Simona Di Mario
- SaPeRiDoc, Primary health care, general medicine, planning and development of health services, Regional health authority of Emilia-Romagna, Bologna, Italy.
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Comparison of four commercially available avidity tests for Toxoplasma gondii-specific IgG antibodies. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 20:197-204. [PMID: 23239801 DOI: 10.1128/cvi.00356-12] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Toxoplasma infection in pregnant women may cause congenital toxoplasmosis. Diagnosis of infection is based on serological tests aimed at detecting IgM and IgG antibodies against Toxoplasma gondii. However, IgM antibodies are not an accurate marker for discriminating between acute and latent infection. Detection of residual or persistent IgM may occur months or even years after primary infection, while the IgG avidity test is a rapid means of identifying latent infections in pregnant women who exhibit both IgG and IgM anti-Toxoplasma antibodies on initial testing during pregnancy. In this study, we assessed and compared the performances of four commercially available Toxoplasma IgG avidity tests in immunocompetent and immunocompromised patients with acute and latent toxoplasmosis. The positive predictive value of high avidity to confirm latent toxoplasmosis was 100% for all the assays, indicating that high avidity is a hallmark of latent infection. However, the negative predictive value of high avidity ranged from 99.2% (bioMérieux) to 95.3% (Abbott), indicating that acute toxoplasmosis could not be reliably diagnosed based on low IgG avidity alone. Thus, the avidity test provides a rapid means for identifying latent Toxoplasma infection in immunocompetent pregnant women presenting both IgG and IgM anti-Toxoplasma antibodies on initial testing. In terms of cost-effectiveness, avidity testing is a powerful tool that optimizes screening and follow-up of pregnant women while minimizing the costs of screening by avoiding subsequent costly maternal and fetal investigation and unnecessary treatment. The cheapest assay, Vidas Toxo IgG Avidity, also had the best performance for the diagnosis of latent toxoplasmosis.
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Robert-Gangneux F, Dardé ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev 2012; 25:264-96. [PMID: 22491772 PMCID: PMC3346298 DOI: 10.1128/cmr.05013-11] [Citation(s) in RCA: 969] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The apicomplexan parasite Toxoplasma gondii was discovered a little over 100 years ago, but knowledge of its biological life cycle and its medical importance has grown in the last 40 years. This obligate intracellular parasite was identified early as a pathogen responsible for congenital infection, but its clinical expression and the importance of reactivations of infections in immunocompromised patients were recognized later, in the era of organ transplantation and HIV infection. Recent knowledge of host cell-parasite interactions and of parasite virulence has brought new insights into the comprehension of the pathophysiology of infection. In this review, we focus on epidemiological and diagnostic aspects, putting them in perspective with current knowledge of parasite genotypes. In particular, we provide critical information on diagnostic methods according to the patient's background and discuss the implementation of screening tools for congenital toxoplasmosis according to health policies.
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Affiliation(s)
- Florence Robert-Gangneux
- Service de Parasitologie, Faculté de Médecine et Centre Hospitalier Universitaire de Rennes, Rennes, France.
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Carlier Y, Truyens C, Deloron P, Peyron F. Congenital parasitic infections: a review. Acta Trop 2012; 121:55-70. [PMID: 22085916 DOI: 10.1016/j.actatropica.2011.10.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 10/27/2011] [Accepted: 10/29/2011] [Indexed: 12/11/2022]
Abstract
This review defines the concepts of maternal-fetal (congenital) and vertical transmissions (mother-to-child) of pathogens and specifies the human parasites susceptible to be congenitally transferred. It highlights the epidemiological features of this transmission mode for the three main congenital parasitic infections due to Toxoplasma gondii, Trypanosoma cruzi and Plasmodium sp. Information on the possible maternal-fetal routes of transmission, the placental responses to infection and timing of parasite transmission are synthesized and compared. The factors susceptible to be involved in parasite transmission and development of congenital parasitic diseases, such as the parasite genotypes, the maternal co-infections and parasitic load, the immunological features of pregnant women and the capacity of some fetuses/neonates to overcome their immunological immaturity to mount an immune response against the transmitted parasites are also discussed and compared. Analysis of clinical data indicates that parasitic congenital infections are often asymptomatic, whereas symptomatic newborns generally display non-specific symptoms. The long-term consequences of congenital infections are also mentioned, such as the imprinting of neonatal immune system and the possible trans-generational transmission. The detection of infection in pregnant women is mainly based on standard serological or parasitological investigations. Amniocentesis and cordocentesis can be used for the detection of some fetal infections. The neonatal infection can be assessed using parasitological, molecular or immunological methods; the place of PCR in such neonatal diagnosis is discussed. When such laboratory diagnosis is not possible at birth or in the first weeks of life, standard serological investigations can also be performed 8-10 months after birth, to avoid detection of maternal transmitted antibodies. The specific aspects of treatment of T. gondii, T. cruzi and Plasmodium congenital infections are mentioned. The possibilities of primary and secondary prophylaxes, as well as the available WHO corresponding recommendations are also presented.
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Alberto Cortés J, Enrique Gómez J, Ignacio Silva P, Arévalo L, Arévalo Rodríguez I, Isabel Alvarez M, Beltrán S, Fernanda Corrales I, Angel Muller E, Ruiz G, Iván Gómez P. Guía de atención integral para la prevención, detección temprana y tratamiento de las complicaciones del embarazo, parto y puerperio: sección toxoplasmosis en el embarazo. INFECTIO 2012. [DOI: 10.1016/s0123-9392(12)70018-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Malinger G, Werner H, Rodriguez Leonel JC, Rebolledo M, Duque M, Mizyrycki S, Lerman-Sagie T, Herrera M. Prenatal brain imaging in congenital toxoplasmosis. Prenat Diagn 2011; 31:881-6. [PMID: 21706510 DOI: 10.1002/pd.2795] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 01/12/2011] [Accepted: 05/02/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe brain imaging findings and outcomes in fetuses with confirmed congenital toxoplasmosis (CTX). METHODS Physicians from Prenatal Diagnosis Units in ten Latin American countries were contacted and asked to provide data on fetuses with ultrasound findings suggestive of intrauterine infection and a positive diagnosis of CTX. The imaging studies were reviewed, and findings were described and tabulated. RESULTS Intracranial findings suggestive of CTX were identified in eight patients at a median gestational age of 31.5 weeks (range, 24.4-34 weeks). Ventriculomegaly was found in seven patients [severe (3), mild (4)]. Multiple echogenic nodular foci consistent with calcifications were found in seven patients [brain parenchyma (7), periventricular zone (3) and caudothalamic zone (3)]. Diffuse periventricular echogenicity or cysts were seen in three and callosal dysgenesis in one. All six survivors have choroidoretinitis and intracranial calcifications, four suffer from developmental delay and three of these four children also suffer from seizures and blindness. Postnatal hydrocephaly was found in five children. CONCLUSIONS Ventriculomegaly associated with multiple echo-dense nodules is characteristic of severe fetal toxoplasmosis and carries a poor prognosis. When the ventricles have normal size or are only mildly dilated, the nodules restricted to the parenchyma development may be normal.
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Affiliation(s)
- G Malinger
- Fetal Neurology Clinic, Edith Wolfson Medical Center, Holon, Israel.
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Polymerase chain reaction in the diagnosis of congenital toxoplasmosis: more than two decades of development and evaluation. Parasitol Res 2011; 108:505-12. [PMID: 21221639 DOI: 10.1007/s00436-010-2245-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
Abstract
Toxoplasmosis, a protozoan disease caused by the coccidian parasite Toxoplasma gondii, is one of the most prevalent parasitic diseases of humans. Although most infections are subclinical and asymptomatic, it has a great importance with respect to immunocompromized hosts and congenitally infected newborns. The diagnosis of T. gondii infection has gained in great interest over the past decades with a wide variety of techniques being investigated from animal inoculation to advanced molecular techniques. This paper reviews and highlights the development and evaluation of polymerase chain reaction in the diagnosis of congenital toxoplasmosis in human population to present the redundant research on it in a chronologically simple approach.
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Feldman DM, Timms D, Borgida AF. Toxoplasmosis, Parvovirus, and Cytomegalovirus in Pregnancy. Clin Lab Med 2010; 30:709-20. [DOI: 10.1016/j.cll.2010.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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In utero and at birth diagnosis of congenital toxoplasmosis: use of likelihood ratios for clinical management. Pediatr Infect Dis J 2010; 29:421-5. [PMID: 19952858 DOI: 10.1097/inf.0b013e3181c80493] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The results of the ante- and neonatal diagnostic tests for congenital toxoplasmosis influence the decision to treat the newborn immediately after birth. Here, we estimate the positive and negative likelihood ratios (LRs) and the probabilities of congenital infection according to PCR and IgM-IgA tests results. METHODS The study concerned 767 children born between 1996 and 2002 and followed-up for 1-year at Croix-Rousse hospital, Lyon, France. The LRs and the post-test probabilities were estimated conditionally on gestational age at maternal infection using a logistic regression approach. RESULTS For the PCR and the IgM-IgA tests, the positive LRs were high. In children with one positive test when only one test was done, the probability of infection reached 90% when the maternal infection occurred at 18-weeks gestation or later. This probability was close to 100% when the 2 tests were positive, whatever the gestational age. The negative LRs of the 2 tests moved closer to 0 at later gestational ages. However, when the tests were negative, the probability of infection remained greater or equal to 10%, except in early maternal infection. When the 2 tests were discordant, the probability of infection was about 50% in early maternal infection. CONCLUSION Providing reliable probabilities of congenital infection, the PCR and IgM-IgA tests guide clinical management and counseling of parents.
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Abstract
BACKGROUND Neonates with congenital toxoplasmosis, even asymptomatic at birth, should be treated early to reduce long-term sequelae. Postnatal diagnosis of congenital toxoplasmosis is essential because prenatal diagnosis fails to detect approximately 15% of cases or cannot be performed when maternal infection is acquired in late pregnancy. Detection of parasites in the placenta is one diagnostic approach to the early neonatal diagnosis of congenital toxoplasmosis. METHODS The parasitic analyses of 102 placentas from cases of toxoplasmosis acquired during gestation were reviewed, with complete biologic follow-up of neonates. The value of quantitative PCR and mouse inoculation was assessed, and results are discussed in light of prenatal treatment and postnatal outcome. RESULTS Congenital toxoplasmosis was diagnosed in 28 of the 102 cases. A prenatal diagnosis was obtained in only 16 cases. Specific IgM was detected in 57% of the babies at birth. A positive placental examination by PCR and mouse inoculation was the only evidence of infection in 3 neonates (11%) who were asymptomatic at birth. The sensitivities of PCR and mouse inoculation were 71% and 67%, respectively, and the specificities were 97% and 100%. Parasites were detected more often when maternal infection was acquired during the third trimester of pregnancy (P < 0.01), regardless the type of treatment. The sensitivity of IgM detection appeared to be related to maternal treatment since IgM was positive in 43% and 75% when mothers were treated or not, respectively (P < 0.01). Though 5/7 symptomatic infants had a positive placenta examination, there was no correlation between a positive placenta and the presence of clinical signs during the first year of life. The positive and negative predictive values of placental examination were 91% and 90%, respectively. CONCLUSION Placental examination is an efficient tool for the early diagnosis of congenital toxoplasmosis.
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Blood and tissue protozoa. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
We report a case of asymptomatic congenital toxoplasmosis following a periconceptional infection of the mother. Fetal infection is very uncommon in such a situation, and mostly associated with fetal damage. We recommend that newborns undergo postnatal screening, even after maternal periconceptional infection, and receive specific therapy to reduce long-term sequelae.
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Di Mario S, Basevi V, Gagliotti C, Spettoli D, Gori G, D'Amico R, Magrini N. Prenatal education for congenital toxoplasmosis. Cochrane Database Syst Rev 2009:CD006171. [PMID: 19160267 DOI: 10.1002/14651858.cd006171.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Congenital toxoplasmosis is considered a rare but potentially severe infection. Prenatal education about congenital toxoplasmosis could be the most efficient and least harmful intervention, yet its effectiveness is uncertain. OBJECTIVES To assess the effects of prenatal education for preventing congenital toxoplasmosis. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2007), CENTRAL (The Cochrane Library 2007, Issue 3), MEDLINE (1966 to November 2007), EMBASE (1980 to November 2007), CINAHL (1982 to November 2007), LILACS (1982 to November 2007) IMEMR (1984 to November 2007), and reference lists of relevant papers, reviews and websites. SELECTION CRITERIA Randomized and quasi-randomized controlled trials (RCT) of all types of prenatal education on toxoplasmosis infection during pregnancy. DATA COLLECTION AND ANALYSIS Three authors independently assessed study quality and extracted data. MAIN RESULTS One cluster-randomized controlled trial (432 women) met the inclusion criteria. However, the overall methodological quality was poor. The authors did not report measure of association but only provided P values (P less than 0.05) for all outcomes. The authors concluded that prenatal education can effectively change pregnant women's behavior as it increased pet, personal and food hygiene. There are no randomized trials on the effect of prenatal education on congenital toxoplasmosis rate, or toxoplasmosis seroconversion rate during pregnancy, but three observational studies consistently suggest that prenatal education might have a positive impact on these outcomes. AUTHORS' CONCLUSIONS Even though primary prevention of congenital toxoplasmosis is considered a desirable intervention, given the lack of related risks compared to secondary and tertiary prevention, its effectiveness has not been adequately evaluated. There is very little evidence from RCTs that prenatal education is effective in reducing congenital toxoplasmosis even though evidence from observational studies suggests it is. Given the lack of good evidence supporting prenatal education for congenital toxoplasmosis prevention, further RCTs are needed to confirm any potential benefits and to further quantify the impact of different sets of educational intervention.
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Affiliation(s)
- Simona Di Mario
- CeVEAS, Centro per la Valutazione della Efficacia della Assistenza Sanitaria, Azienda USL di Modena, V. le L. Muratori 201, Modena, Italy, 41100.
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Reverse enzyme-linked immunosorbent assay using monoclonal antibodies against SAG1-related sequence, SAG2A, and p97 antigens from Toxoplasma gondii to detect specific immunoglobulin G (IgG), IgM, and IgA antibodies in human sera. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2008; 15:1265-71. [PMID: 18562566 DOI: 10.1128/cvi.00069-08] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study aimed to evaluate the performance of three monoclonal antibodies (MAbs) in reverse enzyme-linked immunosorbent assays (ELISAs) for detecting immunoglobulin G (IgG), IgM, and IgA antibodies against Toxoplasma gondii in 175 serum samples from patients at different stages of T. gondii infection, as defined by both serological and clinical criteria, as follows: recent (n = 45), transient (n = 40), and chronic (n = 55) infection as well as seronegative subjects (n = 35). The results were compared with those obtained by indirect ELISA using soluble Toxoplasma total antigen (STAg). Our data demonstrated that MAb A3A4 recognizes a conformational epitope in SAG1-related-sequence (SRS) antigens, while A4D12 and 1B8 recognize linear epitopes defined as SAG2A surface antigen and p97 cytoplasmatic antigen, respectively. Reverse ELISA for IgG with A3A4 or A4D12 MAbs was highly correlated with indirect ELISA for anti-STAg IgG, whereas only A4D12 reverse ELISA showed high correlation with indirect ELISA for IgM and IgA isotypes. To our knowledge, this is the first report analyzing the performance of a reverse ELISA for simultaneous detection of IgG, IgM, and IgA isotypes active toward native SAG2A, SRS, and p97 molecules from STAg, using a panel of human sera from patients with recent and chronic toxoplasmosis. Thus, reverse ELISA based on the capture of native SAG2A and SRS antigens of STAg by MAbs could be an additional approach for strengthening the helpfulness of serological tests assessing the stage of infection, particularly in combination with highly sensitive and specific assays that are frequently used nowadays for diagnosis of toxoplasmosis during pregnancy or congenital infection in newborns.
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Chen R, Lu S, Lou D, Lin A, Zeng X, Ding Z, Wen L, Ohta N, Wang J, Fu C. Evaluation of a rapid ELISA technique for detection of circulating antigens of Toxoplasma gondii. Microbiol Immunol 2008; 52:180-7. [DOI: 10.1111/j.1348-0421.2008.00020.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Di Mario S, Basevi V, Gagliotti C, Spettoli D, Gori G, D'Amico R, Magrini N. Prenatal education for congenital toxoplasmosis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [DOI: 10.1002/14651858.cd006171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gilbert R, Tan HK, Cliffe S, Guy E, Stanford M. Symptomatic toxoplasma infection due to congenital and postnatally acquired infection. Arch Dis Child 2006; 91:495-8. [PMID: 16547084 PMCID: PMC2082761 DOI: 10.1136/adc.2005.088385] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2006] [Indexed: 11/04/2022]
Abstract
AIMS To determine the incidence and severity of symptomatic toxoplasma infection presenting during childhood due to congenital or postnatally acquired infection. METHODS Between 2002 and 2004, newly diagnosed children (<16 years) with signs or symptoms of congenital or ocular toxoplasmosis were reported by clinicians to the British Paediatric and Ophthalmic Surveillance Units or by toxoplasma referral laboratories. Confirmed cases were estimated to have a greater than 50% probability of congenital and/or ocular toxoplasmosis, based on clinical and serological findings. RESULTS Thirty eight children had confirmed toxoplasma infection. Twenty two (58%) were classified with congenital infection (cumulative incidence for England and Wales 1.62[corrected]/100,000 live births; 95% CI 0.85[corrected] to 2.83[corrected]), of whom 2 (9%) were stillborn, 7 (32%) live births had intracranial abnormalities and/or developmental delay (5 of whom had retinochoroiditis), and 10 (45%) had retinochoroiditis with no other abnormalities reported. A further 16 (42%) children were classified as infected after birth; all had retinochoroiditis. CONCLUSIONS The low burden of symptomatic congenital toxoplasmosis combined with the lack of evidence of an effective treatment support current policy not to offer prenatal or neonatal screening for toxoplasma infection. Primary prevention strategies need to address acquisition of infection in childhood which accounts for half the ocular disease due to toxoplasma infection in children in the UK and Ireland.
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Affiliation(s)
- R Gilbert
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK.
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Dreux S, Rousseau T, Gerber S, Col JY, Dommergues M, Muller F. Fetal serum β2-microglobulin as a marker for fetal infectious diseases. Prenat Diagn 2006; 26:471-4. [PMID: 16652403 DOI: 10.1002/pd.1441] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate whether fetal serum beta2-microglobulin could be used as a marker of fetal cytomegalovirus (CMV) or toxoplasmosis infection. METHODS beta2-microglobulin was retrospectively assayed in fetal serum collected from 64 patients with maternal infectious seroconversion (toxoplasmosis in 49 cases, CMV in 15). Using a beta2-microglobulin cutoff of 5 mg/L, infection and control groups were compared. RESULTS Fetal serum beta2-microglobulin was >5 mg/L (5.2-13.5 mg/L) in 12 of the 13 cases with proved fetal toxoplasmosis infection, indicating 90% sensitivity. In the 39 pregnancies with maternal seroconversion but no laboratory signs of fetal infection, fetal serum beta2-microglobulin was <5 mg/L, indicating 100% specificity. Fetal serum was >5 mg/L (6.3-32 mg/L) in 14 of the 15 cases with proved fetal CMV infection, indicating 93.3% sensitivity. Specificity cannot be evaluated because maternal serum is not routinely screened for CMV during pregnancy. CONCLUSIONS Fetal serum beta2-microglobulin is a reliable marker of fetal CMV or toxoplasmosis infection, which can be used in ambiguous situations. Because this increase is not specific, fetal serum beta2-microglobulin would potentially be raised in other fetal infections.
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Affiliation(s)
- Sophie Dreux
- Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, 48 boulevard Sérurier, 75935 Paris cedex 19, France
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Thalib L, Gras L, Romand S, Prusa A, Bessieres MH, Petersen E, Gilbert RE. Prediction of congenital toxoplasmosis by polymerase chain reaction analysis of amniotic fluid. BJOG 2005; 112:567-74. [PMID: 15842278 DOI: 10.1111/j.1471-0528.2005.00486.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the accuracy of polymerase chain reaction (PCR) analysis of amniotic fluid for fetal toxoplasmosis according to clinical predictors of outcome and study centre. DESIGN Prospective cohort study. SETTING Nine European centres. POPULATION Women with suspected toxoplasma infection identified by prenatal screening. METHODS Logistic regression was used to examine the effects of gestational age at maternal seroconversion, treatment and timing of amniocentesis, on PCR accuracy, and to calculate the post-test probability of congenital toxoplasmosis. MAIN OUTCOME MEASURES Infants had congenital toxoplasmosis if specific IgG persisted beyond 11.5 months. Uninfected infants had undetectable IgG in the absence of anti-toxoplasma treatment. RESULTS Of 593 PCR results, 64 were positive (57 confirmed infected), and 529 were negative (23 confirmed infected). The likelihood ratio for a positive PCR result decreased significantly with trimester at seroconversion, but did not change significantly for a negative result. Weak associations were detected between sensitivity and, inversely, with specificity, and gestational age at maternal seroconversion. There was no significant association between sensitivity and centre, type or duration of treatment, or timing of amniocentesis. Specificity differed significantly between centres (P < 0.001). The change in pre- to post-test probability of infection was maximal for a positive PCR after first trimester seroconversion, affecting 1% of women tested, and a negative PCR after third trimester seroconversion, affecting half the women tested. CONCLUSIONS Prediction of the risk of congenital toxoplasmosis should combine estimates of test accuracy and maternal-fetal transmission, which take account of the gestational age at which the mother seroconverted. Local laboratory standards will affect the generalisability of these results.
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Affiliation(s)
- L Thalib
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait
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Nowakowska D, Respondek-Liberska M, Golab E, Stray-Pedersen B, Szaflik K, Dzbenski TH, Wilczynski J. Too Late Prenatal Diagnosis of Fetal Toxoplasmosis: A Case Report. Fetal Diagn Ther 2005; 20:190-3. [PMID: 15824496 DOI: 10.1159/000083903] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2003] [Accepted: 03/12/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We describe a case of severe fetal hydrocephalus due to toxoplasmosis which could not be diagnosed until late gestational age due to the lack of a serologic surveillance program during pregnancy; moreover, this case points to the usefulness of molecular biology tools in the diagnostic process. Abnormal ultrasound in the 2nd trimester was noticed and Toxoplasma gondii was demonstrated in amniotic fluid at the 28th week of gestation both by PCR and by mice inoculation. Fansidar and folinic acid were administered. The newborn suffered from progressive hydrocephalus, seizures, and pathological muscular tonus; ultrasound examination showed massive cerebral calcifications. Ophthalmologic examination revealed bilateral choroidoretinitis. Congenital toxoplasmosis was confirmed by the detection of anti- T. gondii IgM and IgA in the neonatal serum. CONCLUSION The presented case is an example of severe fetal toxoplasmosis diagnosed and treated in utero.
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Affiliation(s)
- Dorota Nowakowska
- Department of Fetal Maternal Medicine, Research Institute Polish Mother's Memorial Hospital, Lodz, Poland.
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Boyer KM, Holfels E, Roizen N, Swisher C, Mack D, Remington J, Withers S, Meier P, McLeod R. Risk factors for Toxoplasma gondii infection in mothers of infants with congenital toxoplasmosis: Implications for prenatal management and screening. Am J Obstet Gynecol 2005; 192:564-71. [PMID: 15696004 DOI: 10.1016/j.ajog.2004.07.031] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether demographic characteristics, history of exposure to recognized transmission vehicles, or illness that was compatible with acute toxoplasmosis during gestation identified most mothers of infants with congenital toxoplasmosis. STUDY DESIGN Mothers of 131 infants and children who were referred to a national study of treatment for congenital toxoplasmosis were characterized demographically and questioned concerning exposure to recognized risk factors or illness. RESULTS No broad demographic features identified populations that were at risk. Only 48% of mothers recognized epidemiologic risk factors (direct or indirect exposure to raw/undercooked meat or to cat excrement) or gestational illnesses that were compatible with acute acquired toxoplasmosis during pregnancy. CONCLUSION Maternal risk factors or compatible illnesses were recognized in retrospect by fewer than one half of North American mothers of infants with toxoplasmosis. Educational programs might have prevented acquisition of Toxoplasma gondii by those mothers who had clear exposure risks. However, only systematic serologic screening of all pregnant women at prenatal visits or of all newborn infants at birth would prevent or detect a higher proportion of these congenital infections.
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Chabbert E, Lachaud L, Crobu L, Bastien P. Comparison of two widely used PCR primer systems for detection of toxoplasma in amniotic fluid, blood, and tissues. J Clin Microbiol 2004; 42:1719-22. [PMID: 15071031 PMCID: PMC387537 DOI: 10.1128/jcm.42.4.1719-1722.2004] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2003] [Revised: 07/20/2003] [Accepted: 01/11/2004] [Indexed: 11/20/2022] Open
Abstract
The PCR diagnosis of toxoplasmosis suffers from lack of standardization. Interlaboratory comparative studies of PCR methods have been performed, but intralaboratory comparisons are scarce. Here, we optimized and compared the technical performances of two PCR primer systems widely used for Toxoplasma detection. The differences between the two methods were visible only at low parasite concentrations (< or = 1 Toxoplasma genome per reaction tube). Nevertheless, when clinical samples were tested, both methods significantly differed in their technical sensitivities and specificities. Only one method appeared adequate for samples containing blood or tissue.
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Affiliation(s)
- Elisabeth Chabbert
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Montpellier, France
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Segundo GRS, Silva DAO, Mineo JR, Ferreira MS. A comparative study of congenital toxoplasmosis between public and private hospitals from Uberlândia, MG, Brazil. Mem Inst Oswaldo Cruz 2004; 99:13-7. [PMID: 15057340 DOI: 10.1590/s0074-02762004000100002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The main purpose of the present study was to examine if there is difference in terms of incidence rates of congenital toxoplasmosis among populations assisted in public and private hospitals from Uberlândia, state of Minas Gerais, Brazil. A total of 805 serum samples from cord blood were collected, being 500 from public hospital and 305 from private hospital, and all patients answered a questionnaire about pregnancy and newborns. An indirect enzyme linked immunosorbent assay (ELISA) was performed to detect IgG antibodies to Toxoplasma gondii and the positive samples were retested to verify the presence of specific IgM and IgA antibodies in a capture ELISA. We found significant differences among data from both hospitals with respect to maternal age, origin city, gestational age, number of visits to physicians during pregnancy, type of delivery, and birth weight. Seroprevalence of IgG antibodies against T. gondii for patients from public and private hospitals was 57.6% and 41.9% respectively, and this difference was statistically significant (P < 0.0001). In addition, the frequency of congenital toxoplasmosis measured by the presence of IgM and/or IgA antibodies toward T. gondii was exclusively located in samples from public hospital (0.8%), and no positive sample was seen in private hospital (0%). Considering that almost all babies suffering from congenital toxoplasmosis, if undiagnosed and untreated, will develop visual or neurological impairments by adulthood, the results presented herein emphasized the importance to accomplish screening programs for toxoplasmosis during pregnancy, particularly in the public hospitals, due to the expressive rate of congenital disease showed in the patients attended at these centers.
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Affiliation(s)
- Gesmar Rodrigues Silva Segundo
- Laboratório de Imunoparasitologia, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, MG, 38400-902, Brasil
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Gay-Andrieu F, Marty P, Pialat J, Sournies G, Drier de Laforte T, Peyron F. Fetal toxoplasmosis and negative amniocentesis: necessity of an ultrasound follow-up. Prenat Diagn 2003; 23:558-60. [PMID: 12868082 DOI: 10.1002/pd.632] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Prenatal diagnosis of congenital toxoplasmosis relies on the PCR test on amniotic fluid and ultrasound follow-up of the fetus. We report two cases of toxoplasma infection during the first trimester of gestation with a discrepant diagnosis of fetal infection. PCR performed more than four weeks after the estimated date of contamination was negative. Ultrasound follow-up was normal up to the third trimester when major hydrocephalus was detected, leading to pregnancy termination. In both cases, post-mortem examination revealed a diffuse infection with severe brain lesions. These observations confirm the necessity to continue a monthly ultrasound follow-up, even if amniocentesis is negative, in case of fetal toxoplasma infection in pregnancy.
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Affiliation(s)
- Françoise Gay-Andrieu
- Laboratoire de Parasitologie et Pathologie Exotique, Hôpital de la Croix-Rousse, 93 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France
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Foudrinier F, Villena I, Jaussaud R, Aubert D, Chemla C, Martinot F, Pinon JM. Clinical value of specific immunoglobulin E detection by enzyme-linked immunosorbent assay in cases of acquired and congenital toxoplasmosis. J Clin Microbiol 2003; 41:1681-6. [PMID: 12682160 PMCID: PMC153890 DOI: 10.1128/jcm.41.4.1681-1686.2003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The clinical value of immunoenzymatic (enzyme-linked immunosorbent assay) detection of anti-Toxoplasma immunoglobulin E (IgE) was assessed by studying 2,036 sera from 792 subjects, comprising seronegative controls and subjects with acute, active, reactivated, or congenital toxoplasmosis. Included were nonimmunized adults; pregnant women with recently acquired infection (acute toxoplasmosis); immunocompetent subjects with recently acquired severe infection (active toxoplasmosis) expressed as fever, adenopathies, splenomegaly, pneumonia, meningitis, or disseminated infection; subjects-some of them immunocompromised-whose previously moderate IgG antibody levels rose, suggesting a reactivation of quiescent toxoplasmosis; and infants born to seroconverted mothers and evaluated for diagnosis of congenital infection and therapeutic management. Specific IgE antibodies were never detected in seronegative subjects. They were present in 85.7% of asymptomatic seroconverters and in 100% of seroconverters with overt toxoplasmosis, following two different kinetics: in the former, the specific IgE titer generally presented a brief peak 2 to 3 months postinfection and then fell rapidly, whereas specific IgE persisted at a very high titer for several months in the latter. IgE emerged concomitantly with the increase in IgG during toxoplasmic reactivation. For neonatal diagnosis of congenital toxoplasmosis, IgE was less informative than IgM and IgA (sensitivities, 59.5, 64.3, and 76.2%, respectively) and had a specificity of 91.9%. Nevertheless, simultaneous measurement of the three isotypes at birth improved the diagnostic yield to 81% relative to the combination of IgA and IgM. Emergence of specific IgE during postnatal treatment for congenital toxoplasmosis is a sign of poor adherence or inadequate dosing.
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Affiliation(s)
- F Foudrinier
- Toxoplasmosis Group, Laboratory of Parasitology-Mycology, IFR53, EA 2070, Hôpital Maison Blanche, 51092 Reims, France.
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Villena I, Bory JP, Chemla C, Hornoy P, Pinon JM. Congenital toxoplasmosis: necessity of clinical and ultrasound follow-up despite negative amniocentesis. Prenat Diagn 2003; 23:1098-9. [PMID: 14692001 DOI: 10.1002/pd.754] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Fabre E, Bartha J, de Miguel J, Rodríguez-Alarcón J, Dulín E, Farrán I, González A. Grupo de consenso sobre toxoplasmosis. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0304-5013(03)75906-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Antsaklis A, Daskalakis G, Papantoniou N, Mentis A, Michalas S. Prenatal diagnosis of congenital toxoplasmosis. Prenat Diagn 2002; 22:1107-11. [PMID: 12454967 DOI: 10.1002/pd.476] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ninety-three pregnant women with Toxoplasma gondii seroconversion during pregnancy underwent prenatal diagnosis of fetal toxoplasmosis. The following tests were used: (1). amniocentesis for mouse inoculation (93 subjects), (2). amplification of T. gondii DNA by polymerase chain reaction (PCR) (79 subjects), and (3). cordocentesis for the detection of T. gondii-specific IgM antibodies (13 subjects). All patients had serial ultrasonographic scans to detect those fetuses with abnormalities that could be associated with congenital toxoplasmosis. Eighteen pregnancies (19.4%) had evidence of vertical transmission. A total of 11/18 (61.1%) had positive amniotic mouse inoculation test, while 10/12 (83.3%) had positive PCR results. The combination of both tests allowed the prenatal diagnosis in 17/18 infected fetuses (94.4%). All patients who underwent cordocentesis for the detection of T. gondii-specific IgM antibodies had negative results. However, in two of the above cases fetal toxoplasmosis was detected by amniotic fluid studies. In five of the infected fetuses there were abnormal ultrasonographic findings. All pregnancies with evidence of vertical transmission were terminated, whereas the remaining pregnancies proceeded normally to term. The present data showed that amniotic fluid studies, preferably PCR amplification of T. gondii DNA, are the best diagnostic tools for the detection of vertical transmission in pregnancies with seroconversion during pregnancy.
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Affiliation(s)
- Aris Antsaklis
- First Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Alexandra Hospital, University of Athens, Athens, Greece
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