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Montoya JG. In defense of children's brain: reshuffling the laboratory toolbox for the diagnosis of congenital toxoplasmosis. J Clin Microbiol 2024:e0169723. [PMID: 38780287 DOI: 10.1128/jcm.01697-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
For decades, an immunosorbent agglutination assay (ISAGA) has been considered the gold standard method for the detection of Toxoplasma gondii-specific IgM in infants for the diagnosis of congenital toxoplasmosis (CT). The Toxoplasma IgM ISAGA was consistently reported as having superior sensitivity. Unfortunately, the commercial kit for the detection of Toxoplasma IgM ISAGA will no longer be available in 2024 and alternatives will only be available at a handful of reference laboratories as in-house or laboratory-developed tests. In a recent study, S. Arkhis, C. Rouges, N. Dahane, H. Guegan, et al. (J Clin Microbiol 62:e01222-23, 2024, https://doi.org/10.1128/jcm.01222-23), reported that the performance of the PLATELIA Toxo IgM was comparable to that of the ISAGA method for the diagnosis of CT. A second study revealing similar results supports the PLATELIA Toxo IgM as the new gold standard for the detection of T. gondii-specific IgM in infants. Although the laboratory toolbox for CT diagnosis has been reshuffled successfully, it is by universally implementing all available serological and molecular tools at the earliest possible time during gestation that we can best defend children's brain from the potential harm caused by trans-placentally transmitted T. gondii.
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Affiliation(s)
- Jose G Montoya
- Dr. Jack S. Remington Laboratory for Specialty Diagnostics, National Reference Laboratory for the Study and Diagnosis of Toxoplasmosis, Palo Alto Medical Foundation, Palo Alto, California, USA
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2
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Denis J, Lemoine JP, L'ollivier C, Deleplancque AS, Fricker Hidalgo H, Pelloux H, Pomares C, Cimon B, Paris L, Houzé S, Villena I, Villard O. Contribution of serology in congenital toxoplasmosis diagnosis: results from a 10-year French retrospective study. J Clin Microbiol 2023; 61:e0035423. [PMID: 37728898 PMCID: PMC10595068 DOI: 10.1128/jcm.00354-23] [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: 03/21/2023] [Accepted: 07/11/2023] [Indexed: 09/22/2023] Open
Abstract
This study aimed to evaluate different serological strategies for the postnatal diagnosis of congenital toxoplasmosis (CT) and establish a biological algorithm for CT diagnosis. The study analyzed serological data of immunoglobulins M, A, and G (IgM, IgA, IgG) performed by immunoenzymatic and compared immunological profile (CIP) assays in 668 newborns with CT diagnosis across four testing periods: P1 (D0- D10), P2 (D11-D35), P3 (D36-D45), and P4 (>D45). Forty-nine percent of the 668 CT cases were diagnosed during P1 and 34%, 4%, and 12% during P2, P3, and P4, respectively. CIP assays detected neosynthetized IgMs/IgGs in 98% of CT cases diagnosed during P1, while IgMs and IgAs were detected in 90% and 57% of CT cases diagnosed during P2 and in 88% and 67% of diagnoses made during P3, respectively. Detection of neosynthesized IgMs/IgGs, IgMs, and IgAs by immunoassay contributed to CT diagnosis in 81%, 77%, and 60% of cases, respectively. In total, 46% of serum samples were positive for all three parameters, 27% for two, and 27% for one of the three. The study recommends using the CIP assay as standard during P1 for CT diagnosis and IgM and IgA immunoassays after P1. A clinical and biological follow-up in a specialized center with a close collaboration between biologists and clinicians is highly recommended to increase the chances of early diagnosis. Overall, this study provides useful information for the development of a biological algorithm for CT diagnosis, which can aid in early detection and appropriate treatment of this disease.
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Affiliation(s)
- Julie Denis
- Institut de Parasitologie et de Pathologie Tropicale, UR7292 Dynamique des interactions hôte pathogène, Fédération de Médecine Transrationnelle, Université de Strasbourg, Strasbourg, France
- Laboratoire de Parasitologie et Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Coralie L'ollivier
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- IHU-Méditerranée Infection, Assistance Publique Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU Méditerranée, Marseille, France
| | - Anne-Sophie Deleplancque
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- CHU Lille, Parasitology Mycology Department, Lille University, Inserm, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | - Hélène Fricker Hidalgo
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Laboratory of Parasitology and Mycology, INSERM U1209, CNRS UMR5309, Grenoble-Alpes University Hospital, Institute for Advanced Biosciences, Grenoble Alpes University Hospital, Grenoble, France
| | - Hervé Pelloux
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Laboratory of Parasitology and Mycology, INSERM U1209, CNRS UMR5309, Grenoble-Alpes University Hospital, Institute for Advanced Biosciences, Grenoble Alpes University Hospital, Grenoble, France
| | - Christelle Pomares
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Parasitology-Mycology laboratory, Côte d'Azur University, INSERM 1065, Nice University Hospital, Nice, France
- Centre Méditerranéen de Médecine Moléculaire (C3M), U1065, Université Côte d'Azur, Inserm, Nice, France
| | - Bernard Cimon
- Laboratoire de Parasitologie-Mycologie, CHU d'Angers, Angers, France
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Angers University, Brest University, IRF, SFR 4208 ICAT, Angers, France
| | - Luc Paris
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Parasitology laboratory, AP-HP Pitié-Salpêtrière, Paris, France
| | - Sandrine Houzé
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Parasitology laboratory, AP-HP, Hôpital Bichat - Claude Bernard, Paris, France
- University of Paris Cité, IRD 261, MERIT, Paris, France
| | - Isabelle Villena
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Department of Parasitology and Medical Mycology, National Reference Centre on Toxoplasmosis, Reims Hospital, Reims, France
- Team EA 7510, SFR CAP-SANTE, Reims Champagne Ardenne University, Reims, France
| | - Odile Villard
- Institut de Parasitologie et de Pathologie Tropicale, UR7292 Dynamique des interactions hôte pathogène, Fédération de Médecine Transrationnelle, Université de Strasbourg, Strasbourg, France
- Laboratoire de Parasitologie et Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Centre National de Référence Toxoplasmose-Pôle sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Márquez-Mauricio A, Caballero-Ortega H, Gómez-Chávez F. Congenital Toxoplasmosis Diagnosis: Current Approaches and New Insights. Acta Parasitol 2023; 68:473-480. [PMID: 37368128 DOI: 10.1007/s11686-023-00693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The aim of this study is to describe and discuss current disadvantages in congenital toxoplasmosis (CT) diagnosis, and what can be improved or changed through new perspectives and technological advances. METHODS We used Pubmed, Cochrane, and EBSCO databases to research publications from 10 years to date describing current diagnostic methods for CT. The keywords used for this Mini-Review were Toxoplasma gondii, congenital toxoplasmosis, diagnosis, and prospects using Boolean operators such as AND, OR, identifying scientific publications highlighting the importance of implementing new diagnostic methods. RESULTS Current diagnosis methods have several disadvantages, i.e., time-consuming, low sensitivity or specificity, and non-cost effective, that bring up the necessity of improving or developing new approaches. Recombinant proteins can help improve specificity by generating tests that use circulating strains in a specific geographical region, SAG1 and BAG1, as they are expressed during a particular stage of the disease (acute or chronic, respectively), for its use in serological diagnoses, such as capture ELISA and immunochromatography. Point of Care (POC) tests are methods performed at the patient care site, which leads to rapid patient treatment; despite the advantages, several improvements and perspectives are necessary to be implemented globally. CONCLUSIONS Although already established diagnosis methods for CT may be sufficient in some regions, there is still a persistent demand to develop tests with higher throughput, cost, and time reduction in developing countries, where prevalence is high. New approaches in CT diagnosis, such as recombinant proteins, capture ELISA, immunochromatography, and POC tests methods, can increase performance in terms of specificity and sensitivity simplifying diagnostic tests' requirements.
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Affiliation(s)
| | | | - Fernando Gómez-Chávez
- Laboratorio de Enfermedades Osteoarticulares e Inmunológicas, Sección de Estudios de Posgrado e Investigación, ENMyH-Instituto Politécnico Nacional, Mexico City, Mexico.
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Brito C, Lourenço C, Magalhães J, Reis S, Borges M. Nanoparticles as a Delivery System of Antigens for the Development of an Effective Vaccine against Toxoplasma gondii. Vaccines (Basel) 2023; 11:vaccines11040733. [PMID: 37112645 PMCID: PMC10142924 DOI: 10.3390/vaccines11040733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Nanoparticles include particles ranging in size from nanometers to micrometers, whose physicochemical characteristics are optimized to make them appropriate delivery vehicles for drugs or immunogens important in the fight and/or prevention of infectious diseases. There has been a rise in the use of nanoparticles in preventive vaccine formulations as immunostimulatory adjuvants, and as vehicles for immunogen delivery to target immune cells. Toxoplasma is important worldwide, and may cause human toxoplasmosis. In immunocompetent hosts, infection is usually asymptomatic, but in immunocompromised patients it can cause serious neurological and ocular consequences, such as encephalitis and retinochoroiditis. Primary infection during pregnancy may cause abortion or congenital toxoplasmosis. Currently, there is no effective human vaccine against this disease. Evidence has emerged from several experimental studies testing nanovaccines showing them to be promising tools in the prevention of experimental toxoplasmosis. For the present study, a literature review was carried out on articles published over the last 10 years through the PubMed database, pertaining to in vivo experimental models of T. gondii infection where nanovaccines were tested and protection and immune responses evaluated. This review aims to highlight the way forward in the search for an effective vaccine for toxoplasmosis.
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Diagnosis of Congenital Toxoplasmosis: Performance of Four IgG and IgM Automated Assays at Birth in a Tricentric Evaluation. J Clin Microbiol 2022; 60:e0011522. [DOI: 10.1128/jcm.00115-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For postnatal diagnosis of congenital toxoplasmosis (CT), the gold standard for the detection of anti-
Toxoplasma
IgM in newborns relies on the immunosorbent agglutination assay (ISAGA), which is manufactured from whole
Toxoplasma
parasites that become difficult to maintain. For IgG, only the Platelia assay provides a validated assay for cord blood according to the manufacturer, allowing its use in this context.
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Diagnosis of Congenital Toxoplasmosis: No Benefit of IgA Antibody Detection by Platelia ELISA in a Tricentric Evaluation. J Clin Microbiol 2022; 60:e0011622. [DOI: 10.1128/jcm.00116-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The diagnostic accuracy of a commercial
Toxoplasma gondii
IgA antibody enzyme-linked immunosorbent assay (ELISA) was evaluated in the context of routine practice on 289 newborns with congenital toxoplasmosis (CT) and 220 healthy controls. The performance of this assay was compared to that of the current gold-standard test for anti-
Toxoplasma
IgM detection, an immunosorbent agglutination assay (ISAGA).
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Abedi B, Akbari M, Azadi D, Habibi D, Khodashenas S, Shariatmadari F. Toxoplasmosis infection in newborn: A systematic review and meta-analysis. Adv Biomed Res 2022; 11:75. [DOI: 10.4103/abr.abr_24_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/04/2022] Open
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Maternal Anti- Toxoplasma Treatment during Pregnancy Is Associated with Reduced Sensitivity of Diagnostic Tests for Congenital Infection in the Neonate. J Clin Microbiol 2021; 59:JCM.01368-20. [PMID: 33208476 DOI: 10.1128/jcm.01368-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022] Open
Abstract
Neonatal diagnosis of congenital toxoplasmosis is based on a combination of serological and molecular tests. Maternal screening and treatment differ according to national policies and may impact the sensitivity of diagnostic methods in infants at birth. In this multicenter study, 115 neonates born to 61 treated (53%) and 54 (47%) untreated women were retrospectively included in three centers (France, Serbia, and the United States) to assess the impact of maternal anti-Toxoplasma treatment on the performance of neonatal workup at birth (neosynthesized anti-Toxoplasma IgM, IgA, and IgG and quantitative PCR [qPCR]) using univariate and multivariate approaches. Independently of the time of maternal seroconversion, the serological techniques were impacted differently by maternal treatment. The detection of IgM by immunosorbent agglutination assay (ISAGA) and Western blotting (WB) dropped from 90.7% and 88.2% in untreated neonates to 53.3% and 51.9% in treated neonates (P < 0.05), whereas IgM enzyme-linked immunosorbent assay (ELISA) and IgA ISAGA were not significantly affected by maternal treatment. A 2-fold reduction in the sensitivity of neosynthesized IgG by WB was also observed in the case of treatment during pregnancy (37.7% versus 82.3%). Interestingly, the effect of treatment was shown to be duration dependent, especially for IgM detection, when the treatment course exceeded 8 weeks, whatever the therapy. The sensitivity of Toxoplasma PCR in blood was also lowered by maternal treatment from 39.1% to 23.2%. These results highlight that anti-Toxoplasma therapy during pregnancy may set back biological evidence of neonatal infection at birth and underline the need for a careful serological follow-up of infants with normal workup.
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9
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Sardarian K, Maghsood AH, Farimani M, Hajiloii M, Saidijam M, Rezaeepoor M, Mahaki H, Zamani A. Evaluation of Toxoplasma gondii B1 gene in Placental Tissues of Pregnant Women with Acute Toxoplasmosis. Adv Biomed Res 2018; 7:119. [PMID: 30211132 PMCID: PMC6124216 DOI: 10.4103/abr.abr_58_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: One of the consequences of toxoplasmosis is the risk of passing it from mother to fetus and the onset of congenital toxoplasmosis during pregnancy. The purpose of this study was to evaluate the B1 gene of Toxoplasma gondii in the placental tissues of pregnant women with acute toxoplasmosis. Materials and Methods: The study was a cross-sectional study. Serum samples of pregnant women who attended to Fatemieh Hospital of Hamadan University of Medical Sciences were tested for immunoglobulin G (IgG) antibodies against T. gondii by enzyme-linked immunosorbent assay. Then, polymerase chain reaction was used to identify the specific B1 gene of T. gondii in IgG seropositive women. The placental tissues of the pregnant women with positive serum B1 gene examined for this gene. Anti-Toxoplasma immunoglobulin M (IgM) was performed on the umbilical cord and neonate blood. Results: Anti-Toxoplasma IgG was detected in 167 out of 653 (25.6%) pregnant women. T. gondii B1 gene was identified in 36 out of 167 (21.6%) of IgG seropositive women. After delivery, the B1 gene was evaluated in 15 out of 36 (41.7%) patients’ placental tissues, 13 of which were positive for this gene (86.7%). Anti-Toxoplasma IgM was detected neither in any umbilical cord nor in neonatal blood samples. All newborns, with the exception of one case, were born with normal birth weight and in term birth. Conclusion: The B1 gene was detected in 86.7% of the placental tissue of women who were involved in acute toxoplasmosis during pregnancy.
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Affiliation(s)
- Khosro Sardarian
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Medical Parasitology and Mycology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Hossein Maghsood
- Department of Medical Parasitology and Mycology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marzieh Farimani
- Department of Endometrium and Endometriosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehrdad Hajiloii
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Immunology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Massoud Saidijam
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahsa Rezaeepoor
- Department of Immunology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hanie Mahaki
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Zamani
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Immunology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Abstract
Pediatric uveitis differs from adult-onset uveitis and is a topic of special interest because of its diagnostic and therapeutic challenges. Children with uveitis are often asymptomatic and the uveitis is often chronic, persistent, recurrent, and resistant to conventional treatment. Anterior uveitis is the most common type of uveitis in children; the prevalence of intermediate, posterior, and panuveitis varies geographically and among ethnic groups. Regarding etiology, most cases of pediatric uveitis are idiopathic but can be due to systemic inflammatory disorders, infections, or a manifestation of masquerade syndrome. Ocular complications include cataracts, hypotony or glaucoma, band keratopathy, synechiae formation, macular edema, optic disc edema, choroidal neovascular membranes, and retinal detachment. These complications are often severe, leading to irreversible structural damage and significant visual disability due to delayed presentation and diagnosis, persistent chronic inflammation from suboptimal treatment, topical and systemic corticosteroid dependence, and delayed initiation of systemic disease‒modifying agents. Treatment for noninfectious uveitis is a stepwise approach starting with corticosteroids. Immunomodulatory therapy should be initiated in cases where quiescence cannot be achieved without steroid dependence. Patients should be monitored regularly for complications of uveitis along with systemic and ocular adverse effects from treatments. The goals are to achieve steroid-free durable remission, to reduce the risk of sight-threatening complications from the uncontrolled ocular inflammation, and to avoid the impact of lifelong burden of visual loss on the child and their family. Multidisciplinary management will ensure holistic care of affected children and improve the support for their families.
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Affiliation(s)
| | - Jessy Choi
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield Children NHS Foundation Trust, Sheffield, United Kingdom
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
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Boudaouara Y, Aoun K, Maatoug R, Souissi O, Bouratbine A, Abdallah RB. Congenital Toxoplasmosis in Tunisia: Prenatal and Neonatal Diagnosis and Postnatal Follow-up of 35 Cases. Am J Trop Med Hyg 2018; 98:1722-1726. [PMID: 29663900 DOI: 10.4269/ajtmh.17-0580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Congenital toxoplasmosis (CT) results from transplacental passage of Toxoplasma gondii to the fetus during acute maternal infection. Our study aims to report clinical and biological patterns of 35 cases of CT diagnosed at the department of the Parasitology of the Pasteur Institute of Tunis and to access the performance of prenatal and early postnatal diagnosis techniques. Serological screening of maternal infection was performed by Immunoglobulin (Ig) M and IgG detection and IgG avidity determination. Prenatal diagnosis was based on both Toxoplasma DNA detection in the amniotic fluid and monthly ultrasound examinations. polymerase chain reaction analysis on amniotic fluid, performed only in 15 cases, detected Toxoplasma's DNA in five cases (33.3%). Ultrasound examination did not reveal any morphological abnormalities. Thirty newborns had serological criteria of Toxoplasma infection. Congenital toxoplasmosis diagnosis was confirmed in 23 cases (76.6%) by immunoblot. Among the 35 born-infants, five (14.3%) were symptomatic: three had chorioretinitis at the first clinical ocular examination, one had neurological symptoms (seizures) with positive parasite DNA in cerebral spinal fluid, and one had both ophthalmological and neurological damages- chorioretinitis and intracranial calcifications in the computed tomography scan. Thirty-four of 35 infected children were treated with pyrimethamine-sulfadiazine combination. Four (11.7%) of the treated infants showed abnormal hematological values because of the treatment side effect. Serological rebound was observed in seven infants. A screening program and a diagnostic algorithm in pregnant women should be implemented in Tunisia to improve the follow-up of seronegative ones and to prevent CT cases.
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Affiliation(s)
- Yosr Boudaouara
- Research Laboratory Medical Parasitology, Biotechnology and Biomolecule LR11IPT-06, Institute Pasteur of Tunis, Tunis, Tunisia
| | - Karim Aoun
- Department of Parasitology, Institute Pasteur of Tunis, Tunis, Tunisia.,Research Laboratory Medical Parasitology, Biotechnology and Biomolecule LR11IPT-06, Institute Pasteur of Tunis, Tunis, Tunisia
| | - Rania Maatoug
- Department of Parasitology, Institute Pasteur of Tunis, Tunis, Tunisia
| | - Olfa Souissi
- Department of Parasitology, Institute Pasteur of Tunis, Tunis, Tunisia
| | - Aïda Bouratbine
- Department of Parasitology, Institute Pasteur of Tunis, Tunis, Tunisia.,Research Laboratory Medical Parasitology, Biotechnology and Biomolecule LR11IPT-06, Institute Pasteur of Tunis, Tunis, Tunisia
| | - Rym Ben Abdallah
- Research Laboratory Medical Parasitology, Biotechnology and Biomolecule LR11IPT-06, Institute Pasteur of Tunis, Tunis, Tunisia.,Department of Parasitology, Institute Pasteur of Tunis, Tunis, Tunisia
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12
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An updated literature review on maternal-fetal and reproductive disorders of Toxoplasma gondii infection. J Gynecol Obstet Hum Reprod 2017; 47:133-140. [PMID: 29229361 DOI: 10.1016/j.jogoh.2017.12.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Toxoplasma gondii infection is one of the most prevalent infectious disease with worldwide distribution. Congenital toxoplasmosis is annually responsible for 1.20 million disability-adjusted life years around the world, but often it is overlooked many countries. METHODS We performed an updated review to summarize the current researches on fetal, neonatal and maternal consequences of T. gondii infection and also adverse effects of toxoplasmosis on women reproductive organs. RESULTS T. gondii infection could be cause of several abnormalities from hydrocephalus, microcephaly, deafness, abortion and still birth in fetal to psychomotor retardation, intellectual disability, hearing loss, slower postnatal motor development during the first year of life; and chorioretinitis, cryptogenic epilepsy and autism spectrum disorders in newborns. Moreover, this infection is related with neuropsychiatric disorders such as anxiety, schizophrenia spectrum disorders, depression, decreased weight, autoimmune thyroid diseases, self-directed violence, violent suicide attempts in mothers. This literature review emphasized that toxoplasmosis could be an important neglected factor endometritis, ovarian dysfunction, impaired folliculogenesis, ovarian and uterine atrophy, decrease in reproductive organs weight and reproductive performance in women. We reviewed role of the immunological profile such as pro-infiammatory cytokines and hormonal changes as main potential mechanisms related to this infection and development of maternal-fetal and reproductive disorders. CONCLUSION T. gondii is associated with several brain related disorders in both mothers and newborns, and also it is cause of several abnormalities in reproductive organs. Early diagnosis and treatment of the infection could be effective to significantly improve the clinical outcome.
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de Castro Zacche-Tonini A, Fonseca GSF, de Jesus LNNP, Barros GB, Coelho-Dos-Reis JGA, Béla SR, Machado AS, Carneiro ACAV, Andrade GMQ, Vasconcelos-Santos DV, Januário JN, Teixeira-Carvalho A, Vitor RWA, Ferro EAV, Mineo JR, Martins-Filho OA, Lemos EM. Establishing tools for early diagnosis of congenital toxoplasmosis: Flow cytometric IgG avidity assay as a confirmatory test for neonatal screening. J Immunol Methods 2017; 451:37-47. [PMID: 28827190 DOI: 10.1016/j.jim.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 11/24/2022]
Abstract
The aim of this study was to evaluate the performance of conventional serology (Q-Preven™ and ELFAVIDAS™) and flow cytometry-based serologic tools for early serologic diagnosis of congenital toxoplasmosis. The study groups included prospectively confirmed cases of congenital toxoplasmosis (TOXO=88) and age-matching non-infected controls (NI=15).The results demonstrated that all samples tested positive/indeterminate for anti-T. gondii IgM screening at birth using air-dried whole blood samples. Serum samples collected at 30-45days after birth tested positive for ELFAVIDAS™ IgG in both groups. While all NI tested negative for ELFAVIDAS™ IgM and IgA, only 78% and 36% of TOXO tested positive for IgM and IgA, respectively. Flow cytometry-based anti-T. gondii IgM, IgA and IgG reactivity displayed moderate performance with low sensitivity (47.6%, 72.6% and 75.0%, respectively). Regardless the remarkable specificity of IgG1, IgG2 and IgG3 subclasses for early diagnosis, weak or moderate specificity was observed (Se=73.9%, 60.2% and 83.0%, respectively). The analysis of IgG avidity indices (AI) demonstrated the highest performance among the flow cytometry-based methods (Se=96.6%; Sp=93.3%), underscoring the low avidity index (AI<60%) within TOXO (97.0%) in contrast with the high avidity index (AI>60%) in NI (93%). Analysis of anti-T. gondii IgG and IgG3 reactivity for mother:infant paired samples may represent a relevant complementary tests for early diagnosis. In conclusion, a feasible high-standard algorithm (Accuracy=97.1%) was proposed consisting of Q-Preven™ IgM screening at birth, followed by ELFAVIDAS™ IgM and flow cytometric IgG avidity analysis at 30-45days after birth as a high performance tool for early serological diagnosis of congenital toxoplasmosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gláucia Manzan Queiroz Andrade
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Núcleo de Ações e pesquisa em Apoio Diagnóstico (NUPAD), Belo Horizonte, MG, Brazil
| | | | - José Nélio Januário
- Núcleo de Ações e pesquisa em Apoio Diagnóstico (NUPAD), Belo Horizonte, MG, Brazil
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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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Dard C, Chemla C, Fricker-Hidalgo H, Brenier-Pinchart MP, Baret M, Mzabi A, Villena I, Pelloux H. Late diagnosis of congenital toxoplasmosis based on serological follow-up: A case report. Parasitol Int 2017; 66:186-189. [DOI: 10.1016/j.parint.2016.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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Mahmoudi S, Mamishi S, Suo X, Keshavarz H. Early detection of Toxoplasma gondii infection by using a interferon gamma release assay: A review. Exp Parasitol 2016; 172:39-43. [PMID: 27988201 DOI: 10.1016/j.exppara.2016.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 11/15/2022]
Abstract
Antibody-based serological tests are currently the most common diagnostic methods for detection of Toxoplasma gondii; however, these tests bear several limitations. Recently, Interferon-gamma release assay (IGRA), a T-cell-based test, was introduced as an in vitro test for detection of T. gondii infection. Few studies have investigated the potential role of cell immunity in diagnosis of toxoplasmosis. IGRA accurately distinguished infected from uninfected individuals, showing strong lymphocyte activation after in vitro stimulation with T. gondii antigens, even during the first days of life. IGRA is an easy-operation and low-cost method to measure cell mediated immunity against T. gondii. The results of this review underline the importance of evaluating cellular immunity to establish an early diagnosis particularly for congenital toxoplasmosis. Therefore, ELISA-based IGRA holds the potential to become a useful diagnostic tool for early detection of T. gondii infection.
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Affiliation(s)
- Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran; Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran; Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Xun Suo
- State Key Laboratory for Agrobiotechnology, China Agricultural University, Beijing 100193, China; National Animal Protozoa Laboratory & College of Veterinary Medicine, China Agricultural University, Beijing 100193, China; Key Laboratory of Animal Epidemiology and Zoonosis of Ministry of Agriculture, Beijing 100193, China
| | - Hossein Keshavarz
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran; Department of Medical Parasitology and Mycology, School of Public Heath, Tehran University of Medical Science, Tehran, Iran.
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Evaluation of the Western blotting method for the diagnosis of congenital toxoplasmosis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Evaluation of the Western blotting method for the diagnosis of congenital toxoplasmosis. J Pediatr (Rio J) 2016; 92:616-623. [PMID: 27504975 DOI: 10.1016/j.jped.2016.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the Western blotting method for the detection of IgG anti-Toxoplasma gondii (T. gondii) (IgG-WB) in the serum of children with suspected congenital toxoplasmosis. METHODS We accompanied 47 mothers with acquired toxoplasmosis in pregnancy and their children, between June of 2011 and June of 2014. The IgG-WB was done in house and the test was considered positive if the child had antibodies that recognized at least one band on IgG blots different from the mother's or with greater intensity than the corresponding maternal band, during the first three months of life. RESULTS 15 children (15.1%) met the criteria for congenital toxoplasmosis and 32 (32.3%) had the diagnosis excluded. The symptoms were observed in 12 (80.0%) children and the most frequent were cerebral calcification in 9 (60.0%), chorioretinitis in 8 (53.3%), and hydrocephalus in 4 (26.6%). IgM antibodies anti-T. gondii detected by chemiluminescence (CL) were found in 6 (40.0%) children and the polymerase chain reaction (PCR) for detection of T. gondii DNA was positive in 5 of 7 performed (71.4%). The sensitivity of IgG-WB was of 60.0% [95% confidence interval (CI) 32.3-83.7%] and specificity 43.7% (95% CI 26.7-62.3%). The sensitivity of IgG-WB increased to 76.0 and 89.1% when associated to the research of IgM anti-T. gondii or PCR, respectively. CONCLUSIONS The IgG-WB showed greater sensitivity than the detection of IgM anti-T. gondii; therefore, it can be used for the diagnosis of congenital toxoplasmosis in association with other congenital infection markers.
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Dard C, Fricker-Hidalgo H, Brenier-Pinchart MP, Pelloux H. Relevance of and New Developments in Serology for Toxoplasmosis. Trends Parasitol 2016; 32:492-506. [PMID: 27167666 DOI: 10.1016/j.pt.2016.04.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 12/26/2022]
Abstract
Toxoplasmosis is a widespread parasitic disease caused by the intracellular parasite Toxoplasma gondii with a wide spectrum of clinical outcomes. The biological diagnosis of toxoplasmosis is often difficult and of paramount importance because clinical features are not sufficient to discriminate between toxoplasmosis and other illnesses. Serological tests are the most widely used biological tools for the diagnosis of toxoplasmosis worldwide. This review focuses on the crucial role of serology in providing answers to the most important questions related to the epidemiology and diagnosis of toxoplasmosis in human pathology. Notwithstanding their undeniable importance, serological tools need to be continuously improved and the interpretation of the ensuing results remains complex in many circumstances.
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Affiliation(s)
- Céline Dard
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier et Universitaire de Grenoble Alpes, Grenoble, France; Institut Albert Bonniot, INSERM U1209 - CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France.
| | - Hélène Fricker-Hidalgo
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier et Universitaire de Grenoble Alpes, Grenoble, France
| | - Marie-Pierre Brenier-Pinchart
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier et Universitaire de Grenoble Alpes, Grenoble, France; Institut Albert Bonniot, INSERM U1209 - CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
| | - Hervé Pelloux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier et Universitaire de Grenoble Alpes, Grenoble, France; Institut Albert Bonniot, INSERM U1209 - CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
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20
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Abstract
Recent studies have demonstrated that screening and treatment for toxoplasmosis during gestation result in a decrease of vertical transmission and clinical sequelae. Early treatment was associated with improved outcomes. Thus, laboratory methods should aim for early identification of infants with congenital toxoplasmosis (CT). Diagnostic approaches should include, at least, detection of Toxoplasma IgG, IgM, and IgA and a comprehensive review of maternal history, including the gestational age at which the mother was infected and treatment. Here, we review laboratory methods for the diagnosis of CT, with emphasis on serological tools. A diagnostic algorithm that takes into account maternal history is presented.
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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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Hernández-Cortazar I, Acosta-Viana KY, Ortega-Pacheco A, Guzman-Marin EDS, Aguilar-Caballero AJ, Jiménez-Coello M. Toxoplasmosis in Mexico: epidemiological situation in humans and animals. Rev Inst Med Trop Sao Paulo 2016; 57:93-103. [PMID: 25923887 PMCID: PMC4435006 DOI: 10.1590/s0036-46652015000200001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/16/2014] [Indexed: 11/22/2022] Open
Abstract
Toxoplasmosis is a parasitic disease widely distributed throughout the world,
infecting a wide variety of animal species including humans. In Mexico, this parasite
has been detected in different parts of the country, particularly in the tropical
areas where the parasite can remain infective for long periods of time due to the
environmental conditions (i.e. high temperature and humidity over the whole year).
Several epidemiological studies have been conducted in both human and animal
populations, but despite the wide distribution of the agent in the country, there is
a significant lack of knowledge on the parasite transmission, treatment alternatives
and control measures. The lack of feral cat populations and control measures in sites
of meat production for human consumption are playing a role that has led to the wide
spread of the disease in the country, particularly in tropical areas of Southeastern
Mexico. For these reasons, this manuscript aims to review the published information
on relevant epidemiological aspects of infection with T. gondii in
humans and animals from Mexico.
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Affiliation(s)
- Ivonne Hernández-Cortazar
- CA Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Hideyo Noguchi", Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Karla Y Acosta-Viana
- CA Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Hideyo Noguchi", Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Antonio Ortega-Pacheco
- CA Salud Animal, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Eugenia del S Guzman-Marin
- CA Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Hideyo Noguchi", Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Armando J Aguilar-Caballero
- CA Salud Animal, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Matilde Jiménez-Coello
- CA Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Hideyo Noguchi", Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
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Blay EA, Ghansah A, Otchere J, Koku R, Kwofie KD, Bimi L, Takashi S, Ohta N, Ayi I. Congenital toxoplasmosis and pregnancy malaria detection post-partum: Effective diagnosis and its implication for efficient management of congenital infection. Parasitol Int 2015; 64:603-8. [DOI: 10.1016/j.parint.2015.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/25/2015] [Accepted: 08/07/2015] [Indexed: 11/28/2022]
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Villard O, Cimon B, L'Ollivier C, Fricker-Hidalgo H, Godineau N, Houze S, Paris L, Pelloux H, Villena I, Candolfi E. Serological diagnosis of Toxoplasma gondii infection: Recommendations from the French National Reference Center for Toxoplasmosis. Diagn Microbiol Infect Dis 2015; 84:22-33. [PMID: 26458281 DOI: 10.1016/j.diagmicrobio.2015.09.009] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/03/2015] [Accepted: 09/09/2015] [Indexed: 11/17/2022]
Abstract
Toxoplasmosis manifests no clinical signs in 80% of cases in immunocompetent patient, causing immunization characterized by the persistence of cysts, particularly in brain, muscles, and retina. Assessing the serological status, based on testing for serum toxoplasma IgG and IgM antibodies, is essential in cases that are increasingly at risk for the more severe disease forms, such as congenital or ocular toxoplasmosis. This disease also exposes immunosuppressed patients to reactivation, which can lead to more widespread forms and increased mortality. By interpreting the serological results, we can estimate the risk of contamination or reactivation and define appropriate prophylactic and preventive measures, such as hygienic and dietetic, therapeutic, biological, and clinical follow-up, according to the clinical context. We hereby propose practical approaches based on serological data, resulting from a consensus of a group of experts from the French National Reference Center Network for Toxoplasmosis, according to both routine and specific clinical situations.
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Affiliation(s)
- O Villard
- Institut de Parasitologie et de Pathologie Tropicale de Strasbourg, Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, 1-3 rue Koeberlé, F-67000 Strasbourg, France.
| | - B Cimon
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, 4 rue Larrey, F-49933 Angers Cedex 9, France
| | - C L'Ollivier
- Laboratoire de Parasitologie-Mycologie, Hôpital de la Timone, 264 rue Saint Pierre, F-13385 Marseille Cedex 05, France
| | - H Fricker-Hidalgo
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire A. Michallon et Université de Grenoble BP 217, 38043 Grenoble Cedex, France
| | - N Godineau
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Saint-Denis, 2 rue du Docteur Pierre Delafontaine, BP 279, F-93205 Saint-Denis Cedex, France
| | - S Houze
- Laboratoire de Parasitologie Mycologie, AP-HP Hôpital BICHAT-Claude Bernard, 46 rue Henri Huchard, F-75877 Paris Cedex 18, France
| | - L Paris
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Laboratoire de Parasitologie-Mycologie, 47-83 Boulevard de l'Hôpital, F-75651 Paris Cedex 13, France
| | - H Pelloux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire A. Michallon et Université de Grenoble BP 217, 38043 Grenoble Cedex, France
| | - I Villena
- Laboratoire de Parasitologie-Mycologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire et Université de Reims Champagne Ardennes, 45 rue Cognacq-Jay, F-51092 Reims Cedex, France
| | - E Candolfi
- Institut de Parasitologie et de Pathologie Tropicale de Strasbourg, Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, 1-3 rue Koeberlé, F-67000 Strasbourg, France.
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Assessment of the IgA immunosorbent agglutination assay for the diagnosis of congenital toxoplasmosis on a series of 145 toxoplasmic seroconversions. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:456-8. [PMID: 25673306 DOI: 10.1128/cvi.00666-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A retrospective analysis of 145 medical records from our teaching hospital laboratory showed an overall specificity of greater than 97% for the IgA immunosorbent agglutination assay (ISAGA A) performed on the sera of babies to diagnose congenital toxoplasmosis (CT). These actualized data emphasize the ability of this test to confirm a diagnosis of congenital toxoplasmosis.
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Ángel Muller E, Hougton MP, Eslava C, Riaño J, Rey GE, Gómez Marín JE. Gestational and congenital toxoplasmosis in two hospitals in Bogota, Colombia. REVISTA DE LA FACULTAD DE MEDICINA 2014. [DOI: 10.15446/revfacmed.v62n2.45430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Rodrigues IMX, Costa TL, Avelar JB, Amaral WN, Castro AM, Avelino MM. Assessment of laboratory methods used in the diagnosis of congenital toxoplasmosis after maternal treatment with spiramycin in pregnancy. BMC Infect Dis 2014; 14:349. [PMID: 24961630 PMCID: PMC4230641 DOI: 10.1186/1471-2334-14-349] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 06/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The different laboratory methods used in the diagnosis of congenital toxoplasmosis have variable sensitivity and specificity. There is no evidence to prove that maternal treatment reduces the risk of fetal infection. The purpose of this study was to assess methods for the confirmation of congenital toxoplasmosis after maternal treatment with spiramycin during pregnancy, and to evaluate the effect of this treatment on clinical manifestations of the disease in newborns (NB). METHODS This was a community-based, cross-sectional study of acute toxoplasmosis in newborns at risk of acquiring congenital infection. Participating newborns were born in the Clinical Hospital Maternity Ward of the Federal University of Goiás. Eligible participants were divided into 2 groups: group 1 consisted of 44 newborns born to mothers treated with spiramycin during pregnancy and group 2 consisted of 24 newborns born to mothers not treated with spiramycin during pregnancy because the diagnosis of toxoplasmosis was not performed. The sensitivity and specifity of PCR for T. gondii DNA in peripheral blood and serological testing for specific anti-T. gondii IgM and IgA, and the effects of maternal spiramycin treatment on these parameters, were determined by associating test results with clinical manifestations of disease. RESULTS The sensitivity of the markers (T. gondii DNA detected by PCR, and the presence of specific anti-T. gondii IgM and IgA) for congenital toxoplasmosis was higher in group 2 than in group 1 (31.6, 68.4, 36.8% and 3.7, 25.9, 11.1% respectively). Even with a low PCR sensitivity, the group 2 results indicate the importance of developing new techniques for the diagnosis of congenital toxoplasmosis in newborns. Within group 1, 70.4% of the infected newborns were asymptomatic and, in group 2, 68.4% showed clinical manifestations of congenital toxoplasmosis. CONCLUSIONS The higher proportion of infants without clinical symptoms in group 1 (70.4%) suggests the maternal treatment with spiramycin delays fetal infection, reducing the clinical sequelae of the disease in newborns. Given the low sensitivity of the tests used, when there is suspicion of congenital transmission several serological and parasitological tests are required in order to confirm or exclude congenital toxoplasmosis in newborns.
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Affiliation(s)
- Isolina MX Rodrigues
- Laboratory studies of the host-parasite relationship (LAERPH) of Institute for Tropical Pathology and Public Health (IPTSP) of the Federal University of Goiás (UFG), Goiânia, Brazil
| | - Tatiane L Costa
- Clinical Laboratory of the University Hospital of the Federal University of Goiás (UFG), Goiânia, Brazil
| | - Juliana B Avelar
- Laboratory studies of the host-parasite relationship (LAERPH) of Institute for Tropical Pathology and Public Health (IPTSP) of the Federal University of Goiás (UFG), Goiânia, Brazil
| | - Waldemar N Amaral
- Department of Gynecology and Obstetrics of the Faculty of Medicine - FM/UFG, Goiânia, Brazil
| | - Ana M Castro
- Laboratory studies of the host-parasite relationship (LAERPH) of Institute for Tropical Pathology and Public Health (IPTSP) of the Federal University of Goiás (UFG), Goiânia, Brazil
| | - Mariza M Avelino
- Department of Pediatrics and Puericulture in the Medical School (MS) of Federal University of Goiás (UFG), Av. s/n Setor Leste Universitário, Goiânia-GO CEP: 74001-970, Brazil
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Evaluation of a new protocol for retrospective diagnosis of congenital toxoplasmosis by use of Guthrie cards. J Clin Microbiol 2014; 52:2963-70. [PMID: 24899036 DOI: 10.1128/jcm.00106-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to assess the diagnostic value of IgM Western blotting (WB), IgA enzyme immunoassay (EIA), and DNA amplification by real-time PCR on Guthrie cards to retrospectively establish the diagnosis of congenital toxoplasmosis (CT). To this purpose, Guthrie cards were collected from 18 infants born to mothers with primary Toxoplasma gondii infection during pregnancy. Moreover, the analytical sensitivity of T. gondii PCR was assessed by testing mock dried blood specimens set up with several known DNA dilutions. IgM WB was demonstrated to be the most sensitive method. When the results of T. gondii DNA detection and specific IgM recovery were combined, retrospective CT diagnosis by using Guthrie cards was established in 3 out of 6 infected infants (sensitivity, 50%; 95% confidence interval, 26.8% to 73.2%). No positive PCR or serologic results were found in the group of 12 uninfected infants, demonstrating the excellent specificity of the three methods (95% confidence interval, 78.1% to 99.5%). The findings of the present study suggest that, in cases of missed diagnosis of CT at birth, analysis of Guthrie cards for children with compatible clinical findings after the perinatal period, in particular the combination of recovery of specific IgM antibodies and T. gondii DNA amplification, could be helpful. Nevertheless, since suboptimal conditions of storage of dried blood specimens can seriously affect sensitivity, negative results cannot rule out CT diagnosis. In contrast, because of the excellent specificity shown by IgM serologic testing and T. gondii DNA amplification on Guthrie cards, positive results obtained by either of the two methods should be considered diagnostic.
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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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30
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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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Murat JB, Fricker Hidalgo H, Brenier-Pinchart MP, Pelloux H. Human toxoplasmosis: which biological diagnostic tests are best suited to which clinical situations? Expert Rev Anti Infect Ther 2014; 11:943-56. [DOI: 10.1586/14787210.2013.825441] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Malik A, Rizvi M, Khan F, Khan N, Rabbani T, Khan HM. Toxoplasma gondii in women with bad obstetric history and infertility: a five-year study. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60446-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Siberry GK, Abzug MJ, Nachman S, Brady MT, Dominguez KL, Handelsman E, Mofenson LM, Nesheim S, National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association of the Infectious Diseases Society of America, Pediatric Infectious Diseases Society, American Academy of Pediatrics. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. Pediatr Infect Dis J 2013; 32 Suppl 2:i-KK4. [PMID: 24569199 PMCID: PMC4169043 DOI: 10.1097/01.inf.0000437856.09540.11] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- George K Siberry
- 1National Institutes of Health, Bethesda, Maryland 2University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado 3State University of New York at Stony Brook, Stony Brook, New York 4Nationwide Children's Hospital, Columbus, Ohio 5Centers for Disease Control and Prevention, Atlanta, Georgia
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Meira CS, Vidal JE, Costa-Silva TA, Motoie G, Gava R, Hiramoto RM, Pereira-Chioccola VL. IgG4 specific to Toxoplasma gondii excretory/secretory antigens in serum and/or cerebrospinal fluid support the cerebral toxoplasmosis diagnosis in HIV-infected patients. J Immunol Methods 2013; 395:21-8. [PMID: 23811152 DOI: 10.1016/j.jim.2013.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 06/16/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
Cerebral toxoplasmosis is the most common neurological opportunistic disease manifested in HIV infected patients. Excretory/secretory antigens (ESA) are serological markers for the diagnosis of reactivation of the infection in HIV-infected patients with cerebral toxoplasmosis. Immunosuppressed patients develop high antibody titers for ESA. However, little is known about the humoral response for these antigens. The present study analyzed the profile of antibody recognition against ESA in comparison with tachyzoite lysate antigen (TLA) in 265 sera and 270 cerebrospinal fluid (CSF) samples from infected patients with Toxoplasma gondii and or HIV and in sera of 50 healthy individuals. The samples of sera and CSF were organized in 8 groups. The sera sample groups were: Group I - Se/CT/AIDS (patients with cerebral toxoplasmosis/AIDS) with 58 samples; Group II - Se/ONinf/AIDS/PosT (patients with AIDS/other neuroinfections/positive toxoplasmosis) with 49 samples; Group III - Se/ONinf/AIDS/NegT (patients with AIDS/other neuroinfections/negative toxoplasmosis) with 58 samples; Group IV - Se/PosT/NegHIV (individuals with asymptomatic toxoplasmosis/negative HIV) with 50 samples and Group V - Se/NegT/NegHIV (healthy individuals/negative toxoplasmosis and HIV) with 50 samples. The CSF sample groups were: Group VI - CSF/CT/AIDS (patients with cerebral toxoplasmosis/AIDS) with 99 samples; Group VII - CSF/ONinf/AIDS/PosT (patients with AIDS/other neuroinfections/positive toxoplasmosis) with 112 samples, and Group VIII - CSF/ONinf/AIDS/NegT (patients with AIDS/other neuroinfections/negative toxoplasmosis) with 59 samples. Levels of IgM, IgA, IgE, IgG and subclasses were determined by ELISA against TLA and ESA antigens. IgM, IgA or IgE antibodies against ESA or TLA were not detected in sera from patients with toxoplasmosis suggesting that all patients were in chronic phase of the infection. High levels of IgG1 against TLA were found in sera samples from groups I, II and IV and in CSF samples from groups VI and VII; whereas IgG2, IgG3 and IgG4 levels were not detected in the same sera or CSF sample groups. However, patients from groups I and VI, that had tachyzoites circulating in blood and CSF respectively, produced a mix of IgG1 and IgG4 antibodies against ESA. IgG2 against ESA were predominant in serum from patients with the latent (non-active) T. gondii infection/HIV negative and in CSF samples from patients with other neuroinfections and positive toxoplasmosis (groups IV and VII, respectively). IgG4 levels against ESA were found to be significantly (P<0.05 and P<0.005) higher in patients with cerebral toxoplasmosis (groups I and VI, respectively) in comparison with groups II, IV and VII. This data suggest that IgG4 can be valuable for supporting the diagnosis of focal brain lesions, caused by T. gondii infection, in HIV-infected patients. This approach might be useful, mainly when molecular investigation to detect parasites is not available.
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Affiliation(s)
- Cristina S Meira
- Laboratorio de Parasitologia do Instituto Adolfo Lutz, Sao Paulo, SP, Brazil
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Comparison of the Vidas system and two recent fully automated assays for diagnosis and follow-up of toxoplasmosis in pregnant women and newborns. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 20:1203-12. [PMID: 23740928 DOI: 10.1128/cvi.00089-13] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Serological testing to detect toxoplasmosis is of major importance to avoid the possible effects of the disease in newborns. This study assessed anti-Toxoplasma IgG and IgM with the Vidas (bioMérieux), Architect (Abbott), and Liaison (DiaSorin) systems in 631 sera from pregnant women and newborns as well as anti-Toxoplasma IgG avidity with these three systems on 54 sera from pregnant women with positive IgG and IgM. The IgG and IgM results were in agreement in, respectively, 95.2% and 98.3% (Vidas versus Architect) and 96.9% and 95.3% (Vidas versus Liaison) of the samples. Specificities were excellent for all the assays, while Vidas sensitivities ranged (depending on the classification of gray zone results) from 93.8 to 98.4% for IgG (Architect, 84.4 to 93.8%; Liaison, 93.8%) and from 81.8 to 90.9% for IgM (Architect, 63.6%; Liaison, 81.8 to 90.9%). In seroconversion sequences, IgMs were generally detected simultaneously by the three assays, while Architect was the earliest assay to detect IgG. In noninfected children, maternally transmitted IgGs were detected for a longer time with Architect than with the other systems. IgMs were positive in only one infected child with the Vidas and Liaison systems. Significantly more sera were classified in the high-avidity category with Vidas than with Architect. This evaluation shows similar performances for Vidas and more recent systems. The Vidas system adequately detects toxoplasmosis in pregnant women and newborns. This system fits the needs of laboratories working on small routine series for first-line testing as well as expert laboratories, due to a high specificity and a powerful avidity test.
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Abstract
Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus have in common that they can cause congenital (TORCH) infection, leading to fetal and neonatal morbidity and mortality. During the last decades, TORCH screening, which is generally considered to be single serum testing, has been increasingly used inappropriately and questions have been raised concerning the indications and cost-effectiveness of TORCH testing. The problems of TORCH screening lie in requesting the screening for the wrong indications, wrong interpretation of the single serum results and in case there is a good indication for diagnosis of congenital infection, sending in the wrong materials. This review provides an overview of the pathogenesis, epidemiology and clinical consequences of congenital TORCH infections and discusses the indications for, and interpretation of, TORCH screens.
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Affiliation(s)
- Eveline P de Jong
- Department of Paediatrics, Juliana Children’s Hospital, HAGA Hospital, The Hague, The Netherlands
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Abstract
IgM may persist for months, presenting a risk of an erroneous diagnosis where serology is the only available tool. Indeed, IgM may be detected in secondary infection as a result of crossreactivity and/or nonspecific stimulation of the immune system. One test that can aid the serologist is IgG avidity testing, in that the avidity of IgG is low early in infection with the avidity of IgG antibodies increasing over time. Congenital toxoplasmosis can induce serious sequelae. Detectable IgM usually persists long after the acute infection. IgG avidity can be an important aid in diagnosis and assessing the risk to the fetus. Another infection that is of concern in pregnancy is cytomegalovirus (CMV). In pregnant women it is very important to differentiate primary from secondary infection, as primary infection presents the highest risk to the fetus. Serologic detection of IgM alone is not a specific marker of primary CMV infection. IgG avidity can have utility in identifying or excluding primary CMV infections during pregnancy. Outside of pregnancy, IgG avidity testing is increasingly recognized as a valuable tool. During the recent West Nile virus (WNV) epidemic in the US, it was recognized that WNV-specific IgM may persist for 6 - 12 months following exposure. Thus, a person presenting to their clinician with nonspecific symptoms may be tested and return a positive WNV IgM that may be the product of exposure during the previous period. In this environment, WNV IgG avidity testing is able to provide some assistance. IgG avidity testing should not be used alone and without an understanding of the limitations of the technique. Serology remains an important tool for the diagnosis and management of infectious disease. Classically, IgM is defined as a marker of acute infection and IgG, in the absence of clinical disease, is often considered a marker of past infection. However, the clinical reality can be quite different.
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Affiliation(s)
- Stuart L Hazell
- Panbio Ltd, 532 Seventeen Mile Rocks Road, Sinnamon Park, Brisbane, Queensland 4073, Australia +617 3363 7100 ; +617 3363 7199 ;
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Soares JAS, Carvalho SFG, Caldeira AP. Profile of pregnant women and children treated at a reference center for congenital toxoplasmosis in the northern state of Minas Gerais, Brazil. Rev Soc Bras Med Trop 2012; 45:55-9. [PMID: 22370829 DOI: 10.1590/s0037-86822012000100011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 09/09/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To describe the clinical and epidemiological profile of pregnant women and children treated at a reference outpatient clinic for congenital toxoplasmosis. METHODS Pregnant women potentially exposed to Toxoplasma gondii were observed. Diagnoses were made using serologic tests compatible with acute toxoplasmosis. Children presenting with: Toxoplasma-specific antibodies (IgM or IgA or ascending IgG titers higher than maternal titers in the first 3 months of life) coupled with toxoplasmosis symptoms; intracranial calcifications (by transfontanelar ultrasound or cephalic segment tomography); or retinochoroiditis (by fundoscopy examination) in the first 8 months of life were also included in the study. RESULTS Fifty-eight mother-child pairs were observed (mean age of the mothers was 22.1 years). Most patients lived in urban areas (86.2%) and had attended less than 8 years of school (51.7%). Diagnosis was made after birth in 19 (32.8%) children. Thirty-four (58.6%) women received some type of treatment during pregnancy. Most (72.4%) of the children did not present with clinical alterations at birth. The main findings were ophthalmological: 20 (34.5%) children with retinochoroiditis, 17 (29.3%) with strabismus, and 7 (12.1%) with nystagmus. Of the children with retinochoroiditis, 9 presented with subnormal vision. Ten (32.3%) out of 31 children presented with intracranial calcifications by cephalic segment congenital toxoplasmosis, and 9 (42.9%) children presented with delayed psychomotor development. CONCLUSIONS Our results highlight a critical situation. Protocols for follow-up of pregnant women and their children must be created to improve medical care and minimize sequelae.
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Evaluation of the liaison automated testing system for diagnosis of congenital toxoplasmosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1859-63. [PMID: 23015644 DOI: 10.1128/cvi.00489-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital toxoplasmosis is a worldwide health problem, and different screening strategies exist. Testing of toxoplasma-specific antibodies in infants identifies congenital toxoplasmosis during the first year of life. However, experience with commercial available immunoassays is limited. The aim of this study was to evaluate both the performance and analytical characteristics of the Liaison diagnostic system in infants. In a retrospective study, serum Toxoplasma gondii antibodies were measured in samples from 333 infants, including 212 noninfected infants and 121 infants with congenital toxoplasmosis. A total of 1,157 umbilical cord blood and peripheral serum samples were analyzed. Liaison toxoplasma-specific IgG and IgM antibodies and the IgG avidity index were compared to the infection status of the infant, determined by the Sabin-Feldman dye test and immunosorbent agglutination assay--IgM. All noninfected infants were seronegative by Liaison IgG within the first year of life. The Liaison system showed a sensitivity of 81.8%, a specificity of 100.0%, a positive predictive value of 100.0%, a negative predictive value of 90.6%, and overall agreement of 84.4% by comparison with the dye test. Overall agreement of both IgM test systems was 96.0%. In this study cohort, avidity did not show a potential diagnostic benefit for the detection of congenital infection. In conclusion, the Liaison system is a valuable tool to monitor the serologic course of infants at risk. A final serologic confirmatory test is recommended to improve the rate of detection of congenital toxoplasmosis at 1 year of life. Protocols of routine follow-up testing in infants and accurate diagnostic tools after acute gestational infections are needed to improve medical care.
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Dechavanne C, Guillonneau F, Chiappetta G, Sago L, Lévy P, Salnot V, Guitard E, Ehrenmann F, Broussard C, Chafey P, Le Port A, Vinh J, Mayeux P, Dugoujon JM, Lefranc MP, Migot-Nabias F. Mass spectrometry detection of G3m and IGHG3 alleles and follow-up of differential mother and neonate IgG3. PLoS One 2012; 7:e46097. [PMID: 23049948 PMCID: PMC3457951 DOI: 10.1371/journal.pone.0046097] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 08/28/2012] [Indexed: 12/03/2022] Open
Abstract
Mass spectrometry (MS) analysis for detection of immunoglobulins (IG) of the human IgG3 subclass is described that relies on polymorphic amino acids of the heavy gamma3 chains. IgG3 is the most polymorphic human IgG subclass with thirteen G3m allotypes located on the constant CH2 and CH3 domains of the gamma3 chain, the combination of which leads to six major G3m alleles. Amino acid changes resulting of extensive sequencing previously led to the definition of 19 IGHG3 alleles that have been correlated to the G3m alleles. As a proof of concept, MS proteotypic peptides were defined which encompass discriminatory amino acids for the identification of the G3m and IGHG3 alleles. Plasma samples originating from ten individuals either homozygous or heterozygous for different G3m alleles, and including one mother and her baby (drawn sequentially from birth to 9 months of age), were analyzed. Total IgG3 were purified using affinity chromatography and then digested by a combination of AspN and trypsin proteases, and peptides of interest were detected by mass spectrometry. The sensitivity of the method was assessed by mixing variable amounts of two plasma samples bearing distinct G3m allotypes. A label-free approach using the high-performance liquid chromatography (HPLC) retention time of peptides and their MS mass analyzer peak intensity gave semi-quantitative information. Quantification was realized by selected reaction monitoring (SRM) using synthetic peptides as internal standards. The possibility offered by this new methodology to detect and quantify neo-synthesized IgG in newborns will improve knowledge on the first acquisition of antibodies in infants and constitutes a promising diagnostic tool for vertically-transmitted diseases.
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Affiliation(s)
- Célia Dechavanne
- Unité Mixte de Recherche (UMR) 216 Mère et enfant face aux infections tropicales, Institut de Recherche pour le Développement (IRD), Paris, France.
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Abstract
Toxoplasmosis is a worldwide infection caused by the intracellular parasite Toxoplasma gondii. At least a third of the world human population are infected with the parasite, making it one of the most successful parasitic infections. Primary maternal infection may cause health-threatening sequelae for the foetus, or even cause death in uterus. Reactivation of a latent infection in immune deficiency conditions such as AIDS and organ transplantation can cause fatal toxoplasmic encephalitis. Toxoplasmosis is a major cause of retinochoroiditis, especially in individuals with an impaired immune system. Despite the usually 'asymptomatic' nature of the infection, a significant burden imposed by the parasite necessitates the implementation of effective means for the prevention, diagnosis, and management of this disease. Laboratory diagnosis, i.e. PCR and serologic assays, plays the main role in the diagnosis of congenital infection and assists in the confirmatory diagnosis of toxoplasmic encephalitis and ocular toxoplasmosis. Here, we briefly review general aspects of Toxoplasma infection and focus on the diagnostic methods currently used in medical laboratories for the diagnosis of Toxoplasma infection.
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Affiliation(s)
- Geita Saadatnia
- Molecular Parasitology Laboratory, Parasitology Department, Pasteur Institute of Iran, Tehran, Iran
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Bamba S, Some DA, Chemla C, Geers R, Guiguemde TR, Villena I. [Serological analysis of toxoplasmosis during pregnancy: risk assessment and perspectives of prenatal screening at the University Hospital of Bobo Dioulasso in Burkina Faso]. Pan Afr Med J 2012; 12:43. [PMID: 22937183 PMCID: PMC3428163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 02/24/2012] [Indexed: 11/23/2022] Open
Abstract
Introduction La présente étude rapporte les données sérologiques de 306 sérums collectés chez des parturientes au CHU de Bobo Dioulasso et analysés rétrospectivement au CHU de Reims en 2011. Le but était de déterminer le statut sérologique de ces parturientes et d'en déduire la conduite à tenir. Méthodes La recherche des IgG et des IgM anti toxoplasmiques était systématique. Les techniques d'agglutination haute sensibilisée et celle d'Immunocapture M ont servi à la recherche respective des anticorps spécifiques IgG et des IgM. Résultats Sur 306 sérums analysés, 95 (31%) avaient des IgG positifs et aucun n'avait des IgM. Deux cent onze (211) sérums (69%) des sérums n'avaient ni IgG, ni IgM. Conclusion Nos résultats montrent que 31% des femmes en dehors d'une immunodépression sous jacente, possèdent une immunité résiduelle vis à vis de Toxoplasma gondii et n'ont pas la nécessité d'avoir une surveillance sérologique pendant la grossesse. Cependant, 69% (211) des parturientes sont à risque d'une séroconversion, et devraient bénéficier de conseils hygiéno diététiques, associés à une surveillance sérologique durant la grossesse. Ces résultats montrent l'intérêt de mettre en place des mesures de prévention contre la toxoplasmose congénitale, étant l'une des affections materno - foetales les plus fréquentes par la mise en place d'un diagnostic prénatal de la toxoplasmose en routine dans notre hôpital.
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Affiliation(s)
- Sanata Bamba
- Universitaire Sanou Souro de Bobo Dioulasso, Burkina Faso,Laboratoire de Parasitologie-Mycologie, Institut supérieur des Sciences de la Santé / Université polytechnique de Bobo Dioulasso, Burkina Faso,Corresponding author: Dr Sanata Bamba, Assistante hospitalo universitaire/ Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Sanou Souro de Bobo Dioulasso, BP: 1091 Bobo Dioulasso 01, Burkina Faso
| | | | - Cathy Chemla
- Laboratoire de Parasitologie-Mycologie, Centre National de Référence de la Toxoplasmose, CHU Maison Blanche, Reims, France
| | - Régine Geers
- Laboratoire de Parasitologie-Mycologie, Centre National de Référence de la Toxoplasmose, CHU Maison Blanche, Reims, France
| | - Tinga Robert Guiguemde
- Laboratoire de Parasitologie-Mycologie, Institut supérieur des Sciences de la Santé / Université polytechnique de Bobo Dioulasso, Burkina Faso
| | - Isabelle Villena
- Laboratoire de Parasitologie-Mycologie, Institut supérieur des Sciences de la Santé / Université polytechnique de Bobo Dioulasso, Burkina Faso
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Comparison of mother and child antibodies that target high-molecular-mass Toxoplasma gondii antigens by immunoblotting improves neonatal diagnosis of congenital toxoplasmosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1326-8. [PMID: 22695159 DOI: 10.1128/cvi.00060-12] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This retrospective study proposes a new reading of immunoblotting (IB) in the diagnosis of congenital toxoplasmosis. Our findings demonstrate that a three-IgM-band association at 75, 90, and 100 kDa called the IgM triplet increases the sensitivity to 95.8% when combined with prenatal and serological neonatal tests.
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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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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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Robert-Gangneux F, Murat JB, Fricker-Hidalgo H, Brenier-Pinchart MP, Gangneux JP, Pelloux H. The placenta: a main role in congenital toxoplasmosis? Trends Parasitol 2011; 27:530-6. [PMID: 22079164 DOI: 10.1016/j.pt.2011.09.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 09/09/2011] [Accepted: 09/21/2011] [Indexed: 02/08/2023]
Abstract
Systemic infections, such as toxoplasmosis, acquired during pregnancy can lead to placental infection and have profound effects on the mother-to-child relationship and the success of pregnancy. Placental permeability to Toxoplasma gondii is a main parameter that determines parasite transmission to the foetus, and the use of antibiotics to decrease placental parasite load and prevent congenital toxoplasmosis has been suggested for decades. Although parasitological examination of the placenta at birth is commonly used to diagnose neonatal congenital toxoplasmosis, this approach can be controversial. Here we argue in favour of placental examination for both diagnostic and epidemiological purposes.
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Affiliation(s)
- Florence Robert-Gangneux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier et Universitaire de Rennes, Rennes, France.
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Said RN, Zaki MM, Abdelrazik MB. Congenital toxoplasmosis: evaluation of molecular and serological methods for achieving economic and early diagnosis among Egyptian preterm infants. J Trop Pediatr 2011; 57:333-9. [PMID: 20961951 DOI: 10.1093/tropej/fmq097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early diagnosis of congenital toxoplasmosis (CT) is difficult when specific immunoglobulin M (IgM) antibodies are absent, or if persist for months, in the newborn infant's blood. OBJECTIVES To study the risk factors of neonatal toxoplasmosis and to compare different immunologic profiles (Toxoplasma-specific IgM, IgA antibodies and the avidity of IgG antibodies) with polymerase chain reaction (PCR) for reaching economic and early postnatal diagnosis. MATERIALS AND METHODS We prospectively studied 80 preterm neonates, recruited from neonatal intensive care units (NICUs) of Cairo University hospitals. Whose gestational age ≤ 34 weeks with (n = 60) or without (n = 20) CT risk. Serum samples for specific IgA, IgM antibodies and avidity of IgG toxoplasma antibodies were measured by ELISA then compared to PCR. RESULTS Of the 60 studied cases, 16 (26.7%) were positive for toxoplasmosis by PCR, of which 15 (25%) had low avidity of IgG antibodies (positive), 14 (23.3%) were positive for IgA and 10 (16.7%) were positive for IgM, with sensitivity for avidity of IgG, IgA and IgM: 93.2%, 87.5% and 62.5%, respectively. CONCLUSION Determination of avidity of IgG toxoplasma antibodies and/or serological detection of specific IgA for toxoplasmosis offer, simple tests for diagnosis of congenital toxoplasmosis with (better sensitivity) than IgM.
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MESH Headings
- Antibodies, Protozoan/blood
- Antibody Affinity
- Early Diagnosis
- Egypt
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Immunoglobulin A/blood
- Immunoglobulin G/blood
- Immunoglobulin M/blood
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/blood
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/immunology
- Male
- Neonatal Screening/economics
- Neonatal Screening/methods
- Polymerase Chain Reaction
- Prospective Studies
- Risk Factors
- Sensitivity and Specificity
- Toxoplasma/immunology
- Toxoplasmosis, Congenital/blood
- Toxoplasmosis, Congenital/diagnosis
- Toxoplasmosis, Congenital/immunology
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Affiliation(s)
- Reem N Said
- Department of Neonatology, Cairo University Children's Hospital, Cairo, Egypt.
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di Carlo P, Romano A, Casuccio A, Cillino S, Schimmenti MG, Mancuso G, la Chiusa S, Novara V, Ingrassia D, li Vecchi V, Trizzino M, Titone L. Investigation and management of Toxoplasma gondii infection in pregnancy and infancy: a prospective study. Acta Pharmacol Sin 2011; 32:1063-70. [PMID: 21743484 DOI: 10.1038/aps.2011.55] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM Toxoplasma gondii infection during pregnancy poses a serious risk to the fetus, therefore timely and accurate diagnosis is essential. The aim of this study was to estimate the frequency of congenital infection via evaluating mother's immunological status and the possibility to improving the diagnostic and therapeutic approaches. METHODS Eighty five mothers with Toxoplasma seroconversion and their offspring were enrolled (among them, 2 spontaneous abortions were documented in the first trimester). Prenatal PCR diagnosis was carried out on 50 patients (60%), with 7 positive cases (14%). Morphological ultrasound scanning revealed anomalies in one fetus. Long-term follow-up included general physical examinations, serological status tested using Western blot, neuro-radiological, ophthalmologic and neurologic examinations, psychological and developmental tests, visual evoked potential tests and audiology tests, as well as anti-Toxoplasma treatment regimes. RESULTS Fourteen (17%) of the infants were infected at one-year serological follow-up. Chi-square for linear trend of vertical transmission from the first to the third trimester was significant (P=0.009). Western blot analysis showed IgM and IgA in half of the infected infants. In 69 uninfected infants, anti-Toxoplasma IgG immunoblot analysis excluded infection within the 3 months in 18 infants (26%) and in the others within 6 months of life. The most relevant instrumental findings are described. CONCLUSION Western blot analysis may help to evaluate infection within the 6 months of life. The accuracy of ultrasound imaging to determine the brain damage in the fetus and newborns is doubtful, and should be combined with MR imaging. Multistep approaches can improve the timing of postnatal follow-up.
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Ferguson W, Mayne PD, Cafferkey M, Butler K. Lack of awareness of risk factors for primary toxoplasmosis in pregnancy. Ir J Med Sci 2011; 180:807-11. [PMID: 21660651 DOI: 10.1007/s11845-011-0723-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 05/21/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND The overall seroprevalence of toxoplasma antibodies in women of childbearing age in Ireland is 25% [1]. Hence, 75% of women remain susceptible to primary toxoplasma infection during pregnancy, which if transmitted to the foetus can cause ocular, neurological and other sequelae. Toxoplasma exposure during pregnancy can be avoided if there is an awareness of the potential sources of infection, mainly contaminated food, water, soil and cat faeces. AIMS To determine risk factor exposure in a cohort of women with congenitally infected infants and to assess maternal risk awareness prior to diagnosis of infection. METHODS Data, prospectively gathered during 2 years of pilot newborn screening for congenital toxoplasmosis in Ireland, was retrospectively analysed. Known risk factors for acquisition of infection were identified. Women were questioned regarding risk awareness and implementation of avoidance measures, if any, during pregnancy. RESULTS Fifteen congenitally infected infants were identified by newborn screening. Seventy-three percent of their mothers (11/15) reported lack of knowledge concerning risk factors for toxoplasma infection or its potential threat to the foetus. Ingestion of raw or undercooked meat during pregnancy was the predominant source of toxoplasma cyst exposure identified. Contact with cats was reported in just one case. CONCLUSIONS Most women were uneducated about the risks posed by Toxoplasma gondii exposure during pregnancy. There is a clear need for better educational programmes regarding primary prevention of congenital toxoplasmosis if neonatal infection is to be avoided.
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Affiliation(s)
- W Ferguson
- Department of Paediatrics, The Rotunda Hospital, Parnell Square, Dublin 1, Ireland.
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