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Deleplancque AS, Fricker-Hidalgo H, Pomares C, L’Ollivier C, Lemoine JP, Cimon B, Paris L, Houzé S, Villena I, Pelloux H, Villard O. Comparative performance of ISAGA IgM and ELISA assays for the diagnosis of maternal and congenital Toxoplasma infections: which technique could replace ISAGA IgM? Parasite 2024; 31:7. [PMID: 38334687 PMCID: PMC10854481 DOI: 10.1051/parasite/2024004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
The ISAGA immunocapture test for the detection of anti-Toxoplasma immunoglobulin M is a manual technique known for its excellent sensitivity and specificity. The purpose of this retrospective, multicenter study was to compare the performances and agreement between ISAGA and other IgM detection techniques before cessation of ISAGA production. The analytic performance of the different tests was evaluated using 1,341 serum samples from adults with positive IgM and negative IgG to Toxoplasma gondii, and 1,206 sera from neonates born to mothers with seroconversion. The agreement between the tests was evaluated on 13,506 adult and 5,795 child serum samples. The sensitivity of Toxo-ISAGA IgM® (adults 98.7%, neonates 63.1%) was similar to that of Platelia Toxo IgM® (adults 94.4%, neonates 64.6%), and significantly higher than Liaison Toxo IgM® (adults 90.6%), Architect/Alinity Toxo IgM® (adults 95.7%, neonates 48.6%), and Vidas Toxo IgM® (adults 81.8%, neonates 17.5%). However, the specificities varied between 24.4% (Platelia Toxo IgM®) and 95.2% (Liaison Toxo IgM®) in adults and were >95% for all tests in neonates. An analysis of the kappa coefficients showed better agreement between ISAGA IgM® and the other tests in children (0.75-0.83%) than in adults (0.11-0.53%). We conclude that, in the absence of Toxo-ISAGA IgM®, the association of a very sensitive technique (Platelia Toxo IgM® or Architect/Alinity Toxo IgM®) and a very specific technique (Vidas Toxo IgM® or Liaison Toxo IgM®) is recommended for IgM detection in adult sera. For neonates, Platelia Toxo IgM® appeared to be the best alternative to replace Toxo-ISAGA IgM®.
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Affiliation(s)
- Anne-Sophie Deleplancque
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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CHU Lille, Parasitology Mycology Department, INSERM U1285, CNRS UMR 8576, Glycobiology in Fungal Pathogenesis and Clinical Applications, Université de Lille Lille France
| | - Hélène Fricker-Hidalgo
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Laboratory of Parasitology and Mycology, Grenoble Alpes University Hospital and Institute for Advanced Biosciences, Grenoble Alpes University, INSERM U1209, CNRS UMR5309 Grenoble France
| | - Christelle Pomares
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Parasitology-Mycology laboratory, Côte d’Azur University, INSERM 1065, Nice University Hospital Nice France
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Centre Méditerranéen de Médecine Moléculaire (C3 M), U1065, Université Côte d’Azur, INSERM, Archimed Building 151 route Saint Antoine de Ginestière Nice France
| | - Coralie L’Ollivier
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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IHU-Méditerranée Infection, Assistance Publique Hôpitaux de Marseille (AP-HM) Marseille France
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Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Marseille France
| | | | - Bernard Cimon
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Laboratoire de Parasitologie-Mycologie, CHU d’Angers Angers France
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Angers University, Brest University, IRF, SFR 4208 ICAT Angers France
| | - Luc Paris
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Parasitology laboratory, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière Paris France
| | - Sandrine Houzé
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Parasitology laboratory, AP-HP, Hôpital Bichat - Claude Bernard Paris France
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University of Paris Cité, IRD 261, MERIT Paris France
| | - Isabelle Villena
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Department of Parasitology and Medical Mycology, National Reference Centre on Toxoplasmosis, Reims Hospital Reims France
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Team EA 7510, SFR CAP-SANTE, Reims Champagne Ardenne University Reims France
| | - Hervé Pelloux
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Laboratory of Parasitology and Mycology, Grenoble Alpes University Hospital and Institute for Advanced Biosciences, Grenoble Alpes University, INSERM U1209, CNRS UMR5309 Grenoble France
| | - Odile Villard
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Institut de Parasitologie et de Pathologie Tropicale, UR7292 Dynamique des Interactions Hôte-Pathogène, Fédération de Médecine Transrationnelle, Université de Strasbourg Strasbourg France
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Laboratoire de Parasitologie et Mycologie Médicale, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Peyclit L, Villard O, Paris L, Fricker-Hidalgo H, Houzé S, Cimon B, Deleplancque AS, Tournus C, Pelloux H, Villena I, Pomares C, L'Ollivier C. IgM triplet in neonatal diagnosis by immunoblotting and its potential use as a diagnostic marker for congenital toxoplasmosis. Parasite 2023; 30:19. [PMID: 37265252 DOI: 10.1051/parasite/2023020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/09/2023] [Indexed: 06/03/2023] Open
Abstract
Primary infection during pregnancy by the protozoan Toxoplasma gondii can be worrisome because transmission to the fetus may lead to congenital toxoplasmosis (CT). Neonatal diagnosis is usually performed by serological profile comparison of the mother and newborn. As previously reported in 2012 by C. L'Ollivier et al., three IgM bands at 75, 90 and 100 kDa called the "IgM triplet" has caught our attention and seems to be pathognomonic of CT. This retrospective multicenter study involved nine reference laboratories included in the French National Reference Center for Toxoplasmosis network and concerned determining the specificity and sensitivity of this IgM triplet. On this basis, we were able to propose a new read of the comparison of IgG and IgM immunoblot profiles of mother and infant to increase the sensitivity of this diagnostic marker. The effect of the trimester of pregnancy at the time of infection, but also of maternal treatment with pyrimethamine/sulfadiazine/folinic acid on the presence of this IgM triplet in the infant, could be studied. The presence of the triplet appears pathognomonic for the diagnosis of CT, and it increased the sensitivity of the immunoblot assay from 55.04% to 72.48%. As a result, it would be wise to enhance conventional immunoblot reading by adding the presence of the three IgM bands in the infant pattern for neonatal diagnosis of CT.
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Affiliation(s)
| | - Odile Villard
- Laboratoire de Parasitologie et Mycologie Médicale, CNR de la Toxoplasmose, Les Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France - Institut de Parasitologie et Pathologie Tropicale, UR7292 Dynamique des interactions hôte pathogène, Fédération de Médecine Translationnelle, Université de Strasbourg, 67091 Strasbourg, France
| | - Luc Paris
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Parasitologie Mycologie, 75013 Paris, France
| | - Hélène Fricker-Hidalgo
- Service de Parasitologie Mycologie, CHU Grenoble Alpes et Université Grenoble Alpes, 38700 Grenoble, France
| | - Sandrine Houzé
- Service de Parasitologie Mycologie, Hôpital Bichat-Claude Bernard, AP-HP, 75018 Paris, et UMR 261 Merit Université Paris Cité, 75018 Paris, France
| | - Bernard Cimon
- Service de Parasitologie Mycologie, CHU Angers, 49100 Angers, France
| | | | - Céline Tournus
- Laboratoire de Microbiologie, Centre Hospitalier de Saint-Denis, 93200 Saint-Denis, France
| | - Hervé Pelloux
- Service de Parasitologie Mycologie, CHU Grenoble Alpes et Université Grenoble Alpes, 38700 Grenoble, France
| | - Isabelle Villena
- Service de Parasitologie Mycologie, EA 7510 Université Reims-Champagne Ardenne, Centre National de Référence de la Toxoplasmose, Centre Hospitalier Universitaire (CHU) Reims, 51092 Reims, France
| | - Christelle Pomares
- Service de Parasitologie Mycologie, Université de la Côte d'Azur, C3M INSERM 1065, CHU Nice, 06204 Nice, France
| | - Coralie L'Ollivier
- IHU Méditerranée Infection, 13005 Marseille, France - Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, 13005 Marseille, France
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Delshadi S, Fratzl M, Ramel O, Bigotte P, Kauffmann P, Kirk D, Masse V, Brenier-Pinchart MP, Fricker-Hidalgo H, Pelloux H, Bruckert F, Charrat C, Cugat O, Dempsey NM, Devillers T, Halfon P, Leroy A, Weidenhaupt M, Marche PN. Magnetically localized and wash-free fluorescence immunoassay (MLFIA): proof of concept and clinical applications. Lab Chip 2023; 23:645-658. [PMID: 36723037 DOI: 10.1039/d2lc00926a] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Immunoassays are used for many applications in various markets, from clinical diagnostics to the food industry, generally relying on gold-standard ELISAs that are sensitive, robust, and cheap but also time-consuming and labour intensive. As an alternative, we propose here the magnetically localized and wash-free fluorescence immunoassay (MLFIA): a no-wash assay to directly measure a biomolecule concentration, without mixing nor washing steps. To do so, a fluorescence no-wash measurement is performed to generate a detectable signal. It consists of a differential measurement between the fluorescence of fluorophores bound to magnetic nanoparticles specifically captured by micro-magnets against the residual background fluorescence of unbound fluorophores. Targeted biomolecules (antibodies or antigens) are locally concentrated on micro-magnet lines, with the number of captured biomolecules quantitatively measured without any washing step. The performance of the MLFIA platform is assessed and its use is demonstrated with several biological models as well as clinical blood samples for HIV, HCV and HBV detection, with benchmarking to standard analyzers of healthcare laboratories. Thus, we demonstrated for the first time the versatility of the innovative MLFIA platform. We highlighted promising performances with the successful quantitative detection of various targets (antigens and antibodies), in different biological samples (serum and plasma), for different clinical tests (HCV, HBV, HIV).
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Affiliation(s)
- S Delshadi
- MagIA diagnostics, 15 rue Maréchal Leclerc, 38130 Échirolles, France.
- Univ. Grenoble Alpes, Inserm U1209, CNRS UMR 5309, IAB, 38000 Grenoble, France
- Univ. Grenoble Alpes, CNRS, Grenoble INP, G2Elab, 21 Av. des Martyrs, 38000 Grenoble, France
| | - M Fratzl
- MagIA diagnostics, 15 rue Maréchal Leclerc, 38130 Échirolles, France.
- Univ. Grenoble Alpes, CNRS, Grenoble INP, G2Elab, 21 Av. des Martyrs, 38000 Grenoble, France
- Univ. Grenoble Alpes, CNRS, Grenoble INP, Institut Néel, 25 Av. des Martyrs, 38042 Grenoble, France
| | - O Ramel
- MagIA diagnostics, 15 rue Maréchal Leclerc, 38130 Échirolles, France.
| | - P Bigotte
- MagIA diagnostics, 15 rue Maréchal Leclerc, 38130 Échirolles, France.
| | - P Kauffmann
- MagIA diagnostics, 15 rue Maréchal Leclerc, 38130 Échirolles, France.
| | - D Kirk
- MagIA diagnostics, 15 rue Maréchal Leclerc, 38130 Échirolles, France.
| | - V Masse
- MagIA diagnostics, 15 rue Maréchal Leclerc, 38130 Échirolles, France.
| | - M P Brenier-Pinchart
- Univ. Grenoble Alpes, Inserm U1209, CNRS UMR 5309, IAB, 38000 Grenoble, France
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - H Fricker-Hidalgo
- Univ. Grenoble Alpes, Inserm U1209, CNRS UMR 5309, IAB, 38000 Grenoble, France
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - H Pelloux
- Univ. Grenoble Alpes, Inserm U1209, CNRS UMR 5309, IAB, 38000 Grenoble, France
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, 38000 Grenoble, France
| | - F Bruckert
- Univ. Grenoble Alpes, CNRS, Grenoble INP, LMGP, 38000 Grenoble, France
| | - C Charrat
- Univ. Grenoble Alpes, Inserm U1209, CNRS UMR 5309, IAB, 38000 Grenoble, France
| | - O Cugat
- Univ. Grenoble Alpes, CNRS, Grenoble INP, G2Elab, 21 Av. des Martyrs, 38000 Grenoble, France
| | - N M Dempsey
- Univ. Grenoble Alpes, CNRS, Grenoble INP, Institut Néel, 25 Av. des Martyrs, 38042 Grenoble, France
| | - T Devillers
- Univ. Grenoble Alpes, CNRS, Grenoble INP, Institut Néel, 25 Av. des Martyrs, 38042 Grenoble, France
| | - P Halfon
- Hopital Europeen, Laboratoire Alphabio-Biogroup, 13003 Marseille, France
| | - A Leroy
- Univ. Grenoble Alpes, Inserm U1209, CNRS UMR 5309, IAB, 38000 Grenoble, France
| | - M Weidenhaupt
- Univ. Grenoble Alpes, CNRS, Grenoble INP, LMGP, 38000 Grenoble, France
| | - P N Marche
- Univ. Grenoble Alpes, Inserm U1209, CNRS UMR 5309, IAB, 38000 Grenoble, France
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Meroni V, Genco F, Scudeller L, Brenier-Pinchart MP, Fricker-Hidalgo H, L’Ollivier C, Paris L, Pelloux H. Diagnostic Accuracy of LDBIO-Toxo II IgG and IgM Western Blot in Suspected Seroconversion in Pregnancy: A Multicentre Study. Pathogens 2022; 11:pathogens11060665. [PMID: 35745519 PMCID: PMC9231380 DOI: 10.3390/pathogens11060665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
The high sensitivity of the automated tests used for Toxoplasma gondii serology can yield false-positive IgM results due to aspecific reactions. On the other hand, specific therapy can delay IgG production and, therefore, the diagnosis of seroconversion. There is a need for confirmation tests to early detect seroconversions during pregnancy. We conducted a multicentre study to evaluate the diagnostic accuracy of the Toxo II IgG and a new, not yet commercialised Toxo II IgM western blot (WB) (LDBio diagnostics Lyon France) on 229 sera corresponding to 93 patients with seroconversions and 158 sera corresponding to 68 patients with nonspecific IgM. Sensitivity was 97.8% for IgM WB and 98.9% for IgG WB. Specificity was 89.7% and 100%, respectively. The concordance between IgM and IgG Toxo WB with the final diagnosis was very good, K = 0.89 and K = 0.99, respectively. In 5 cases (5.4%), the appearance of IgM, and in 55 cases (59.1%), the appearance of IgG was recorded by WB earlier than by traditional tests. In 10 cases (10.8%), IgM was detected after the traditional tests and in 2 cases (2.2%) for IgG. The association of IgG and IgM WB on the same sample not only detected all seroconversions but also correctly identified most of the false-positive results.
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Affiliation(s)
- Valeria Meroni
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Francesca Genco
- Microbiology and Virology Unit, Fondazione IRCCS San Matteo Hospital Foundation, 27100 Pavia, Italy;
| | - Luigia Scudeller
- UOC Innovation and Research, IRCCS University Hospital Sant’Orsola, 40138 Bologna, Italy;
| | - Marie-Pierre Brenier-Pinchart
- Parasitology-Mycology, University Hospital and Grenoble-Alpes University, 38043 Grenoble, France; (M.-P.B.-P.); (H.F.-H.); (H.P.)
| | - Hélène Fricker-Hidalgo
- Parasitology-Mycology, University Hospital and Grenoble-Alpes University, 38043 Grenoble, France; (M.-P.B.-P.); (H.F.-H.); (H.P.)
| | - Coralie L’Ollivier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU Méditerranée, 13005 Marseille, France;
| | - Luc Paris
- APHP-Sorbonne Université, Parasitology-Mycology, Pitié-Salpêtrière Hospital, 75013 Paris, France
- Correspondence: ; Tel.: +33-(0)1-42-16-01-60
| | - Hervé Pelloux
- Parasitology-Mycology, University Hospital and Grenoble-Alpes University, 38043 Grenoble, France; (M.-P.B.-P.); (H.F.-H.); (H.P.)
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Jean-Pierre V, Miozzo J, Fricker-Hidalgo H, Garnaud C, Robert MG, Pelloux H, Brenier-Pinchart MP. Serological diagnosis of toxoplasmosis: evaluation of the commercial test recomLine Toxoplasma IgG immunoblot (Mikrogen) based on recombinant antigens. Parasite 2022; 29:52. [PMCID: PMC9645231 DOI: 10.1051/parasite/2022050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background: IgG detection to determine immune status to Toxoplasma gondii infection and seroconversion mainly relies on ELISA techniques and, if necessary, on a confirmatory test, Western blot. This study evaluated the performance of the recomLine Toxoplasma IgG immunoblot (IB-recomLine) (Mikrogen) as a confirmatory test on a large number of sera. A total of 171 sera were selected (113 patients) and had previously been analyzed by two ELISA tests, ARCHITECT (Abbott) and VIDAS (bioMérieux) ± LDBIO-Toxo II IgG Western blot (WB-LDBIO) (LDBio). The sera were classified into three groups: group 1 included 50 sera without difficulty in interpreting the IgG results (patients with documented past infection or uninfected); group 2 included 47 sera with difficulty in interpreting the ELISA results; and group 3 included 74 sequential sera from 25 pregnant women with seroconversion. Results: In group 1, overall IgG agreements were 94% and 90% with ARCHITECT and VIDAS, respectively. In group 2, low agreement was observed between IB-recomLine and WB-LDBIO, with eight false-positive and 13 false-negative results. In group 3, 4/13 seroconversions were detected earlier with IB-recomLine compared to other tests. Conclusions: IB-recomLine allowed for earlier diagnosis of toxoplasmic seroconversion compared to both ELISA tests and WB-LDBIO but led to insufficient performance to confirm the immune status when ELISA results were discordant or equivocal.
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Affiliation(s)
- Vincent Jean-Pierre
- Parasitology-Mycology, Grenoble Alpes University Hospital 38000 Grenoble France
- Corresponding author:
| | - Julien Miozzo
- Parasitology-Mycology, Grenoble Alpes University Hospital 38000 Grenoble France
| | | | - Cécile Garnaud
- Parasitology-Mycology, Grenoble Alpes University Hospital 38000 Grenoble France
- TIMC, CNRS, Université Grenoble Alpes 38000 Grenoble France
| | - Marie Gladys Robert
- Parasitology-Mycology, Grenoble Alpes University Hospital 38000 Grenoble France
| | - Hervé Pelloux
- Parasitology-Mycology, Grenoble Alpes University Hospital 38000 Grenoble France
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Schaeffer M, Ballonzoli L, Gaucher D, Arndt C, Angioi-Duprez K, Baudonnet R, Bodaghi B, Bron A, Chiambaretta F, Cimon B, Chiquet C, Creuzot-Garcher C, Daien V, Deleplanque AS, Fricker-Hidalgo H, Hadjadj E, Houze S, Ifrah T, Korobelnik JF, Labalette P, Le Lez ML, L’Ollivier C, Mercie M, Mouriaux F, Paris L, Pelloux H, Pomares C, Quintyn JC, Rougier MB, Rousseau A, Soler V, Talmud M, Villena I, Villard O, Speeg-Schatz C, Bourcier T, Sauer A. Prise en charge de la toxoplasmose oculaire en France : résultats d’une étude Delphi modifiée. J Fr Ophtalmol 2022; 45:413-422. [DOI: 10.1016/j.jfo.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
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Robert MG, Brenier-Pinchart MP, Garnaud C, Fricker-Hidalgo H, Pelloux H. Molecular diagnosis of toxoplasmosis: recent advances and a look to the future. Expert Rev Anti Infect Ther 2021; 19:1529-1542. [PMID: 34112045 DOI: 10.1080/14787210.2021.1941867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Toxoplasmosis is a globally distributed parasitic infection that can be particularly severe when opportunistic or congenital. Its diagnosis requires accurate and rapid techniques that rely mainly on serology and molecular methods. AREAS COVERED The aim of this review was to discuss the positioning of the molecular diagnosis of toxoplasmosis according to the different clinical situations possibly resulting from infection with T. gondii, and to detail recent developments in this technique. The English and French literature were searched with the following keywords: 'Toxoplasmosis', "Molecular diagnosis" and 'PCR'. EXPERT OPINION Molecular techniques have revolutionized the diagnosis of toxoplasmosis, and practices have considerably evolved over the past decades. However, there is still a high degree of inter-laboratory heterogeneity which impairs comparisons between results and studies. Efforts to standardize practices are underway.
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Affiliation(s)
- Marie Gladys Robert
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France
| | - Marie-Pierre Brenier-Pinchart
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France.,Centre National de Référence Toxoplasmose - Pôle Biologie Moléculaire, France
| | - Cécile Garnaud
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Hervé Pelloux
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France.,Centre National de Référence Toxoplasmose - Pôle Biologie Moléculaire, France
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8
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Wallon M, Fricker-Hidalgo H, Chapey E, Bailet C, Dard C, Brenier-Pinchart MP, Pelloux H. Performance of a Toxo IgM prototype assay for the diagnosis of maternal and congenital Toxoplasma infections. Clin Chem Lab Med 2020; 58:1959-1964. [PMID: 32333648 DOI: 10.1515/cclm-2019-1199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/26/2020] [Indexed: 11/15/2022]
Abstract
Background Testing for anti-Toxoplasma immunoglobulin (Ig)M is of main importance in the context of pregnancy to promptly alert to an acute maternal infection prior to the detection of IgG and to identify infected newborns. Their absence helps exclude a recent maternal infection in the presence of IgG. Methods The performance of a Toxo IgM immunocapture prototype assay (bioMérieux, France) was compared with that of the VIDAS® Toxo IgM and the ARCHITECT® Toxo IgM (Abbott, Germany) assays at Grenoble and Lyon (France). A total of 1446 sera were sampled from (i) 1054 pregnant women found by routine workup to have no infection (n = 843), an acute infection (<4 months) (n = 28) or a chronic infection (>4 months) with residual (n = 120) or no IgM (n = 62); (ii) 50 three-serum panels sampled immediately after a maternal seroconversion; (iii) 242 samples taken in 41 children with a congenital toxoplasmosis (n = 122) and in 40 uninfected children (n = 120). Results In pregnant women, the overall agreement with the VIDAS® assay was 99.23% (CI: 99.16-99.27) and that with the ARCHITECT® assay was 99.14% (CI: 99.07-99.17). Sensitivity of the Toxo IgM prototype assay was 100% (CI: 87.66-100.00) and specificity was 99.64% (98.96-99.93). In acute maternal infections, IgM assays were detected as early with the prototype as with the other two. In the congenitally infected children, IgM were detected on their first sample in 25/40 with the prototype vs. 23/40 with the VIDAS® test. No uninfected child had positive IgM. Conclusion The prototype performed comparably to the ARCHITECT® and VIDAS® Toxo IgM assays for the diagnosis of maternal and congenital toxoplasmosis.
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Affiliation(s)
- Martine Wallon
- Service de Parasitologie et de Mycologie Médicale, Hôpital de la Croix Rousse, CHU de Lyon, Lyon, France.,Faculté de Médecine Lyon-Sud, Waking Team, Centre de Recherche en Neurosciences de Lyon, INSERM U1028-CNRS UMR 5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Hélène Fricker-Hidalgo
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, CS 10217, Grenoble, France.,Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
| | - Emmanuelle Chapey
- Service de Parasitologie et de Mycologie Médicale, Hôpital de la Croix Rousse, CHU de Lyon, Lyon, France.,Faculté de Médecine Lyon Sud-Charles Mérieux, Lyon, France
| | - Claire Bailet
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, CS 10217, Grenoble, France.,Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
| | - Céline Dard
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, CS 10217, Grenoble, France.,Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
| | - Marie-Pierre Brenier-Pinchart
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, CS 10217, Grenoble, France.,Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
| | - Hervé Pelloux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, CS 10217, Grenoble, France.,Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
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9
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Dupont D, Fricker-Hidalgo H, Brenier-Pinchart MP, Garnaud C, Wallon M, Pelloux H. Serology for Toxoplasma in Immunocompromised Patients: Still Useful? Trends Parasitol 2020; 37:205-213. [PMID: 33046380 DOI: 10.1016/j.pt.2020.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022]
Abstract
Toxoplasmosis represents one of the most common comorbidity factors in solid organ or hematopoietic stem cell transplant recipients as well as in other immunocompromised patients. In the past decades, availability and performance of molecular tools for the diagnosis or the exclusion of toxoplasmosis in these patients have greatly improved. However, if accurately used, serology remains a complementary and essential diagnostic tool for physicians and medical parasitologists for the prevention and management of toxoplasmosis in immunocompromised patients as well. It is required for determination of the immunological status of patients against Toxoplasma. It also helps diagnose and monitor complex cases of opportunistic Toxoplasma infection in immunocompromised patients. New perspectives are available to further enhance their yield and ease of use.
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Affiliation(s)
- Damien Dupont
- Institut des Agents Infectieux, Service de Parasitologie Mycologie Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, 69004, France; Physiologie intégrée du système d'éveil, Centre de Recherche en Neurosciences de Lyon, INSERM U1028-CNRS UMR 5292, Faculté de Médecine, Université Claude Bernard Lyon 1, Bron, 69500, France.
| | - Hélène Fricker-Hidalgo
- Laboratoire de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France; Institut pour l'Avancée des Biosciences (IAB), INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, 38000, France
| | - Marie-Pierre Brenier-Pinchart
- Laboratoire de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France; Institut pour l'Avancée des Biosciences (IAB), INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, 38000, France
| | - Cécile Garnaud
- Laboratoire de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France; Université Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, 38000, France
| | - Martine Wallon
- Institut des Agents Infectieux, Service de Parasitologie Mycologie Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, 69004, France; Physiologie intégrée du système d'éveil, Centre de Recherche en Neurosciences de Lyon, INSERM U1028-CNRS UMR 5292, Faculté de Médecine, Université Claude Bernard Lyon 1, Bron, 69500, France
| | - Hervé Pelloux
- Laboratoire de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France; Institut pour l'Avancée des Biosciences (IAB), INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, 38000, France
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10
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Garnaud C, Fricker-Hidalgo H, Evengård B, Álvarez-Martínez MJ, Petersen E, Kortbeek LM, Robert-Gangneux F, Villena I, Costache C, Paul M, Meroni V, Guy E, Chiodini PL, Brenier-Pinchart MP, Pelloux H. Toxoplasma gondii-specific IgG avidity testing in pregnant women. Clin Microbiol Infect 2020; 26:1155-1160. [PMID: 32334096 DOI: 10.1016/j.cmi.2020.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The parasite Toxoplasma gondii can cause congenital toxoplasmosis following primary infection in a pregnant woman. It is therefore important to distinguish between recent and past infection when both T. gondii-specific IgM and IgG are detected in a single serum in pregnant women. Toxoplasma gondii-specific IgG avidity testing is an essential tool to help to date the infection. However, interpretation of its results can be complex. OBJECTIVES To review the benefits and limitations of T. gondii-specific avidity testing in pregnant women, to help practitioners to interpret the results and adapt the patient management. SOURCES PubMed search with the keywords avidity, toxoplasmosis and Toxoplasma gondii for articles published from 1989 to 2019. CONTENT Toxoplasma gondii-specific IgG avidity testing remains a key tool for dating a T. gondii infection in immunocompetent pregnant women. Several commercial assays are available and display comparable performances. A high avidity result obtained on a first-trimester serum sample is indicative of a past infection, which occurred before pregnancy. To date, a low avidity result must still be considered as non-informative to date the infection, although some authors suggest that very low avidity results are highly suggestive of recent infections depending on the assay. Interpretation of low or grey zone avidity results on a first-trimester serum sample, as well as any avidity result on a second-trimester or third-trimester serum sample, is more complex and requires recourse to expert toxoplasmosis laboratories. IMPLICATIONS Although used for about 30 years, T. gondii-specific avidity testing has scarcely evolved. The same difficulties in interpretation have persisted over the years. Some authors have proposed additional thresholds to exclude an infection of <9 months, or in contrast to confirm a recent infection. Such thresholds would be of great interest to adapt management of pregnant women and avoid unnecessary treatment; however, they need confirmation and further studies.
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Affiliation(s)
- C Garnaud
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France; Parasitology-Mycology, CHU Grenoble Alpes, Grenoble, France.
| | | | - B Evengård
- Department Clinical Microbiology, Umea University, Umea, Sweden
| | - M J Álvarez-Martínez
- Microbiology Department, Hospital Clínic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - E Petersen
- Directorate General for Disease Surveillance and Control, Ministry of Health, Oman; Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark; ESCMID Emerging Infections Task Force, ESCMID, Basel, Switzerland
| | - L M Kortbeek
- National Institute for Public Health and the Environment; Centre for Infectious Disease Control (CIb) Bilthoven, the Netherlands
| | - F Robert-Gangneux
- Université Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement et Travail)-UMR_S 1085, Rennes, France
| | - I Villena
- Université Reims Champagne-Ardenne EA 7510, CHU Reims, Centre National de Référence de La Toxoplasmose, CRB Toxoplasma, Reims, France
| | - C Costache
- Microbiology Department 'Iuliu Hatieganu', University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - M Paul
- Department and Clinic of Tropical and Parasitic Diseases, University of Medical Sciences, Poznan, Poland
| | - V Meroni
- University Pavia Internal Medicine and Medical Therapy Department, Microbiology and Virology Department IRCCS, Foundation San Matteo Polyclinic, Pavia Italy
| | - E Guy
- Toxoplasma Reference Unit, Public Health Wales Microbiology, Swansea, UK
| | - P L Chiodini
- Hospital for Tropical Diseases and the London School of Hygiene and Tropical Medicine, London, UK
| | - M-P Brenier-Pinchart
- Parasitology-Mycology, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, INSERM-CNRS, Institute for Advanced Biosciences, Grenoble, France
| | - H Pelloux
- Parasitology-Mycology, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, INSERM-CNRS, Institute for Advanced Biosciences, Grenoble, France
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11
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Zhao F, Bulin L, Fricker-Hidalgo H, Renaut Q, Robert MG, Garnaud C, Pelloux H, Brenier-Pinchart MP. Molecular diagnosis of toxoplasmosis: evaluation of automated DNA extraction using eMAG® (bioMérieux) on buffy coat, cerebrospinal and bronchoalveolar lavage fluids. ACTA ACUST UNITED AC 2019; 58:e91-e93. [DOI: 10.1515/cclm-2019-0753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/15/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Fanny Zhao
- Parasitology-Mycology Laboratory, Institute of Biology and Pathology , Grenoble-Alpes University Hospital , Grenoble , France
| | - Lionnel Bulin
- Parasitology-Mycology Laboratory, Institute of Biology and Pathology , Grenoble-Alpes University Hospital , Grenoble , France
| | - Hélène Fricker-Hidalgo
- Parasitology-Mycology Laboratory, Institute of Biology and Pathology , Grenoble-Alpes University Hospital , Grenoble , France
| | - Quentin Renaut
- Parasitology-Mycology Laboratory, Institute of Biology and Pathology , Grenoble-Alpes University Hospital , Grenoble , France
| | - Marie Gladys Robert
- Parasitology-Mycology Laboratory, Institute of Biology and Pathology , Grenoble-Alpes University Hospital , Grenoble , France
- Host-Pathogen Interactions and Immunity to Infections, Institute for Advanced Biosciences , Grenoble Alpes University , Grenoble , France
| | - Cécile Garnaud
- Parasitology-Mycology Laboratory, Institute of Biology and Pathology , Grenoble-Alpes University Hospital , Grenoble , France
- TIMC-TheREx , Grenoble Alpes University , Grenoble , France
| | - Hervé Pelloux
- Parasitology-Mycology Laboratory, Institute of Biology and Pathology , Grenoble-Alpes University Hospital , Grenoble , France
- Host-Pathogen Interactions and Immunity to Infections, Institute for Advanced Biosciences , Grenoble Alpes University , Grenoble , France
| | - Marie-Pierre Brenier-Pinchart
- Parasitology-Mycology Laboratory, Institute of Biology and Pathology , Grenoble-Alpes University Hospital , Grenoble , France
- Host-Pathogen Interactions and Immunity to Infections, Institute for Advanced Biosciences, Grenoble Alpes University, INSERMU1209 , CNRS UMR 5309, Grenoble , France
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12
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Bonnet Ducrot S, Plantaz D, Mathieu N, Debillon T, Bost Bru C, Brenier-Pinchart MP, Fricker-Hidalgo H, Chevallier M. Neonatal fever: A puzzling case. Arch Pediatr 2018; 25:435-438. [PMID: 30249489 DOI: 10.1016/j.arcped.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/17/2018] [Accepted: 08/15/2018] [Indexed: 02/07/2023]
Abstract
Toxoplasmosis is a potentially serious fetal infection associated with maternal seroconversion of toxoplasmosis during pregnancy. Follow-up and treatment vary between different countries. We present a case of congenital toxoplasmosis with unusual physiopathology and symptomatology. The mother was immunized before the beginning of pregnancy but immunosuppressive treatments for Crohn disease maintained during the pregnancy could explain toxoplasmosis reactivation in the mother and congenital toxoplasmosis. The baby presented reversible B lymphopenia and hypogammaglobulinemia.
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Affiliation(s)
- S Bonnet Ducrot
- Neonatal Intensive Care Unit, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France.
| | - D Plantaz
- Department of Pediatrics, Unit of Pediatric Immuno-Hemato-Oncology, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - N Mathieu
- Hepato-gastroenterology Unit, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - T Debillon
- Neonatal Intensive Care Unit, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France; ThEMAS, TIMC-IMAG, CNRS UMR5525, Université Grenoble Alpes, 38041 Grenoble, France
| | - C Bost Bru
- Department of Pediatrics, General Pediatrics and Infectious Diseases, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - M-P Brenier-Pinchart
- Laboratory of Parasitology and Mycology, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - H Fricker-Hidalgo
- Laboratory of Parasitology and Mycology, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France
| | - M Chevallier
- Neonatal Intensive Care Unit, Grenoble Alpes University, CS10217, Grenoble University Hospital, 38043 Grenoble, France; ThEMAS, TIMC-IMAG, CNRS UMR5525, Université Grenoble Alpes, 38041 Grenoble, France
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13
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Dard C, Marty P, Brenier-Pinchart MP, Garnaud C, Fricker-Hidalgo H, Pelloux H, Pomares C. Management of toxoplasmosis in transplant recipients: an update. Expert Rev Anti Infect Ther 2018; 16:447-460. [DOI: 10.1080/14787210.2018.1483721] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Céline Dard
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
- Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209 - CNRS UMR5309, Université Grenoble Alpes, Grenoble France
| | - Pierre Marty
- Faculté de Médecine, Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, 06202 Nice, France Université de la Côte d’Azur, Nice, France
- 38043, INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, C3M, Nice, France
| | - Marie-Pierre Brenier-Pinchart
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
- Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209 - CNRS UMR5309, Université Grenoble Alpes, Grenoble France
| | - Cécile Garnaud
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
| | - Hélène Fricker-Hidalgo
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
| | - Hervé Pelloux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
- Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209 - CNRS UMR5309, Université Grenoble Alpes, Grenoble France
| | - Christelle Pomares
- Faculté de Médecine, Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, 06202 Nice, France Université de la Côte d’Azur, Nice, France
- 38043, INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, C3M, Nice, France
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14
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Brenier-Pinchart MP, Fricker-Hidalgo H, Dard C, Pelloux H. Impact of heat-inactivation on anti-Toxoplasma IgM antibody levels. Clin Chem Lab Med 2017; 55:e291-e293. [PMID: 28708569 DOI: 10.1515/cclm-2017-0209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/04/2017] [Indexed: 11/15/2022]
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15
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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] [What about the content of this article? (0)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Villard O, Cimon B, Franck J, Fricker-Hidalgo H, Godineau N, Houze S, Paris L, Pelloux H, Villena I, Candolfi E. Evaluation of the usefulness of six commercial agglutination assays for serologic diagnosis of toxoplasmosis. Diagn Microbiol Infect Dis 2012; 73:231-5. [DOI: 10.1016/j.diagmicrobio.2012.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/16/2012] [Accepted: 03/16/2012] [Indexed: 10/28/2022]
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chumpitazi BFF, Bouillet L, Fricker-Hidalgo H, Lacharme T, Romanet JP, Massot C, Chiquet C, Pelloux H. Contribution of anti-Hsp70.1 IgG Antibody Levels to the Diagnostic Certainty of Clinically Suspected Ocular Toxoplasmosis. ACTA ACUST UNITED AC 2010; 51:5530-6. [DOI: 10.1167/iovs.10-5244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Laurence Bouillet
- the Departments of Internal Medicine and 3INSERM (Institut National de la Santé et de la Recherche Médicale) Unit 882, CEA (French Atomic Energy and Alternative Energies Commission)-Grenoble, and
| | | | | | | | | | | | - Hervé Pelloux
- From the Laboratory of Parasitology and Mycology, the 5CNRS (Centre National de la Recherche Scientifique) UMR (Unité Mixte de Recherche) 5163, Joseph Fourier University (Grenoble 1), Grenoble, France
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Parat S, Fricker-Hidalgo H, Perdrix A, Bemer D, Pelissier N, Grillot R. Airborne Fungal Contamination in Air-Conditioning Systems: Effect of Filtering and Humidifying Devices. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15428119691014323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sylvie Parat
- a Institut Universitaire de Médecine du Travail et d'Ergonomie (IUMTE), Université Joseph Fourier, Faculté de Médecine de Grenoble, 38700 La Tronche, France
| | - Hélène Fricker-Hidalgo
- b Département de Parasitologie-Mycologie Médicale et Moléculaire, (DP3M), Université Joseph Fourier, Faculté de Médecine de Grenoble
| | - Alain Perdrix
- a Institut Universitaire de Médecine du Travail et d'Ergonomie (IUMTE), Université Joseph Fourier, Faculté de Médecine de Grenoble, 38700 La Tronche, France
| | - Denis Bemer
- c Centre Technique des Industries Aérauliques et Thermiques (CETIAT), BP 2042, 69603 Villeurbanne Cedex, France
| | - Nathalie Pelissier
- a Institut Universitaire de Médecine du Travail et d'Ergonomie (IUMTE), Université Joseph Fourier, Faculté de Médecine de Grenoble, 38700 La Tronche, France
| | - Renée Grillot
- b Département de Parasitologie-Mycologie Médicale et Moléculaire, (DP3M), Université Joseph Fourier, Faculté de Médecine de Grenoble
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22
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Gay-Andrieu F, Fricker-Hidalgo H, Sickinger E, Espern A, Brenier-Pinchart MP, Braun HB, Pelloux H. Comparative evaluation of the ARCHITECT Toxo IgG, IgM, and IgG Avidity assays for anti-Toxoplasma antibodies detection in pregnant women sera. Diagn Microbiol Infect Dis 2009; 65:279-87. [DOI: 10.1016/j.diagmicrobio.2009.07.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 07/07/2009] [Accepted: 07/10/2009] [Indexed: 11/16/2022]
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Golkar M, Azadmanesh K, Khalili G, Khoshkholgh-Sima B, Babaie J, Mercier C, Brenier-Pinchart MP, Fricker-Hidalgo H, Pelloux H, Cesbron-Delauw MF. Serodiagnosis of recently acquired Toxoplasma gondii infection in pregnant women using enzyme-linked immunosorbent assays with a recombinant dense granule GRA6 protein. Diagn Microbiol Infect Dis 2008; 61:31-9. [PMID: 18249081 DOI: 10.1016/j.diagmicrobio.2007.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 08/21/2007] [Accepted: 09/04/2007] [Indexed: 10/22/2022]
Abstract
Indirect immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays (ELISAs) with a recombinant GRA6 protein of Toxoplasma gondii were developed and evaluated for accurate diagnosis of recently acquired infection in pregnant women. According to the results from Toxoplasma serodiagnostic tests, women were classified into 3 groups representing acute (group I), chronic (group II), or no Toxoplasma infection (group III). To discriminate group I from group II sera, the GRA6-IgG-ELISA reached sensitivity and specificity of 87.5% and 94.1%, respectively. Although 22 (91.7%) of 24 group I sera were positive by the GRA6-IgM-ELISA, only 1 (2.9%) of 34 group II sera scored positive. The GRA6-IgM-ELISA displayed a meaningful correlation with Vidas Toxo IgM and exhibited higher specificity (97.1%) than Euroimmun IgM ELISA (88.2%) (Euroimmun, Lübeck, Germany) for detection of recent infection. These results demonstrate that IgG and IgM ELISA with rGRA6 are useful to identify and discriminate recent from past Toxoplasma infection in pregnant women.
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Affiliation(s)
- Majid Golkar
- Molecular Parasitology Laboratory, Parasitology Department, Pasteur Institute of Iran, Tehran 1316943551, Iran.
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Fricker-Hidalgo H, Brenier-Pinchart MP, Schaal JP, Equy V, Bost-Bru C, Pelloux H. Value of Toxoplasma gondii detection in one hundred thirty-three placentas for the diagnosis of congenital toxoplasmosis. Pediatr Infect Dis J 2007; 26:845-6. [PMID: 17721384 DOI: 10.1097/inf.0b013e318123e8d3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The placenta examination by polymerase chain reaction and mouse inoculation increased the sensitivity of the diagnosis of congenital toxoplasmosis at birth from 60% (use of serologic techniques on the newborn's blood only) to 75% (both serologic techniques and placental analysis). The specificity of Toxoplasma gondii detection in the placenta was 94.7%.
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Affiliation(s)
- Hélène Fricker-Hidalgo
- Service de Parasitologie-Mycologie, Département des Agents Infectieux; Départements de Gynécologie Obstétrique, Centre Hospitalier Universitaire, BP217, 38043, Grenoble, France.
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25
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Brenier-Pinchart MP, Morand-Bui V, Fricker-Hidalgo H, Equy V, Marlu R, Pelloux H. Adapting a conventional pcr assay forToxoplasma gondiidetection to real-time quantitative pcr including a competitive internal control. Parasite 2007; 14:149-54. [PMID: 17645187 DOI: 10.1051/parasite/2007142149] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We have developed a quantitative PCR assay (LightCycler* using the pair of primers JW58 and JW59 for the detection of the 35-fold repeated B gene of oxoplasma gondii. This real-time PCR, using fluorescence resonance energy transfert (FRET) hybridization probes, allows the quantification of . gondii with several technical requirements not previously described: i) an internal amplification control (co-amplified in a single tube with the same primers), ii) Uracil-N-Glycosylase and iii) a standard curve corresponding to a serial dilution from a calibrated suspension of T. gondii ranging from 40 to 4.106( )parasites in one ml of amniotic fluid (1 to 105( ) . gondii/PCR). In artificial samples, one parasite could be detected if at least three reactions were performed.
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Affiliation(s)
- M P Brenier-Pinchart
- Parasitologie-Mycologie, Département des Agents Infectieux, Centre Hospitalier Universitaire, BP 217, 38 043 Grenoble Cedex 9, France.
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26
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Golkar M, Rafati S, Abdel-Latif MS, Brenier-Pinchart MP, Fricker-Hidalgo H, Sima BK, Babaie J, Pelloux H, Cesbron-Delauw MF, Mercier C. The dense granule protein GRA2, a new marker for the serodiagnosis of acute Toxoplasma infection: comparison of sera collected in both France and Iran from pregnant women. Diagn Microbiol Infect Dis 2007; 58:419-26. [PMID: 17509806 DOI: 10.1016/j.diagmicrobio.2007.03.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2006] [Revised: 03/05/2007] [Accepted: 03/05/2007] [Indexed: 11/19/2022]
Abstract
GRA2 is a highly immunogenic protein secreted from the dense granules of Toxoplasma gondii. Recent success in purifying full-length, soluble GRA2 from bacteria as a thioredoxin (TRX)-(Hisx6) fusion protein led to investigate the antigenicity of the recombinant protein against human sera. On immunoblots, TRX-(Hisx6)-GRA2 was recognized by sera collected in Iran from T. gondii-infected pregnant women. An IgG enzyme-linked immunosorbent assay was developed to evaluate the reactivity of sera, collected from pregnant women both in France and Iran, to the TRX-(Hisx6)-GRA2 fusion protein. Specificity of the test was 96.4%. Sensitivity of the GRA2 enzyme-linked immunosorbent assay ranged from 95.8% (sera collected in France) to 100% (sera collected in Iran) for sera of acute infection and from 65.7% (sera collected in France) to 71.4% (sera collected in Iran) for sera of chronic infection. The recombinant GRA2 could thus advantageously complement previously described T. gondii antigens for the serodiagnosis of acute Toxoplasma infection.
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Affiliation(s)
- Majid Golkar
- CNRS UMR 5163, UFR de Biologie, Institut Jean Roget, Université Joseph Fourier, Campus Santé, Domaine de la Merci, and Parasitology and Mycology Laboratory, Grenoble Teaching Hospital A. Michallon, Grenoble cedex 09, France
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Maubon D, Brenier-Pinchart MP, Fricker-Hidalgo H, Pelloux H. [Real-time PCR in the diagnosis of toxoplasmosis: the way to standardisation?]. ACTA ACUST UNITED AC 2007; 55:304-11. [PMID: 17303349 DOI: 10.1016/j.patbio.2006.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 11/15/2006] [Indexed: 11/24/2022]
Abstract
Severity of toxoplasmosis is highly correlated to the immune status of the infected individual. Foetus and immunocompromised patient are mostly at risk to develop life threatening forms. In this situation, serological diagnosis gives poor information. DNA detection using polymerase-chain-reaction technology (PCR) has significantly improved the management of this disease. Even so, the growing number of conventional PCR assays has finally led to variable performance results. Real-Time PCR (RT-PCR) in toxoplasmosis has been developed since 2000. This new technology can improve standardisation. Moreover, quantification of parasitic load in samples becomes possible. This review describes the main RT-PCR procedures actually under use and the studies comparing different target genes. The effective benefit of quantification is also discussed. Reducing number of procedures and more systematic external quality control should be considered, in order to improve reliability in PCR results, which has undoubtedly become a major tool in toxoplasmosis diagnosis.
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Affiliation(s)
- D Maubon
- Parasitologie-mycologie, département des agents infectieux, centre hospitalier universitaire, BP 217, 38043 Grenoble, cedex 09, France.
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28
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Brenier-Pinchart MP, Faure O, Garban F, Fricker-Hidalgo H, Mallaret MR, Trens A, Lebeau B, Pelloux H, Grillot R. Ten-year surveillance of fungal contamination of food within a protected haematological unit. Mycoses 2006; 49:421-5. [PMID: 16922796 DOI: 10.1111/j.1439-0507.2006.01257.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Since 1992, we have established a protocol of food management (restrictive diet, food distribution protocol and fungal surveillance) for allogeneic stem-cell transplant (SCT) recipients hospitalised in protected ward. This study analyses the results of 10-year surveillance of fungal contamination of this diet. Among the 456 types of foods tested filamentous fungi were isolated in 37 of them (8.1%). Aspergillus fumigatus was isolated in one type of food only, while the majority of the food was contaminated to a lower extent.
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Affiliation(s)
- M P Brenier-Pinchart
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire, BP 217, 38-043 Grenoble Cedex 9, France.
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29
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Fricker-Hidalgo H, Saddoux C, Suchel-Jambon AS, Romand S, Foussadier A, Pelloux H, Thulliez P. New Vidas assay for Toxoplasma-specific IgG avidity: evaluation on 603 sera. Diagn Microbiol Infect Dis 2006; 56:167-72. [PMID: 16725296 DOI: 10.1016/j.diagmicrobio.2006.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 03/27/2006] [Accepted: 04/07/2006] [Indexed: 10/24/2022]
Abstract
After the development of the new version of the test Vidas Toxo IgG with antigens obtained from tachyzoites cultured on cells, a Vidas avidity test has been recently developed. The aim of this study was to assess the value of the determination of avidity on the new Vidas test. This avidity test was performed on 553 sera obtained from pregnant women whose dates of infection had been determined and on 50 sera obtained from immunosuppressed patients. In the group of infection occurring less than 4 months before sampling, the avidity index was <0.3 on 266 among 267 sera. In the group of infection occurring more than 15 months before sampling, the avidity index was >0.3 for 44/46 sera of pregnant women and for 47/47 sera of immunosuppressed patients. Thus, the new version of avidity test was helpful primarily to rule out that an infection had occurred within the prior 4 months.
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Affiliation(s)
- Hélène Fricker-Hidalgo
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Grenoble, BP217, 38043 Grenoble Cedex 9, France.
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30
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Durand F, Crassous B, Fricker-Hidalgo H, Carpentier F, Brion JP, Grillot R, Pelloux H. Performance of the Now Malaria rapid diagnostic test with returned travellers: a 2-year retrospective study in a French teaching hospital. Clin Microbiol Infect 2005; 11:903-7. [PMID: 16216106 DOI: 10.1111/j.1469-0691.2005.01253.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Malaria caused by Plasmodium falciparum remains the major life-threatening parasitic infection in the world. The number of cases in non-endemic countries continues to increase, and it is important that misdiagnosis of malaria should not occur, especially in non-immune travellers, because of the high risk of a fatal outcome. In a retrospective study of 399 sera, the Now Malaria rapid test was compared with the quantitative buffy coat (QBC) test and microbiological examination of thin blood films. Compared with the QBC test and thin blood films, the Now Malaria test had sensitivity and specificity values of 96.4% and 97%, respectively, for the detection of pure P. falciparum infection. A negative predictive value of 99.4% allows this test to be included in diagnostic strategies for patients presenting with clinical suspicion of malaria. Two false-negative results were associated with low levels of parasitaemia in the specimens. Thus, use of the Now Malaria test alone to detect P. falciparum infection in non-endemic countries could lead to misdiagnosis of malaria. This rapid diagnostic test should therefore be performed in association with another prompt traditional method such as examination of thin blood films.
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Affiliation(s)
- F Durand
- Service de Parasitologie-Mycologie Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
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31
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Roux-Buisson N, Fricker-Hidalgo H, Foussadier A, Rolland D, Suchel-Jambon AS, Brenier-Pinchart MP, Pelloux H. Comparative analysis of the VIDAS Toxo IgG IV assay in the detection of antibodies to Toxoplasma gondii. Diagn Microbiol Infect Dis 2005; 53:79-81. [PMID: 16054325 DOI: 10.1016/j.diagmicrobio.2005.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 04/21/2005] [Indexed: 11/30/2022]
Abstract
A new serological test, Vidas Toxo IgG IV, has been developed with antigens obtained from tachyzoites cultured on cells. Vidas Toxo IgG IV replaces Vidas Toxo IgG II by offering a more standardized antigenic production and a lower number of indeterminate results while retaining equivalent sensitivity and specificity.
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Affiliation(s)
- Nathalie Roux-Buisson
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire, BP217, 38043 Grenoble, France
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Fricker-Hidalgo H, Brion JP, Durand M, Chavanon O, Brenier-Pinchart MP, Pelloux H. Disseminated toxoplasmosis with pulmonary involvement after heart transplantation. Transpl Infect Dis 2005; 7:38-40. [PMID: 15984948 DOI: 10.1111/j.1399-3062.2005.00086.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a case of pulmonary toxoplasmosis after heart transplant despite the prophylactic anti-toxoplasmic treatment that was given but was not sufficient to prevent toxoplasmosis. However, the patient survived thanks to early diagnosis confirmed by polymerase chain reaction on blood and by serological techniques, and early treatment.
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Affiliation(s)
- H Fricker-Hidalgo
- Service de Parasitologie-Mycologie, Chentre Hospitalo-Universitaire, Grenoble, France.
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33
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Brenier-Pinchart MP, Garban F, Fricker-Hidalgo H, Richard MJ, Makowski C, Pelloux H. Avoidance of Toxoplasma gondii transmission from a recently infected donor to the recipient of hematopoietic stem cell transplantation. Bone Marrow Transplant 2005; 35:735-6. [PMID: 15711570 DOI: 10.1038/sj.bmt.1704879] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fricker-Hidalgo H, Lebeau B, Pelloux H, Grillot R. Use of the BACTEC 9240 System with Mycosis-IC/F blood culture bottles for detection of fungemia. J Clin Microbiol 2004; 42:1855-6; author reply 1855-6. [PMID: 15071071 PMCID: PMC387625 DOI: 10.1128/jcm.42.4.1855-1856.2004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pinel C, Fricker-Hidalgo H, Lebeau B, Garban F, Hamidfar R, Ambroise-Thomas P, Grillot R. Detection of circulating Aspergillus fumigatus galactomannan: value and limits of the Platelia test for diagnosing invasive aspergillosis. J Clin Microbiol 2003; 41:2184-6. [PMID: 12734275 PMCID: PMC154675 DOI: 10.1128/jcm.41.5.2184-2186.2003] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The effectiveness of galactomannan detection with the Platelia test was evaluated in a prospective study of 3,327 sera from 807 patients. The specificity was 99.6% (748 of 751 cases). For the groups of patients with proven and probable invasive aspergillosis, the sensitivity was 50.0% (17 of 34 cases). The disappointing sensitivity associated with the presence of rare false-positive cases underlines the limits of this test.
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Affiliation(s)
- Claudine Pinel
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire, 38043 Grenoble, France.
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36
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Tissot Dupont D, Fricker-Hidalgo H, Brenier-Pinchart MP, Bost-Bru C, Ambroise-Thomas P, Pelloux H. Usefulness of Western blot in serological follow-up of newborns suspected of congenital toxoplasmosis. Eur J Clin Microbiol Infect Dis 2003; 22:122-5. [PMID: 12627289 DOI: 10.1007/s10096-003-0887-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The goal of the study reported here was to compare the results of Western blot with other serological methods for testing newborns suspected of having congenital toxoplasmosis. Western blot, enzyme-linked immunosorbent assay, immunoglobulin (Ig)M immunosorbent agglutination assay, and indirect immunofluorescence assay were performed on the sera of 126 neonates collected at birth and at 1 and 3 months of life. Western blot was more sensitive than IgM detection with the immunosorbent agglutination assay (82.6% vs. 69.6%), and the specificity of the two methods was 96.1% and 92.2%, respectively. Among the serological techniques tested, the combination of Western blot (IgG and IgM) with IgM immunosorbent agglutination assay achieved the greatest improvement in the sensitivity of early (postpartum) diagnosis of congenital toxoplasmosis.
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Affiliation(s)
- D Tissot Dupont
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire, BP217, 38043, Grenoble, France
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Pelloux H, Fricker-Hidalgo H, Pons JC, Bost-Bru C, Brenier-Pinchart MP, Jouk PS, Ambroise-Thomas P. [Congenital toxoplasmosis: prevention in the pregnant woman and management of the neonate]. Arch Pediatr 2002; 9:206-12. [PMID: 11915504 DOI: 10.1016/s0929-693x(01)00731-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The management of a pregnant women or a child infected by Toxoplasma gondii rests on the screening of pregnant women at risk of infection. Treatment is prescribed if an infection occurs. A prenatal diagnosis (detection of T. gondii in amniotic fluid) may be performed, a positive result leading to a reinforcement of the treatment. After birth, the follow-up of the child is needed in order to prevent and detect the sequellae, mainly ocular. For all these steps, the biological methods used to diagnose T. gondii infection are of paramount importance.
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Affiliation(s)
- H Pelloux
- Département de pédiatrie, hôpital A Michallon, BP 217, 38043 Grenoble, France.
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Faure O, Fricker-Hidalgo H, Lebeau B, Mallaret MR, Ambroise-Thomas P, Grillot R. Eight-year surveillance of environmental fungal contamination in hospital operating rooms and haematological units. J Hosp Infect 2002; 50:155-60. [PMID: 11846544 DOI: 10.1053/jhin.2001.1148] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An eight-year fungal environmental surveillance was carried out in 15 operating theatres and two haematological units. Sampling was performed twice a year in each room, using contact plates for plane surfaces and sterile swabs for grids. From 1992 to 1999, individual rooms in the 17 units were sampled on 1094 occasions and 3822 samples were collected. The percentage of rooms without fungus increased regularly between 1992 and 1999 (41.1% and 74.8%, respectively). The units were classified according to the fungal contamination during the eight years: the operating theatres which required the highest protection (cardiological, thoracic, vascular, hand, orthopaedic and neurosurgery) and the adult haematological unit showed least contamination (71.8% rooms were negative). The most frequent species isolated were Penicillium spp. (28.4%), Cladosporium spp. (15.6%) and Aspergillus spp. (7.6%). Aspergillus fumigatus was rarely isolated (3.7%), and was mainly isolated at the beginning of the study. This study demonstrates that environmental control programmes are effective in reducing environmental mould contamination and could be useful in establishing exposure guidelines, especially by defining an acceptable level of biocontamination in zones at risk.
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Affiliation(s)
- O Faure
- Département de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Grenoble, France.
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Fricker-Hidalgo H, Orenga S, Lebeau B, Pelloux H, Brenier-Pinchart MP, Ambroise-Thomas P, Grillot R. Evaluation of Candida ID, a new chromogenic medium for fungal isolation and preliminary identification of some yeast species. J Clin Microbiol 2001; 39:1647-9. [PMID: 11283107 PMCID: PMC87990 DOI: 10.1128/jcm.39.4.1647-1649.2001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Candida ID, a new chromogenic medium, allows identification of Candida albicans (blue colonies) and preliminary identification into a group of four species (pink colonies). In comparison with Albicans ID2 and Sabouraud gentamicin chloramphenicol on 446 fungal strains, Candida ID allowed the isolation of more species than Albicans ID 2 (95.5% versus 91.2%).
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Affiliation(s)
- H Fricker-Hidalgo
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire, 38043 Grenoble, France.
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41
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Pelloux H, Fricker-Hidalgo H, Brochier G, Goullier-Fleuret A, Ambroise-Thomas P. Intravenous immunoglobulin therapy: confounding effects on serological screening for toxoplasmosis during pregnancy. J Clin Microbiol 1999; 37:3423-4. [PMID: 10488226 PMCID: PMC85593 DOI: 10.1128/jcm.37.10.3423-3424.1999] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The serological diagnosis of toxoplasmic infection during pregnancy is intended to prevent congenital infection of the fetus. However, in the context of recurrent pregnancy loss intravenous immunoglobulin therapy can create a biological trap for the interpretation of serological results, with potentially serious consequences for the outcome of the pregnancy.
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Affiliation(s)
- H Pelloux
- Service de Parasitologie-Mycologie, CHU A Michallon, 38043 Grenoble Cedex, France.
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Goubet S, Pelloux H, Fricker-Hidalgo H, Goullier-Fleuret A, Ambroise-Thomas P. [Serodiagnosis of toxoplasmosis: comparison of tje Elisa Axysm (Abbott) kit with the Vidas (bioMérieux) kit, indirect immunofluorescence and Isaga]. Ann Biol Clin (Paris) 1999; 57:481-4. [PMID: 10432373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- S Goubet
- Département de parasitologie-mycologie, CHU, BP 217, 38043 Grenoble
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Faure AK, Fricker-Hidalgo H, Pelloux H, Bost-Bru C, Goullier-Fleuret A, Ambroise-Thomas P. Lack of value of specific IgA detection in the postnatal diagnosis of congenital toxoplasmosis. J Clin Lab Anal 1999; 13:27-30. [PMID: 10025734 PMCID: PMC6808018 DOI: 10.1002/(sici)1098-2825(1999)13:1<27::aid-jcla5>3.0.co;2-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
To improve the performance of the postnatal diagnosis of congenital toxoplasmosis, we assessed the detection of IgA antibodies to Toxoplasma gondii by ELISA, compared with that of IgM by ELISA, ISAGA, and IFAT and neosynthesized antibodies using Western blot. From 1993 to 1996, IgA antibodies were detected using the Toxo IgA test (SFRI, Société Française de Recherches et d'Investissements, Bordeaux, France), in 195 serum and cord blood samples from 63 infants born to mothers who seroconverted during pregnancy. Eighteen infants had proven congenital toxoplasmosis (confirmed by the presence of IgG after 12 months of life) and 45 had no congenital toxoplasmosis (negativity of IgG after 6-12 months of life). The sensitivity of IgA detection by ELISA on serum and cord blood samples was 38.9 and 54.5% respectively, which is low when compared with the sensitivity of IgM detection by ISAGA (66.7% on serum samples, 90.9% on cord blood), ELISA (61.1% on sera, 81.8% on cord blood) and Western blot (83.3% on sera, 72.7% on cord blood). IgA antibodies were never detected by ELISA earlier than IgM or neosynthesized Ig (antibodies synthesized by infants). Thus, the detection of IgA antibodies by Toxo IgA is not useful in improving the diagnosis of congenital toxoplasmosis.
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Affiliation(s)
- A K Faure
- Département de Parasitologie, Mycologie Médicale et Moléculaire, Centre Hospitalier Universitaire, Grenoble, France
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De Champs C, Pelloux H, Cambon M, Fricker-Hidalgo H, Goullier-Fleuret A, Ambroise-Thomas P. Evaluation of the second generation IMx Toxo IgG antibody assay for detection of antibodies to Toxoplasma gondii in human sera. J Clin Lab Anal 1998; 11:214-9. [PMID: 9219063 PMCID: PMC6760745 DOI: 10.1002/(sici)1098-2825(1997)11:4<214::aid-jcla7>3.0.co;2-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
For an evaluation of the Abbott IMx Toxo IgG second generation, antibodies to Toxoplasma gondii were detected by Abbott IMx Toxo IgG and IgM, Vidas Toxo IgG and Toxo IgM (bioMérieux, France) with immunofluorescence assay verified by the dye-test for IgG, and immunosorbent agglutination assay (ISAGA) for IgM as references. The study included 507 serum samples collected over one month in two laboratories, 32 samples from HIV-infected patients, and 70 serial samples from 23 women surveyed for seroconversion or persistent IgM. After exclusion of nine equivocal results from the 507 samples, the sensitivity and specificity, respectively, were 100% (156/156) and 100% (342/342) for the IMx Toxo IgG and 98.1% (153/156) and 100% (342/342) for the Vidas Toxo IgG. Of the 32 HIV-infected patient samples, 7 gave false positive results with IMx Toxo IgG. This was because the samples had been heated. In 5 of the 70 serial samples. IMx Toxo IgG gave positive results earlier than Vidas Toxo IgG and in two cases earlier than IgM antibody assays. In this study IMx Toxo IgG second generation showed an increase in sensitivity and specificity in comparison with data reported previously for the first generation.
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Affiliation(s)
- C De Champs
- Département de Parasitologie, Mycologie Médicale et Moléculaire, Centre Hospitalier Universitaire, Grenoble, France
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Pelloux H, Brun E, Vernet G, Marcillat S, Jolivet M, Guergour D, Fricker-Hidalgo H, Goullier-Fleuret A, Ambroise-Thomas P. Determination of anti-Toxoplasma gondii immunoglobulin G avidity: adaptation to the Vidas system (bioMérieux). Diagn Microbiol Infect Dis 1998; 32:69-73. [PMID: 9823527 DOI: 10.1016/s0732-8893(98)00077-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The determination of specific anti-Toxoplasma gondii IgG avidity has been proposed to improve the determination of the date of toxoplasmic seroconversion in pregnant women. In this study, we adapted this serological technique to the Vidas system (bioMérieux) using 6 M urea as the dissociating agent. We studied 356 sera, including 42 sequential sera from sero-conversions in pregnant women. Our results show that the test is easy to use, and that an avidity index higher than 0.300 allows the exclusion of a recent infection acquired less than 4 months before serum sampling.
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Affiliation(s)
- H Pelloux
- Département de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Grenoble, France
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Fricker-Hidalgo H, Pelloux H, Racinet C, Grefenstette I, Bost-Bru C, Goullier-Fleuret A, Ambroise-Thomas P. Detection of Toxoplasma gondii in 94 placentae from infected women by polymerase chain reaction, in vivo, and in vitro cultures. Placenta 1998; 19:545-9. [PMID: 9778129 DOI: 10.1016/s0143-4004(98)91049-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The biological diagnosis of congenital toxoplasmosis at birth is important to determine the infant's treatment. The aim of this study was to evaluate the placenta results in the congenital toxoplasmosis diagnosis and to compare them with those obtained with other samples collected at birth (cord blood and newborn blood). A total of 94 placentas, of which 33 came from fetuses suspected of or with proven congenital toxoplasmosis (CT+) and 61 from definitely or probably non-infected fetuses (CT-), was analysed by in vitro culture, mouse inoculation and polymerase chain reaction (PCR). The PCR sensitivity was higher (60.9 per cent) than that of cell culture (29.6 per cent) and mouse inoculation (51.5 per cent) but the number of PCR positive results in CT - patients was also higher (9.5 per cent). The presence of Toxoplasma gondii in the placenta tissues was the only argument at birth (IgM and neosynthesized Ig were negative) in three out of the 33 CT+ cases. The detection of IgM by ELISA and ISAGA and the detection of neosynthesized Ig by immunoblotting were more satisfactory to diagnose congenital toxoplasmosis but the placenta analysis was important to improve the sensitivity of the diagnosis at birth, especially when the prenatal diagnosis was negative or not performed.
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Affiliation(s)
- H Fricker-Hidalgo
- Département de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Grenoble, France
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Fricker-Hidalgo H, Chazot F, Lebeau B, Pelloux H, Ambroise-Thomas P, Grillot R. Use of simulated blood cultures to compare a specific fungal medium with a standard microorganism medium for yeast detection. Eur J Clin Microbiol Infect Dis 1998; 17:113-6. [PMID: 9629977 DOI: 10.1007/bf01682167] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to compare the performance of a specific blood culture medium recently developed to detect fungi on the Bactec 9240 system (Mycosis IC/F; Becton Dickinson Diagnostic Instrument Systems, USA) with that of the standard medium used for detection of bacteria (Aerobic Plus/F; Becton Dickinson). Simulated blood cultures were performed on 43 strains belonging to ten fungal species using the two media. The mean time to yeast detection using the Mycosis IC/F medium was 29.03+/-13.99 h, in contrast to a mean time of 73.92+/-56.74 h using the Aerobic Plus/F medium. These results show that the Mycosis IC/F medium clearly reduces the time to yeast detection on the Bactec 9240.
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Affiliation(s)
- H Fricker-Hidalgo
- Département de Parasitologie-Mycologie Médicale et Moléculaire, Centre Hospitalier Universitaire, Grenoble, France
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Fricker-Hidalgo H, Pelloux H, Muet F, Racinet C, Bost M, Goullier-Fleuret A, Ambroise-Thomas P. Prenatal Diagnosis of Congenital Toxoplasmosis: Comparative Value of Fetal Blood and Amniotic Fluid using Serological Techniques and Cultures. Prenat Diagn 1997. [DOI: 10.1002/(sici)1097-0223(199709)17:9%3c831::aid-pd156%3e3.0.co;2-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Fricker-Hidalgo H, Pelloux H, Muet F, Racinet C, Bost M, Goullier-Fleuret A, Ambroise-Thomas P. Prenatal diagnosis of congenital toxoplasmosis: comparative value of fetal blood and amniotic fluid using serological techniques and cultures. Prenat Diagn 1997; 17:831-5. [PMID: 9316127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The prenatal diagnosis of congenital toxoplasmosis is mainly based on biological tests performed on fetal blood and amniotic fluid. We studied the performance of neonatal diagnosis procedures and the results of fetal blood and amniotic fluid analysis. Of 127 women who contracted toxoplasmosis and underwent prenatal diagnosis, the postnatal serological follow-up was long enough to definitively diagnose congenital toxoplasmosis in 19 cases and to exclude it in 27 cases. Prenatal diagnosis allowed the detection of 94.7 per cent (18/19) of the infected fetuses. The sensitivities of tests in amniotic fluid and fetal blood were equivalent, 88.2 per cent (15/17) and 87.5 per cent (14/16), respectively. In fetal blood, biological techniques were positive in 12/16 cases and in 2/16 cases, serological tests were the only positive sign. The specificities of tests in amniotic fluid and fetal blood were respectively 100 per cent (23/23) and 86.3 per cent (19/22) (three false-positive serological results). These results, added to the lower morbidity of amniocentesis compared with cordocentesis, might lead to cordocentesis being abandoned in the prenatal diagnosis of congenital toxoplasmosis.
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Affiliation(s)
- H Fricker-Hidalgo
- Département de Parasitologie-Mycologie Médicale et Moléculaire, Centre Hospitalier Universitaire, Grenoble, France
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Fricker-Hidalgo H, Pelloux H, Muet F, Racinet C, Bost M, Goullier-Fleuret A, Ambroise-Thomas P. Prenatal Diagnosis of Congenital Toxoplasmosis: Comparative Value of Fetal Blood and Amniotic Fluid using Serological Techniques and Cultures. Prenat Diagn 1997. [DOI: 10.1002/(sici)1097-0223(199709)17:9<831::aid-pd156>3.0.co;2-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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