Conventional polymerase chain reaction for the diagnosis of neurotoxoplasmosis: comparison of three sets of primers for the B1 gene using CSF samples

Molecular diagnosis of toxoplasmosis: recent advances and a look to the future

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.

Molecular diagnosis of toxoplasmosis in immunocompromised patients

PURPOSE OF REVIEW

Toxoplasmosis in immunocompromised patients is associated with a high mortality rate. Molecular techniques are important tools to diagnose acute disease in immunocompromised patients, but there are various methods with variable efficiency. Some of them have been validated for the diagnosis of congenital toxoplasmosis, but the impact of their use has not been evaluated in immunocompromised patients.

RECENT FINDINGS

Toxoplasmosis is of increasing importance in non-HIV immunocompromised patients. In addition, the picture of disease shows greater severity in South America, both in immunocompetent study participants and in congenitally infected infants. These epidemiological differences could influence the sensitivity of diagnostic methods. This review analyzes recent data on molecular diagnosis and compares them with older ones, in light of progress gained in molecular techniques and of recent epidemiological findings. Most recent studies were conducted in South America and used PCR targeting the B1 gene. PCR on blood could allow diagnosing a significant proportion of patients with ocular toxoplasmosis in Brazil.

SUMMARY

Quantitative PCR methods with specific probes should be used to improve sensitivity and warrant specificity. Performance of quantitative PCR targeting the repeated 529 bp sequence for the diagnosis of toxoplasmosis in immunocompromised patients needs evaluation in field studies in South America and in western countries.

CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)-Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Diagnosis of CNS infections remains a great challenge in patients with hematological disorders since symptoms might both be masked and be mimicked by other conditions such as metabolic disturbances or consequences from antineoplastic treatment. Thus, awareness of this complication is crucial and any suspicion of a CNS infection should lead to timely and adequate diagnostics and treatment to improve the outcome in this population.

Infections of the central nervous system (CNS) are infrequently diagnosed in immunocompetent patients, but they do occur in a significant proportion of patients with hematological disorders. In particular, patients undergoing allogeneic hematopoietic stem-cell transplantation carry a high risk for CNS infections of up to 15%. Fungi and Toxoplasma gondii are the predominant causative agents. The diagnosis of CNS infections is based on neuroimaging, cerebrospinal fluid examination and biopsy of suspicious lesions in selected patients. However, identification of CNS infections in immunocompromised patients could represent a major challenge since metabolic disturbances, side-effects of antineoplastic or immunosuppressive drugs and CNS involvement of the underlying hematological disorder may mimic symptoms of a CNS infection. The prognosis of CNS infections is generally poor in these patients, albeit the introduction of novel substances (e.g. voriconazole) has improved the outcome in distinct patient subgroups. This guideline has been developed by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) with the contribution of a panel of 14 experts certified in internal medicine, hematology/oncology, infectious diseases, intensive care, neurology and neuroradiology. Grades of recommendation and levels of evidence were categorized by using novel criteria, as recently published by the European Society of Clinical Microbiology and Infectious Diseases.

Evidence for Toxoplasma gondii in migratory vs. nonmigratory herbivores in a terrestrial arctic ecosystem

It is currently unclear how Toxoplasma gondii (Nicolle and Manceaux, 1908) persists in arctic tundra ecosystems in the absence of felid definitive hosts. To investigate potential transmission routes of T. gondii in a terrestrial arctic food web, we collected samples from two migratory herbivores, Ross’s Geese (Chen rossi (Cassin, 1861)) and Lesser Snow Geese (Chen caerulescens (L., 1758)), and from two resident herbivores, Nearctic brown lemmings (Lemmus trimucronatus (Richardson, 1825)) and collared lemmings (Dicrostonyx groenlandicus (Traill, 1823)), trapped at Karrak Lake, Nunavut, Canada. Antibodies were detected in 76 of 234 (32.4%) serum samples from Ross’s Geese and 66 of 233 (28.3%) serum samples from Lesser Snow Geese. We did not detect T. gondii antibodies in filter-paper eluate tested from thoracic fluid samples collected from 84 lemmings. We did not detect T. gondii DNA in brain tissue from these lemmings. Although a small sample size, our findings suggest that lemmings in this terrestrial arctic ecosystem are not exposed to, or infected with, the parasite. This suggests that oocysts are not introduced into the terrestrial arctic ecosystem at Karrak Lake via freshwater runoff from temperate regions. This study demonstrated that live adult arctic-nesting geese are exposed to T. gondii and therefore migratory herbivorous hosts are potential sources of T. gondii infection for predators in terrestrial arctic ecosystems.