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Nguyen MN, Yeo SJ, Park H. Identification of novel biomarkers for anti- Toxoplasma gondii IgM detection and the potential application in rapid diagnostic fluorescent tests. Front Microbiol 2024; 15:1385582. [PMID: 38894968 PMCID: PMC11184589 DOI: 10.3389/fmicb.2024.1385582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/03/2024] [Indexed: 06/21/2024] Open
Abstract
Toxoplasmosis, while often asymptomatic and prevalent as a foodborne disease, poses a considerable mortality risk for immunocompromised individuals during pregnancy. Point-of-care serological tests that detect specific IgG and IgM in patient sera are critical for disease management under limited resources. Despite many efforts to replace the T. gondii total lysate antigens (TLAs) by recombinant antigens (rAgs) in commercial kits, while IgG detection provides significant specificity and sensitivity, IgM detection remains comparatively low in sensitivity. In this study, we attempted to identify novel antigens targeting IgM in early infection, thereby establishing an IgM on-site detection kit. Using two-dimensional gel electrophoresis (2DE) and mouse serum immunoblotting, three novel antigens, including EF1γ, PGKI, and GAP50, were indicated to target T. gondii IgM. However, rAg EF1γ was undetectable by IgM of mice sera in Western blotting verification experiments, and ELISA coated with PGKI did not eliminate cross-reactivity, in contrast to GAP50. Subsequently, the lateral flow reaction employing a strip coated with 0.3 mg/mL purified rAg GAP50 and exhibited remarkable sensitivity compared with the conventional ELISA based on tachyzoite TLA, which successfully identified IgM in mouse sera infected with tachyzoites, ranging from 103 to 104 at 5 dpi and 104 at 7 dpi, respectively. Furthermore, by using standard T. gondii-infected human sera from WHO, the limit of detection (LOD) for the rapid fluorescence immunochromatographic test (FICT) using GAP50 was observed at 0.65 IU (international unit). These findings underline the particular immunoreactivity of GAP50, suggesting its potential as a specific biomarker for increasing the sensitivity of the FICT in IgM detection.
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Affiliation(s)
- Minh-Ngoc Nguyen
- Department of Infection Biology, School of Medicine, Zoonosis Research Center, Wonkwang University, Iksan, Republic of Korea
| | - Seon-Ju Yeo
- Department of Tropical Medicine and Parasitology, Department of Biomedical Sciences, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Tropical Medicine and Parasitology, Medical Research Center, Institute of Endemic Diseases, Seoul National University, Seoul, Republic of Korea
| | - Hyun Park
- Department of Infection Biology, School of Medicine, Zoonosis Research Center, Wonkwang University, Iksan, Republic of Korea
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Zhou Y, Leahy K, Grose A, Lykins J, Siddiqui M, Leong N, Goodall P, Withers S, Ashi K, Schrantz S, Tesic V, Abeleda AP, Beavis K, Clouser F, Ismail M, Christmas M, Piarroux R, Limonne D, Chapey E, Abraham S, Baird I, Thibodeau J, Boyer KM, Torres E, Conrey S, Wang K, Staat MA, Back N, L’Ollivier C, Mahinc C, Flori P, Gomez-Marin J, Peyron F, Houzé S, Wallon M, McLeod R. Novel paradigm enables accurate monthly gestational screening to prevent congenital toxoplasmosis and more. PLoS Negl Trop Dis 2024; 18:e0011335. [PMID: 38805559 PMCID: PMC11132520 DOI: 10.1371/journal.pntd.0011335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/01/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Congenital toxoplasmosis is a treatable, preventable disease, but untreated causes death, prematurity, loss of sight, cognition and motor function, and substantial costs worldwide. OBJECTIVES We asked whether high performance of an Immunochromatographic-test (ICT) could enable accurate, rapid diagnosis/treatment, establishing new, improved care-paradigms at point-of-care and clinical laboratory. METHODS Data were obtained in 12 studies/analyses addressing: 1-feasibility/efficacy; 2-false-positives; 3-acceptability; 4-pink/black-line/all studies; 5-time/cost; 6-Quick-Information/Limit-of-detection; 7, 8-acute;-chronic; 9-epidemiology; 10-ADBio; 11,12-Commentary/Cases/Chronology. FINDINGS ICT was compared with gold-standard or predicate-tests. Overall, ICT performance for 1093 blood/4967 sera was 99.2%/97.5% sensitive and 99.0%/99.7% specific. However, in clinical trial, FDA-cleared-predicate tests initially caused practical, costly problems due to false-positive-IgM results. For 58 persons, 3/43 seronegative and 2/15 chronically infected persons had false positive IgM predicate tests. This caused substantial anxiety, concerns, and required costly, delayed confirmation in reference centers. Absence of false positive ICT results contributes to solutions: Lyon and Paris France and USA Reference laboratories frequently receive sera with erroneously positive local laboratory IgM results impeding patient care. Therefore, thirty-two such sera referred to Lyon's Reference laboratory were ICT-tested. We collated these with other earlier/ongoing results: 132 of 137 USA or French persons had false-positive local laboratory IgM results identified correctly as negative by ICT. Five false positive ICT results in Tunisia and Marseille, France, emphasize need to confirm positive ICT results with Sabin-Feldman-Dye-test or western blot. Separate studies demonstrated high performance in detecting acute infections, meeting FDA, CLIA, WHO REASSURED, CEMark criteria and patient and physician satisfaction with monthly-gestational-ICT-screening. CONCLUSIONS/SIGNIFICANCE This novel paradigm using ICT identifies likely false positives or raises suspicion that a result is truly positive, rapidly needing prompt follow up and treatment. Thus, ICT enables well-accepted gestational screening programs that facilitate rapid treatment saving lives, sight, cognition and motor function. This reduces anxiety, delays, work, and cost at point-of-care and clinical laboratories. TRIAL REGISTRATION NCT04474132, https://clinicaltrials.gov/study/NCT04474132 ClinicalTrials.gov.
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Affiliation(s)
- Ying Zhou
- Departments of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
| | - Karen Leahy
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, United States of America
| | - Andrew Grose
- Departments of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Pritzker School of Medicine, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
| | - Joseph Lykins
- Departments of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Pritzker School of Medicine, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
| | - Maryam Siddiqui
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, United States of America
| | - Nicole Leong
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, United States of America
| | - Perpetua Goodall
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, United States of America
| | - Shawn Withers
- Departments of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
| | - Kevin Ashi
- Departments of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Pritzker School of Medicine, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
| | - Stephen Schrantz
- Pritzker School of Medicine, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
- Chicago Medicine, The University of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
- Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Vera Tesic
- Pritzker School of Medicine, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
- Chicago Medicine, The University of Chicago, Chicago, Illinois, United States of America
- Department of Pathology, The University of Chicago, Chicago, Illinois, United States of America
| | - Ana Precy Abeleda
- Chicago Medicine, The University of Chicago, Chicago, Illinois, United States of America
- Department of Pathology, The University of Chicago, Chicago, Illinois, United States of America
| | - Kathleen Beavis
- Pritzker School of Medicine, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
- Chicago Medicine, The University of Chicago, Chicago, Illinois, United States of America
- Department of Pathology, The University of Chicago, Chicago, Illinois, United States of America
| | - Fatima Clouser
- Departments of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
| | - Mahmoud Ismail
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, United States of America
- Pritzker School of Medicine, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
- Chicago Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Monica Christmas
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, United States of America
- Pritzker School of Medicine, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
- Chicago Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | | | | | - Emmanuelle Chapey
- Institut des agents infectieux, Hôpital de la Croix-Rousse, Lyon, France
| | - Sylvie Abraham
- Laboratory of Parasitologie, Bichat-Claude Bernard Hôpital, Paris, France
| | - Isabelle Baird
- The College, The University of Chicago, Chicago, Illinois, United States of America
- Global Health Center, The University of Chicago, Chicago, Illinois, United States of America
| | - Juliette Thibodeau
- The College, The University of Chicago, Chicago, Illinois, United States of America
- Global Health Center, The University of Chicago, Chicago, Illinois, United States of America
| | - Kenneth M. Boyer
- Department of Pediatrics, Division of Infectious Diseases, Rush Presbyterian Hospital and Medical Center, Chicago, Illinois, United States of America
| | - Elizabeth Torres
- Group of Molecular Parasitology (GEPAMOL), Center of Biomedical Research, Faculty of Health Sciences, University of Quindio, Armenia (Quindio), Colombia
| | - Shannon Conrey
- University of Cincinnati and Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Kanix Wang
- Carl H. Lindner College of Business, The University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Mary Allen Staat
- University of Cincinnati and Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Nancy Back
- University of Cincinnati and Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Coralie L’Ollivier
- Centre National de Référence Toxoplasmose—Pôle Sérologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- IHU-Méditerranée Infection, Assistance Publique Hôpitaux de Marseille (AP-HM), Marseille, France; Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU Méditerranée, Marseille, France
| | - Caroline Mahinc
- Parasitology and Mycology Laboratory, Pôle de Biologie-Pathologie, University Hospital of Saint Etienne, Saint Etienne, France
| | - Pierre Flori
- Parasitology and Mycology Laboratory, Pôle de Biologie-Pathologie, University Hospital of Saint Etienne, Saint Etienne, France
| | - Jorge Gomez-Marin
- Group of Molecular Parasitology (GEPAMOL), Center of Biomedical Research, Faculty of Health Sciences, University of Quindio, Armenia (Quindio), Colombia
| | - Francois Peyron
- Institut des agents infectieux, Hôpital de la Croix-Rousse, Lyon, France
| | - Sandrine Houzé
- Laboratory of Parasitologie, Bichat-Claude Bernard Hôpital, Paris, France
| | - Martine Wallon
- Institut des agents infectieux, Hôpital de la Croix-Rousse, Lyon, France
| | - Rima McLeod
- Departments of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Pritzker School of Medicine, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, Division of Infectious Diseases, The University of Chicago, Chicago, Illinois, United States of America
- Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
- The College, The University of Chicago, Chicago, Illinois, United States of America
- Global Health Center, The University of Chicago, Chicago, Illinois, United States of America
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Voyiatzaki C, Zare Chormizi AD, Tsoumani ME, Efstathiou A, Konstantinidis K, Chaniotis D, Chrysos G, Argyraki A, Papastamopoulos V, Kotsianopoulou M. Seroprevalence of Toxoplasma gondii among HIV Positive Patients under Surveillance in Greek Infectious Disease Units: A Screening Study with Comparative Evaluation of Serological Methods. Pathogens 2024; 13:375. [PMID: 38787227 PMCID: PMC11123859 DOI: 10.3390/pathogens13050375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
This study aims to screen for IgG antibodies against Toxoplasma gondii (T. gondii) in the sera of 155 newly diagnosed Human Immunodeficiency Virus (HIV) positive patients under surveillance in Greek Infectious Disease Units. Additionally, risk factors based on patient demographics were examined, and a comparative evaluation of commercially available serological methods was conducted. Three methods were employed to detect IgG antibodies against T. gondii: Enzyme-Linked Immunosorbent Assay (ELISA), Indirect Immunofluorescence Antibody Test (IFAT), and Western Blot (WB), which was used as a reference here. Forty-nine sera samples were true-positive for IgG antibodies against T. gondii, resulting in a 31.61% positivity rate, and the immunoassay test statistical reliability analysis resulted in higher IFAT accuracy (90.97%) compared to ELISA (76.26%). Furthermore, statistical analysis of demographic and immunological data included in the study placed female and foreign/non-Greek individuals at 2.24 (p = 0.0009) and 2.34 (p = 0.0006) times higher risk of positive T. gondii IgG testing compared to their male and Greek counterparts, respectively. Our findings on positivity rates and comparative serology underscore the importance of early and suitable screening measures for newly diagnosed HIV+ patients to mitigate the life-threatening outcomes that may arise from a potential subsequent T. gondii activation.
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Affiliation(s)
- Chrysa Voyiatzaki
- Department of Biomedical Sciences, Division of Medical Laboratories Science, University of West Attica, 12243 Athens, Greece
| | - Apollon Dareios Zare Chormizi
- Department of Biomedical Sciences, Division of Medical Laboratories Science, University of West Attica, 12243 Athens, Greece
| | - Maria E. Tsoumani
- Department of Biomedical Sciences, Division of Medical Laboratories Science, University of West Attica, 12243 Athens, Greece
| | - Antonia Efstathiou
- Department of Biomedical Sciences, Division of Medical Laboratories Science, University of West Attica, 12243 Athens, Greece
- Immunology of Infection Group, Department of Microbiology, Hellenic Pasteur Institute, 11521 Athens, Greece
| | - Konstantinos Konstantinidis
- Department of Medicine, Laboratory of Biology, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece
| | - Dimitrios Chaniotis
- Department of Biomedical Sciences, Division of Medical Laboratories Science, University of West Attica, 12243 Athens, Greece
| | - Georgios Chrysos
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, 18536 Athens, Greece
| | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria Thoracic Diseases General Hospital, 11527 Athens, Greece
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine, Infectious Diseases Unit, Evaggelismos General Hospital, 10676 Athens, Greece
| | - Marika Kotsianopoulou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece
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4
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Dupont D, Robert M, Brenier-Pinchart M, Lefevre A, Wallon M, Pelloux H. Toxoplasma gondii, a plea for a thorough investigation of its oncogenic potential. Heliyon 2023; 9:e22147. [PMID: 38034818 PMCID: PMC10685377 DOI: 10.1016/j.heliyon.2023.e22147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023] Open
Abstract
It is estimated that 30 % of the world's population harbours the parasite Toxoplasma gondii, particularly in the brain. Beyond its implication in potentially severe opportunistic or congenital infections, this persistence has long been considered as without consequence. However, certain data in animals and humans suggest that this carriage may be linked to various neuropsychiatric or neurodegenerative disorders. The hypothesis of a potential cerebral oncogenicity of the parasite is also emerging. In this personal view, we will present the epidemiological arguments in favour of an association between toxoplasmosis and cerebral malignancy, before considering the points that could underlie a potential causal link. More specifically, we will focus on the brain as the preferred location for T. gondii persistence and the propensity of this parasite to interfere with the apoptosis and cell cycle signalling pathways of their host cell.
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Affiliation(s)
- D. Dupont
- Institut des Agents Infectieux, Parasitologie Mycologie, 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
| | - M.G. Robert
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France
- Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), INSERM U1209-CNRS UMR 5309, Grenoble, 38000, France
| | - M.P. Brenier-Pinchart
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France
- Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), INSERM U1209-CNRS UMR 5309, Grenoble, 38000, France
| | - A. Lefevre
- Institut des Agents Infectieux, Parasitologie Mycologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, 69004, France
| | - M. Wallon
- Institut des Agents Infectieux, Parasitologie Mycologie, 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
| | - H. Pelloux
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France
- Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), INSERM U1209-CNRS UMR 5309, Grenoble, 38000, France
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Márquez-Mauricio A, Caballero-Ortega H, Gómez-Chávez F. Congenital Toxoplasmosis Diagnosis: Current Approaches and New Insights. Acta Parasitol 2023; 68:473-480. [PMID: 37368128 DOI: 10.1007/s11686-023-00693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The aim of this study is to describe and discuss current disadvantages in congenital toxoplasmosis (CT) diagnosis, and what can be improved or changed through new perspectives and technological advances. METHODS We used Pubmed, Cochrane, and EBSCO databases to research publications from 10 years to date describing current diagnostic methods for CT. The keywords used for this Mini-Review were Toxoplasma gondii, congenital toxoplasmosis, diagnosis, and prospects using Boolean operators such as AND, OR, identifying scientific publications highlighting the importance of implementing new diagnostic methods. RESULTS Current diagnosis methods have several disadvantages, i.e., time-consuming, low sensitivity or specificity, and non-cost effective, that bring up the necessity of improving or developing new approaches. Recombinant proteins can help improve specificity by generating tests that use circulating strains in a specific geographical region, SAG1 and BAG1, as they are expressed during a particular stage of the disease (acute or chronic, respectively), for its use in serological diagnoses, such as capture ELISA and immunochromatography. Point of Care (POC) tests are methods performed at the patient care site, which leads to rapid patient treatment; despite the advantages, several improvements and perspectives are necessary to be implemented globally. CONCLUSIONS Although already established diagnosis methods for CT may be sufficient in some regions, there is still a persistent demand to develop tests with higher throughput, cost, and time reduction in developing countries, where prevalence is high. New approaches in CT diagnosis, such as recombinant proteins, capture ELISA, immunochromatography, and POC tests methods, can increase performance in terms of specificity and sensitivity simplifying diagnostic tests' requirements.
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Affiliation(s)
| | | | - Fernando Gómez-Chávez
- Laboratorio de Enfermedades Osteoarticulares e Inmunológicas, Sección de Estudios de Posgrado e Investigación, ENMyH-Instituto Politécnico Nacional, Mexico City, Mexico.
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Zhou Y, Leahy K, Grose A, Lykins J, Siddiqui M, Leong N, Goodall P, Withers S, Ashi K, Schrantz S, Tesic V, Abeleda AP, Beavis K, Clouser F, Ismail M, Christmas M, Piarroux R, Limonne D, Chapey E, Abraham S, Baird I, Thibodeau J, Boyer K, Torres E, Conrey S, Wang K, Staat MA, Back N, Gomez Marin J, Peyron F, Houze S, Wallon M, McLeod R. Novel paradigm enables accurate monthly gestational screening to prevent congenital toxoplasmosis and more. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.26.23289132. [PMID: 37162985 PMCID: PMC10168490 DOI: 10.1101/2023.04.26.23289132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Congenital toxoplasmosis is a treatable, preventable disease, but untreated causes death, prematurity, loss of sight, cognition and motor function, and substantial costs worldwide. Methods/Findings In our ongoing USA feasibility/efficacy clinical trial, data collated with other ongoing and earlier published results proved high performance of an Immunochromatographic-test(ICT) that enables accurate, rapid diagnosis/treatment, establishing new paradigms for care. Overall results from patient blood and/or serum samples tested with ICT compared with gold-standard-predicate-test results found ICT performance for 4606 sera/1876 blood, 99.3%/97.5% sensitive and 98.9%/99.7% specific. However, in the clinical trial the FDA-cleared-predicate test initially caused practical, costly problems due to false-positive-IgM results. For 58 persons, 3/43 seronegative and 2/15 chronically infected persons had false positive IgM predicate tests. This caused substantial anxiety, concerns, and required costly, delayed confirmation in reference centers. Absence of false positive ICT results contributes to solutions: Lyon and Paris France and USA Reference laboratories frequently receive sera with erroneously positive local laboratory IgM results impeding patient care. Therefore, thirty-two such sera referred to Lyon's Reference laboratory were ICT-tested. We collated these with other earlier/ongoing results: 132 of 137 USA or French persons had false positive local laboratory IgM results identified correctly as negative by ICT. Five false positive ICT results in Tunisia and Marseille, France, emphasize need to confirm positive ICT results with Sabin-Feldman-Dye-test or western blot. Separate studies demonstrated high performance in detecting acute infections, meeting FDA, CLIA, WHO ASSURED, CEMark criteria and patient and physician satisfaction with monthly-gestational-ICT-screening. Conclusions/Significance This novel paradigm using ICT identifies likely false positives or raises suspicion that a result is truly positive, rapidly needing prompt follow up and treatment. Thus, ICT enables well-accepted gestational screening programs that facilitate rapid treatment saving lives, sight, cognition and motor function. This reduces anxiety, delays, work, and cost at point-of-care and clinical laboratories. Author’s Summary Toxoplasmosis is a major health burden for developed and developing countries, causing damage to eyes and brain, loss of life and substantial societal costs. Prompt diagnosis in gestational screening programs enables treatment, thereby relieving suffering, and leading to > 14-fold cost savings for care. Herein, we demonstrate that using an ICT that meets WHO ASSURED-criteria identifying persons with/without antibody to Toxoplasma gondii in sera and whole blood with high sensitivity and specificity, is feasible to use in USA clinical practice. We find this new approach can help to obviate the problem of detection of false positive anti- T.gondii IgM results for those without IgG antibodies to T.gondii when this occurs in present, standard of care, predicate USA FDA cleared available assays. Thus, this accurate test facilitates gestational screening programs and a global initiative to diagnose and thereby prevent and treat T.gondii infection. This minimizes likelihood of false positives (IgG and/or IgM) while maintaining maximum sensitivity. When isolated IgM antibodies are detected, it is necessary to confirm and when indicated continue follow up testing in ∼2 weeks to establish seroconversion. Presence of a positive ICT makes it likely that IgM is truly positive and a negative ICT makes it likely that IgM will be a false positive without infection. These results create a new, enthusiastically-accepted, precise paradigm for rapid diagnosis and validation of results with a second-line test. This helps eliminate alarm and anxiety about false-positive results, while expediting needed treatment for true positive results and providing back up distinguishing false positive tests.
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7
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Dambrun M, Sare N, Vianou B, Amagbégnon R, Fievet N, Massougbodji A, Houzé S, Migot-Nabias F. Serological diagnosis of toxoplasmosis in pregnancy: comparison between a manual commercial ELISA assay and the automated VIDAS ® kit. Eur J Clin Microbiol Infect Dis 2023; 42:759-769. [PMID: 37095264 DOI: 10.1007/s10096-023-04603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
Knowledge of the toxoplasmosis serological status in pregnant women is important to allow adequate management for the prevention of congenital toxoplasmosis of those who are not immunized. Serological screening is generally carried out using commercial kits to determine the presence or absence of immunoglobulins M or G in the maternal blood. Robust results are therefore needed. We evaluated the performances of a commercial ELISA assay composed of several recombinant parasite antigens and of a commercial assay using parasite lysate to determine the serological status against Toxoplasma gondii of African pregnant women. A recruitment of 106 pregnant women during their third trimester of pregnancy was carried out in Benin. Serologies were performed with recomWell Toxoplasma IgM and IgG kits. Subsequently, the serological assays were carried out by an automaton method with the VIDAS® TOXO IgM and IgG II kits. Here we compared recomWell Toxoplasma to VIDAS® TOXO results. Reproducibility tests of the recomWell kits were assessed following the discrepancies observed in the results. Of 106 plasmas tested, 47 showed anti-T. gondii IgG (44.3%), including 5 with IgM and high IgG avidity (4.7%). Of the two techniques, VIDAS® TOXO was more robust and specific for IgG while the recomWell Toxoplasma gave more false positive results. The combination of several techniques for the determination of serological toxoplasmosis status remains relevant. Methods using native proteins are closer to the reality of the environment. Therefore, kits using recombinant proteins should be tested on highly geographically diverse populations to refine their composition.
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Affiliation(s)
| | - Nawal Sare
- Centre d'Etude et de Recherche sur les Pathologies Associées à la Grossesse et à L'Enfance, Cotonou, Bénin
| | - Bertin Vianou
- Centre d'Etude et de Recherche sur les Pathologies Associées à la Grossesse et à L'Enfance, Cotonou, Bénin
| | - Richard Amagbégnon
- Laboratoire de Biologie Médicale, Centre Hospitalier Universitaire de la Mère et de L'Enfant-Lagune (CHU-MEL), 01 BP 107, Cotonou, Bénin
| | - Nadine Fievet
- Universite Paris Cite, MERIT, IRD, Paris, F-75006, France
| | - Achille Massougbodji
- Centre d'Etude et de Recherche sur les Pathologies Associées à la Grossesse et à L'Enfance, Cotonou, Bénin
- Institut de Recherche Clinique du Bénin, Cotonou, Bénin
| | - Sandrine Houzé
- Universite Paris Cite, MERIT, IRD, Paris, F-75006, France
- Service de Parasitologie, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Bichat Claude-Bernard, Paris, 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: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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] [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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The association of IL-3, IL-17A, and IL 27 serum levels with susceptibility to toxoplasmosis in recurrent abortion of Iraqi women. Exp Parasitol 2022; 234:108217. [DOI: 10.1016/j.exppara.2022.108217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/03/2021] [Accepted: 01/21/2022] [Indexed: 11/21/2022]
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11
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Identification of Oocyst-Driven Toxoplasma gondii Infections in Humans and Animals through Stage-Specific Serology-Current Status and Future Perspectives. Microorganisms 2021; 9:microorganisms9112346. [PMID: 34835471 PMCID: PMC8618849 DOI: 10.3390/microorganisms9112346] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
The apicomplexan zoonotic parasite Toxoplasma gondii has three infective stages: sporozoites in sporulated oocysts, which are shed in unsporulated form into the environment by infected felids; tissue cysts containing bradyzoites, and fast replicating tachyzoites that are responsible for acute toxoplasmosis. The contribution of oocysts to infections in both humans and animals is understudied despite being highly relevant. Only a few diagnostic antigens have been described to be capable of discriminating which parasite stage has caused an infection. Here we provide an extensive overview of the antigens and serological assays used to detect oocyst-driven infections in humans and animals according to the literature. In addition, we critically discuss the possibility to exploit the increasing knowledge of the T. gondii genome and the various 'omics datasets available, by applying predictive algorithms, for the identification of new oocyst-specific proteins for diagnostic purposes. Finally, we propose a workflow for how such antigens and assays based on them should be evaluated to ensure reproducible and robust results.
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Robert-Gangneux F, Guegan H. Anti-Toxoplasma IgG assays: What performances for what purpose? A systematic review. Parasite 2021; 28:39. [PMID: 33904818 PMCID: PMC8078101 DOI: 10.1051/parasite/2021035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022] Open
Abstract
Chronic infection with Toxoplasma gondii is attested by the detection of specific anti-Toxoplasma IgG. A wide panel of serologic methods is currently marketed, and the most suitable method should be chosen according to the laboratory resources and the screened population. This systematic review of evaluation studies aimed at establishing an overview of the performances, i.e. sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of marketed anti-Toxoplasma IgG assays, and discussing their technical characteristics to guide further choice for routine diagnostic use. According to PRISMA guidelines, the search performed in PubMed and Web of Science databases recovered 826 studies, of which 17 were ultimately included. Twenty commercial anti-Toxoplasma IgG assays were evaluated, in comparison with an accepted reference method. Most of them were enzyme-immunoassays (EIAs, n = 12), followed by agglutination tests (n = 4), immunochromatographic tests (n = 3), and a Western-Blot assay (WB, n = 1). The mean sensitivity of IgG assays ranged from 89.7% to 100% for standard titers and from 13.4% to 99.2% for low IgG titers. A few studies pointed out the ability of some methods, especially WB to detect IgG early after primary infection. The specificity of IgG assays was generally high, ranging from 91.3% to 100%; and higher than 99% for most EIA assays. The PPV was not a discriminant indicator among methods, whereas significant disparities (87.5%-100%) were reported among NPVs, a key-parameter assessing the ability to definitively rule out a Toxoplasma infection in patients at-risk for opportunistic infections.
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Affiliation(s)
- Florence Robert-Gangneux
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Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085 35000 Rennes France
| | - Hélène Guegan
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Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085 35000 Rennes France
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