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Ikuta K, Kanno R, Bessho T, Koshizuka T, Suzutani T. Evaluation of Toxoplasma gondii IgG avidity assays through a comparison of IgM serostatus. Diagn Microbiol Infect Dis 2023; 105:115901. [PMID: 36889215 DOI: 10.1016/j.diagmicrobio.2023.115901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/23/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Primary Toxoplasma gondii (T. gondii) infection during pregnancy could result in congenital disease with severe clinical complications. IgM antibodies are one of the indices of primary infection. The IgG avidity index (AI) is also known to remain low for at least 3 months after primary infection. Here, we evaluated and compared the performance of T. gondii IgG avidity assays as confirmed by T. gondii IgM serostatus and number of days post-exposure. Four assays preferentially used in Japan were employed to measure the T. gondii IgG AI. Results for the T. gondii IgG AI showed good concordance, particularly in cases with a low IgG AI. This study confirms that the combination of T. gondii IgM and IgG AI tests is a reliable and suitable method for identifying T. gondii primary infections. Our study proposes the necessity of measuring the T. gondii IgG AI as an additional indicator of T. gondii primary infection.
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Affiliation(s)
- Kazufumi Ikuta
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima , Japan; Division of Microbiology, Tohoku Medical and Pharmaceutical University School of Medicine, Miyagi, Japan
| | - Ryoko Kanno
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima , Japan
| | - Tomoaki Bessho
- Department of Vaccine and Diagnostics, Life Innovation Center, Denka Co., Ltd, Niigata, Japan
| | - Tetsuo Koshizuka
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima , Japan; Laboratory of Microbiology and Immunology, Gifu Pharmaceutical University, Gifu, Japan
| | - Tatsuo Suzutani
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima , Japan.
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Kodym P, Kurzová Z, Berenová D, Malý M. Detection of persistent low IgG avidity-an interpretative problem in the diagnosis of acute toxoplasmosis. PLoS One 2023; 18:e0284499. [PMID: 37053239 PMCID: PMC10101438 DOI: 10.1371/journal.pone.0284499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/02/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES For the proper diagnosis of toxoplasmosis it is essential to determine the stage of the infection, for which the most preferred method is IgG avidity test. The avidity index (AI) should initially be low (AI≤0.3) in the acute phase and increase during the infection. However, persistent low avidity can occur in patients with latent toxoplasmosis, which can complicate the interpretation of the results. The aim of the study is to explain the causes of this phenomenon. METHODOLOGY A retrospective study was carried out with 717 serum samples collected from 442 patients from the categories of pregnant and non-pregnant women, men, and newborns + infants (age < 0.5 year). The trends of AI kinetics were evaluated in repeatedly examined patients. The frequency of cases with low avidity was compared in individual categories of patients and in groups of people with acute and non-acute toxoplasmosis. RESULTS The proportion of patients with initially low avidity was 42.1% in the acute toxoplasmosis group while it was 13.0% in the non-acute groups. In uninfected newborns with anti-Toxoplasma antibodies transmitted from the mother, a decrease in IgG avidity levels over time was observed, resulting in 29.2% of samples showing low (improper) avidity. While the dynamics of IgG avidity and the frequency of cases of improperly low avidity were similar in men and pregnant and non-pregnant women, the category of newborns and infants differed substantially for these indicators. CONCLUSIONS Due to acceptable specificity and negative predictive value, high avidity can rule out acute toxoplasmosis, but moderate sensitivity complicates the possibility of its confirmation. The results of the avidity test must be interpreted in the context of the results of other methods.
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Affiliation(s)
- Petr Kodym
- National Reference Laboratory for Toxoplasmosis, National Institute of Public Health, Prague, Czech Republic
| | - Zuzana Kurzová
- National Reference Laboratory for Toxoplasmosis, National Institute of Public Health, Prague, Czech Republic
| | - Dagmar Berenová
- National Reference Laboratory for Toxoplasmosis, National Institute of Public Health, Prague, Czech Republic
| | - Marek Malý
- National Institute of Public Health, Unit of Biostatistics, Prague, Czech Republic
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Skvarč M. Diagnostic accuracy of adjusted low IgG avidity index to predict acute Toxoplasma gondii infection in the first trimester of pregnancy. Folia Parasitol (Praha) 2022; 69. [DOI: 10.14411/fp.2022.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/01/2022] [Indexed: 11/19/2022]
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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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Menu E, Kopec L, Luciani L, Legrand S, L’Ollivier C. Measurement of the IgG Avidity Index in the Diagnosis of Clinical Toxocariasis Patients. Pathogens 2021; 10:pathogens10091086. [PMID: 34578119 PMCID: PMC8468318 DOI: 10.3390/pathogens10091086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/01/2022] Open
Abstract
Toxocara spp. are parasitic nematodes responsible for human toxocariasis, a common zoonotic helminth infection. The five main features of human toxocariasis are the classical ocular toxocariasis and visceral larva migrans syndrome, followed by covert toxocariasis, common toxocariasis and neurotoxocariasis. The diagnosis of toxocariasis is feasible by considering clinical symptoms, anamnestic history and serology laboratory results; however, serological criteria cannot be used to distinguish active Toxocara infection from past exposure, which is an area of much discussion in clinical practice. In this context, we developed avidity tests (ELISA and immunoblotting) and evaluated their clinical usefulness in distinguishing past from active toxocariasis. Our study involved 46 patients divided into two groups: “active toxocariasis” (n = 14) and “chronic toxocariasis” (n = 32). According to the avidity indices obtained for both the chronic and active toxocariasis groups, we proposed two thresholds: first, an AI lower than 32% supports an active infection; secondly, a threshold above 42% can exclude an active infection. In order to use this assay in routine clinical practice, however, is still requires standardisation with regards to the method and threshold values, which can be established through studies involving larger populations.
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Affiliation(s)
- Estelle Menu
- Laboratoire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire Méditerranée Infection, 13385 Marseille, France; (E.M.); (L.K.); (S.L.)
- VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Aix Marseille Université, 13385 Marseille, France
| | - Lora Kopec
- Laboratoire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire Méditerranée Infection, 13385 Marseille, France; (E.M.); (L.K.); (S.L.)
| | - Léa Luciani
- Unité des Virus Emergents (UVE), Aix Marseille Université, IRD 190, INSERM 1207, 13385 Marseille, France;
| | - Sophie Legrand
- Laboratoire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire Méditerranée Infection, 13385 Marseille, France; (E.M.); (L.K.); (S.L.)
| | - Coralie L’Ollivier
- Laboratoire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire Méditerranée Infection, 13385 Marseille, France; (E.M.); (L.K.); (S.L.)
- VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Aix Marseille Université, 13385 Marseille, France
- Correspondence:
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Khalil A, Sotiriadis A, Chaoui R, da Silva Costa F, D'Antonio F, Heath PT, Jones C, Malinger G, Odibo A, Prefumo F, Salomon LJ, Wood S, Ville Y. ISUOG Practice Guidelines: role of ultrasound in congenital infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:128-151. [PMID: 32400006 DOI: 10.1002/uog.21991] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - F da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
| | - P T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's University of London and St George's University Hospitals NHS Trust, London, UK
| | - C Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Malinger
- Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Odibo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - F Prefumo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | | | - Y Ville
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
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Mandelbrot L. Congenital toxoplasmosis: What is the evidence for chemoprophylaxis to prevent fetal infection? Prenat Diagn 2020; 40:1693-1702. [PMID: 32453454 DOI: 10.1002/pd.5758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/02/2020] [Accepted: 05/23/2020] [Indexed: 12/25/2022]
Abstract
Although prenatal diagnosis and prenatal and neonatal therapy of congenital toxoplasmosis are available, there is controversy concerning the effectiveness of prophylaxis to prevent placental transmission. Experimental, parasitological, and clinical data suggest a "window of opportunity" following maternal infection. Among medications active against Toxoplasma gondii, mainly spiramycin (Spy) and pyrimethamine + sulfonamide combinations (P-S) have been evaluated. Results from observational studies suffered treatment bias, since prescriptions differed according to the gestational age at seroconversion, which is the major risk factor for transmission, and many lacked precise timing. Some large retrospective studies found no difference in transmission according to prophylactic treatment, but transmission was lower when treatment started promptly after maternal seroconversion. A few recent studies adjusting for timing of infection observed lower transmission in case of P-S than other or no prophylaxis. In the only randomized controlled trial, transmission was lower with P-S than S (18.5% vs 30%, P = .147); this association was strengthened when the treatment was started within 3 weeks of seroconversion, and the incidence of fetal cerebral ultrasound signs was significantly reduced in the P-S group. Rapid initiation of prophylactic therapy following maternal infection, which is usually asymptomatic, requires systematic screening for maternal seroconversion during pregnancy.
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Affiliation(s)
- Laurent Mandelbrot
- Service de Gynécologie-Obstétrique, Assistance Publique-Hôpitaux de Paris Nord Université de Paris, Hôpital Louis Mourier, Colombes, France.,Inserm IAME 1137, Université de Paris, Paris, France
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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: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [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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Ferra BT, Holec-Gąsior L, Gatkowska J, Dziadek B, Dzitko K, Grąźlewska W, Lautenbach D. The first study on the usefulness of recombinant tetravalent chimeric proteins containing fragments of SAG2, GRA1, ROP1 and AMA1 antigens in the detection of specific anti-Toxoplasma gondii antibodies in mouse and human sera. PLoS One 2019; 14:e0217866. [PMID: 31170254 PMCID: PMC6553757 DOI: 10.1371/journal.pone.0217866] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2019] [Indexed: 12/22/2022] Open
Abstract
This study presents an evaluation of four tetravalent recombinant chimeric proteins containing fragments of the Toxoplasma gondii antigens, SAG2, GRA1, ROP1 and AMA1, as potential replacements of a the soluble, whole-cell tachyzoite lysate (TLA) used in serological assays. Recombinant chimeric proteins (SAG2-GRA1-ROP1-AMA1N, AMA1N-SAG2-GRA1-ROP1, AMA1C-SAG2-GRA1-ROP1, and AMA1-SAG2-GRA1-ROP1) obtained by genetic engineering were tested for their reactivity with specific IgM and IgG antibodies from sera of experimentally infected mice and humans with T. gondii infection using an enzyme-linked immunosorbent assay (ELISA). In total 192 serum samples from patients with acquired T. gondii infection and 137 sera from seronegative individuals were examined. The reactivity of chimeric antigens with antibodies generated during T. gondii invasion was measured and compared to the results obtained in assays based on whole-cell Toxoplasma antigen. Chimeric proteins proved effective in differentiation between T. gondii-infected and uninfected individuals (100% sensitivity and specificity in the IgG ELISAs) which shows their potential usefulness as a replacements for TLA in standardized commercial tests for the serodiagnosis of toxoplasmosis. In addition, the chimeric proteins were tested for use in avidity determination. Obtained results were comparable to those of the corresponding commercial assays, suggesting the utility of these proteins for avidity assessment. Furthermore, this study demonstrated that the AMA1-SAG2-GRA1-ROP1 chimeric protein has the potential to distinguish specific antibodies from serum samples of individuals with the early and chronic phase of T. gondii infection.
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Affiliation(s)
- Bartłomiej Tomasz Ferra
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
- * E-mail:
| | - Lucyna Holec-Gąsior
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | - Justyna Gatkowska
- Department of Immunoparasitology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Bożena Dziadek
- Department of Immunoparasitology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Katarzyna Dzitko
- Department of Immunoparasitology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Weronika Grąźlewska
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
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De Luca G, Di Lisio C, Lattanzio G, D'Antuono T, Liberatore M, Aiello FB. First case report of M1 macrophage polarization in an untreated symptomatic patient with toxoplasmosis. BMC Infect Dis 2018; 18:139. [PMID: 29580227 PMCID: PMC5870517 DOI: 10.1186/s12879-018-3048-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/19/2018] [Indexed: 11/22/2022] Open
Abstract
Background In immunocompetent patients, acute toxoplasmosis is usually asymptomatic. We identified M1 macrophages in a case of symptomatic acute Toxoplasma gondii infection that resolved without treatment. M1 macrophages have been demonstrated in animal models of toxoplasmosis, but not in humans. Case presentation A 63-year-old woman presented with laterocervical and axillary bilateral lymphadenopathy. Her anamnesis defined an episode of high fever and prolonged asthenia 4 months previously, which suggested an infectious disease. Following laboratory, radiological, and pathological analyses, she was diagnosed with toxoplasmosis. Immunohistochemical analyses were performed on lymph node sections. More than 50% of the macrophages in the lymph node microgranulomas were M1 macrophages, defined by CD68+/p-Stat1+ staining, and the presence of T helper 1 lymphocytes indicated an immune response known to induce M1 macrophage polarization. Activated endothelial cells were found only in inflamed areas. No therapy was administered before or after diagnosis, and the lymphadenopathy resolved after a follow-up of 5 months. Conclusions This is the first report to demonstrate the presence of M1 macrophages in human toxoplasmosis. Our findings contribute to the understanding of the pathogenesis of toxoplasmosis, and encourage further studies on the role of macrophage polarization in human toxoplasmosis.
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Affiliation(s)
- Graziano De Luca
- Center for Excellence on Aging and Translational Medicine, University G. d'Annunzio, Chieti-Pescara, via dei Vestini, 66100, Chieti, Italy
| | - Chiara Di Lisio
- Center for Excellence on Aging and Translational Medicine, University G. d'Annunzio, Chieti-Pescara, via dei Vestini, 66100, Chieti, Italy.,Department of Medicine ad Aging Sciences, University G. d'Annunzio, Chieti-Pescara, via dei Vestini, 66100, Chieti, Italy
| | - Giuseppe Lattanzio
- Department of Oncology, ASL2, SS Annunziata Hospital, via dei Vestini, 66100, Chieti, Italy
| | - Tommaso D'Antuono
- Department of Oncology, ASL2, SS Annunziata Hospital, via dei Vestini, 66100, Chieti, Italy
| | - Marcella Liberatore
- Department of Oncology, ASL2, SS Annunziata Hospital, via dei Vestini, 66100, Chieti, Italy
| | - Francesca Bianca Aiello
- Department of Medicine ad Aging Sciences, University G. d'Annunzio, Chieti-Pescara, via dei Vestini, 66100, Chieti, Italy.
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Panchaud A, Stojanov M, Ammerdorffer A, Vouga M, Baud D. Emerging Role of Zika Virus in Adverse Fetal and Neonatal Outcomes. Clin Microbiol Rev 2016; 29:659-94. [PMID: 27281741 PMCID: PMC4978612 DOI: 10.1128/cmr.00014-16] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The rapid spread of the Zika virus (ZIKV) in the Americas and its potential association with thousands of suspected cases of microcephaly in Brazil and higher rates of Guillain-Barré syndrome meet the conditions for a Public Health Emergency of International Concern, as stated by the World Health Organization in February 2016. Two months later, the Centers for Disease Control and Prevention (CDC) announced that the current available evidence supports the existence of a causal relationship between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Microcephaly can be caused by several factors, and its clinical course and prognosis are difficult to predict. Other pathogens with proven teratogenicity have been identified long before the current ZIKV epidemic. Despite the growing number of cases with maternal signs of infection and/or presence of ZIKV in tissues of affected newborns or fetuses, it is currently difficult to assess the magnitude of increase of microcephaly prevalence in Brazil, as well as the role of other factors in the development of congenital neurological conditions. Meanwhile, health agencies and medical organizations have issued cautious guidelines advising health care practitioners and expectant couples traveling to, returning from, or living in affected areas. Analogous to dengue virus (DENV) epidemics, ZIKV has the potential to become endemic in all countries infested by Aedes mosquitoes, while new mutations could impact viral replication in humans, leading to increased virulence and consequently heightened chances of viral transmission to additional naive mosquito vectors. Studies are urgently needed to answer the questions surrounding ZIKV and its role in congenital neurological conditions.
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Affiliation(s)
- Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA Swiss Teratogen Information Service and Division of Clinical Pharmacology, University of Lausanne and University Hospital, Lausanne, Switzerland
| | - Miloš Stojanov
- Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University of Lausanne and University Hospital, Lausanne, Switzerland
| | - Anne Ammerdorffer
- Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University of Lausanne and University Hospital, Lausanne, Switzerland
| | - Manon Vouga
- Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University of Lausanne and University Hospital, Lausanne, Switzerland
| | - David Baud
- Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University of Lausanne and University Hospital, Lausanne, Switzerland
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Persistent Low Toxoplasma IgG Avidity Is Common in Pregnancy: Experience from Antenatal Testing in Norway. PLoS One 2015; 10:e0145519. [PMID: 26714282 PMCID: PMC4703128 DOI: 10.1371/journal.pone.0145519] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/05/2015] [Indexed: 11/19/2022] Open
Abstract
The parasite Toxoplasma gondii might harm the fetus if a woman is infected during pregnancy. IgG seroconversion and significant increase in IgG antibody amount in pregnancy indicates maternal infection. Presence of toxoplasma immunoglobulin M (IgM), immunoglobulin G (IgG) and low IgG avidity in a single serum sample indicates possible maternal infection, but positive toxoplasma IgM and low IgG avidity may persist for months and even years. We aimed to evaluate avidity development during pregnancy in a retrospective study. Serial blood samples from 176 pregnant women admitted to Oslo University Hospital 1993–2013 for amniocentesis because of suspected toxoplasma infection were included. Data were obtained from journals and laboratory records. The avidity method used was based on Platelia Toxo IgG assay. Mean maternal age at first serology was 29.9 years (SD 5.2, range 18–42). In 37 (21%) women only the avidity increased from low to high in < 3 months. In 139 (79%) the IgG avidity remained below the high threshold ≥ 3 months and within this group 74 (42%) women had stable low IgG avidity during the observation period. Median gestational age at first test was 10.6 weeks (range 4.6–28.7). Fetal infection was detected in four children, but none among children whose mother had stable low IgG avidity. The first antenatal toxoplasma serology should ideally be collected in early pregnancy and if stable values of toxoplasma IgM and low IgG-avidity are detected in a second sample after three to four weeks, the need for amniocentesis can be questioned.
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A Systematic Review and Meta-Analysis of the Efficacy of Anti-Toxoplasma gondii Medicines in Humans. PLoS One 2015; 10:e0138204. [PMID: 26394212 PMCID: PMC4578932 DOI: 10.1371/journal.pone.0138204] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 07/20/2015] [Indexed: 11/19/2022] Open
Abstract
No effective drug and definitive "gold standard" treatment for Toxoplasma gondii (T. gondii) infection has been available so far, though some medicines have been commonly used in the treatment of T. gondii infection, such as spiramycin, azithromycin, traditional Chinese medicine (TCM), pyrimethamine- sulfadiazine (P-S), trimethoprim-sulfamethoxazole (TMP-SMX), and pyrimethamine-clindamycin (P-C). A systematic review and meta-analysis were performed to compare the efficacies of these conventional medicines in the treatment. Cohort studies for the treatment of acute T. gondii infection were searched from PubMed, Google Scholar, ect. All the cases number for different group extracted from each included literature were input to meta-analysis 3.13 software to calculate the pooled negative conversion rate (NCR), cure rate (CR) or vertical transmission rate based on their sample size and weight. The pooled NCR with 95% confidence intervals (CI) was used to evaluate the overall rate of a diagnosis positive result conversion to a negative result after treatment, which of spiramycin, azithromycin and TCM were 83.4% (95%CI, 72.1%-90.8%), 82.5% (95%CI, 75.9%-87.6%), and 85.5% (95%CI, 71.3%-93.3%) respectively, with no statistical difference between them. The pooled CR with 95% CI was used to evaluate the overall rate of complete disappearance of clinical symptoms for toxoplasmic encephalitis after therapy, which of P-S, TMP-SMX, and P-C were 49.8% (95%CI, 38. 8% -60.8%), 59.9% (95%CI, 48.9%-70.0%), and 47.6% (95%CI, 24.8%-71.4%) respectively, with no statistical difference between them. Primary T. gondii infection in pregnancy was treated mainly with spiramycin alone or combined with other drugs, and the pooled rate of vertical transmission was about 9.9% (95%CI, 5.9%-16.2%) after therapy. Toxoplasmic encephalitis in AIDS patients was usually treated with sulfonamides combined with other drugs and the pooled CR was 49.4% (95%CI, 37.9%-60.9%).
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Liu Q, Wang ZD, Huang SY, Zhu XQ. Diagnosis of toxoplasmosis and typing of Toxoplasma gondii. Parasit Vectors 2015; 8:292. [PMID: 26017718 PMCID: PMC4451882 DOI: 10.1186/s13071-015-0902-6] [Citation(s) in RCA: 240] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/18/2015] [Indexed: 11/25/2022] Open
Abstract
Toxoplasmosis, caused by the obligate intracellular protozoan Toxoplasma gondii, is an important zoonosis with medical and veterinary importance worldwide. The disease is mainly contracted by ingesting undercooked or raw meat containing viable tissue cysts, or by ingesting food or water contaminated with oocysts. The diagnosis and genetic characterization of T. gondii infection is crucial for the surveillance, prevention and control of toxoplasmosis. Traditional approaches for the diagnosis of toxoplasmosis include etiological, immunological and imaging techniques. Diagnosis of toxoplasmosis has been improved by the emergence of molecular technologies to amplify parasite nucleic acids. Among these, polymerase chain reaction (PCR)-based molecular techniques have been useful for the genetic characterization of T. gondii. Serotyping methods based on polymorphic polypeptides have the potential to become the choice for typing T. gondii in humans and animals. In this review, we summarize conventional non-DNA-based diagnostic methods, and the DNA-based molecular techniques for the diagnosis and genetic characterization of T. gondii. These techniques have provided foundations for further development of more effective and accurate detection of T. gondii infection. These advances will contribute to an improved understanding of the epidemiology, prevention and control of toxoplasmosis.
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Affiliation(s)
- Quan Liu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, People's Republic of China. .,Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Military Veterinary Institute, Academy of Military Medical Sciences, Changchun, Jilin Province, 130122, People's Republic of China.
| | - Ze-Dong Wang
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Military Veterinary Institute, Academy of Military Medical Sciences, Changchun, Jilin Province, 130122, People's Republic of China.
| | - Si-Yang Huang
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, People's Republic of China. .,Jiangsu Co-innovation Center for the Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University College of Veterinary Medicine, Yangzhou, Jiangsu Province, 225009, People's Republic of China.
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, People's Republic of China. .,Jiangsu Co-innovation Center for the Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University College of Veterinary Medicine, Yangzhou, Jiangsu Province, 225009, People's Republic of China.
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SARAEI M, FATTAHI SZ, SHAHNAZI M, AFSHARI A, ALIZADEH SA, JAHANIHASHEMI H. The necessity of confirmatory testing in serodiagnosis of toxoplasmosis in iran. IRANIAN JOURNAL OF PARASITOLOGY 2013; 8:608-16. [PMID: 25516743 PMCID: PMC4266126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 09/25/2013] [Indexed: 10/29/2022]
Abstract
BACKGROUND Toxoplasma specific IgM antibodies; the common serologic marker in diagnosis of acute toxoplasmosis has its own limitations. Confirmatory testing with other markers, introduced as a complementary tool in distinguish acute and chronic infections is unusual in Iran. In the present study, we investigated the correlation between the results of IgM ELISA, IgA ELISA, and IgG avidity tests in the diagnosis of toxoplasmosis to demonstrate the necessity of confirmatory testing in serodiagnosis of infection in the country. METHODS A total of 107 positive Toxoplasma IgG and IgM sera were obtained from patients referred to private laboratories and stored at -20 °C for futures use. Serologic tests were set up in duplicate to analyze the serum levels of IgG, IgM, IgA, and IgG avidity antibodies using commercial ELISA kits. The results were presented as semi quantitative for IgG, IgM and IgA ELISA, and Relative Avidity Index in percentage for IgG avidity test. Pearson's correlation coefficient (rp) was applied to analyze the data. RESULTS Of 107 serum samples, T. gondii specific IgM and IgA antibodies were positive in 67.3% and 53.3%, respectively. Besides, 29.9% of the sera displayed low avidity for IgG antibodies. The rp was - 0.572 (P<0.01) between the IgG avidity and IgM ELISA, - 0.364 between the IgG avidity and IgA ELISA (P<0.01), and 0.564 between the IgM and IgA ELISA (P<0.01). CONCLUSION The study strongly highlights the necessity of confirmatory testing in differential diagnosis of acute and chronic toxoplasmosis in Iran.
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Affiliation(s)
- Mehrzad SARAEI
- Dept. of Medical Parasitology and Mycology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran,Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, Iran,Reference Laboratory, Qazvin University of Medical Sciences, Qazvin, Iran,Correspondence
| | | | - Mojtaba SHAHNAZI
- Dept. of Medical Parasitology and Mycology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Afshin AFSHARI
- Dept. of Microbiology and Immunology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Safar Ali ALIZADEH
- Dept. of Pathobiology, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan JAHANIHASHEMI
- Dept. of Community Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
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Toxoplasma seroconversion with negative or transient immunoglobulin M in pregnant women: myth or reality? A French multicenter retrospective study. J Clin Microbiol 2013; 51:2103-11. [PMID: 23616461 DOI: 10.1128/jcm.00169-13] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Classically, Toxoplasma infection is associated with high levels of specific IgM antibody and a rise in specific IgG levels 1 to 3 weeks later. Atypical IgG seroconversion, without IgM detection or with transient IgM levels, has been described during serologic follow-up of seronegative pregnant women and raises difficulties in interpreting the results. To evaluate the frequency and the characteristics of these atypical cases of seroconversion, an investigation was conducted within the French National Reference Center for Toxoplasmosis, from which 26 cases collected from 12 laboratories belonging to the network were identified. The aim of this work was to retrospectively analyze the results of serologic testing, the treatments administered, and the results of prenatal and postnatal follow-up for these women. In each case, IgG antibodies were detected using both screening and confirmatory tests. IgM antibodies were not detected in 15 cases, and the levels were equivocal or low-positive in 11 cases. The IgG avidity results were low in 16 cases and high in one case. Most of the pregnant women (22/26) were treated with spiramycin from the time that IgG antibodies appeared until delivery. Amniotic fluid was analyzed for Toxoplasma gondii DNA by PCR in 11/26 cases, and the results were negative in all cases. Congenital toxoplasmosis was ruled out in 12/26 newborns. There was no abnormality observed at birth for 10 newborns and no information available for 4 newborns. In conclusion, when the interpretation of serological results is so difficult, it seems cautious to initiate treatment by spiramycin and to follow the pregnant women and their newborns.
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Xiao J, Viscidi RP, Kannan G, Pletnikov MV, Li Y, Severance EG, Yolken RH, Delhaes L. The Toxoplasma MAG1 peptides induce sex-based humoral immune response in mice and distinguish active from chronic human infection. Microbes Infect 2012; 15:74-83. [PMID: 23142034 DOI: 10.1016/j.micinf.2012.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/18/2012] [Accepted: 10/24/2012] [Indexed: 11/30/2022]
Abstract
To distinguish active from inactive/chronic infection in Toxoplasma gondii-seropositive individuals, we have developed an enzyme-linked immunosorbent assay (ELISA) using specific peptides derived from Toxoplasma matrix antigen MAG1. We used this assay to measure matrix specific antibodies and pilot studies with infected mice established the validity of two peptides. The immune response against MAG1 occurs in about 12 days postinfection and displays a sex difference later on in mouse model, with males producing higher antibody titers than females. Serum samples from 22 patients with clinical toxoplasmosis and from 26 patients with serological evidence of past exposure to Toxoplasma (more than one year infection history) were analyzed. Both MAG1 peptides detected antibodies significant frequently and robustly from active stage than from the chronic stage of toxoplasmosis. The results indicate that both MAG1 peptides may be used as a tool to differentiate active from inactive infection. It also may be considered in the design of potential vaccines in humans.
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Affiliation(s)
- Jianchun Xiao
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
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Robert-Gangneux F, Dardé ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev 2012; 25:264-96. [PMID: 22491772 PMCID: PMC3346298 DOI: 10.1128/cmr.05013-11] [Citation(s) in RCA: 983] [Impact Index Per Article: 81.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The apicomplexan parasite Toxoplasma gondii was discovered a little over 100 years ago, but knowledge of its biological life cycle and its medical importance has grown in the last 40 years. This obligate intracellular parasite was identified early as a pathogen responsible for congenital infection, but its clinical expression and the importance of reactivations of infections in immunocompromised patients were recognized later, in the era of organ transplantation and HIV infection. Recent knowledge of host cell-parasite interactions and of parasite virulence has brought new insights into the comprehension of the pathophysiology of infection. In this review, we focus on epidemiological and diagnostic aspects, putting them in perspective with current knowledge of parasite genotypes. In particular, we provide critical information on diagnostic methods according to the patient's background and discuss the implementation of screening tools for congenital toxoplasmosis according to health policies.
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Affiliation(s)
- Florence Robert-Gangneux
- Service de Parasitologie, Faculté de Médecine et Centre Hospitalier Universitaire de Rennes, Rennes, France.
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Sagel U, Krämer A, Mikolajczyk RT. Incidence of maternal Toxoplasma infections in pregnancy in Upper Austria, 2000-2007. BMC Infect Dis 2011; 11:348. [PMID: 22168604 PMCID: PMC3274486 DOI: 10.1186/1471-2334-11-348] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 12/14/2011] [Indexed: 11/27/2022] Open
Abstract
Background Despite three decades of prenatal screening program for toxoplasmosis in Austria, population-based estimates for the incidence of maternal infections with Toxoplasma gondii during pregnancy are lacking. We studied the incidence of primary maternal infections during pregnancy in the Federal State of Upper Austria. Methods Screening tests for 63,416 women and over 90,000 pregnancies (more than 84.5% of pregnancies in the studied region) in the time period between 01.01.2000 and 31.12.2007 were analysed. The incidence of toxoplasmosis was estimated indirectly by binomial and directly by interval censored regression. Results During the studied period, 66 acute infections (risk of 0.07% per pregnancy) were detected, but only 29.8% of seronegative women were tested at least three times during their pregnancies. The seroprevalence of Toxoplasma antibodies among all tested women was 31%. Indirectly estimated incidence (from differences in prevalence by age) was 0.5% per pregnancy, while directly estimated incidence (interval censored regression) was 0.17% per pregnancy (95% confidence interval: 0.13-0.21%). Conclusions Calculating incidence from observed infections results in severe underreporting due to many missed tests and potential diagnostic problems. Using statistical modelling, we estimated primary toxoplasmosis to occur in 0.17% (0.13-0.21%) of all pregnancies in Upper Austria.
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Affiliation(s)
- Ulrich Sagel
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, PO Box 10 01 31, D-33501 Bielefeld, Germany
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Alvarado-Esquivel C, Niewiadomski A, Schweickert B, Liesenfeld O. Antiparasitic treatment suppresses production and avidity of Toxoplasma gondii-specific antibodies in a murine model of acute infection*. Eur J Microbiol Immunol (Bp) 2011; 1:249-55. [PMID: 24516731 DOI: 10.1556/eujmi.1.2011.3.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 07/14/2011] [Indexed: 01/04/2023] Open
Abstract
Infection with Toxoplasma gondii during pregnancy may result in congenital transmission of the parasite. Infection is commonly diagnosed using serological tests for IgG, IgM and IgA antibodies. Avidity of IgG antibodies is used to exclude acute infection. Few studies have investigated the impact of antiparasitic treatment on the production of anti-T. gondii antibody and the avidity of IgG antibodies. We therefore investigated the production of IgG, IgM, and IgA antibodies and IgG avidity in a murine model of acute infection with 10 cysts of T. gondii. All antibody classes increased following infection. Treatment of mice with pyrimethamine/sulfadiazine but not with spiramycin or azithromycin at dosages equivalent to those used in patients resulted in a significant decrease in the concentration of T. gondii-specific IgG and IgM antibodies postinfection. IgG and IgM antibody decreases were paralleled by a significant reduction in cyst numbers in brains of mice treated with pyrimethamine/sulfadiazine but not with other drugs. In contrast, treatment with atovaquone did significantly reduce the concentrations of IgM antibodies and resulted in reduced IgG avidity indices. T. gondii-specific DNA was not detected in blood between days 1 and 3. In conclusion, antiparasitic treatment with pyrimethamine/sulfadiazine and atovaquone appears to impact the generation of antibody responses against T. gondii. Future studies will have to determine the specific impact of antiparasitic treatment on antibody responses and the consequences for the management of patients infected with T. gondii.
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Affiliation(s)
- C Alvarado-Esquivel
- Department of Microbiology and Hygiene, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin Germany
| | - A Niewiadomski
- Department of Microbiology and Hygiene, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin Germany
| | - B Schweickert
- Department of Microbiology and Hygiene, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin Germany
| | - O Liesenfeld
- Department of Microbiology and Hygiene, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin Germany
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di Carlo P, Romano A, Casuccio A, Cillino S, Schimmenti MG, Mancuso G, la Chiusa S, Novara V, Ingrassia D, li Vecchi V, Trizzino M, Titone L. Investigation and management of Toxoplasma gondii infection in pregnancy and infancy: a prospective study. Acta Pharmacol Sin 2011; 32:1063-70. [PMID: 21743484 DOI: 10.1038/aps.2011.55] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM Toxoplasma gondii infection during pregnancy poses a serious risk to the fetus, therefore timely and accurate diagnosis is essential. The aim of this study was to estimate the frequency of congenital infection via evaluating mother's immunological status and the possibility to improving the diagnostic and therapeutic approaches. METHODS Eighty five mothers with Toxoplasma seroconversion and their offspring were enrolled (among them, 2 spontaneous abortions were documented in the first trimester). Prenatal PCR diagnosis was carried out on 50 patients (60%), with 7 positive cases (14%). Morphological ultrasound scanning revealed anomalies in one fetus. Long-term follow-up included general physical examinations, serological status tested using Western blot, neuro-radiological, ophthalmologic and neurologic examinations, psychological and developmental tests, visual evoked potential tests and audiology tests, as well as anti-Toxoplasma treatment regimes. RESULTS Fourteen (17%) of the infants were infected at one-year serological follow-up. Chi-square for linear trend of vertical transmission from the first to the third trimester was significant (P=0.009). Western blot analysis showed IgM and IgA in half of the infected infants. In 69 uninfected infants, anti-Toxoplasma IgG immunoblot analysis excluded infection within the 3 months in 18 infants (26%) and in the others within 6 months of life. The most relevant instrumental findings are described. CONCLUSION Western blot analysis may help to evaluate infection within the 6 months of life. The accuracy of ultrasound imaging to determine the brain damage in the fetus and newborns is doubtful, and should be combined with MR imaging. Multistep approaches can improve the timing of postnatal follow-up.
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Prusa AR, Hayde M, Unterasinger L, Pollak A, Herkner KR, Kasper DC. Evaluation of the Roche Elecsys Toxo IgG and IgM electrochemiluminescence immunoassay for the detection of gestational Toxoplasma infection. Diagn Microbiol Infect Dis 2010; 68:352-7. [PMID: 20884150 DOI: 10.1016/j.diagmicrobio.2010.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 07/15/2010] [Accepted: 07/21/2010] [Indexed: 11/26/2022]
Abstract
Unidentified gestational infection with Toxoplasma gondii may lead to fetal infection with severe complications later in childhood. Because diagnosis of maternal infection solely depends on serology, routine tests with high sensitivity and specificity are required. In this study, the new Roche Elecsys Toxo IgG and IgM immunoassay was compared with Sabin-Feldman dye test and immunosorbent agglutination assay-IgM as reference test. Serum samples were analyzed from 927 pregnant women, including 100 negative, 706 chronic, and 121 acute infections. The combination of both Elecsys IgG and IgM assays demonstrated high sensitivity and specificity of 97.1% and 100.0%, respectively, and a positive and negative predictive value of 100.0% and 81.3%, respectively. The Elecsys assay is a useful tool as a first-line screening method to detect gestational infections. However, if gestational infection is assumed, confirmatory testing by a reference laboratory might be necessary to discriminate between pre- and postconceptional infection to start antiparasitic treatment to avoid mother-to-fetus transmission and severe sequelae.
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Affiliation(s)
- Andrea-Romana Prusa
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
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