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Deleplancque AS, Fricker-Hidalgo H, Pomares C, L’Ollivier C, Lemoine JP, Cimon B, Paris L, Houzé S, Villena I, Pelloux H, Villard O. Comparative performance of ISAGA IgM and ELISA assays for the diagnosis of maternal and congenital Toxoplasma infections: which technique could replace ISAGA IgM? Parasite 2024; 31:7. [PMID: 38334687 PMCID: PMC10854481 DOI: 10.1051/parasite/2024004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
The ISAGA immunocapture test for the detection of anti-Toxoplasma immunoglobulin M is a manual technique known for its excellent sensitivity and specificity. The purpose of this retrospective, multicenter study was to compare the performances and agreement between ISAGA and other IgM detection techniques before cessation of ISAGA production. The analytic performance of the different tests was evaluated using 1,341 serum samples from adults with positive IgM and negative IgG to Toxoplasma gondii, and 1,206 sera from neonates born to mothers with seroconversion. The agreement between the tests was evaluated on 13,506 adult and 5,795 child serum samples. The sensitivity of Toxo-ISAGA IgM® (adults 98.7%, neonates 63.1%) was similar to that of Platelia Toxo IgM® (adults 94.4%, neonates 64.6%), and significantly higher than Liaison Toxo IgM® (adults 90.6%), Architect/Alinity Toxo IgM® (adults 95.7%, neonates 48.6%), and Vidas Toxo IgM® (adults 81.8%, neonates 17.5%). However, the specificities varied between 24.4% (Platelia Toxo IgM®) and 95.2% (Liaison Toxo IgM®) in adults and were >95% for all tests in neonates. An analysis of the kappa coefficients showed better agreement between ISAGA IgM® and the other tests in children (0.75-0.83%) than in adults (0.11-0.53%). We conclude that, in the absence of Toxo-ISAGA IgM®, the association of a very sensitive technique (Platelia Toxo IgM® or Architect/Alinity Toxo IgM®) and a very specific technique (Vidas Toxo IgM® or Liaison Toxo IgM®) is recommended for IgM detection in adult sera. For neonates, Platelia Toxo IgM® appeared to be the best alternative to replace Toxo-ISAGA IgM®.
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Affiliation(s)
- Anne-Sophie Deleplancque
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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CHU Lille, Parasitology Mycology Department, INSERM U1285, CNRS UMR 8576, Glycobiology in Fungal Pathogenesis and Clinical Applications, Université de Lille Lille France
| | - Hélène Fricker-Hidalgo
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Laboratory of Parasitology and Mycology, Grenoble Alpes University Hospital and Institute for Advanced Biosciences, Grenoble Alpes University, INSERM U1209, CNRS UMR5309 Grenoble France
| | - Christelle Pomares
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Parasitology-Mycology laboratory, Côte d’Azur University, INSERM 1065, Nice University Hospital Nice France
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Centre Méditerranéen de Médecine Moléculaire (C3 M), U1065, Université Côte d’Azur, INSERM, Archimed Building 151 route Saint Antoine de Ginestière Nice France
| | - Coralie L’Ollivier
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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IHU-Méditerranée Infection, Assistance Publique Hôpitaux de Marseille (AP-HM) Marseille France
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Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Marseille France
| | | | - Bernard Cimon
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Laboratoire de Parasitologie-Mycologie, CHU d’Angers Angers France
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Angers University, Brest University, IRF, SFR 4208 ICAT Angers France
| | - Luc Paris
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Parasitology laboratory, AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière Paris France
| | - Sandrine Houzé
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Parasitology laboratory, AP-HP, Hôpital Bichat - Claude Bernard Paris France
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University of Paris Cité, IRD 261, MERIT Paris France
| | - Isabelle Villena
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Department of Parasitology and Medical Mycology, National Reference Centre on Toxoplasmosis, Reims Hospital Reims France
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Team EA 7510, SFR CAP-SANTE, Reims Champagne Ardenne University Reims France
| | - Hervé Pelloux
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Laboratory of Parasitology and Mycology, Grenoble Alpes University Hospital and Institute for Advanced Biosciences, Grenoble Alpes University, INSERM U1209, CNRS UMR5309 Grenoble France
| | - Odile Villard
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Centre National de Référence Toxoplasmose – Pôle Sérologie, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Institut de Parasitologie et de Pathologie Tropicale, UR7292 Dynamique des Interactions Hôte-Pathogène, Fédération de Médecine Transrationnelle, Université de Strasbourg Strasbourg France
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Laboratoire de Parasitologie et Mycologie Médicale, Hôpitaux Universitaires de Strasbourg Strasbourg France
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2
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Abraham S, Piarroux R, Zhou Y, Tesic V, Abeleda A, Houhou-Fidouh N, Nicaise-Rolland P, Landraud L, McLeod R, Houzé S. Performances of ICT Toxoplasma IgG-IgM test in comparison with Vidas® toxo competition to determine the immune status against Toxoplasma gondii. Eur J Clin Microbiol Infect Dis 2023; 42:1327-1335. [PMID: 37749274 DOI: 10.1007/s10096-023-04669-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Toxoplasmosis is a ubiquitous parasitic infection caused by Toxoplasma gondii (Tg). In immunocompetent people, the infection may be asymptomatic with the induction of an immune response that may prevent reinfection or transmission to the fetus in immune pregnant woman. In immunocompromised persons or seronegative pregnant woman with a primary infection during pregnancy, the infection may result in the loss of life, sight, cognition, and motor function in the immune-compromised person or immunologically immature fetus. The objective of this study was to evaluate a new immunochromatographic test Toxoplasma ICT IgG-IgM (ICT) that allows detection of specific anti-Tg immunoglobulins G (Ig G) and M (Ig M). We included 1145 prospectively obtained sera and 376 samples selected for specificity or sensitivity studies. The performance of ICT was compared using Vidas® Toxo Competition (TXC) and Toxoscreen®. In case of discrepancy, Vidas® Toxo Ig G or Ig M and LDBIO Toxo II IgG western blot were used to establish definitive results by additional methods. Sensitivity and specificity of ICT were respectively 99.3% and 100%. In comparison, Toxoscreen®'s sensitivity was 100% and the specificity was 99.8%. TXC had a sensitivity of 98.7% with a specificity of 99.1%. ICT has excellent performance even for low Ig G titers, especially in immunocompromised patients, and confirms the specificity of isolated Ig M. This ICT provides reliable results easily and quickly. This screening technique is not designed to differentiate the Ig M from Ig G. When positive, additional tests may be necessary.
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Affiliation(s)
- Sylvie Abraham
- Laboratory of Parasitology, Toxoplasma National Reference Center, Bichat-Claude Bernard Hospital, APHP Nord, 46 Rue Henri Huchard, 75018, Paris, France
| | - Raphael Piarroux
- LD Bio Diagnostics, Lyon, France
- Efor-CVO, Champagne Aux Monts d'Or, France
| | - Ying Zhou
- Department of Ophthalmology and Visual Sciences, The University of Chicago, Chicago, IL, USA
- Toxoplasmosis Center, The University of Chicago, AMB N310, Chicago, IL, USA
| | - Vera Tesic
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Ana Abeleda
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Nadhira Houhou-Fidouh
- Laboratory of Virology, Bichat-Claude Bernard Hospital, APHP Nord, 46 Rue Henri Huchard, 75018, Paris, France
| | - Pascale Nicaise-Rolland
- Laboratory of Immunology, Bichat-Claude Bernard Hospital, APHP Nord, 46 Rue Henri Huchard, 75018, Paris Paris, France
| | - Luce Landraud
- Laboratory of Microbiology, Louis Mourier Hospital, APHP Nord, 178 Rue Des Renouillers, 92700, Colombes, France
| | - Rima McLeod
- Department of Ophthalmology and Visual Sciences, The University of Chicago, Chicago, IL, USA
- Toxoplasmosis Center, The University of Chicago, AMB N310, Chicago, IL, USA
- Department of Pediatrics, Division of Infectious Diseases, The University of Chicago, Chicago, IL, USA
| | - Sandrine Houzé
- Laboratory of Parasitology, Toxoplasma National Reference Center, Bichat-Claude Bernard Hospital, APHP Nord, 46 Rue Henri Huchard, 75018, Paris, France.
- Université Paris Cité, IRD, 75006, MERITParis, France.
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3
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Panazzolo GK, Kmetiuk LB, Domingues OJ, Farinhas JH, Doline FR, França DAD, Rodrigues NJL, Biondo LM, Giuffrida R, Langoni H, Santarém VA, Biondo AW, Fávero GM. One Health Approach in Serosurvey of Toxoplasma gondii in Former Black Slave (Quilombola) Communities in Southern Brazil and Among Their Dogs. Trop Med Infect Dis 2023; 8:377. [PMID: 37505673 PMCID: PMC10386098 DOI: 10.3390/tropicalmed8070377] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023] Open
Abstract
Brazilian quilombos are rural semi-isolated remnant communities of former black slaves and their descendants who traditionally maintained themselves through archaic subsistence livestock and agriculture practices and historically lacked specific public health policies. Although such individuals and their dogs may be exposed to zoonotic pathogens such as Toxoplasma gondii, no study to date has assessed these human-animal populations together. Populations in four different Brazilian quilombos in southern Brazil were evaluated. Overall, 93/208 people (44.7%) and 63/100 dogs (63.0%) were seropositive for IgG anti-T. gondii antibodies by indirect immunofluorescent antibody test (IFAT), 4/208 (1.9%) human samples seropositive for IgM anti-T. gondii antibodies, with a human-dog seropositivity ratio for IgG of 0.71. Quilombola individuals ingesting game meat were 2.43-fold more likely (95% CI: 1.05-5.9) to be seropositive. No risk factors were associated with seropositivity among dogs, thus suggesting that their exposure to T. gondii was random. Surprisingly, our research group had previously found an inverted human-dog ratio for T. gondii seropositivity of 2.54 in the urban area of a nearby major city. Because consumption of raw/undercooked game meat by quilombola individuals may have contributed to higher exposure, higher overall seroprevalence among dogs may have also indicated interaction with wildlife. Although these dogs may hunt wildlife without their owners' awareness, the higher dog seropositivity may also be related to feeding from discarded food in the community or backyard livestock animals and drinking surface water contaminated with oocysts. Thus, wildlife cannot be singled out as the reason, and future studies should consider sampling water, soil, wildlife, and livestock tissues, to fully establish the source of infection in dogs herein.
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Affiliation(s)
- Giovanni Kalempa Panazzolo
- Graduate College of Pharmaceutical Sciences, State University of Ponta Grossa, Ponta Grossa 84030-900, PR, Brazil
| | - Louise Bach Kmetiuk
- Graduate College of Cellular and Molecular Biology, Federal University of Paraná, Curitiba 81530-000, PR, Brazil
| | - Orlei José Domingues
- Graduate College of Pharmaceutical Sciences, State University of Ponta Grossa, Ponta Grossa 84030-900, PR, Brazil
| | - João Henrique Farinhas
- Graduate College of Cellular and Molecular Biology, Federal University of Paraná, Curitiba 81530-000, PR, Brazil
| | - Fernando Rodrigo Doline
- Graduate College of Cellular and Molecular Biology, Federal University of Paraná, Curitiba 81530-000, PR, Brazil
| | - Danilo Alves de França
- Department of Veterinary Hygiene and Public Health, São Paulo State University, Botucatu 18618-681, SP, Brazil
| | | | - Leandro Meneguelli Biondo
- National Institute of the Atlantic Forest (INMA), Brazilian Ministry of Science, Technology and Innovation, Santa Teresa 29650-000, ES, Brazil
| | - Rogério Giuffrida
- Laboratory of Veterinary Parasitology, Veterinary Teaching Hospital, University of Western São Paulo, Presidente Prudente 19001-970, SP, Brazil
| | - Helio Langoni
- Department of Veterinary Hygiene and Public Health, São Paulo State University, Botucatu 18618-681, SP, Brazil
| | - Vamilton Alvares Santarém
- Laboratory of Veterinary Parasitology, Veterinary Teaching Hospital, University of Western São Paulo, Presidente Prudente 19001-970, SP, Brazil
| | - Alexander Welker Biondo
- Graduate College of Cellular and Molecular Biology, Federal University of Paraná, Curitiba 81530-000, PR, Brazil
| | - Giovani Marino Fávero
- Graduate College of Pharmaceutical Sciences, State University of Ponta Grossa, Ponta Grossa 84030-900, PR, Brazil
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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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Screening for the Detection of Toxoplasma gondii IgG, IgM and IgA in Females of Reproductive Age from Western Romania. Life (Basel) 2022; 12:life12111771. [PMID: 36362926 PMCID: PMC9694844 DOI: 10.3390/life12111771] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/20/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Toxoplasma gondii, a zoonotic protozoan parasite, has the capacity to infect the fetus if the pregnant woman primarily acquires the infection during pregnancy. We evaluated the prevalence of T. gondii IgG, IgM and IgA antibodies in women of reproductive age residing in Western Romania. We also assessed the value of adding a T. gondii IgA test to the serologic panel for the diagnosis of toxoplasmosis, including the detection of a recently acquired infection. Serologic testing to demonstrate the presence of T. gondii IgG antibodies was conducted in 1317 females aged 15−45 years. T. gondii IgM and IgA antibody tests were performed in those with detectable IgG antibodies and IgG avidity test was performed if IgM and/or IgA screening test results were positive. T. gondii IgG were detected in 607 (46.09%; 95%CI: 43.41−48.79) of 1317 study participants and IgG seroprevalence tended to increase with age from 35.44% (95%CI: 29.89−41.30) in age group 15−24 years to 62.85% (95%CI: 56.57−68.82) in age group 35−45 years, showing a significant age-associated increase (p < 0.001). Of the 607 persons with detectable T. gondii IgG antibodies, T. gondii IgM antibodies were demonstrated in 8.90% (95%CI: 6.88−11.43), T. gondii IgA in 1.65% (95%CI: 0.90−3.01) and both T. gondii IgM and IgA in 0.99% (95%CI: 0.45−2.14). The prevalence of IgA antibodies tended to decrease with increasing avidity, from 75% (95%CI: 19.41−99.37) in samples with low avidity to 11.76% (95%CI: 4.44−23.87) in those with high avidity (p = 0.01). Of the study participants who were positive for both T. gondii IgM and IgA antibodies, 66.67% had low or equivocal IgG avidity test results compared to 6.25% who tested positive for IgM, were negative for IgA and in whom low or equivocal IgG avidity test results were noted (p = 0.001). This study indicates that in Western Romania, T. gondii IgG seroprevalence is high in females of reproductive age and T. gondii IgA antibodies may be rarely detected during a serologic screening. However, in individuals with demonstrable T. gondii IgG and IgM antibodies, testing for T. gondii IgA may improve the rate for the detection of a recently acquired toxoplasmosis.
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Diagnosis of Congenital Toxoplasmosis: Performance of Four IgG and IgM Automated Assays at Birth in a Tricentric Evaluation. J Clin Microbiol 2022; 60:e0011522. [DOI: 10.1128/jcm.00115-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
For postnatal diagnosis of congenital toxoplasmosis (CT), the gold standard for the detection of anti-
Toxoplasma
IgM in newborns relies on the immunosorbent agglutination assay (ISAGA), which is manufactured from whole
Toxoplasma
parasites that become difficult to maintain. For IgG, only the Platelia assay provides a validated assay for cord blood according to the manufacturer, allowing its use in this context.
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Plazas MI, Marín JS, Torres E, Londoño JC, Celis-Giraldo D, Marín JEG. FREQUENCY OF NATURAL ANTIBODIES AND CONCORDANCE ANALYSIS FOR ANTI-TOXOPLASMA IgM TESTS IN COLOMBIAN SERA OF PREGNANT WOMEN. Diagn Microbiol Infect Dis 2022; 103:115733. [DOI: 10.1016/j.diagmicrobio.2022.115733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/13/2022] [Accepted: 05/21/2022] [Indexed: 11/03/2022]
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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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Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Ocular Infections. Clin Microbiol Rev 2021; 34:e0007019. [PMID: 34076493 DOI: 10.1128/cmr.00070-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The variety and complexity of ocular infections have increased significantly in the last decade since the publication of Cumitech 13B, Laboratory Diagnosis of Ocular Infections (L. D. Gray, P. H. Gilligan, and W. C. Fowler, Cumitech 13B, Laboratory Diagnosis of Ocular Infections, 2010). The purpose of this practical guidance document is to review, for individuals working in clinical microbiology laboratories, current tools used in the laboratory diagnosis of ocular infections. This document begins by describing the complex, delicate anatomy of the eye, which often leads to limitations in specimen quantity, requiring a close working bond between laboratorians and ophthalmologists to ensure high-quality diagnostic care. Descriptions are provided of common ocular infections in developed nations and neglected ocular infections seen in developing nations. Subsequently, preanalytic, analytic, and postanalytic aspects of laboratory diagnosis and antimicrobial susceptibility testing are explored in depth.
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10
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Robert-Gangneux F, Guegan H. Anti-Toxoplasma IgG assays: What performances for what purpose? A systematic review. ACTA ACUST UNITED AC 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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022]
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
- Université de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085, 35000 Rennes, France
| | - Hélène Guegan
- 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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Picone O, Fuchs F, Benoist G, Binquet C, Kieffer F, Wallon M, Wehbe K, Mandelbrot L, Villena I. Toxoplasmosis screening during pregnancy in France: Opinion of an expert panel for the CNGOF. J Gynecol Obstet Hum Reprod 2020; 49:101814. [PMID: 32428782 DOI: 10.1016/j.jogoh.2020.101814] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 11/15/2022]
Abstract
Prenatal screening to prevent congenital toxoplasmosis as performed in France for several decades has been questioned in view of the decreasing incidence of this infection and the cost of testing. The French College of Obstetrics and Gynecology mandated a multidisciplinary panel of experts to perform a reassessment of the screening program in accordance with international good practice. In France, about 70% of pregnant women are not immune to T. gondii, and 0.2-0.25% become infected during pregnancy. The risk of maternal-fetal transmission of infection is on average 25-29% and depends greatly on the gestational age at seroconversion. In case of fetal transmission, the outcome is livebirth in 95% of cases, with latent congenital toxoplasmosis in 90% of cases and symptomatic forms in 10% of cases, of which 1/3 are severe and 2/3 moderate. Biological techniques have satisfactory performance regarding serologies for the diagnosis of maternal infections and PCR on amniotic fluid for the prenatal diagnosis of congenital toxoplasmosis. Primary prevention of toxoplasmosis is based on hygiene measures that are relatively simple, but poorly implemented. In case of maternal seroconversion, there is a strong case for prenatal prophylactic treatment as soon as possible (ideally within 3 weeks of seroconversion), spiramycin before 14 weeks of gestation (WG), and with a tendency to superiority of the pyrimethamine/sulfadiazine association over spiramycin beyond 14 W G, in order to reduce the risk of symptomatic congenital toxoplasmosis. In case of congenital toxoplasmosis, prompt initiation of treatment reduces the occurrence of cerebral signs and symptoms, as well as retinal lesions. Several medico-economic evaluations of the French toxoplasmosis screening program have been conducted including an individual cost-effectiveness approach with decision analysis which concluded on the profitability of prenatal screening as carried out in France (monthly surveillance of seronegative women, prenatal treatment in case of seroconversion, termination of pregnancy in severe forms). Though most international societies do not recommend systematic screening for mainly financial reasons, if congenital toxoplasmosis appears benign in France today, it is probably thanks to screening and the possibility of early treatment of fetuses and/or newborns. Thus, the panel recommends continuing for now the program in France for prevention of congenital toxoplasmosis.
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Affiliation(s)
- Olivier Picone
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris; Inserm IAME-U1137, Paris, France; FHU PREMA; Groupe de Recherche sur les Infections pendant la grossesse (GRIG)
| | - Florent Fuchs
- Service de Gynécologie Obstétrique CHU de Montpellier, Hopital Arnaud de Villeneuve, Montpellier, France; Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018, Reproduction et Développement de l'enfant, 94807 Villejuif, France; EA2415: Aide à la décision médicale Personnalisée, Axe B: Méthode en épidémiologie Clinique, Université de Montpellier
| | | | - Christine Binquet
- Inserm, CIC1432, module Epidémiologie Clinique, Dijon, France; CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Epidémiologie Clinique/Essais Cliniques, Dijon, France
| | - François Kieffer
- Assistance Publique-Hôpitaux de Paris, Service de néonatologie, Hôpital Armand Trousseau, Paris, France
| | - Martine Wallon
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Parasitologie - Mycologie Médicale, Lyon, France; Université Lyon-1, Equipe Waking, Physiologie Intégrée du Système d'éveil, Centre de Recherche en Neurosciences de Lyon (INSERM U1028 - CNRS UMR 5292), Bron, France
| | - Karl Wehbe
- Centre Hospitalier Universitaire de Strasbourg, Service de Gynécologie-Obstétrique, Strasbourg, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris; Inserm IAME-U1137, Paris, France; FHU PREMA; Groupe de Recherche sur les Infections pendant la grossesse (GRIG)
| | - Isabelle Villena
- Université Reims Champagne -Ardenne, EA7510 et Centre National de Référence de la Toxoplasmose, Centre de Ressources Biologiques Toxoplasma, Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Reims, Reims, France
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12
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Simon L, Fillaux J, Guigon A, Lavergne RA, Villard O, Villena I, Marty P, Pomares C. Serological diagnosis of Toxoplasma gondii: analysis of false-positive IgG results and implications. ACTA ACUST UNITED AC 2020; 27:7. [PMID: 32031519 PMCID: PMC7006501 DOI: 10.1051/parasite/2020006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary infection by Toxoplasma gondii in pregnant women can result in serious outcomes for the foetus. A false-positive IgG result during pregnancy can lead to a misdiagnosis of past infection and to stopping preventive measures. We collected 189 sera with positive Architect® Toxo IgG assay (Abbott Laboratories) and negative IgG results with at least two other serological tests, in order to find an explanation for the suspected false-positive IgG results. We used the recomLine Toxoplasma IgG® immunoblot (Mikrogen Diagnostik) to search for specific antigenic reactivities of the sera, and the LDBio Toxo II IgG® immunoblot (LDBio Diagnostics) as a confirmatory test. RESULTS The bands GRA8 and/or GRA7 were positive for 148 samples (78.3%). GRA8 was the most frequent band, appearing in 133 patterns (70.4%), whereas GRA7 was present for 49 samples (25.9%). Of the 81 samples tested with LDBio®, 23 (28.4%) turned out to be positive. Of the 58 negative LDBio® tests (71.6%) (real false-positive Architect® IgG), 23 samples (39.6%) did not show either a GRA8 or p30 band by recomLine®. Their false positivity with Architect® remains unexplained since Abbott uses these two recombinant antigens for their assay. CONCLUSIONS The Architect® IgG false positivity for T. gondii seems to be due to reactivity against GRA8 for the majority of the sera and GRA7 to a lesser extent. The hypothesis of past contact with parasites genetically close to T. gondii such as Hammondia hammondi or Neospora caninum seems promising and should be assessed further.
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Affiliation(s)
- Loïc Simon
- Service de Parasitologie-Mycologie, CHU de Nice, Université Côte d'Azur, 06202 Nice, France - Inserm U1065, C3M, 06204 Nice, France
| | - Judith Fillaux
- Service de Parasitologie-Mycologie, CHU de Toulouse, 31300 Toulouse, France - PharmaDev, IRD UMR 152, Université de Toulouse, 31062 Toulouse, France
| | - Aurélie Guigon
- Service de Microbiologie, Hôpital La Source, CHR d'Orléans, 45100 Orléans, France
| | - Rose-Anne Lavergne
- Parasitologie-Mycologie, CHU de Nantes, 44093 Nantes, France - Université de Nantes, Nantes Atlantique Universités, EA1155-IICiMed, Institut de Recherche en Santé 2, 44200 Nantes, France
| | - Odile Villard
- Institut de Parasitologie et de Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 67000 Strasbourg, France
| | - Isabelle Villena
- EA7510, ESCAPE, Laboratoire de Parasitologie-Mycologie, Université de Reims Champagne-Ardenne, SFR Cap Santé FED 4231, 51096 Reims, France
| | - Pierre Marty
- Service de Parasitologie-Mycologie, CHU de Nice, Université Côte d'Azur, 06202 Nice, France - Inserm U1065, C3M, 06204 Nice, France
| | - Christelle Pomares
- Service de Parasitologie-Mycologie, CHU de Nice, Université Côte d'Azur, 06202 Nice, France - Inserm U1065, C3M, 06204 Nice, France
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Murata FHA, Previato M, Frederico FB, Barbosa AP, Nakashima F, de Faria GM, Silveira Carvalho AP, Meira Strejevitch CDS, Pereira-Chioccola VL, Castiglioni L, de Mattos LC, Siqueira RC, Brandão de Mattos CC. Evaluation of Serological and Molecular Tests Used for the Identification of Toxoplasma gondii Infection in Patients Treated in an Ophthalmology Clinic of a Public Health Service in São Paulo State, Brazil. Front Cell Infect Microbiol 2020; 9:472. [PMID: 32117820 PMCID: PMC7019025 DOI: 10.3389/fcimb.2019.00472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/23/2019] [Indexed: 11/13/2022] Open
Abstract
Ocular toxoplasmosis is one of the most common complications caused by the infection with the parasite Toxoplasma gondii. The risk of developing eye lesions and impaired vision is considered higher in Brazil than other countries. The clinical diagnosis is difficult and the use of sensitive and specific laboratorial methods can aid to the correct diagnosis of this infection. We compared serological methods ELISA and ELFA, and molecular cPCR, Nested PCR and qPCR for the diagnosis of T. gondii infection in groups of patients clinically evaluated with ocular diseases non-toxoplasma related (G1 = 185) and with lesions caused by toxoplasmosis (G2 = 164) in an Ophthalmology clinic in Brazil. Results were compared by the Kappa index, and sensitivity (S), specificity (E), positive predictive value (PPV), and negative (NPV) were calculated. Serologic methods were in agreement with ELISA more sensitive and ELFA more specific to characterize the acute and chronic infections while molecular methods were discrepant where qPCR presented higher sensitivity, however, lower specificity when compared to cPCR and Nested PCR.
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Affiliation(s)
- Fernando Henrique Antunes Murata
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | - Mariana Previato
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | - Fábio Batista Frederico
- FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil.,Ambulatório de Oftalmologia Do Hospital de Base, Fundação Faculdade Regional de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil
| | - Amanda Pires Barbosa
- Ambulatório de Oftalmologia Do Hospital de Base, Fundação Faculdade Regional de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil
| | - Fabiana Nakashima
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil
| | - Geraldo Magela de Faria
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | | | | | - Vera Lucia Pereira-Chioccola
- Laboratório de Biologia Molecular de Parasitas e Fungos Do Centro de Parasitologia e Micologia, Instituto Adolfo Lutz, São Paulo, Brazil
| | - Lilian Castiglioni
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil
| | - Luiz Carlos de Mattos
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | - Rubens Camargo Siqueira
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | - Cinara Cássia Brandão de Mattos
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
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14
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How to estimate time of infection with Toxoplasma gondii in pregnant women. Use of specific IgG and IgM kinetics by 7 techniques on 691 sera. Diagn Microbiol Infect Dis 2020; 96:114987. [PMID: 32005405 DOI: 10.1016/j.diagmicrobio.2020.114987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/20/2022]
Abstract
A difficulty when detecting both anti-Toxoplasma gondii-specific IgG and IgM in pregnant women is estimating the date of infection. The aim of this study was to compare the anti-Toxoplasma-specific immunoglobulin kinetics of 7 serological techniques to date the infection and to draw kinetic curves that are easy to use on a daily basis. IgG and IgM antibodies were measured on 691 sera samples. IgM appeared a few days, less than 1 week, after the beginning of the infection. Then, the levels of IgM reached a peak at approximately 3, 4, and 5 weeks with Toxo-ISAGA® IgM, IgM homemade indirect immunofluorescence assays, and Vidas Toxo® IgM, respectively. Furthermore, the Architect Toxo® IgG titers were higher than those of the Vidas Toxo® IgG results in recent infection (less than 6 months). This study provides new average IgM and IgG curves that can help to determine the approximate date of infection.
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15
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Abstract
Ocular toxoplasmosis (OT), a parasitic infection of the eye, is considered to be the most important infectious cause of posterior uveitis worldwide. Its prevalence is particularly high in South America, where aggressive Toxoplasma gondii strains are responsible for more-severe presentations. The particular pathophysiology of this infection leads, from recurrence to recurrence, to potentially severe vision impairment. The diagnosis of this infection is usually exclusively based on the clinical examination. However, the symptoms may be misleading and are not always sufficient to confirm a diagnosis of OT. In such cases, biological tests performed by means of several techniques on blood and ocular samples may facilitate the diagnosis. In this study, we analyzed the tests that were performed in our laboratory over a 9-year period every time OT was suspected. Our report highlights that the quality of ocular sampling by ophthalmologists and combinations of several techniques are critical for a reliable biological OT diagnosis. Ocular toxoplasmosis (OT), i.e., the ocular manifestation of Toxoplasma gondii infection, is one of the leading causes of posterior uveitis. While ocular lesions are often typical, atypical forms often require biological confirmation of the diagnosis. Our study sought to review the biological OT diagnoses made in our laboratory to further assess the role of each test in the diagnostic procedure. All ocular samples sent to our laboratory over the last 9 years for OT diagnosis were included. These samples were analyzed using T. gondii PCR and antibody detection by means of immunoblotting and Candolfi coefficient (CC) determinations, either alone or in combination. Since serum analysis is required to interpret both the CC and immunoblotting, blood serology for T. gondii was also performed in most cases. Of the 249 samples analyzed, 80 (32.1%; 95% confidence interval [95%CI], 26.3 to 37.9) were positive for OT. Of these 80 cases, 52/80 (65.0%; 54.6 to 74.5) displayed a positive PCR, 15/80 (18.8%; 10.2 to 27.3) a positive CC, and 33/80 (41.3%; 95%CI, 30.5 to 52.0) a positive immunoblot result. Overall, 63 of the 80 OT diagnoses (78.8%; 95%CI, 69.8 to 87.7) were made on the basis of a single positive test result. Our study results remind us that current biological diagnostic tools for OT must be employed in combination to obtain an optimal diagnosis based on the precious ocular fluids sampled by ophthalmologists. Clinicobiological studies that are focused on correlating the performances of the different tests with clinical features are critically needed to improve our understanding of the pathophysiology and diagnosis of OT. IMPORTANCE Ocular toxoplasmosis (OT), a parasitic infection of the eye, is considered to be the most important infectious cause of posterior uveitis worldwide. Its prevalence is particularly high in South America, where aggressive Toxoplasma gondii strains are responsible for more-severe presentations. The particular pathophysiology of this infection leads, from recurrence to recurrence, to potentially severe vision impairment. The diagnosis of this infection is usually exclusively based on the clinical examination. However, the symptoms may be misleading and are not always sufficient to confirm a diagnosis of OT. In such cases, biological tests performed by means of several techniques on blood and ocular samples may facilitate the diagnosis. In this study, we analyzed the tests that were performed in our laboratory over a 9-year period every time OT was suspected. Our report highlights that the quality of ocular sampling by ophthalmologists and combinations of several techniques are critical for a reliable biological OT diagnosis.
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16
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Douet T, Armengol C, Charpentier E, Chauvin P, Cassaing S, Iriart X, Berry A, Fillaux J. Performance of seven commercial automated assays for the detection of low levels of anti-Toxoplasma IgG in French immunocompromised patients. ACTA ACUST UNITED AC 2019; 26:51. [PMID: 31441775 PMCID: PMC6707100 DOI: 10.1051/parasite/2019052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/02/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Immunocompromised patients are at high risk for the development of severe toxoplasmosis from tissue cyst reactivation, the most frequently, or from recently acquired acute infections. Knowledge of serologic status is therefore crucial. Screening for toxoplasmosis is sometimes performed while patients are already immunocompromised and have a low or even undetectable IgG titer by routine automated enzyme immunoassays. The aim of this study was to assess the sensitivity and specificity of seven reagents for the detection of low levels of IgG. Sera from 354 patients were collected and analysed. RESULTS Elecsys® offered the best analytic performances, superior to those of Architect® and Platelia®, which were superior to those of Access II® and TGS TA®. Vidas II® and Liaison II® reagents exhibited poor analytical performances in this cohort. For Elecsys®, Platelia® and Architect®, new thresholds for the grey zone and positive zone have been defined to improve the sensitivity of these reagents while maintaining excellent specificity. CONCLUSIONS Commercialized assays for toxoplasmosis screening are not suitable for IgG low-level detection in patients without adapting the supplier thresholds to avoid false negative results and risk generalized toxoplasmosis.
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Affiliation(s)
- Tiphaine Douet
- Service de Parasitologie - Mycologie, Centre Hospitalier Universitaire de Toulouse-Purpan, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Catherine Armengol
- Service de Parasitologie - Mycologie, Centre Hospitalier Universitaire de Toulouse-Purpan, 330 avenue de Grande Bretagne, 31059 Toulouse, France - Laboratoire d'analyse biomédicale, Centre Hospitalier Comminges Pyrénées, Avenue de Saint Plancard, 31806 Saint Gaudens, France
| | - Elena Charpentier
- Service de Parasitologie - Mycologie, Centre Hospitalier Universitaire de Toulouse-Purpan, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Pamela Chauvin
- Service de Parasitologie - Mycologie, Centre Hospitalier Universitaire de Toulouse-Purpan, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Sophie Cassaing
- Service de Parasitologie - Mycologie, Centre Hospitalier Universitaire de Toulouse-Purpan, 330 avenue de Grande Bretagne, 31059 Toulouse, France - Pharmacochimie et Biologie Pour le Développement (PHARMA-DEV), IRD UMR 152 Université Paul Sabatier, 35 Chemin des Maraîchers, 31400 Toulouse, France
| | - Xavier Iriart
- Service de Parasitologie - Mycologie, Centre Hospitalier Universitaire de Toulouse-Purpan, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Antoine Berry
- Service de Parasitologie - Mycologie, Centre Hospitalier Universitaire de Toulouse-Purpan, 330 avenue de Grande Bretagne, 31059 Toulouse, France
| | - Judith Fillaux
- Service de Parasitologie - Mycologie, Centre Hospitalier Universitaire de Toulouse-Purpan, 330 avenue de Grande Bretagne, 31059 Toulouse, France - Pharmacochimie et Biologie Pour le Développement (PHARMA-DEV), IRD UMR 152 Université Paul Sabatier, 35 Chemin des Maraîchers, 31400 Toulouse, France
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Miernyk KM, Bruden D, Parkinson AJ, Hurlburt D, Klejka J, Berner J, Stoddard RA, Handali S, Wilkins PP, Kersh GJ, Fitzpatrick K, Drebot MA, Priest JW, Pappert R, Petersen JM, Teshale E, Hennessy TW, Bruce MG. Human Seroprevalence to 11 Zoonotic Pathogens in the U.S. Arctic, Alaska. Vector Borne Zoonotic Dis 2019; 19:563-575. [PMID: 30789314 PMCID: PMC10874833 DOI: 10.1089/vbz.2018.2390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Due to their close relationship with the environment, Alaskans are at risk for zoonotic pathogen infection. One way to assess a population's disease burden is to determine the seroprevalence of pathogens of interest. The objective of this study was to determine the seroprevalence of 11 zoonotic pathogens in people living in Alaska. Methods: In a 2007 avian influenza exposure study, we recruited persons with varying wild bird exposures. Using sera from this study, we tested for antibodies to Cryptosporidium spp., Echinococcus spp., Giardia intestinalis, Toxoplasma gondii, Trichinella spp., Brucella spp., Coxiella burnetii, Francisella tularensis, California serogroup bunyaviruses, and hepatitis E virus (HEV). Results: Eight hundred eighty-seven persons had sera tested, including 454 subsistence bird hunters and family members, 160 sport bird hunters, 77 avian wildlife biologists, and 196 persons with no wild bird exposure. A subset (n = 481) of sera was tested for California serogroup bunyaviruses. We detected antibodies to 10/11 pathogens. Seropositivity to Cryptosporidium spp. (29%), California serotype bunyaviruses (27%), and G. intestinalis (19%) was the most common; 63% (301/481) of sera had antibodies to at least one pathogen. Using a multivariable logistic regression model, Cryptosporidium spp. seropositivity was higher in females (35.7% vs. 25.0%; p = 0.01) and G. intestinalis seropositivity was higher in males (21.8% vs. 15.5%; p = 0.02). Alaska Native persons were more likely than non-Native persons to be seropositive to C. burnetii (11.7% vs. 3.8%; p = 0.005) and less likely to be seropositive to HEV (0.4% vs. 4.1%; p = 0.01). Seropositivity to Cryptosporidium spp., C. burnetii, HEV, and Echinococcus granulosus was associated with increasing age (p ≤ 0.01 for all) as was seropositivity to ≥1 pathogen (p < 0.0001). Conclusion: Seropositivity to zoonotic pathogens is common among Alaskans with the highest to Cryptosporidium spp., California serogroup bunyaviruses, and G. intestinalis. This study provides a baseline for use in assessing seroprevalence changes over time.
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Affiliation(s)
- Karen M. Miernyk
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Alan J. Parkinson
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | | | - James Berner
- Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Robyn A. Stoddard
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sukwan Handali
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia P. Wilkins
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gilbert J. Kersh
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelly Fitzpatrick
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mike A. Drebot
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Jeffrey W. Priest
- Waterborne Diseases Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Pappert
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado
| | - Jeannine M. Petersen
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Ft. Collins, Colorado
| | - Eyasu Teshale
- Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas W. Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Michael G. Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
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Yamamoto L, Filho AGA, Queiroz JA, de Carvalho MHB, Rodrigues JC, Kanunfre KA, Francisco RPV, Okay TS. Performance of a Multiplex Nested Polymerase Chain Reaction in Detecting 7 Pathogens Containing DNA in Their Genomes Associated With Congenital Infections. Arch Pathol Lab Med 2019; 144:99-106. [PMID: 31219343 DOI: 10.5858/arpa.2018-0544-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Infections are the leading cause of perinatal and infant mortality in low-income and low-resource countries, which have a higher prevalence of infections. Definitive diagnosis of congenital and perinatal infections is largely dependent upon the results of laboratory tests. OBJECTIVE.— To develop a multiplex nested polymerase chain reaction (PCR) technique for the simultaneous detection of 7 pathogens containing DNA in their genomes in suspected cases of congenital infection. DESIGN.— Eligible participants were pregnant women with positive immunoglobulin M antibodies raised to one of the pathogens in the prenatal serologic screening, associated or not with fetal ultrasound abnormalities or positive fetal serology. Neonates whose mothers did not attend prenatal care were included when they presented with symptomatology and laboratory parameters suggestive of infection. The detection rate of the multiplex nested PCR was compared with maternal, fetal, and neonatal serology, as well as placental immunohistochemistry and noncommercial amplifications. RESULTS.— Of 161 suspected cases, the multiplex nested PCR detected 60 (37.3%), whereas the tests available in hospital laboratories detected 13 of 60 (21.7%) of the cases detected by the multiplex nested PCR, demonstrating a 4.6 times higher detection rate for the multiplex nested PCR (Fisher exact test, P < .001). Positive amplifications were to Toxoplasma gondii (32 cases), cytomegalovirus (14 cases), parvovirus B19 (5 cases), and adenovirus (5 cases). In 4 cases, 2 pathogens were simultaneously detected. All types of biological matrices were suitable for amplification. Sequencing of multiplex nested PCR products confirmed the molecular findings. CONCLUSIONS.— The multiplex nested PCR significantly increased the number of diagnosed congenital infections. Given the scarcity of DNA recovered from amniotic fluid and some neonatal samples, this multiplex nested PCR allows the simultaneous detection of 7 pathogens associated with congenital infections in a reliable, faster, cost-effective, and more sensitive way.
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Affiliation(s)
- Lidia Yamamoto
- From the Laboratory of Seroepidemiology and Immunobiology, Institute of Tropical Medicine (Drs Yamamoto, Rodrigues, Kanunfre, and Okay), the Department of Obstetrics and Gynecology, School of Medicine (Drs Amorim Filho, Queiroz, Carvalho, and Francisco), and LIM 48, Laboratory of Immunology, Department of Infectious and Parasitic Diseases, School of Medicine (Dr Kanunfre), University of São Paulo, São Paulo, Brazil
| | - Antonio G Amorim Filho
- From the Laboratory of Seroepidemiology and Immunobiology, Institute of Tropical Medicine (Drs Yamamoto, Rodrigues, Kanunfre, and Okay), the Department of Obstetrics and Gynecology, School of Medicine (Drs Amorim Filho, Queiroz, Carvalho, and Francisco), and LIM 48, Laboratory of Immunology, Department of Infectious and Parasitic Diseases, School of Medicine (Dr Kanunfre), University of São Paulo, São Paulo, Brazil
| | - Joelma A Queiroz
- From the Laboratory of Seroepidemiology and Immunobiology, Institute of Tropical Medicine (Drs Yamamoto, Rodrigues, Kanunfre, and Okay), the Department of Obstetrics and Gynecology, School of Medicine (Drs Amorim Filho, Queiroz, Carvalho, and Francisco), and LIM 48, Laboratory of Immunology, Department of Infectious and Parasitic Diseases, School of Medicine (Dr Kanunfre), University of São Paulo, São Paulo, Brazil
| | - Mario H B de Carvalho
- From the Laboratory of Seroepidemiology and Immunobiology, Institute of Tropical Medicine (Drs Yamamoto, Rodrigues, Kanunfre, and Okay), the Department of Obstetrics and Gynecology, School of Medicine (Drs Amorim Filho, Queiroz, Carvalho, and Francisco), and LIM 48, Laboratory of Immunology, Department of Infectious and Parasitic Diseases, School of Medicine (Dr Kanunfre), University of São Paulo, São Paulo, Brazil
| | - Jonatas C Rodrigues
- From the Laboratory of Seroepidemiology and Immunobiology, Institute of Tropical Medicine (Drs Yamamoto, Rodrigues, Kanunfre, and Okay), the Department of Obstetrics and Gynecology, School of Medicine (Drs Amorim Filho, Queiroz, Carvalho, and Francisco), and LIM 48, Laboratory of Immunology, Department of Infectious and Parasitic Diseases, School of Medicine (Dr Kanunfre), University of São Paulo, São Paulo, Brazil
| | - Kelly A Kanunfre
- From the Laboratory of Seroepidemiology and Immunobiology, Institute of Tropical Medicine (Drs Yamamoto, Rodrigues, Kanunfre, and Okay), the Department of Obstetrics and Gynecology, School of Medicine (Drs Amorim Filho, Queiroz, Carvalho, and Francisco), and LIM 48, Laboratory of Immunology, Department of Infectious and Parasitic Diseases, School of Medicine (Dr Kanunfre), University of São Paulo, São Paulo, Brazil
| | - Rossana P V Francisco
- From the Laboratory of Seroepidemiology and Immunobiology, Institute of Tropical Medicine (Drs Yamamoto, Rodrigues, Kanunfre, and Okay), the Department of Obstetrics and Gynecology, School of Medicine (Drs Amorim Filho, Queiroz, Carvalho, and Francisco), and LIM 48, Laboratory of Immunology, Department of Infectious and Parasitic Diseases, School of Medicine (Dr Kanunfre), University of São Paulo, São Paulo, Brazil
| | - Thelma Suely Okay
- From the Laboratory of Seroepidemiology and Immunobiology, Institute of Tropical Medicine (Drs Yamamoto, Rodrigues, Kanunfre, and Okay), the Department of Obstetrics and Gynecology, School of Medicine (Drs Amorim Filho, Queiroz, Carvalho, and Francisco), and LIM 48, Laboratory of Immunology, Department of Infectious and Parasitic Diseases, School of Medicine (Dr Kanunfre), University of São Paulo, São Paulo, Brazil
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Greigert V, Di Foggia E, Filisetti D, Villard O, Pfaff AW, Sauer A, Candolfi E. When biology supports clinical diagnosis: review of techniques to diagnose ocular toxoplasmosis. Br J Ophthalmol 2019; 103:1008-1012. [DOI: 10.1136/bjophthalmol-2019-313884] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/03/2019] [Accepted: 03/24/2019] [Indexed: 11/04/2022]
Abstract
Toxoplasmosis is a common infection whose worldwide prevalence is estimated at 30%, with large disparities across the world. Among infected subjects, the prevalence of ocular toxoplasmosis (OT) is, however, limited to about 2% in Europe and 17% in South America. In France, it is estimated that about 1 000 000 patients present either active OT or subsequent chorioretinal scars. Toxoplasmagondii is the first cause of posterior uveitis worldwide, responsible for retinochoroiditis, at times associated with anterior uveitis. To date, there is no consensus yet on how to diagnose OT, which is often based only on clinical presentation. Nevertheless, OT-associated symptoms are often atypical and misleading. Over the last 20 years, tremendous progress has been made in biological tools, enabling parasitologists to confirm the diagnosis in most suspected cases of OT. Using anterior chamber puncture, a safe and fast procedure, ophthalmologists sample aqueous humour for analysis using multiple techniques in order to reach high specificity and sensitivity in OT diagnosis. In this article, we present the different techniques available for the biological diagnosis of OT, along with their characteristics, and propose a diagnostic algorithm designed to select the best of these techniques if clinical examination is not sufficient to ascertain the diagnosis.
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Jones JL, Kruszon-Moran D, Elder S, Rivera HN, Press C, Montoya JG, McQuillan GM. Toxoplasma gondii Infection in the United States, 2011-2014. Am J Trop Med Hyg 2018; 98:551-557. [PMID: 29260660 PMCID: PMC5929212 DOI: 10.4269/ajtmh.17-0677] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/11/2017] [Indexed: 11/07/2022] Open
Abstract
Toxoplasma gondii can cause severe neurologic and ocular disease when transmitted congenitally and in immunosuppressed persons. Sera collected in the National Health and Nutrition Examination Survey 2011 through 2014 in 13,507 persons ≥ 6 years old were tested for T. gondii immunoglobulin (Ig) G and IgM antibodies, and in those both IgG and IgM antibody positive, for IgG avidity. Overall, 11.14% (95% confidence limits [CL] 9.88%, 12.51%) were seropositive for T. gondii IgG antibody (age-adjusted seroprevalence 10.42% [95% CL 9.19%, 11.76%]); in women aged 15-44 years, the age-adjusted T. gondii IgG seroprevalence was 7.50% (95% CL 6.00%, 9.25%). In multivariable analysis, risk for IgG seropositivity increased with age and was higher in males; persons living below the poverty level; persons with ≤ a high school education compared with those with > a high school education; and non-Hispanic black, Mexican American, and foreign born non-Hispanic white persons compared with U.S.-born non-Hispanic white persons. Overall, 1.16% (95% CL 0.94%, 1.42%) were T. gondii IgM antibody positive and 0.71%, (95% CL 0.54%, 0.92%) were both IgM and IgG antibody positive. In multivariable analysis, the significant risk factors for being both IgM and IgG positive were older age, crowding, and non-U.S. birth origin compared with U.S.-born persons. Among those positive for both IgM and IgG antibody, almost all had high avidity (all women aged 15-44 years had high avidity). Toxoplasma gondii antibody prevalence remains relatively low in the United States, although it is higher in non-U.S.-born persons, males, and some minority and socioeconomically disadvantaged groups.
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Affiliation(s)
- Jeffrey L. Jones
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deanna Kruszon-Moran
- Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Scott Elder
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hilda N. Rivera
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cindy Press
- Palo Alto Medical Foundation, Toxoplasma Serology Laboratory, Palo Alto, California
| | - Jose G. Montoya
- Palo Alto Medical Foundation, Toxoplasma Serology Laboratory, Palo Alto, California
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Geraldine M. McQuillan
- Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
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Evaluation of a New Immunochromatography Technology Test (LDBio Diagnostics) To Detect Toxoplasma IgG and IgM: Comparison with the Routine Architect Technique. J Clin Microbiol 2017; 55:3395-3404. [PMID: 28954897 DOI: 10.1128/jcm.01106-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/08/2017] [Indexed: 11/20/2022] Open
Abstract
A study comparing the ICT (immunochromatography technology) Toxoplasma IgG and IgM rapid diagnostic test (LDBio Diagnostics, France) with a fully automated system, Architect, was performed on samples from university hospitals of Marseille and Saint-Etienne. A total of 767 prospective sera and 235 selected sera were collected. The panels were selected to test various IgG and IgM parameters. The reference technique, Toxoplasma IgGII Western blot analysis (LDBio Diagnostics), was used to confirm the IgG results, and commercial kits Platelia Toxo IgM (Bio-Rad) and Toxo-ISAgA (bioMérieux) were used in Saint-Etienne and Marseille, respectively, as the IgM reference techniques. Sensitivity and specificity of the ICT and the Architect IgG assays were compared using a prospective panel. Sensitivity was 100% for the ICT test and 92.1% for Architect (cutoff at 1.6 IU/ml). The low-IgG-titer serum results confirmed that ICT sensitivity was superior to that of Architect. Specificity was 98.7% (ICT) and 99.8% (Architect IgG). The ICT test is also useful for detecting IgM without IgG and is both sensitive (100%) and specific (100%), as it can distinguish nonspecific IgM from specific Toxoplasma IgM. In comparison, IgM sensitivity and specificity on Architect are 96.1% and 99.6%, respectively (cutoff at 0.5 arbitrary units [AU]/ml). To conclude, this new test overcomes the limitations of automated screening techniques, which are not sensitive enough for IgG and lack specificity for IgM (rare IgM false-positive cases).
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