Comparison of a latex agglutination test with other serological tests for the measurement of antibodies to Toxoplasma gondii

Seroprevalence of Toxoplasma gondii immunoglobulins and its association with systemic lupus erythematosus: A systematic review and meta-analysis

BACKGROUND

The exact cause of systemic lupus erythematosus (SLE) is still unknown. However, hormonal, genetic, and environmental factors may play significant roles in its development. Infection has been recognized as a crucial trigger for SLE development. Several studies have reported a higher prevalence of Toxoplasma gondii infections in patients with SLE than in healthy individuals. However, these results were inconsistent. Therefore, this study aimed to conduct a systematic review and meta-analysis of published studies to provide a definitive conclusion regarding the relationship between T. gondii infection and SLE.

MATERIALS AND METHODS

We conducted a comprehensive search across diverse databases using an array of search tools to uncover pertinent literature. Following the stringent application of the inclusion and exclusion criteria, we carefully selected the appropriate reports for our meta-analysis. Using Comprehensive Meta-Analysis software v4, we analyzed the data and determined the prevalence of antibodies against T. gondii in patients affected with SLE. To investigate the correlation between T. gondii seropositivity and SLE, we computed the risk ratios (RRs) and 95% confidence intervals (CI).

RESULTS

Eleven studies were considered eligible for inclusion in the present study. The prevalence of anti-IgG and IgM antibodies against T. gondii was 33.9% and 7.7%, respectively. A significant association between T. gondii IgG seropositivity and SLE was observed when compared to the controls (risk ratio = 2.14, 95% CI = 1.42 to 3.22, p = .000). However, IgM seropositivity against T. gondii was comparable between patients with SLE and healthy controls.

CONCLUSIONS

In summary, this study suggests that T. gondii IgG is more prevalent in patients with SLE than in healthy individuals in areas where T. gondii infections are more frequent. However, an exact cause-and-effect relationship still needs to be established. Therefore, additional research is necessary to validate these findings and to investigate the underlying mechanisms.

Serological detection of T. gondii infection in humans using an immunochromatographic assay based on dense granule protein 7

Toxoplasma gondii causes toxoplasmosis, one of the world's most common parasitic diseases. It secretes large amounts of dense granule antigens (TgGRAs), which are crucial to the parasite's survivability. TgGRA7 is found abundantly on the surface of host cells, within the parasitophorous vacuole lumen and membrane, and the host cell cytosol. It stimulates a strong antibody response during acute and chronic infections. While it has been well utilized as an antigen for enzyme-linked immunosorbent assay (ELISA), only one report has documented its efficacy as an antigen for an immunochromatographic test (ICT) in pigs. To date, there is no study yet documenting its use for ICT in human toxoplasmosis. Here, we validated the efficacy of the TgGRA7-ICT we developed by testing 88 human sera. Results were compared with those obtained by ELISA based on TgGRA7, a commercial ELISA, and latex agglutination test (LAT). With high sensitivity, specificity, and kappa values, our TgGRA7-ICT results revealed very good agreement with standard test results. We also found a strong correlation between the relative ICT band intensity and absorbance values in the ELISA. Altogether, our data suggest that the current ICT with TgGRA7 is a reliable test for the diagnosis of human toxoplasmosis, which produced results similar to conventional serological methods. Thus, this can be used as a screening tool for routine testing of toxoplasmosis and a good option for point of care application. The present study also documents the first utilization of TgGRA7 as an antigen for ICT for the serodiagnosis of human toxoplasmosis.

A review on human toxoplasmosis

Toxoplasmosis is a worldwide infection caused by the intracellular parasite Toxoplasma gondii. At least a third of the world human population are infected with the parasite, making it one of the most successful parasitic infections. Primary maternal infection may cause health-threatening sequelae for the foetus, or even cause death in uterus. Reactivation of a latent infection in immune deficiency conditions such as AIDS and organ transplantation can cause fatal toxoplasmic encephalitis. Toxoplasmosis is a major cause of retinochoroiditis, especially in individuals with an impaired immune system. Despite the usually 'asymptomatic' nature of the infection, a significant burden imposed by the parasite necessitates the implementation of effective means for the prevention, diagnosis, and management of this disease. Laboratory diagnosis, i.e. PCR and serologic assays, plays the main role in the diagnosis of congenital infection and assists in the confirmatory diagnosis of toxoplasmic encephalitis and ocular toxoplasmosis. Here, we briefly review general aspects of Toxoplasma infection and focus on the diagnostic methods currently used in medical laboratories for the diagnosis of Toxoplasma infection.

Laboratory techniques in the investigation of toxoplasmosis

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Use of acute-stage-specific antigens of Toxoplasma gondii for serodiagnosis of acute toxoplasmosis

Antisera to acetone-fixed tachyzoites were prepared by immunizing rabbits intravenously with the fixed organisms. Immunoblots in which purified immunoglobulin G (IgG) of the antisera was used recognized four antigens of a supernatant (after centrifugation at 10,000 x g for 30 min) fraction of sonicated tachyzoites. A purified toxoplasma antigen fraction, referred to as acute-stage-specific (AC) antigen, that contained mainly three antigens was obtained by affinity chromatography by using the purified IgG. One antigen had a molecular weight of approximately 52,000, and two antigens had molecular weights of approximately 6,000. An enzyme-linked immunosorbent assay (AC-ELISA) in which this purified antigen fraction, obtained by affinity chromatography, was used for detection of IgG antibody detected early acute infection in sera of patients with toxoplasmic lymphadenopathy. Ninety-two percent of sera obtained within 2 months after onset of lymphadenopathy were positive in the AC-ELISA, whereas only 9% of sera obtained later than 5 months after onset of the clinical illness were positive. The AC-ELISA appears highly sensitive and specific for diagnosis of acute toxoplasmosis.

Direct agglutination test and other assays for measuring antibodies to Toxoplasma gondii

The performance of a direct agglutination test for the detection of toxoplasma specific IgG immunoglobulin was compared with that of the latex agglutination test. The direct agglutination test was less sensitive but more specific than the latex agglutination test. Quantitative results were not directly comparable, reflecting the different antibody profiles detected in each assay. The direct agglutination test represents an alternative to the latex agglutination test as a screening test for toxoplasmosis. Patients at risk of life threatening infection require detailed serological examination using additional assays.

Discrepant toxoplasma latex agglutination test results

The analysis of 4450 toxoplasma serology results showed that 59 (1.3%) latex agglutination reactions were not confirmed in the dye test. These discrepant results were associated with an unspecified IgM antibody but not associated with kit batch variation, inactivation of sera, concurrent cytomegalovirus infection, or the presence of hepatitis B virus "e" antigen. The latex agglutination test is useful as a screen for toxoplasma infection but false positive reactions do occur. Patients at risk of severe toxoplasmosis should be investigated by additional tests.

Serological survey for toxoplasmosis in Tripoli, S.P.L.A.J. Libya

Toxoplasma antibodies were found at a titre of 1:16 or above in 51.6% of 2000 adult males, in 43.4% of 300 adult females, and in 43.7% of 1980 schoolchildren (7-18 years of age) from the area of Tripoli (Libya). However, 69.4% of a group of 1921 female patients with a history of abortion and clinically suspected of being infected with T. gondii had Toxoplasma antibodies, and 18.6% of them exhibited serological evidence of recent infection (4-fold or greater increase in antibody titre over 2-3 weeks).

Antibody patterns in the serological diagnosis of acute lymphadenopathic toxoplasmosis

Sera from six patients at various stages of acute lymphadenopathic toxoplasmosis were tested using nine different types of test currently available for the serological diagnosis of the disease. A diagnosis was made on positive serology in three of the patients. The antibody patterns of two of these patients were studied over a period of six months and the third was studied over two months. A diagnosis was made on lymph node morphology in the other three cases. Two serum samples were tested from each of these patients. The results obtained suggest that a rationalisation of the types of test used should be encouraged and that an enzyme-linked immunosorbent assay (ELISA) for parasite-specific IgG and an antibody class capture ELISA for parasite-specific IgM are sufficient to confirm the diagnosis of acute lymphadenopathic toxoplasmosis.