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Franco PS, Scussel ACMO, Silva RJ, Araújo TE, Gonzaga HT, Marcon CF, Brito-de-Sousa JP, Diniz ALD, Paschoini MC, Barbosa BF, Martins-Filho OA, Mineo JR, Ferro EAV, Gomes AO. Systematic Review and Meta-Analysis of Congenital Toxoplasmosis Diagnosis: Advances and Challenges. J Trop Med 2024; 2024:1514178. [PMID: 38419946 PMCID: PMC10901580 DOI: 10.1155/2024/1514178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/21/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
Objective To understand how congenital toxoplasmosis (CT) diagnosis has evolved over the years, we performed a systematic review and meta-analysis to summarize the kind of analysis that has been employed for CT diagnosis. Methods PubMed and Lilacs databases were used in order to access the kind of analysis that has been employed for CT diagnosis in several samples. Our search combined the following combining terms: "congenital toxoplasmosis" or "gestational toxoplasmosis" and "diagnosis" and "blood," "serum," "amniotic fluid," "placenta," or "colostrum." We extracted data on true positive, true negative, false positive, and false negative to generate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Random-effects models using MetaDTA were used for analysis. Results Sixty-five articles were included in the study aiming for comparisons (75.4%), diagnosis performance (52.3%), diagnosis improvement (32.3%), or to distinguish acute/chronic infection phases (36.9%). Amniotic fluid (AF) and placenta were used in 36.9% and 10.8% of articles, respectively, targeting parasites and/or T. gondii DNA. Blood was used in 86% of articles for enzymatic assays. Colostrum was used in one article to search for antibodies. In meta-analysis, PCR in AF showed the best performance for CT diagnosis based on the highest summary sensitivity (85.1%) and specificity (99.7%) added to lower magnitude heterogeneity. Conclusion Most of the assays being researched to diagnose CT are basically the same traditional approaches available for clinical purposes. The range in diagnostic performance and the challenges imposed by CT diagnosis indicate the need to better explore pregnancy samples in search of new possibilities for diagnostic tools. Exploring immunological markers and using bioinformatics tools and T. gondii recombinant antigens should address the research needed for a new generation of diagnostic tools to face these challenges.
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Affiliation(s)
- Priscila Silva Franco
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
| | | | - Rafaela José Silva
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
| | - Thadia Evelyn Araújo
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
- Instituto René Rachou, Fundação Oswaldo Cruz, Avenida Augusto de Lima, 1715, Barro Preto 30190-002, Belo Horizonte, MG, Brazil
| | - Henrique Tomaz Gonzaga
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
| | - Camila Ferreira Marcon
- Universidade Federal do Triângulo Mineiro, Rua Frei Paulino, 30, Nossa Sra. da Abadia 38025-180, Uberaba, MG, Brazil
| | - Joaquim Pedro Brito-de-Sousa
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
- Instituto René Rachou, Fundação Oswaldo Cruz, Avenida Augusto de Lima, 1715, Barro Preto 30190-002, Belo Horizonte, MG, Brazil
| | - Angélica Lemos Debs Diniz
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
| | - Marina Carvalho Paschoini
- Universidade Federal do Triângulo Mineiro, Rua Frei Paulino, 30, Nossa Sra. da Abadia 38025-180, Uberaba, MG, Brazil
| | - Bellisa Freitas Barbosa
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
| | - Olindo Assis Martins-Filho
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
- Instituto René Rachou, Fundação Oswaldo Cruz, Avenida Augusto de Lima, 1715, Barro Preto 30190-002, Belo Horizonte, MG, Brazil
| | - José Roberto Mineo
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
| | - Eloisa Amália Vieira Ferro
- Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil
| | - Angelica Oliveira Gomes
- Universidade Federal do Triângulo Mineiro, Rua Frei Paulino, 30, Nossa Sra. da Abadia 38025-180, Uberaba, MG, Brazil
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Assessment of an In-House Enzyme-Linked Immunosorbent Assay and IgG Avidity Test Based on SAG1 and GRA7 Proteins for Discriminating between Acute and Chronic Toxoplasmosis in Humans. J Clin Microbiol 2021; 59:e0041621. [PMID: 34077255 DOI: 10.1128/jcm.00416-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To improve serodiagnostic methods for diagnosis of acute from chronic toxoplasmosis, an economical in-house enzyme-linked immunosorbent assay (ELISA) for measuring Toxoplasma-specific IgG, IgM, and IgG avidity has been developed and assessed based on use of various Toxoplasma gondii antigens, including SAG1, GRA7, and a combination of SAG1 and GRA7 (SAG1+GRA7), as well as Toxoplasma lysate antigens (TLAs). Performances of in-house IgM, IgG, and IgG avidity assays were compared to those of ELISA commercial kits and VIDAS Toxo IgG avidity. A set of 138 sera from patients with acquired T. gondii infection and seronegative people were assessed. Receiver operating characteristic (ROC) analysis revealed an area under curve (AUC) of 0.98, 0.97, 0.99, and 0.99 for IgM-TLAs, IgM-SAG1, IgM-GRA7, and IgM-SAG1+GRA7, respectively. Furthermore, AUC was calculated as 0.99, 0.99, 0.98, and 0.99 for IgG-TLAs, IgG-SAG1, IgG-GRA7, and IgG-SAG1+GRA7, respectively. The current study showed that GRA7 included 100% sensitivity for the detection of Toxo IgM, while SAG1 included 89.7% sensitivity. Furthermore, the highest specificity (97.2%) to detect Toxo IgM was achieved using SAG1+GRA7 antigen. For the detection of Toxo IgG, the highest sensitivity (100%) was recorded for SAG1+GRA7, followed by TLAs (97.9%). The SAG1+GRA7 showed the greatest potential for assessing avidity of IgG antibodies, with 97.1% sensitivity and 96.6% specificity compared to those of VIDAS Toxo IgG avidity. The preliminary results have promised better discriminations between acute and chronic infections using a combination of SAG1 and GRA7 recombinant antigens compared to those using TLAs.
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Storchilo HR, Teixeira GM, Moreira ALE, Gomes TC, Borges CL, de Castro AM. Identification of Biomarkers for Diagnosis and Prognosis of Congenital and Acute Toxoplasmosis. J Infect Dis 2021; 223:1965-1972. [PMID: 32995873 DOI: 10.1093/infdis/jiaa613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/25/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The diagnosis of congenital toxoplasmosis can be inconclusive in many cases. Despite the several serological tests developed, the literature on biomarkers that can assist in the diagnosis of congenital an acute toxoplasmosis is limited. The objective of this study was to analyze the immunoreactive profile of Toxoplasma gondii protein bands with the potential to be biomarkers for diagnosis and prognosis of congenital and acute toxoplasmosis. METHODS Peripheral blood samples from women of childbearing age and/or pregnant women diagnosed with acquired toxoplasmosis as well as from congenitally infected children were selected and submitted to immunoblotting for analysis of the immunoreactive bands profile by immunoglobulin G (IgG) antibodies. RESULTS When comparing the immunoreactive bands profile for antibodies present in samples from different groups and subgroups, the 150, 18.5, and 16.96-kDa bands were more immunoreactive with the antibodies present in serum samples from the acquired infection group. The 343, 189, 150, 75, and 42-kDa bands showed more chance to be detected by the symptomatic congenital infection subgroup samples, while the 61, 50, and 16.96-kDa bands were significantly immunoreactive with the acute infection subgroup samples. CONCLUSIONS The identification of these potential biomarkers can assist in early diagnosis and treatment of congenital toxoplasmosis.
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Affiliation(s)
- Heloisa Ribeiro Storchilo
- Department of Biosciences and Technology - Parasitology sector, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Giulianne Monteiro Teixeira
- Department of Biosciences and Technology - Parasitology sector, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - André Luís Elias Moreira
- Department of Biochemistry and Molecular Biology, Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Taynara Cristina Gomes
- Department of Biosciences and Technology - Parasitology sector, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Clayton Luiz Borges
- Department of Biochemistry and Molecular Biology, Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Ana Maria de Castro
- Department of Biosciences and Technology - Parasitology sector, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
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Redondo A, Wood D, Amaral S, Ferré J, Goti D, Bertran J. Production of Toxoplasma gondii Recombinant Antigens in Genome-Edited Escherichia coli. APPL BIOCHEM MICRO+ 2021. [DOI: 10.1134/s0003683821020137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ferra B, Holec-Gąsior L, Gatkowska J, Dziadek B, Dzitko K. Toxoplasma gondii Recombinant antigen AMA1: Diagnostic Utility of Protein Fragments for the Detection of IgG and IgM Antibodies. Pathogens 2020; 9:pathogens9010043. [PMID: 31948063 PMCID: PMC7168680 DOI: 10.3390/pathogens9010043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 01/25/2023] Open
Abstract
Toxoplasma gondii is an important zoonotic protozoan that infects a wide variety of vertebrates as intermediate hosts. For this reason, the diagnosis of this disease is very important and requires continuous improvement. One possibility is to use recombinant antigens in serological tests. Apical membrane antigen 1 (AMA1), a protein located in specific secretory organelles (micronemes) of T. gondii, is very interesting in regard to its potential diagnostic utility. In the present study, we attempted to identify a fragment of the AMA1 protein with a high sensitivity and specificity for the serological diagnosis of human toxoplasmosis. The full-length AMA1 and two different fragments (AMA1N and AMA1C) were produced using an Escherichia coli expression system. After purification by metal affinity chromatography, recombinant proteins were tested for their utility as antigens in enzyme-linked immunosorbent assays (ELISAs) for the detection of IgG and IgM anti-T. gondii antibodies in human and mouse immune sera. Our data demonstrate that the full-length AMA1 recombinant antigen (corresponding to amino acid residues 67–569 of the native protein) has a better diagnostic potential than its N- or C-terminal fragments. This recombinant protein strongly interacts with specific anti-T. gondii IgG (99.4%) and IgM (80.0%) antibodies, and may be used for developing new tools for diagnostics of toxoplasmosis.
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Affiliation(s)
- Bartłomiej Ferra
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, Narutowicza 11/12, 80-233 Gdańsk, Poland;
- Correspondence: ; Tel.: +48-58-347-24-06
| | - Lucyna Holec-Gąsior
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, Narutowicza 11/12, 80-233 Gdańsk, Poland;
| | - Justyna Gatkowska
- Department of Immunoparasitology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Łódź, Poland; (J.G.); (B.D.); (K.D.)
| | - Bożena Dziadek
- Department of Immunoparasitology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Łódź, Poland; (J.G.); (B.D.); (K.D.)
| | - Katarzyna Dzitko
- Department of Immunoparasitology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Łódź, Poland; (J.G.); (B.D.); (K.D.)
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Performance of Zika Assays in the Context of Toxoplasma gondii, Parvovirus B19, Rubella Virus, and Cytomegalovirus (TORCH) Diagnostic Assays. Clin Microbiol Rev 2019; 33:33/1/e00130-18. [PMID: 31826871 DOI: 10.1128/cmr.00130-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Infections during pregnancy that may cause congenital abnormalities have been recognized for decades, but their diagnosis is challenging. This was again illustrated with the emergence of Zika virus (ZIKV), highlighting the inherent difficulties in estimating the extent of pre- and postnatal ZIKV complications because of the difficulties in establishing definitive diagnoses. We reviewed the epidemiology, infection kinetics, and diagnostic methods used for Toxoplasma gondii, parvovirus B19, rubella virus, and cytomegalovirus (TORCH) infections and compared the results with current knowledge of ZIKV diagnostic assays to provide a basis for the inclusion of ZIKV in the TORCH complex evaluations. Similarities between TORCH pathogens and ZIKV support inclusion of ZIKV as an emerging TORCH infection. Our review evaluates the diagnostic performance of various TORCH diagnostic assays for maternal screening, fetal screening, and neonatal screening. We show that the sensitivity, specificity, and positive and negative predictive value of TORCH complex pathogens are widely variable, stressing the importance of confirmatory testing and the need for novel techniques for earlier and accurate diagnosis of maternal and congenital infections. In this context it is also important to acknowledge different needs and access to care for different geographic and resource settings.
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Javadi Mamaghani A, Fathollahi A, Spotin A, Ranjbar MM, Barati M, Aghamolaie S, Karimi M, Taghipour N, Ashrafi M, Tabaei SJS. Candidate antigenic epitopes for vaccination and diagnosis strategies of Toxoplasma gondii infection: A review. Microb Pathog 2019; 137:103788. [DOI: 10.1016/j.micpath.2019.103788] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/05/2019] [Accepted: 10/08/2019] [Indexed: 12/28/2022]
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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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García VS, Peverengo L, Peretti LE, González VD, Gugliotta LM, Dalla Fontana ML, Marcipar IS, Lagier CM. An improved approach to estimate the avidity index of immunoglobulins: Evaluation of the method using IgG anti- Toxoplasma gondii. J Immunol Methods 2018; 457:78-81. [DOI: 10.1016/j.jim.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/26/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
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Costa JG, Vilariño MJ. Antigens to detect the acute phase of toxoplasmosis in pregnant women: standardized comparison. Biomark Med 2018; 12:517-534. [DOI: 10.2217/bmm-2017-0345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A key element in any diagnostic technique is the antigen (Ag), a biomarker, but this is usually a protein that has a function to the parasite. Some biological aspects of the Ags and of the Toxoplasma gondii can influence the effectiveness of the diagnosis, as well as the antibody isotype and the characteristics of the assay. A large number of papers have assessed different proteins to distinguish the phases of infection, but the ‘indices of effectiveness’ differ among reports. This work presents for the first time a summary of all the Ags that have been evaluated, with standardized measurements of sensitivity and specificity. These values were calculated with information presented in the papers on Ag evaluations to differentiate the infection phases.
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Affiliation(s)
- Juan Gabriel Costa
- Laboratorio de Microbiología, Hospital provincial del Centenario, Rosario, Santa Fe, Argentina
- Cátedra de Fisicoquímica, Facultad de Bioquímica y Ciencias Biológicas de Universidad Nacional del Litoral, Ciudad Universitaria, Santa Fe, Santa Fe, Argentina
| | - María Julia Vilariño
- Departamento de Neurología pediátrica, Hospital Escuela Eva Perón, Granadero Baigorria, Santa Fe, Argentina
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