Contribution of IgG avidity and PCR for the early diagnosis of toxoplasmosis in pregnant women from the North-Eastern region of Algeria

Role of IgG avidity in eyes with active Toxoplasma retinochoroiditis

PURPOSE

To study the role of Toxoplasma IgG avidity in evaluating the stage of systemic infection during manifestation as toxoplasma retinochoroiditis and its clinical implications in eastern India.

METHODS

Retrospective chart review of Toxoplasma retinochoroiditis cases with Toxoplasma serology for IgG, IgM, and IgG avidity.

RESULTS

Included in this study were 17 eyes of 17 patients who had active retinitis located in the macula (14), mid-periphery (2), or periphery (1). They were either primary lesions (12) or reactivations (5). All the cases had Toxoplasma IgG positive; one case had IgM positivity, while all the cases had high IgG avidity values. IgG avidity had a positive correlation with the duration of symptoms.

CONCLUSION

We observed high IgG avidity values in active retinochoroiditis in both primary ocular Toxoplasmosis and reactivation subgroups. These results indicate a late ocular manifestation after initial systemic infection with a possible incubation period ranging from 5 weeks to 5 months.

Seroprevalence of Toxoplasma gondii and Associated Risk Factors among Pregnant Women in Algeria

Toxoplasma gondii is an obligate intracellular protozoan parasite affecting all warm-blooded vertebrates, including humans. Infections in humans can lead to severe clinical manifestations in pregnant women and immunocompromised patients. The aim of the present study was to assess seroprevalence of T. gondii infection and to identify the associated risk factors among pregnant women from southern Algeria. A cross-sectional study was conducted from March 2021 to May 2022 among 1,345 pregnant women. A structured questionnaire was used to obtain information on risk factors associated with infection. Participants were screened for anti T. gondii IgG and IgM antibodies using the enzyme-linked fluorescent assay. The overall IgG and IgM seroprevalence was 13.6% and 0.89%, respectively. A significant association was found between seroprevalence of anti T. gondii IgG and history of spontaneous abortion (P = 0.016). Moreover, an increasing trend of seroprevalence was detected in the autumnal season (P = 0.030), and eating raw or undercooked meat was found to be significantly associated with anti-T. gondii IgM seropositivity (P = 0.002). Multivariate analysis showed that women who had experienced spontaneous abortion, regularly ate undercooked meat, and used bottled water in summer were more likely to contract infection with T. gondii. The majority (86.4%) of the studied pregnant women were serologically negative for toxoplasmosis and hence were susceptible to primary acute infection during pregnancy and possible fetal anomalies. Therefore, health education and awareness of the disease and its transmission to women, especially during pregnancy, is imperative.

Employing digital PCR for enhanced detection of perinatal Toxoplasma gondii infection: A cross-sectional surveillance and maternal-infant outcomes study in El Salvador

Toxoplasma gondii is a parasitic infection that can be transmitted in utero, resulting in fetal chorioretinitis and other long-term neurological outcomes. If diagnosed early, pregnancy-safe chemotherapeutics can prevent vertical transmission. Unfortunately, diagnosis of acute, primary infection among pregnant women remains neglected, particularly in low-and-middle-income countries. Clinically actionable diagnosis is complex due to the commonality of infection during childhood and early adulthood which spawn long-last antibody titers and historically unreliable direct molecular diagnostics. The current study employed a cross-sectional T. gondii perinatal surveillance study using digital PCR, a next generation molecular diagnostic platform, and a maternal-fetal outcomes survey to ascertain the risk of vertical toxoplasmosis transmission in the Western Region of El Salvador. Of 198 enrolled mothers at the time of childbirth, 6.6% had evidence of recent T. gondii infection-85% of these cases were identified using digital PCR. Neonates born to these acutely infected mothers were significantly more likely to meconium aspiration syndrome and mothers were more likely to experience labor and delivery complications. Multivariable logistic regression found higher maternal T. gondii infection odds were associated with the presence of pet cats, the definitive T. gondii host. In closing, this study provides evidence of maternal T. gondii infection, vertical transmission and deleterious fetal outcomes in a vulnerable population near the El Salvador-Guatemala border. Further, this is the first published study to show clinical utility potential of digital PCR for accurate diagnosis of congenital toxoplasmosis cases.

Systematic Review and Meta-Analysis of Congenital Toxoplasmosis Diagnosis: Advances and Challenges

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.

Association between breakthrough infection with COVID-19 and Toxoplasma gondii: a cross-sectional study

The breakthrough infection following COVID-19 vaccination has been a subject of concern recently. Evidence suggests that COVID-19 vaccine efficacy diminishes over time due to multiple factors related to the host, and vaccine. Coinfection with other pathogens was claimed earlier as a contributing cause for this phenomenon. Hence, we aimed to stratify the association of post-COVID-19 vaccination breakthrough coinfection with Toxoplasma gondii (T. gondii) and its impact on disease severity. This cross-sectional study included 330 COVID-19-vaccinated patients confirmed by RT-PCR. They were also screened for anti- T. gondii antibodies using ELISA. Toxoplasma seropositive cases' whole blood was screened for DNA using PCR to correlate results with COVID-19 severity. Out of 330 COVID-19 vaccinated patients with breakthrough infection, 34.5% (114 patients) showed positivity for Toxoplasma IgG by ELISA, and none of the cases was IgM positive. Eleven patients (9.6%) of the IgG-positive cases were positive by PCR. Positive PCR cases correlated positively with the Toxoplasma IgG titer (P < 0.001), and the Cutoff point was 191.5. Molecular analysis of Toxoplasma and COVID-19 severity showed that 8 (72.7%), 1 (9.1%), and 2 cases (18.2%) had mild, moderate, and severe courses of the disease, respectively, with no significant correlation. Our study reported a heightened prevalence of latent toxoplasmosis among mild cases of COVID-19 breakthrough infection. Nevertheless, a discernible correlation between latent toxoplasmosis and COVID-19 severity is lacking. Hence, implementing studies on a larger scale could provide a more comprehensive comprehension of this association.

Screening for the Detection of Toxoplasma gondii IgG, IgM and IgA in Females of Reproductive Age from Western Romania

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.

Primary toxoplasmosis acquired during early pregnancy: Is it currently overestimated?

OBJECTIVE

Toxoplasmosis acquired in early pregnancy is a potentially severe complication for the fetus. Evaluating the risk of transplacental infection in pregnant women accessing the Tuscany Reference Center for Infectious Diseases in Pregnancy during the last 20 years with suspected or confirmed toxoplasmosis acquired in early pregnancy was the aim of the study.

STUDY DESIGN

We retrospectively enrolled all pregnant women undergoing amniocentesis for toxoplasmosis acquired in the first 16 gestational weeks in the period 1999-2019, comparing patients with certain acute infection (seroconversion occurred in pregnancy, CAIP) with those with suspected acute infection (IgG positive with low/intermediate IgG avidity index, SAIP).

RESULTS

237 patients were enrolled, 187 (78.9%) with SAIP and 50 (21.1%) with CAIP. Specific IgM was detected in 47.5% and 76.7% (p-value 0.001), and the mean IgG avidity index was 22.7% and 7.1% (p-value < 0.001) in the SAIP and in the CAIP group, respectively. The mean delay from diagnosis to antibiotic initiation was 14.6 in SAIP and 11 days in CAIP group. Toxoplasma DNA was detected in the amniotic fluid in one case in a patient with CAIP. Excluding 24 newborns with not available data, prevalence of congenital infection was 0.47% [1/213 (95% CI 0.08%-2.61%)], 0% [0/178 (95% CI 0%-2.11%)] in SAIP and 2.8% [1/35 (95% CI 0.51%-14.53%)] in CAIP group.

CONCLUSIONS

Toxoplasmosis acquired in early pregnancy has a low risk of fetal infection. Actively discussing case-by-case amniocentesis indication with patients, especially when a recent toxoplasmosis is not properly confirmed, is desirable.

First report of Toxoplasma gondii infection and associated risk factors in the dromedary camel (Camelus dromedarius) population in south East Algeria

The study aimed at assessing the prevalence of toxoplasmosis due to T. gondii in dromedaries by the ELISA test and to identify associated risk factors. A cross-sectional study was performed on 320 dromedaries (Camelus dromedaries) from January to March 2018 in four provinces of southeastern Algeria (Biskra, El- Oued, Ouargla, and Ghardaia). A structured questionnaire was used to collect data on individual characteristics, husbandry management and health conditions. The ELISA test revealed an overall seroprevalence of 15% (CI95%: 11.5-19.33). Possible factors associated with T. gondii infection were analyzed by univariate analysis and multivariate logistic regression. Age, husbandry system, and study area were identified as risk factors for T. gondii infection. Increased seropositivity was observed in old animals older than 10 years (OR = 2.81; CI: 1.51-3.87; p = 0.003), two times higher in animals living in the intensive husbandry system (OR = 2.42; CI: 1.3-3.07; p = 0.003), and four times higher in animals living in Biskra (OR = 4.2; CI: 1.21-9.85; p = 0.0001) than other provinces. The identification of the risk factors determines the type of measures and strategies to be applied to reduce, control and prevent T. gondii infection in dromedaries and thereby reducing human infection risks.

Role of Toxoplasma gondii IgG Avidity Testing in Discriminating between Acute and Chronic Toxoplasmosis in Pregnancy

Risk of mother-to-child transmission of Toxoplasma gondii during pregnancy is much greater in women who are exposed to primary T. gondii infection (toxoplasmosis) after conception compared to those who were exposed to the infection before conception. Therefore, laboratory tests that help classify recent primary toxoplasmosis are important tools for the management of pregnant women suspected to have T. gondii exposure. Detection of Toxoplasma IgM (Toxo IgM) is a sensitive indicator of primary toxoplasmosis, but the indicator specificity is low because sometimes natural IgM antibodies react with Toxoplasma antigens in the absence of the infection. Furthermore, Toxo IgM sometimes persists in blood serum for several months or years following the primary infection. In recent decades, Toxo IgG avidity assay has been used as a standard diagnostic technique for a better estimation of the infection acquisition time and identification of the primary T. gondii infection during pregnancy. Avidity is described as the aggregate strength; by which, a mixture of polyclonal IgG molecules reacts with multiple epitopes of the proteins. This parameter matures gradually within 6 months of the primary infection. A high Toxo IgG avidity index allows a recent infection (less than 4 months) to be excluded, whereas a low Toxo IgG avidity index indicates a probable recent infection with no exclusions of the older infections. This minireview is based on various aspects of T. gondii IgG avidity testing, including (i) description of avidity and basic methods used in primary studies on T. gondii IgG avidity and primary infections; (ii) importance of IgG avidity testing in pregnancy; (iii) result summary of the major studies on the use of T. gondii IgG avidity assay in pregnancy; (iv) brief explanation of the T. gondii IgG avidity values in newborns; (v) result summary of the major studies on T. gondii IgG avidity and PCR; (vi) discussion of commercially available T. gondii IgG avidity assays, including newer automated assays; and (vii) current issues and controversies in diagnosis of primary T. gondii infections in pregnancy.

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

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.

Cross-Sectional Survey on Toxoplasma gondii Infection in Cattle, Sheep, and Goats in Algeria: Seroprevalence and Risk Factors

A cross-sectional study aimed at assessing the seroprevalence and identifying the risk factors for Toxoplasma gondii infection in cattle, sheep, and goats in eight provinces located in two main Algerian agro-ecological zones was carried out from October 2015 to March 2018. Blood sera from 4074 animals of both sexes were tested for the presence of anti-T. gondii IgG antibodies, using the indirect, enzyme-linked, immunosorbent assay technique (ELISA). Moreover, to identify the potential risk factors of T. gondii infection, a survey through a breeders' questionnaires was conducted. Nearly one-fourth of the total number of animals tested (1024/4074)-i.e., 25.1%--were seropositive. The seroprevalence in cattle, sheep, and goats was 28.7%, 25.6%, and 11.9%, respectively. The area, sex, age, and herd size were identified as risk factors for T. gondii infection. Higher seropositivity rates were recorded in cows and goats (odds ratio (OR) = 1.63 and 6.4), in old animals (cattle, OR = 2.1; sheep, OR = 1.9; and goat, OR = 3.9), and in small size herds (cattle, OR = 2.5; sheep, OR = 1.9; goat, OR = 2.2). In conclusion, there is widespread T. gondii infection in cattle, sheep, and goats in these two strategic agricultural areas. The identification of the risk factors determines the type of measures and strategies to be undertaken to reduce, control, and prevent T. gondii infection in domestic animals, and thereby reduce human infection.

Cross-Sectional Survey on Toxoplasma gondii Infection in Cattle, Sheep, and Goats in Algeria: Seroprevalence and Risk Factors

A cross-sectional study aimed at assessing the seroprevalence and identifying the risk factors for Toxoplasma gondii infection in cattle, sheep, and goats in eight provinces located in two main Algerian agro-ecological zones was carried out from October 2015 to March 2018. Blood sera from 4074 animals of both sexes were tested for the presence of anti-T. gondii IgG antibodies, using the indirect, enzyme-linked, immunosorbent assay technique (ELISA). Moreover, to identify the potential risk factors of T. gondii infection, a survey through a breeders' questionnaires was conducted. Nearly one-fourth of the total number of animals tested (1024/4074)-i.e., 25.1%--were seropositive. The seroprevalence in cattle, sheep, and goats was 28.7%, 25.6%, and 11.9%, respectively. The area, sex, age, and herd size were identified as risk factors for T. gondii infection. Higher seropositivity rates were recorded in cows and goats (odds ratio (OR) = 1.63 and 6.4), in old animals (cattle, OR = 2.1; sheep, OR = 1.9; and goat, OR = 3.9), and in small size herds (cattle, OR = 2.5; sheep, OR = 1.9; goat, OR = 2.2). In conclusion, there is widespread T. gondii infection in cattle, sheep, and goats in these two strategic agricultural areas. The identification of the risk factors determines the type of measures and strategies to be undertaken to reduce, control, and prevent T. gondii infection in domestic animals, and thereby reduce human infection.

Serological and molecular screening of umbilical cord blood for Toxoplasma gondii infection

BACKGROUND

Human umbilical cord blood has proven to be a successful alternate source of hematopoietic stem cells for pediatric patients with major hematologic disorders. Toxoplasma gondii is a global opportunistic protozoan which cause fatal complications in immunocompromised individuals.

AIM

Our goal is to study the prevalence of toxoplasmosis in umbilical cord blood (UCB) and to assess the sensitivity of ELISA and PCR for Toxoplasma infection screening.

MATERIAL AND METHODS

One hundred cord blood samples were collected immediately after delivery. Anti-Toxoplasma IgG and IgM antibodies were determined using ELISA method; Toxoplasma DNA was detected using nested PCR technique. Total nucleated cells (TNC) and HB were also determined. Demographic data and risk factors data related to the transmission of toxoplasmosis, were collected from mothers.

RESULTS

Among 100 cord blood samples, 36 (36%) were positive for anti-Toxoplasma IgG antibodies and 6 (6%) were positive for anti-Toxoplasma IgM antibodies. The nested PCR showed 11 (11%) samples containing Toxoplasma DNA from which, 6 (55%) samples were IgM positive. There was no significant association between the risk of Toxoplasma transmission and cord blood positivity for toxoplasmosis.

CONCLUSION

Owing to the prevalence of toxoplasmosis, its rapid progression and its fatal outcome in immunocompromised patients, cord blood screening for toxoplasmosis with nested PCR should be incorporated into cord blood bank screening protocols.

Toxoplasma gondii infection and toxoplasmosis in North Africa: a review

Toxoplasmosis is an important zoonosis caused by an obligate intracellular parasitic protozoan, Toxoplasma gondii. The disease is distributed worldwide and can affect all warm-blooded vertebrates, including humans. The present review aimed to collect, compile and summarize the data on the prevalence of T. gondii infection in humans and animals in the five North African countries (Morocco, Algeria, Tunisia, Libya and Egypt). Published data from national and international databases were used. Distribution patterns and risk factors for T. gondii infection are discussed, focusing on biotic and abiotic factors. This review is a comprehensive epidemiological analysis of T. gondii infection in North Africa and will therefore be a useful tool for researchers. It can also be used to propose or enhance appropriate national toxoplasmosis control programs.