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PubMed1999

Value of the comparative enzyme-linked immunofiltration assay for early neonatal diagnosis of congenital Toxoplasma infection.

BACKGROUND: The transplacental transfer of specific maternal IgG antibodies makes the diagnosis of congenital Toxoplasma infection quite difficult in the neonate. The enzyme-linked immunofiltration assay (ELIFA), comparing at delivery the immunologic profile of the mother's antibody response and that of her child, allows discrimination between IgG antibodies of maternal origin and IgGs synthesized by the fetus. OBJECTIVE: To evaluate the diagnostic reliability of the comparative ELIFA for diagnosing congenital Toxoplasma infection as well as the reliability of testing for IgM- and IgA-specific antibodies in cord blood. METHODS: From November, 1991, to December, 1995, an ELIFA was prospectively performed at delivery on blood samples obtained from 227 women with primary Toxoplasma infection during pregnancy and from their infants. For each child the ELIFA result was evaluated in relation to the serologic follow-up: disappearance of specific anti-Toxoplasma gondii IgG antibodies in the absence of treatment before 12 months of age indicating an uninfected child, as opposed to persistence beyond 12 months of age indicative of a congenital infection. RESULTS: Of 227 children 139 were lost to follow-up. Among the 88 children available for follow up, the ELIFA was negative in 70 infants, 69 of whom were confirmed to be uninfected. Thirteen of these 69 cord blood ELIFA-negative samples were positive for anti-T. gondii IgM and/or IgA detected by means of a conventional immunosorbent agglutination assay. Of the remaining 18 children (representing 75% of all new cases of congenital toxoplasmosis diagnosed during the study period at our institution), the ELIFA was positive in 16, negative in 1 and inconclusive in 1. CONCLUSIONS: The ELIFA test is a valuable tool for diagnosing congenital T. gondii infection and in differentiating between true neonatal infection and cord blood contamination. In our experience the diagnostic sensitivity of the ELIFA test was 94.1% and the specificity was 98.6%. The cord blood was contaminated by specific maternal anti-T. gondii IgA and/or IgM in as many as 20% of the cases.

Animals↗

PubMed2005

Toxoplasmosis in pregnancy.

Pregnant women who acquire infection from Toxoplasma gondii usually remain asymptomatic, although they can still transmit the infection to their fetuses with severe consequences. Given the asymptomatic nature of most Toxoplasma infections, primary prevention in pregnant women may lower the risk of congenital toxoplasmosis. Both consumption of undercooked meat and unprotected contact with soil are independent risk factors for T. gondii seroconversion during pregnancy, while contact with cat litter may pose a risk in certain situations. However, many pregnant women lack knowledge of these risk factors. This article reviews toxoplasmosis infection in pregnancy, with an emphasis on risk factors and appropriate counseling of pregnant women.

Animals↗

PubMedDate not supplied

[Fetal toxoplasmosis. In utero treatment with pyrimethamine sulfamides].

The mothers of 52 cases of toxoplasmic fetopathy diagnosed in utero by fetal blood and/or amniotic fluid sampling were treated with the combination pyrimethamine-sulfadiazine (or sulfisoxazole) and by spiramycine. The infants were compared with 51 other infants with congenital toxoplasmosis whose mothers had received spiramycine alone. Patients of both groups received the same pyrimethamine-sulfadiazine and spiramycine treatment after birth. Parasitologic examination of the placenta was positive in 42 and 76.6% of patients, in group I and group II respectively. The newborns had specific IgM in 17.4 and 69.2% of cases respectively in both groups. These differences were significant. The mean specific IgG titer was significantly reduced at birth and 4 to 6 months of age in the first group. Patients in group I had more often subclinical infection than patients of the comparison group: 57% vs 33.3%. They had less often a high cerebro-spinal protein content during the first week. Prenatal treatment with pyrimethamine-sulfadrugs resulted in a less progressing infection at birth. However in cases with clinically patent toxoplasmosis, the frequency of overt localizations and their sequellae was not significantly altered. This might be related to a relatively late onset of the treatment. The pyrimethamine-sulfadrug combination given to mothers of proved infected fetuses can be rewarding. The indication might be extended to well-documented seroconverted mothers if, in the future, the acquired experience and necessary pharmacological studies bring the proof of its innocuousness.

Drug Therapy, Combination↗

PubMed2004

Severe neonatal toxoplasmosis after third trimester maternal infection.

We report an unusual case of neonatal toxoplasmosis. After a late third trimester maternal infection, the infant developed severe disseminated intravascular coagulopathy with thrombocytopenia, hepatitis, jaundice and severe pneumonitis. Clinicians that manage infants with severe unexplained systemic disease should consider the possibility of congenital toxoplasmosis.

Adult↗

PubMed2006

[Toxoplasmosis--epidemiology, clinical manifestation and infection in pregnant women].

Toxoplasma gondii infection is one of the most popular human zoonosis. Presented is the epidemiology and clinical symptoms of toxoplasmosis with particular attention to infection during pregnancy. The paper presents the life cycle of Toxoplasma gondii, routes of transmission and clinical manifectations. The scheme of diagnostic and terapeutic procedures in case of infection during pregnancy is discussed. Congenital infection, serologic diagnostics and clinical symptoms have been described. Treatment of congenital toxoplasmosis is also presented.

Animals↗

PubMed1993

Toxoplasmosis in pregnancy.

Primary infection with Toxoplasma gondii in pregnant women occurs all over the world with frequencies between 0.1-1%. In approximately 40% of the cases, the unborn child is infected. The risk of fetal infection increases during pregnancy, while at the same time the risk of severe disease decreases. As a result, infants with congenital toxoplasmosis are mostly asymptomatic at birth, but long-term studies indicate that up to 85% of them will develop sequelae including chorioretinitis (leading to severe impairment of vision), hearing loss or mental retardation. Early recognition of maternal infection and treatment with spiramycin or pyrimethamine-sulphadiazine will reduce the parasitic colonization of the placenta by more than 60% and prevent infection in the fetus. If fetal infection has already occurred, maternal treatment modifies the fetal disease. Therapy during the first year of life improves the prognosis. It is possible today to identify infected fetuses by prenatal diagnosis based on detection of the parasite in cord blood, amniotic fluid and placental tissue. Specific antibodies and non-specific signs of infection in fetal blood give additional information. Advances in laboratory techniques have made it feasible to consider serological surveillance of pregnant women. The present recommendation is that each country should provide data on the incidence of toxoplasma infection in pregnancy and thereby decide whether it represents a problem and what measures should be adopted. This paper summarizes the present knowledge of the parasite and its implication for the mother and unborn child. The effect and problems of primary and secondary prevention in pregnancy are discussed as well as the efficacy of treatment. The need for future research including long-term follow-up studies are emphasized.

Female↗

PubMed1990

[The comparison of serological tests used in diagnosing active toxoplasmosis].

ELISA kits from different commercial firms were evaluated and compared with monoclonal immunosorbent agglutination test ISAGA for detection anti-T. gondii IgM antibody. The results presented in this study show that both ELISA-IgM tests, as well from Organon, as from Abbott firms promise to be of the same value for the diagnosis of acute acquired and congenital toxoplasmosis.

Adult↗

PubMedDate not supplied

[Toxoplasmosis in pregnancy with special emphasis on laboratory diagnosis].

On the occasion of the thirty-five years of systematic research of toxoplasmosis, a review of the present knowledge of the role of toxoplasmosis in pregnancy is presented. Diagnostic procedures and the interpretation of the results of laboratory examinations are particularly stressed. The main conclusion is that in a population exposed to the infection in the way as was in the cases studied, the prevention of congenital toxoplasmosis can be achieved through a serologic follow-up of all pregnant women starting from the moment when pregnancy is established. The purpose of such screening is to identify those pregnant women who are not immunized (who are then advised to follow certain hygienic and dietetic measures) and those who are primoinfected in pregnancy. As the latter are at risk for transmitting the infection to their fetuses, they receive specific therapy and their fetuses are carefully controlled by ultrasound and other methods for the antenatal diagnosis of intrauterine infection.

Female↗

PubMed1993

[In spinal symptoms remember toxoplasmosis].

A 4 weeks old girl presented a macrocephalus, elevated intracranial pressure and paralysis of both legs. The CT scan showed a hydrocephalus internus with stenosis of the aqueduct and periventricular calcifications. The cranial and spinal MRT scan revealed numerous lesions of the cerebral parenchyma and the spinal cord, which were detected after injection of Gadolinium Dimethylentriaminaceticacid (Gd DTPA). The serological examination confirmed the diagnosis of congenital toxoplasmosis.

Animals↗

PubMed2004

[Strategies for the diagnosis and treatment of prenatal toxoplasmosis - a survey].

Today, a decreasing number of infants with prenatal toxoplasmosis present with clinical signs of severe, generalised infection and cerebral involvement. The favourable clinical outcome - mild or subclinical infection - is considered to be an effect of early maternofetal treatment with spiramycin and pyrimethamine/sulfadiazine (PS). However, a Cochrane Review and a recently published European multicentre study on congenital toxoplasmosis did not only question this positive effect but also the efficiency of a postnatal long-term therapy. Both studies caused much confusion among neonatologists and paediatricians. The new setting requires an update of the diagnostic possibilities and different therapeutic strategies for prenatal toxoplasmosis. Only few prospective studies are available to compare the efficiency of different drug regimens in infected infants. However, clinical data demonstrate that the available therapeutics are not curative and cannot prevent late sequelae. Follow-up studies in pregnant women and their offspring show that prenatal parasite detection does not predict an unfavourable clinical outcome when treatment is initiated early after diagnosis. In Germany, prenatal screening is not obligatory. In case of primary maternal infection, materno-fetal therapy is recommended. A combination therapy consisting of PS is considered more effective than a spiramycin monotherapy. Treatment is recommended for all infected newborns with different strategies for infants with or without clinical symptoms. The treatment strategies of different European countries are discussed. This paper provides recommendations for the diagnosis and treatment of newborn toxoplasmosis and materno-fetal infection as well as recommendations for the clinical management of infected neonates and their follow-up, including drug monitoring.

Coccidiostats↗

PubMed2000

[Genotyping of Toxoplasma gondii strains from immunocompromised patients].

The genotypes of Toxoplasma gondii strains isolated from HIV and non-HIV immunocompromised patients with cerebral and extracerebral toxoplasmosis were determined and compared to those of strains isolated from non-immunocompromised patients in order to identify the possible relationships between parasite genotype and morbidity of toxoplasmosis. One hundred and ten strains of T. gondii were obtained, either by cell culture (n = 73), brain biopsy (n = 17) or mouse inoculation (n = 20). Ninety strains isolated from immunocompromised patients (74 HIV+ and 16 non-HIV patients) were compared to 20 strains isolated from immunocompetent patients (17 cases of congenital toxoplasmosis, and three cases of primary acquired infection). Genotyping was performed by PCR/RFLP on locus SAG2, and T. gondii strains were classified as Type I, II or III. Ninety out of 110 strains were successfully genotyped, including 20 strains that had been maintained in mice, 69/73 strains maintained in cell cultures, but only 1/17 strains from formalin-fixed paraffin-embedded brain biopsies. 76.7% of the strains in the study population were of type II, 15.6% were type I and 7.7% were type III. The distribution of strain genotypes in immunocompromised and non-immunocompromised patients was comparable: 14.1% and 21% for type I, 76.1% and 79% for type II and 9.8% and 0% for type III, respectively; no correlation could be established between genotype and clinical presentation, i.e., cerebral or extracerebral toxoplasmosis. These results suggest that the type of infecting parasitic strain does not predominantly influence the pathogenesis of toxoplasmosis in immunocompromised patients and fully supports the need for specific prophylaxis in patients infected by T. gondii, regardless of the strain genotype.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

[Investigation of the protein composition and immunochemical properties of Toxoplasma gondii excretory and secretory antigen].

The major proteins of T. gondii excretory and secretory antigens (ESA) obtained during cultivation of tachyzoites by using cultured Vero cells were shown to have molecular weights of 79, 70, 57, 48, 36, and 29 kD. ESA and somatic antigen immunoblotting demonstrated that there were noticeable differences in the immunoactive proteins of these antigens. The antibodies of the sera of patients with toxoplasmosis mainly interacted with ESA proteins having molecular weights of 79, 70, 57, 48, 36, and 29 kD, 57-kD ESA protein antibodies being present on the immunoblots of all the tested sera. When ESA was used as an antigen during enzyme immunoassay, it showed a high sensitivity in the detection of IgM antigens in congenital toxoplasmosis. At the same time, ESA identified the antibodies of this class in the sera of healthy donors much infrequently than somatic antigen (p < 0.05).

Animals↗

PubMed1995

[A preliminary study on the antenatal diagnosis and prevention of the fetus toxoplasmosis infection].

For those pregnant women with an abnormal pregnancy history, the polymerase chain reaction (PCR) technique was adopted to screening the serum toxoplasmosis DNA (TOX-DNA). Then tests were made for further evidence of TOX-DNA in the amnionic fluids TOX-DNA was examined in cases with blood TOX-DNA positive. Gamma glutamyl transpeptidase (GGT) and alpha-fetoprotein (AFP) in the amnionic fluids were measured for reference, a antenatal diagnosis of the fetal congenital toxoplasmosis infection could thus be made. In the present paper, 9 out of 92 blood specimen were TOX-DNA positive, of the 9 cases, 5 had TOX-DNA and 4 had no TOX-DNA in the amnionic fluid tests. The results of follow-up examination in the 9 cases were in conformity with the ante natal diagnosis. This is an important procedure for diagnosis and prevention of maternal-fetal vertical infection of Toxoplasmosis.

Animals↗

PubMed1995

[Biological diagnosis of toxoplasmosis in the course of pregnancy: methods, interpretations and practical recommendations].

The biological diagnosis of infection with Toxoplasma gondii during pregnancy can be performed: either (1.) with direct methods (microscopic examination, in vitro isolation on cell cultures, histology, detection of T. gondii DNA) or (2.) by indirect serological methods in order to demonstrate specific antibodies in serum. An appropriate combination of complementary techniques (antibody detection in serum and demonstration of the parasite) must lead, in the majority of cases, to a precise diagnosis of congenital toxoplasmosis. Serological examination of a woman before or at the beginning of pregnancy serves to distinguish between women with or without specific immune status. The diagnosis of a seroconversion during pregnancy causes few difficulties particularly if carefully followed up. However, it is rather difficult to date an infection during pregnancy based only on a initial positive sample with the presence of anti-T. gondii IgM. Thus, around 1 to 5% of serological examinations during pregnancy cause practical problems of interpretation. A certain number of recommendations are suggested to the laboratory supervisor: 1. Pregnant women should be systematically tested for specific anti-T. gondii IgG or total Ig and IgM. The choice of the techniques serves to reliably distinguish women without anti-T. gondii antibodies (women at risk for primary infection) from those with anti-T. gondii antibodies (immune women). 2. Interpretations of results should be well formulated to be understandable to the practitioner who must adequately inform the patient and determine the proper medical action on the basis of the serological results. 3. Sera should be preserved systematically for a minimum of 12 months (whatever the results may be). 4. Cases or situations causing problems should be referred to a specialized laboratory for expert advice.

Animals↗

PubMed2001

Options for the pharmacotherapy of toxoplasmosis during pregnancy.

Toxoplasmosis infection during pregnancy can cause stillbirths, severe mental retardations or ocular disorders that can also occur later in life and have a potential to relapse. As the disease is generally asymptomatic, diagnosis relies on serological tests. Primary prevention intends to prevent the infection of the fetus, while secondary prevention aims at reducing the severity of sequelae. Preventive attitudes regarding congenital toxoplasmosis differ according to countries. In Austria and France, a nationwide programme based on the screening of seronegative pregnant women and the treatment of all seroconversions has been implemented. The UK and Norway have rejected such a screening due to the lack of evidence of its efficacy. A review of published studies showed that no randomised controlled trials have been conducted. The only available data come from retrospective studies and are methodologically flawed. The impact of chemotherapy on primary and secondary prevention still needs to be assessed. This lack of evidence results in conflicting attitudes that increase the anxiety already raised in pregnant women and doctors by the occurrence of a maternal toxoplasmosis during pregnancy. Before making any change in preventative strategy, it is of utmost importance to increase our knowledge on treatment efficacy through proper randomised trials of existing drugs and of new potentially active compounds.

Antiprotozoal Agents↗

PubMedDate not supplied

Increasing toxoplasma seropositivity in women with bad obstetric history and in newborns.

BACKGROUND: Most infants with congenital Toxoplasma gondii infection have no symptoms at birth but few may develop retinal diseases or neurological abnormalities later in life. The presence of significant titres of antitoxoplasma antibodies in women in the reproductive age group indirectly indicates that Toxoplasma gondii is the cause of such congenital abnormalities and also sporadic abortions in some women. METHODS: We did a retrospective analysis of antitoxoplasma antibodies detected by indirect haemagglutination assay, in women with bad obstetrical history and in newborns clinically suspected of congenital toxoplasmosis during 1981-91. RESULTS: A significant increase in seropositivity in women and newborns was seen during 1989-91 as compared to 1981-88. More seropositive patients were recorded between April-June and October-December. However, no significant correlation could be observed between rising incidence of seropositivity and the seasonal distribution or age of women. CONCLUSION: Epidemiological studies are required to ascertain the reason for the increasing trend of toxoplasma seropositivity and to suggest appropriate control strategies as it is possible to prevent congenital infection.

Adolescent↗

PubMedDate not supplied

[Serodiagnosis of toxoplasmosis in man].

We want to repeat the interest of toxoplasmosis serodiagnostic in human pathology. First, to help the diagnostic of this affection, with adult and children; then, to prevent this parasitose with pregnant women. Results in our laboratory, since two years, point out that a large number of women are seronegative. We are proposing a protocol of supervision for women before and during their pregnancy. This protocol avoids the risk of foetal contamination and prevents congenital toxoplasmosis.

Adult↗

PubMedDate not supplied

[Evaluation of the Immulite 2000 Toxoplasma quantitative IgG et Toxoplasma IgM for the diagnosis of human toxoplasmosis].

Four hundred and ninety five human sera with clinical and biological data were tested for the evaluation of Immulite 2000 Toxoplasma Quantitative IgG and Immulite 2000 Toxoplasma IgM produced by Diagnostic Products Corporation (Los Angeles, USA) for the diagnosis of human toxoplasmosis. The results of these kits were compared to those of the University Hospital of Nancy where the reference assays were Enzygnost Toxoplasmosis IgG and Enzygnost Toxoplasmosis IgM (Berhing-Dade, Germany), Toxoscreen (bioMérieux, France), ISAgA Plus (IgM et IgA) (bioMérieux, France). The sensitivity and the specificity of IgG detection by Immulite 2000 Toxoplasma Quantitative IgG were 98% and 100%, respectively. The high sensitivity of IgM detection by Immulite 2000 Toxoplasma IgM was adapted to the early diagnosis of toxoplasmic primo-infection and to the pediatric diagnosis or follow-up of congenital toxoplasmosis but could reveal IgM a long time after primary infection.

Adult↗