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PubMed1997

[Application from chemiluminescence to serological diagnosis of human toxoplasmosis].

Diagnostic Products Corporation has chosen chemiluminescent for the new kit of quantitative measurement of IgG and qualitative detection of IgM antibodies to Toxoplasma gondii, 878 human sera of principal diagnosis situations were tested, and the results obtained with the IMMULITE Toxoplasmosis kit were compared with those of the Parasitology and Mycology Laboratory of the University of Lille. Chemiluminescent allows a sensitive and specific determination of immunity. In the same ways, this method is able to detect earlier specific IgM and IgG during seroconversion. The kit of quantitative measurement of IgG and qualitative detection of IgM is reproducible and sensitive; this confirms the interest for the pediatric diagnosis of congenital toxoplasmosis.

Aged↗

PubMed1979

Experimental congenital infection of Toxoplasma gondii in Macaca arctoides.

Congenital toxoplasmosis was studied in Macaca arctoides as a model for primates. Time-mated female monkeys were assigned to 5 experimental groups and inoculated with 4 different strains of Toxoplasma gondii before pregnancy and during various stages of gestation. All monkeys showed a rise in indirect hemagglutination antibody (IHA) titers following infection, and some had demonstrable parasitemia. Of the 23 progeny, 2 were stillbirths and 2 died soon after birth, but only the one neonate born of a mother inoculated intrauterally succumbed to acute toxoplasmosis. No physical anomalies were observed in any of the progeny. The toxoplasms organism was not isolated from any of the placentas obtained nor from the cord blood. None of the tissues from the stillborn or infant monkeys that died were positive for toxoplasmosis by mouse inoculation. The live progeny were usually born with high IHA antibody titers which were usually soon lost, indicating presence of passively acquired maternal antibody. However, 2 babies, born of mothers infected with tissue cysts on day 79 and 149 of gestation, maintained moderate to high titers for about 8 and 19 months respectively, indicating that an active infection had taken place but no clinical disease was detected. Data obtained suggest that although certain developmental stages of the toxoplasma organism and of the fetus may favor the occurrence of congenital infection, very little neonatal disease results in this primate model.

Animals↗

PubMed1983

[Incidence of primary toxoplasmosis infection in pregnant women].

Toxoplasma-specific antibodies transferred across the placenta were determined in 1953 blood samples of newborn infants from the Lower Saxony newborn-screening-laboratory using the indirect immunofluorescence test. There were no antibodies demonstrable in 54.4% of the samples. Related to the age of the mothers there was increase of positive findings of about 1% per year. Among 10 000 pregnancies about 70 to 80 mothers can be expected to undergo a primary infection with Toxoplasma gondii. With a fetal infection rate of about 50% derived from the literature 30 to 40 cases of congenital toxoplasmosis of variable severity, three among them serious, may be expected.

Antibodies↗

PubMed1986

A simple model relevant to toxoplasmosis applied to epidemiologic results in France.

A simple mathematical model was applied to the results of a seroepidemiologic study of toxoplasmosis carried out in France in 1982-1983. An adequate fitting to the prevalence data observed on 7,605 women of childbearing age was obtained. Thus, the data were used to estimate the seroconversion rate, allowing the approach to and discussion of insights gained from the model, such as the risk of Toxoplasma infection during pregnancy, the age-related expected risks of maternal seroconversion, as well as an overall prediction of the yearly number of congenitally infected infants in the total population. In addition, the high prevalence of congenital toxoplasmosis in France and the excess risk encountered by young migrant women from lower prevalence areas were confirmed by the model. The model might therefore be useful for public health purposes in other countries.

Adolescent↗

PubMedDate not supplied

Toxoplasmosis and mental retardation--report of a case-control study.

A case-control study evaluating the association between mental retardation and toxoplasmosis was conducted among 845 school children in Belo Horizonte, MG, Brazil. Cases (450) were mentally retarded children attending a public school for special education. Controls (395) were children from the regular public school system. Clinical and anthropometric examinations and interviews were carried out to determine risk factors for toxoplasmosis and mental retardation. Diagnosis of Toxoplasma gondii infection was based upon an indirect immunofluorescent test (IFA); 55% of cases and 29% of controls were positive. The Relative Odds of mental retardation in children with positive serology was 3.0 (95% CI 2.2-4.0). Maternal exposure to cats and contact with soil were associated with an increased risk of mental retardation. Retinochoroiditis was fourfold more prevalent among cases than controls and was only diagnosed in T. gondii IFA positive participants. Congenital toxoplasmosis, in its subclinical form, appears to be an important component in the etiology of mental retardation, especially in high risk (lower socio-economic) groups. The population attributable risk was estimated as 6.0-9.0%, suggesting the amount of mental retardation associated with this infection.

Adolescent↗

PubMed1975

[Indirect flourescent antibody test in toxoplasmosis. Advantage of the use of fluorescent anti-IgG conjugate (author's transl)].

The indirect fluorescent antibody (IFA) test effected with anti-human conjugate gives appreciably equivalent results to those obtained with the dye (SABIN-FELDMAN) test, but weak serum dilutions may raise non specific reactions, due to the presence of substances possessing the IgM antibody properties. Those substances are not present in the serum of children during the first months of their life. The application of an anti-IgG conjugate allows to prevent those unspecific reactions. The application of the modified IFA test for detecting the toxoplasmic infection during pregnancy and the use of the REMINGTON test for the early diagnosis of the congenital toxoplasmosis are discussed.

Female↗

PubMed1983

Immune response to Toxoplasma gondii. I. Toxoplasma-specific proliferation response of peripheral blood lymphocytes from patients with toxoplasmosis.

Peripheral blood leukocytes (PBL) from patients with toxoplasmosis were shown to be highly responsive to in vitro stimulation with Toxoplasma gondii extract as measured by incorporation of [3H]methylated thymidine. Analysis of Toxoplasma-specific proliferative cells in PBL by using monoclonal antibodies specific for human T cell subsets revealed that the Toxoplasma-specific proliferation response of PBL from the patients was mediated by Leu 1, Leu 3a positive cells, that is, helper/inducer T cells. Tests for the Toxoplasma-specific proliferation response may provide a readily available method for the diagnosis of congenital toxoplasmosis, especially during the newborn period.

Antibodies, Monoclonal↗

PubMed1980

A prospective study of acquired toxoplasmosis among 8,043 pregnant women in the Oslo area.

A prospective serologic study of acquired toxoplasmosis has been carried out among 8,043 pregnant women in the Oslo area by means of the DT and IgG-IFAT tests on paired blood samples collected on an average in gestational weeks 13 and 35. The screening results indicated that 54 women had to be considered as having potential "risk pregnancies" and they were selected for special follow-up studies. Thirteen women were found to have acquired a toxoplasma infection during pregnancy. The outcome of these pregnancies was: two spontaneous abortions and probably four congenitally infected children. In three of these cases parasites could be demonstrated in the placenta and/or amniotic fluid. This gives a transmission rate of 46% and an incidence of congenital toxoplasmosis of nearly 1/1,000 births.

Female↗

PubMed1988

Toxoplasmosis: maternal and pediatric findings in 23,000 pregnancies.

An analysis of the antibody titers to toxoplasmosis for 22,845 pregnant women in the Collaborative Perinatal Project was conducted in relation to clinical and laboratory findings in the mothers and children through 7 years of age. More than 900 observations were considered for each mother and child. The major findings were in the children and included a predicted doubling in the frequency of deafness among children born to women with antibody to toxoplasmosis, a predicted 60% increase in microcephaly, and a 30% increase in low IQ (less than 70) in association with the presence of high maternal antibody titer (256 to 512) to toxoplasma. A serologically defined high-risk group of mothers was identified on the basis of high indirect hemagglutination antibody levels or seroconversions and increased IgM toxoplasma antibody levels (indirect fluorescent antibody greater than or equal to 32, enzyme-linked immunosorbent assay greater than or equal to 0.7). Of the 15 pregnancies in this group, two children had congenital toxoplasmosis and three were stillborn.

Antibodies↗

PubMed1992

Diagnosis of Toxoplasma infection in the pregnant woman and the unborn child: current problems.

Prevention of congenital toxoplasmosis requires identification of non immune women at the beginning of pregnancy, instruction on how to avoid contamination and a serological follow-up of the women until the delivery. The latter is easily achieved by a repeated testing for specific IgG and IgM. Most of the interpretation difficulties arise from results suggestive of recent infection obtained on a first specimen. If no rise in IgG titer is demonstrated on a second serum sample, the use of additional tests studying other Ig-isotypes or acute-phase IgG antibodies can be helpful, mainly as a way to exclude the possibility of infection acquired during pregnancy. Congenital infection can be investigated by biological measurements on fetal blood and by ultrasound examination. Detection of specific IgM and IgA in fetal serum must be interpreted with care because of the existing risk of contamination with maternal blood. Demonstration of Toxoplasma gondii in fetal blood or amniotic fluid by mouse inoculation definitely proves the diagnosis; though less sensitive, tissue culture offers the advantage of a more rapid result. The very promising results obtained by the PCR-method applied to amniotic fluid samples give the hope that it can replace som of the existing confirmatory methods.

Animals↗

PubMed2000

[Laboratory diagnosis of toxoplasmosis].

Toxoplasmosis is a world-wide spread parasitosis. The disease potentially highly affects two groups of patients: foetus and immunosuppressed patients. The determination of diagnosis and therapy on the basis of a single serum examination is very important; possible on the basis of a single serum sample. In most cases, it is possible to differentiate between recent and latent infections using a combination of suitable methods, which permit us to confirm particular antibody classes. In the presented paper the authors suggest diagnostic procedures for 4 groups of patients: pregnant, neonates with suspected congenital toxoplasmosis, immunodeficient patients and immunocompetent patients. The diagnostic methods consist of a combination of basic and supplemented diagnostic methods. Each patient's serum should be tested by basic tests which include the detection of total antibodies with CFT or IFT and specific classes of IgM and IgG antibodies by ELISA. The potential activity of toxoplasma infection can be determined by supplementary methods of e.g. IgG avidity antibodies, establishment of IgA antibodies, western blotting method and monitoring of antibodies production. For each situation the authors present interpretations of suspected cases including proposals for clinicians. These procedures are suggested for practical use in laboratories of various diagnostic levels in order to help to the diagnostic procedures in a particular situation as well as for clinical evaluation of established results. (Fig. 4, Ref. 65).

Female↗

PubMedDate not supplied

Too late prenatal diagnosis of fetal toxoplasmosis: a case report.

OBJECTIVE: We describe a case of severe fetal hydrocephalus due to toxoplasmosis which could not be diagnosed until late gestational age due to the lack of a serologic surveillance program during pregnancy; moreover, this case points to the usefulness of molecular biology tools in the diagnostic process. Abnormal ultrasound in the 2nd trimester was noticed and Toxoplasma gondii was demonstrated in amniotic fluid at the 28th week of gestation both by PCR and by mice inoculation. Fansidar and folinic acid were administered. The newborn suffered from progressive hydrocephalus, seizures, and pathological muscular tonus; ultrasound examination showed massive cerebral calcifications. Ophthalmologic examination revealed bilateral choroidoretinitis. Congenital toxoplasmosis was confirmed by the detection of anti- T. gondii IgM and IgA in the neonatal serum. CONCLUSION: The presented case is an example of severe fetal toxoplasmosis diagnosed and treated in utero.

Adult↗

PubMed1994

The diagnosis of toxoplasmosis using IgG avidity.

Current methods to establish the duration of toxoplasma infection in pregnant women and for the diagnosis of toxoplasmosis in the neonate or HIV infected patient have significant limitations. We assessed the precision of a commercial ELISA for the detection of toxoplasma specific IgG and adapted the assay to measure avidity using an elution agent washing step. The sensitivity and specificity of the ELISA were 100 and 75% respectively and optimal measurement of avidity was achieved using 6 M urea as the elution agent. Toxoplasma lymphadenopathy of less than 3 months duration was associated with low avidity specific IgG but some discordant findings were recorded. Serial measurement of IgG avidity assisted the distinction between actively produced antibody in infants with congenital toxoplasmosis and passively acquired antibody of maternal origin in uninfected babies. There was no significant difference between avidity levels in HIV infected patients with or without cerebral toxoplasmosis.

AIDS-Related Opportunistic Infections↗

PubMed2005

Short report: neonatal screening pilot study of Toxoplasma gondii congenital infection in Mexico.

Congenital toxoplasmosis is an obstetric problem in Mexico, but its actual frequency is unknown. Using a network for screening of non-infectious disorders, we performed a pilot study to determine the frequency of IgM antibodies to Toxoplasma gondii in 1,003 infants (53.1% male, mean +/- SD age = 18.3 +/- 13.0 days, birth weight = 3.116 +/- 0.453 kg) in Mexico City from March to April 2003. Blood samples embedded in filter paper were assayed for IgM antibodies using a capture enzyme-linked immunosorbent assay and results were confirmed by Western blot. Two asymptomatic newborns, one of them premature, had IgM and IgG antibodies in a serum sample taken from both the infant and the mother and were clinically followed. Our data suggest a frequency of approximately two cases of congenital T. gondii infection per 1,000 newborns in Mexico City.

Adult↗

PubMed1976

[Toxoplasmosis in the Republic of Mali. An epidemiologic approach].

1664- sera from children and adults were collected in rural and urban areas of Mali and were tested in Toxoplasmosis serology. Immunofluorescent antibody tests and direct agglutination test have been used for this purpose. 65 per cent of adults from urban area and 56 to 58 per cent of adults from rural area gave positive results. Before the age sixteen, only 33 to 40 percent of children are positive in urban area while 51 to 53 per cent are so in rural area. The study of hundreds of sera collected from various animals allows to explain the different ages of the serological changes. In rural area children have been infected very early after catching birds, reptiles and above all, rodents and eating them not cooked enough. In urban area the infection occurs all along the life and, particularly, in adults, after consuming grilled meat. The recent description of three cases of congenital toxoplasmosis demonstrates the interest of such an epidemiological study.

Adolescent↗

PubMed1994

Prevention, diagnosis, and treatment of fetal toxoplasmosis.

Despite the limitations, the available data lead to the conclusion that treatment of the mother may be of benefit to the fetus. To date, harmful effects of maternal therapy on the fetus have not been substantiated. Current recommendations for fetal therapy of toxoplasmosis include the initiation of spiramycin in the pregnant woman when acquired toxoplasmosis is strongly suspected in pregnancy. Prompt detection of infection in the mother is important in order to start therapy as early as possible. An attempt to determine the status of the fetus is undertaken by prenatal diagnostic procedures such as amniocentesis, cordocentesis, and ultrasonography. After confirmation of fetal infection, repeated courses of a combination of pyrimethamine, sulfadiazine, and folinic acid should be alternated with courses of spiramycin. If the fetus is not infected, spiramycin should be continued in repeated courses or throughout pregnancy. Pregnancy termination tends to be reserved for cases in whom ultrasonographic examination demonstrates the fetus to be severely affected. The importance of postnatal follow-up and treatment, although not addressed in this article, must be emphasized. The advent of fetal therapy offers hope that the problem of congenital toxoplasmosis will become less common. In addition to currently available options, the future may offer new avenues of therapy, such as the possibility of treating infected fetuses by the intra-amniotic infusion of drugs.

Antiprotozoal Agents↗

PubMed2006

Serological screening and toxoplasmosis exposure factors among pregnant women in the Democratic Republic of Sao Tome and Principe.

The seroprevalence of Toxoplasma gondii infection among pregnant women in the Democratic Republic of Sao Tome and Principe (DRSTP) from November 2003 to March 2004 was determined by detection of serum anti-T. gondii antibodies. A short questionnaire interview for pregnant women was performed to investigate risk factors associated with T. gondii infection, including consumption of raw meat or unwashed vegetables, drinking unboiled water and keeping pets (cats and dogs). The overall seroprevalence of T. gondii infection was high (75.2%; 375/499). The older age group of > or =35 years had a significantly higher seroprevalence (85.7%; 54/63) than that of the younger age group of 15-25 years (70.4%; 178/253) (odds ratio 2.5, 95% CI 1.2-5.4; P=0.01). No significant difference in the seroprevalence of T. gondii infection was found between the pregnant women with and without exposure to the risk factors studied. However, among pregnant women with high antibody titers of > or =1:1024, it seemed likely that continual contact with pets and consumption of oocyst-contaminated water or raw unwashed vegetables rather than tissue cysts in meat was the primary route of infection. The incidence of congenital toxoplasmosis in unborn babies should be intensively monitored in the DRSTP.

Adolescent↗

PubMed1993

Application of the polymerase chain reaction to the diagnosis of human toxoplasmosis.

Toxoplasmosis may cause significant damage to the developing fetus and is a life-threatening opportunistic infection in immunocompromised persons. Serological investigation is unreliable, while isolation of the parasite is time consuming and may lack sensitivity. We have developed a system for detecting Toxoplasma gondii based on the amplification of the P30 gene using sequential rounds of PCR and nested primers. The clinical value of this technique was assessed by the investigation of a range of tissues taken from pregnant women, fetuses, neonates, AIDS patients and organ graft recipients. The PCR assay produced more positive reactions than isolation of the parasite by means of cell culture or animal inoculation. Extended autoradiography was found to be more sensitive than stained agarose gels for detecting the PCR product. Systematic contamination of PCR reactions was avoided but it was not possible to exclude sporadic contamination in certain cases. Detection of specific DNA is of clinical value in the investigation of the pregnant woman in order to assess the risk of transplacental passage of infection and in the fetus and neonate to identify congenital toxoplasmosis. Even so, PCR findings must be interpreted with caution because of the risk of a sample being contaminated. PCR may be the investigation of choice when brain biopsy is performed on a patient with AIDS and when toxoplasmosis associated with bone marrow transplantation is suspected.

AIDS-Related Opportunistic Infections↗