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Journal of Clinical Microbiology, May 2007, p. 1463-1468, Vol. 45, No. 5
0095-1137/07/$08.00+0     doi:10.1128/JCM.01781-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

The Differential Agglutination Test as a Diagnostic Aid in Cases of Toxoplasmic Lymphadenitis{triangledown}

Jose G. Montoya,1,2* Andrew Berry,1 Fernando Rosso,1,2 and Jack S. Remington1,2

Department of Immunology and Infectious Diseases, Research Institute, Palo Alto Medical Foundation, Palo Alto, California,1 Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California2

Received 28 August 2006/ Returned for modification 15 November 2006/ Accepted 14 February 2007

Lymphadenopathy (LN) is the most common clinical manifestation of acute acquired toxoplasma infection in humans. The diagnosis of toxoplasmic lymphadenitis (TL) is established by serological methods and/or lymph node biopsy. In the United States, the differential agglutination (of acetone [AC]-fixed versus that of formalin [HS]-fixed tachyzoites) test (AC/HS test) has primarily been used in assessments of pregnant women as a component of the toxoplasma serological profile to distinguish between recently acquired infections and infections acquired in the distant past. We studied the AC/HS test in patients with TL to define its usefulness in diagnosing individuals presenting with LN and to determine its kinetics after the onset of LN. One hundred nine consecutive patients (158 serum samples) diagnosed serologically and by lymph node biopsy as having TL were studied. Specific patterns in the AC/HS test were noted to be dependent on the time from the clinical onset of LN (COLN). Acute AC/HS patterns were observed for more than 75% of patients who according to their histories had developed their TL within 6 months after COLN. Acute patterns were not observed beyond the 12th month except for a single patient for whom an acute pattern (400/800) persisted to the 13th month after COLN. Equivocal patterns were observed up to 36 months after COLN. Nonacute patterns were observed only for serum samples drawn at least 13 months after COLN. A nonacute pattern in an individual at less than 12 months after COLN should suggest an etiology other than TL. In such cases, investigation for alternative causes, including malignancy, should be instigated.

* Corresponding author. Mailing address: Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Room S-169, M/C 5107, Stanford, CA 94305. Phone: (650) 853-4824. Fax: (650) 329-9853. E-mail: gilberto{at}stanford.edu

{triangledown} Published ahead of print on 21 February 2007.

Journal of Clinical Microbiology, May 2007, p. 1463-1468, Vol. 45, No. 5
0095-1137/07/$08.00+0     doi:10.1128/JCM.01781-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.





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