DOI: 10.1128/JCM.00487-16
Article Figures & Data
Figures
- FIG 1
Congenital toxoplasmosis diagnostic algorithm for testing and monitoring infants according to whether maternal antenatal screening and treatment was performed (a) or not (b). Cases in gray and white represent data and/or action before and after birth, respectively.
Tables
- TABLE 1
Principles and methods used for the diagnosis of congenital toxoplasmosis
Principle Detection Platform Diagnostic of congenital toxoplasmosis Toxoplasma-specific humoral responses IgG, IgM, IgA Dye test, ELISA, and ELISA-like assays, ISAGA, immunofluorescence, agglutination Positive IgM after 5 days of life and in the absence of blood transfusions. Positive IgA after 10 days of life. Persistence of Toxoplasma IgG beyond 1 year of age IgG, IgM, and IgA to specific Toxoplasma antigens Western blots Presence of specific bands only seen in the newborn or bands with higher intensity than maternal ones for IgG and/or IgM and/or IgA in a reference laboratory Toxoplasma nucleic acid amplification DNA PCR Positive result in any body fluid (e.g., amniotic fluid, cerebrospinal fluida, peripheral blood, urine) Immunohistochemistry of Toxoplasma-specific antigens in tissue Antigens Immunoperoxidase Positive result in any tissue (e.g., brain or other fetal tissue) Visualization by microscopy Visual identification of tachyzoites and/or cysts Stains such as hematoxylin/eosin, Giemsa Positive identification in a reference laboratory Isolation of Toxoplasma Whole live parasite Inoculation in peritoneal cavity of mice Detection of live cysts from any body fluid or tissue that has been inoculated in mice in a reference laboratory Brain imaging Brain calcifications, hydrocephaly, microcephaly Ultrasound, computed tomography, brain magnetic resonance imaging Findings can be suggestive but are not diagnostic of CT since other etiologies may result in similar findings Retinal exam Inflammation in choroidal and retinal layers Ophthalmological exam Retinochoroidal lesions can be highly suggestive or, at times, diagnostic of CT ↵a In CSF, an extremely high level of protein (e.g., >1,000 mg/dl), presence of eosinophil, and detection of Toxoplasma IgM are also highly suggestive of congenital toxoplasmosis.
- TABLE 2
Overview of sensitivity and specificity of Toxoplasma serological tests in the neonatal period
Principle of the test Sensitivity (%) Specificity (%) Comments Reference(s) IgM ELISA and ELISA-like assays 44–81 88.8–100 In two studies, sensitivity was found to be very low (below 30%) 11, 12, 20, 34, 35 IgM ISAGA 44–86.6 77.7–100 IgM ISAGA is the most sensitive test for IgM detection for newborn serology 11, 20, 23, 36 IgA ELISA 52–92.7 64–100 In one study, sensitivity was found to be very low (below 40%) 12, 13, 35–37 IgA ISAGA 52.9–72.5 77.7–97.4 20, 21 IgG Western blotting 33–73.45 96.2–100 25, 26, 38 IgM Western blotting 54.8–78.6 94.74–100 20, 25, 26 Combination of tests IgM ISAGA and IgA ELISA 73 98 13 IgG + IgM Western blotting 86.44 94.74 26 IgM + IgA ISAGA and IgG + IgM Western blotting 87.5 81.4 20
- Top
- Article
- ABSTRACT
- INTRODUCTION
- GENERAL CONSIDERATIONS
- PRINCIPLES AND METHODS AVAILABLE FOR THE DIAGNOSIS OF CONGENITAL TOXOPLASMOSIS
- OVERALL DIAGNOSTIC APPROACH
- DIFFERENCES IN THE DIAGNOSTIC APPROACH TO CT ACCORDING TO THE PRESENCE OR ABSENCE OF MATERNAL SCREENING AND TREATMENT PROGRAMS
- SIMILARITIES IN THE DIAGNOSTIC APPROACH TO CT ACCORDING TO THE PRESENCE OR ABSENCE OF MATERNAL SCREENING AND TREATMENT PROGRAMS
- FUTURE DIRECTIONS
- REFERENCES
- Author Bios
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