Abstract
BackgroundAccurate diagnosis of Toxoplasma gondii (T. gondii) infection remains elusive and requires a comprehensive assessment through laboratory and clinical investigation. In this study, a diagnostic algorithm based on paired serum samples and clinical data was developed and evaluated.MethodsA total of 1267 suspected cases of Toxoplasma infection were enrolled in this study from January 2016 to December 2016. The cases were screened for anti-Toxoplasma IgM and IgG by electrochemiluminiscence immunoassay (ECLIA) method. Based on the serological profiles, all cases with first seropositive serum samples were considered as suggestive cases of Toxoplasma infection. Thus, second serum samples were obtained after an interval of 2 weeks. The diagnosis was made based on laboratory results and clinical data.ResultsA total of 482 T. gondii seroreactive cases were selected. The patient’s records were traced and the data were analysed. Accordingly, 152 cases were diagnosed as clinically confirmed cases; 198 cases were clinically asymptomatic and 132 cases were newborn babies or infants who did not have toxoplasmosis and only acquired passive immunity from their mothers. The paired serum algorithm allowed classifying the seroreactive cases as follows: early (0.6%), acute (1.9%), reactivation (13.5%), recent (1.5%), passive immunity from mother (27.3%) and possible congenital infections (1.2%). In addition, cases of reactivated toxoplasmosis were detected among the pregnant mothers (13/82; 15.8%), children aged above 1 year (2/8; 25.0%) and immunocompetent mothers (5/135; 3.7%). Furthermore, the application of the paired serum analysis resulted in remarkably improved treatment initiation.ConclusionsToxoplasmosis diagnosis and treatment can be improved through the use of paired serum diagnostic algorithm.
Highlights
Accurate diagnosis of Toxoplasma gondii (T. gondii) infection remains elusive and requires a comprehensive assessment through laboratory and clinical investigation
Study participants A total of 1267 hospitalised patients with clinically suspected cases of Toxoplasma infection admitted to Hospital Universiti Sains Malaysia (HUSM) from January 2016 to December 2016 were enrolled in this study
The screening results of the first serum samples for Toxoplasma IgMs and IgGs indicated that the overall seroprevalence of toxoplasmosis antibodies in the suspected cases was 64.9% (822/1267)
Summary
Accurate diagnosis of Toxoplasma gondii (T. gondii) infection remains elusive and requires a comprehensive assessment through laboratory and clinical investigation. The parasite infects more than 30% of the global population, even though, most infected individuals do not develop any clinical symptoms, and the disease often remains unrecognised [2]. The accurate diagnosis of the disease is crucial because early instituted treatment remarkably improves clinical outcomes and decreases mother-to-child transmission in congenital infections [5]. Regardless of the clinical sign, detecting toxoplasma antibodies is the mainstay of toxoplasmosis diagnosis and is generally used for routine investigation in many medical centres worldwide [7]. The fundamental process for identifying T. gondii infection is usually based on the detection of serum IgMs or IgGs or both. The presence of IgMs only suggests current or active infection, whereas the presence of IgGs only indicates chronic or past infection [8]
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