Screening For Toxoplasmosis Research Articles

Case 1: Skin Lesions in a Well Newborn: Can They Be Life-threatening?

A 1-day-old girl is admitted to the NICU after she is discovered to have crusted skin lesions on her trunk, face, and lower limbs during routine newborn examination. She is born at term by vaginal delivery following a normal pregnancy to a primigravida mother with no perinatal problems. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. The parents are not consanguineous and there are no genetic diseases or unexplained infant deaths in the family history. The infant is breastfeeding well. On physical examination, hemorrhagic crusted papules measuring 3 to 5 mm are noted on the trunk, face, and extremities (Fig 1, Fig 2, and Fig 3). Findings of the rest of the systemic examination are otherwise normal, and the infant looks well with normal vital signs. The dermatologist is consulted and empiric treatment with intravenous ampicillin and gentamicin is started for possible nonbullous impetigo, even though the patient is well. Complete blood cell count, blood film, C-reactive protein, serum electrolytes, liver function tests, urea and creatinine, coagulation studies, blood culture, skin swab from the lesion, and screening for toxoplasmosis, other (syphilis, varicella-zoster, parvovirus B19), rubella, cytomegalovirus, and herpes infections (TORCH) are all normal. The antibiotics are stopped after 72 hours after Gram staining of the crusted lesions yields no microorganisms and no growth is seen …

The impact of socioeconomic factors on the efficiency of voluntary toxoplasmosis screening during pregnancy: a population-based study

BackgroundCongenital toxoplasmosis is associated with severe complications. German state health insurance covers rubella, but not toxoplasmosis, immunity screening. We analysed the effect of socioeconomic factors on the efficiency of private toxoplasmosis screening during pregnancy.MethodsToxoplasmosis and rubella screening data (n = 5402 mothers) were collected within the population-based Survey of Neonates in Pomerania (SNiP).ResultsAt the first-trimester screening, 34.4 % (88.1 %) of expecting mothers were immune to toxoplasmosis (rubella). Susceptibility for toxoplasmosis (rubella) was observed in 39.6 % (8.9 %) and 25.8 % (2.95 %) were not tested. Data on a 2nd screening were available in a subgroup of women with negative immunity showing less than 45 % participation rate. Active toxoplasmosis (no rubella) infection was observed in 0.3 % (n = 17) of pregnant women. A multiple logistic regression model (AIC = 719.67; AUC = 0.725) revealed that the likelihood of participating in a second toxoplasmosis screening increased among women with a good level of education and a steady partnership and decreased with paternal unemployment and the absence of breastfeeding. The highest probability of non-participation in toxoplasmosis screening was found among women with temporal burden and family responsibilities. A cost-benefit analysis showed that covering general screening for toxoplasmosis with health insurance saved costs.ConclusionToxoplasmosis carried a substantial risk of infection during pregnancy. Although increased socioeconomic status was positively associated with the participation in toxoplasmosis screening, this was not the case when pregnant women had strong temporal burden and family responsibilities. This data supports the need for toxoplasmosis screening among pregnant women as a general healthcare benefit covered by insurance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0966-0) contains supplementary material, which is available to authorized users.

Towards Universal Screening for Toxoplasmosis: Rapid, Cost-Effective, and Simultaneous Detection of Anti-Toxoplasma IgG, IgM, and IgA Antibodies by Use of Very Small Serum Volumes.

Rapid, cost-effective, and early determination of the serological status of potentially infected individuals, particularly pregnant women, can be critical in preventing life-threatening infections and subsequent fetal congenital abnormalities. An article in this issue of the Journal of Clinical Microbiology (X. Li, C. Pomares, G. Gonfrier, B. Koh, S. Zhu, M. Gong, J. G. Montoya, and H. Dai, J Clin Microbiol 54:1726-1733, 2016, http://dx.doi.org/10.1128/JCM.03371-15) describes an innovative multiplexed immunoassay that offers a path toward universal screening.

Laboratory Diagnosis of Congenital Toxoplasmosis.

Recent studies have demonstrated that screening and treatment for toxoplasmosis during gestation result in a decrease of vertical transmission and clinical sequelae. Early treatment was associated with improved outcomes. Thus, laboratory methods should aim for early identification of infants with congenital toxoplasmosis (CT). Diagnostic approaches should include, at least, detection of Toxoplasma IgG, IgM, and IgA and a comprehensive review of maternal history, including the gestational age at which the mother was infected and treatment. Here, we review laboratory methods for the diagnosis of CT, with emphasis on serological tools. A diagnostic algorithm that takes into account maternal history is presented.

Toxoplasmosis Education for Pregnant Women in Panama [16A

INTRODUCTION: In 2014, Panama passed a law requiring toxoplasmosis screening for pregnant women and reporting of positive cases. Therefore, it is important to educate pregnant women about toxoplasmosis. The objective of this study is to use educational pamphlets to provide essential information to pregnant women in Panama. METHODS: In September 2015, we created three different educational pamphlets on toxoplasmosis for pregnant women in Hospital Santo Tomas. We also created a questionnaire to assess knowledge of toxoplasmosis before and after exposure to the pamphlets. The endpoint of this study was the level of knowledge in answering the questionnaire after exposure to the pamphlets. RESULTS: A total of 164 pregnant women participated. For the initial questionnaire, 76% of the women had no knowledge of toxoplasmosis. We created an understanding scale for those who were able to answer the questionnaire after reading the pamphlets. 0 is answering zero question correctly, 1 is answering one to two questions correctly, 2 is answering three to four questions correctly, and 3 is answering five to six questions correctly. For pamphlet 1, 89% of the participants had an understanding scale of 3 after reading the pamphlet. For pamphlet 2 and 3, 63% and 55% of participants had an understanding scale of 3, respectively. CONCLUSION: After educational pamphlets exposure, there was an increase in understanding of toxoplasmosis in pregnant women. Pamphlet 1 had the best educational results. With education in place, a rapid point of service test will be the next goal to screen for active infections for pregnant women in Panama.

Serological and molecular survey of toxoplasmosis in renal transplant recipients and hemodialysis patients in Kashan and Qom regions, central Iran

Toxoplasma gondii is one of the important opportunistic pathogen among solid-organ transplant recipients and hemodialysis patients (HD). This study was aimed to detect toxoplasmosis among 50 renal transplant recipients (RTR), 135 HD and 120 healthy individuals in two cities (Kashan and Qom) that located in the center of Iran, from 2014 to 2015. Serological detection (IgG and IgM antibodies) was performed among all individuals in case and control groups. Molecular detection was performed on all IgM positive individuals or IgG positive with moderate to high (>51 IU/mL) antibody titers in HD (n = 42) and control groups (n = 21). In RTR patients, molecular detection was conducted among all seropositive or seronegative individuals (n = 50). IgG seropositivity was detected in 52% (26/50) of RTR, 63% (85/135) of HD and 33.3% (40/120) of the control group. The rate of anti-T. gondii IgG antibody was significantly elevated in RTR and HD patients than the control group (p = 0.023 and p < 0.001, respectively). IgM seropositivity was only detected in one HD patient. T. gondii DNA was detected in 12% (6/50) of RTR and 7.1% (3/42) of HD patients. The results of this study suggested that the screening of toxoplasmosis should be given greater consideration among RTR and hemodialysis patients.

Three-year retrospective analysis of the incidence of Toxoplasma gondii infection in pregnant women living in the Greater Romagna Area (northeastern Italy)

The aim of this study was to assess the incidence of Toxoplasma gondii infection in a population of pregnant women living in the Romagna area of the Emilia-Romagna region. From 1 January 2012 to 31 December 2014, 36 876 pregnant women were tested to evaluate the IgG- and IgM-specific anti-T. gondii response. The average incidence was 0.192%, underlining the need for an appropriate and active screening for toxoplasmosis during pregnancy.

Multiple Sclerosis and Panuveitis: A Rare Association

A 28-year-old right-handed male presented in December 2012 with complaints of numbness in the right arm and leg. Neurological examination revealed right hemiparesis and hemihypoesthesia. He had a history of epilepsy, and his mother had Sjogren syndrome. He reported that the numbness in the right arm and leg had started 2 years ago and he was then diagnosed with vasculitis, and thus, was administered 300 mg/day acetylsalicylic acid. Complete blood count, serum biochemistry, and sedimentation rate were normal. Immunological tests, including antinuclear, antiDNA, and antiphospholipids antibodies; laboratory tests for Lyme disease; ENA screening for Sjogren syndrome, syphilis, toxoplasmosis, hepatitis, HIV, CMV, tuberculosis, and sarcoidosis; and Schirmer’s and pathergy tests were negative. Magnetic resonance imaging of the brain revealed periventricular and pericallosal hyperintense lesions that were typical of MS (Figure 1, 2). Cerebrospinal fluid analysis revealed a cellular count of <3 cells/mm3 and protein level at 0.5 g/L with oligoclonal bands. His visual evoked potential revealed a delayed left P100 latency at 139.5 ms. He did not have any ocular symptoms. On ophthalmological evaluation, no ocular abnormalities were found. His ipsilateral delayed P100 latency was considered to be secondary to optic neuropathy. Immunomodulatory therapy (interferon beta 1-a) was initiated following the diagnosis of MS. He was admitted to our department in June 2013 with a complaint of decreased vision in the right and left eyes since the previous 2 days. Ophthalmoscopic examination of both the eyes revealed bilateral panuveitis. The patient was diagnosed with panuveitis associated with MS, and combination therapy with oral prednisolone at a dose of 64 mg/day and azathiopurine at a dose of 100 mg/day were initiated. The patient is still being followed up at our MS polyclinic without any new attack since 2013.

Fifteen Years of Toxoplasmosis Screening at the Institute of Tropical Medicine, a Diagnostic Reference Center in Venezuela

Toxoplasmosis serodiagnosis was analyzed in the Instituto de Medicina Tropical in Caracas during 1999–2013. Subjects for toxoplasmosis diagnosis were grouped into five categories: pregnancy, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome, ocular pathology, lymphadenopathy, and others. Testing for specific anti-Toxoplasma IgM/IgG antibodies, as well as IgG avidity, was performed. Analysis of 68,622 individuals resulted in an overall prevalence of 50.9%, with 50.9% in pregnant women, 63.8% in patients with eye lesions, 53.1% in HIV-positive individuals, 33.3% in patients with lymphadenopathy, and 49% in other individuals. Toxoplasma gondii infection in pregnant women aged ≤15 years was 32%, which increased to 64% in the middle age category. Diagnostic tests detected 54 recent infections in pregnant women and their follow-up showed no congenital infection. The present age-related and comorbidity prevalence data should be used to design control measures to prevent congenital transmission, coinfection in immunosuppressed patients, and eye lesions in children.

In vivo effect of anti-TNF agent (etanercept) in reactivation of latent toxoplasmosis.

Toxoplasma gondii (T. gondii), an intracellular parasite, establishes a chronic infection by forming cysts preferentially in the brain. TNF-α plays an important role in controlling the infection caused by this protozoan. Thus, the blockade of TNF-α could cause reactivation of latent toxoplasmosis infection as well as increase the risk of acute toxoplasmosis. This study evaluated the effect of etanercept, a TNF-α antagonist in reactivation of latent toxoplasmosis compared to the therapeutic effect of sulfadiazine and pyrimethamine in combination on the progress of the disease. A total of 40 laboratory-bred Swiss albino mice were infected with Me49 strain of T. gondii and divided into four groups: infected control group; treated group with sulfadiazine and pyrimethamine; treated group with etanercept and treated group with both etanercept and sulfadiazine and pyrimethamine. The mean number and size of tissue cysts in brain smears of mice of each group were determined and also, serum levels of TNF-α were assessed in different study groups by an enzyme linked immunosorbent assay. The results showed that the mean TNF-α level was significantly different in the treated groups compared to that in infected control group. The highest level of TNF-α was found in the infected controls. After treatment with etanercept alone or combined with sulfadiazine and pyrimethamine, it was significantly decreased. In this study, reactivation of latent toxoplasmosis was observed by a significant increase in the mean number and sizes of Toxoplasma tissue cysts in brains of mice with established chronic toxoplasmosis after treatment with etanercept alone or combined with conventional treatment compared to both untreated chronically infected controls and infected mice treated with sulfadiazine and pyrimethamine. It was concluded that etanercept, a TNF-α antagonist may play a role in reactivation of latent toxoplasmosis. So, serological screening for toxoplasmosis might offer a valuable aid for patients treated with this drug.

Efficient duplex solid-phase fluorescent assay (dFISA) for the simultaneous detection of specific anti-T. gondii IgG and IgM due to refined conjugates

Toxoplasma gondii infections are very common, causing occasional central nervous system and eye diseases, and must be screened in prenatal care for efficient therapy. Here, we developed a duplex solid-phase fluorescent assay (dFISA) for the simultaneous detection of anti-T. gondii IgG and IgM antibodies in prenatal care screening for toxoplasmosis. Assays using commercially available ion-exchange purified conjugates yielded poor results and high background fluorescence. Same-well IgG/IgM dFISA with refined conjugates was used to test 140 samples from university students, 120 samples from pregnant women and 24 samples from adult volunteers at a large public hospital. We found that dFISA offers high concordance, specificity and reproducibility for IgG (Kappa=0.883) and IgM (Kappa=0.918), which is useful in high-throughput applications for antenatal care.

Systematic review of serological methods used in prenatal screening of toxoplasmosis in pregnant women

Systematic review of serological methods used in prenatal screening of toxoplasmosis in pregnant women

Congenital toxoplasmosis: an uncommon disease in Thailand

Background:The seroprevalence of toxoplasma antibodies in pregnant women and the prevalence of congenital infection differ widely between countries. A few cases of congenital toxoplasmosis diagnosed after the neonatal period, with long-term sequelae, have been reported in Thailand. No data on the prevalence of congenital toxoplasmosis have been documented and no screening for toxoplasmosis during pregnancy has been undertaken in Thailand.Subjects and Methods:A questionnaire enquiring about cases of congenital toxoplasmosis during 1995–2013 was distributed to paediatricians in referral and university hospitals in Thailand and the responses were analysed. Specific toxoplasma IgM antibody and clinical features were used for diagnosis.Results:There were 20 cases – 13 most likely and seven suspected cases of congenital toxoplasmosis. Most patients had systemic manifestations, but only 25% of diagnosed patients exhibited the classic triad of hydrocephalus, cerebral calcification and chorioretinitis. One of the five deceased patients lived beyond the age of 13 years and died of a pulmonary infection. All 15 surviving cases developed deafness, visual impairment or developmental delay.Conclusions:Twenty cases of congenital toxoplasmosis are reported. Delayed diagnosis and treatment resulted in a poor outcome. The prevention of toxoplasmosis in pregnant women and prompt diagnosis and appropriate treatment of congenital toxoplasmosis should be a priority in order to prevent a poor outcome in infected children.

PO-0544 Voluntary Toxoplasmosis Screening In Pregnancy Underestimates Active Infection In Dependency Of Socioeconomic Factors: Data From A Population-based Survey Of Neonates In Pomerania (snip)

Background and purpose 40% of all initial infections with Toxoplasma gondii during pregnancy develop into connatal toxoplasmosis, which is associated with the risk of severe damage to the CNS, frequent premature deliveries, and stillbirths. In Germany, toxoplasmosis immunity screenings are not covered by the state health insurance as a general preventive care service, in contrast to screening for rubella immunity. Therefore, we analysed the impact of socioeconomic factors on the efficiency of private toxoplasmosis screening during pregnancy in a population-based study. Material and methods Toxoplasmosis and rubella screening data were collected from 5403 mothers during the period from May 2002 to June 2008 within the population-based Survey of Neonates in Pomerania (SNiP). Results At the first screening, 34.2% of expecting mothers were immune to toxoplasmosis, 75.2% had immunity against rubella after active immunisation. Negative immunity for toxoplasmosis was found in 39.7% and in 7.7% for rubella (missing information: toxoplasmosis: 25.8%; rubella 17.2%). Less than 10% of the women without immunity participated in a second toxoplasmosis screening. An active toxoplasmosis infection was found in 0.3% (n = 17) women during pregnancy. There were no infections with the rubella virus. Pregnant women with a higher socioeconomic status participated in screenings considerably more frequently. Conclusion Our population-based sample demonstrated a substantial risk of toxoplasmosis infection during pregnancy in contrast to the rubella risk. Furthermore, lower socioeconomic status adversely affects the rate of toxoplasmosis screening. This data support the need for toxoplasmosis screening for pregnant women as a general health care benefit covered by insurance.

Toxoplasma Ig M positive in pregnancy: what does it mean from the perspective of the gynecologists?

Toxoplasma gondii infection in pregnancy occurs with maternal ingestion of cysts in undercooked meat or with maternal ingestion of oocysts found in water, food and soil (1). Contaminated under cleaned green salads (like garden rocket, parsley) and water may be important sources for women in Turkey. Although routine screening for toxoplasmosis in pregnancy is not recommended, this is not the case in daily practice and due to unnecessary screening and confounding test results, gynecologists should be also familiar with patients having the results of Toxoplasma IgM(+). One key-point for evaluation the toxoplasmosis-suspected pregnant woman is to know that congenital infection risk for the fetus is higher in third trimester; however, the risk of the injury for the fetus is greater in the first trimester (2). Pregnant women with IgM(+)/IgG(-) should be screened in 1 to 3 weeks again. If seroconversion in Ig G occurs, then infection is probably acquired during pregnancy and there is risk for congenital infection (3). Treatment is to be initiated with Spiramycin. Amniocentesis for amniotic fluid PCR should be performed after 16 weeks. A detailed fetal ultrasonography should be also performed. In case of IgM(+)/IgG(+), the results should be confirmed. Toxoplasma Gondii avidity testing is reasonable at this stage (4). High-avidity IgG antibodies are detected at least 12-16 weeks after infection, so high-avidity IgG results show that the infection was started 16 weeks before. Low-avidity results may persist for a long period (even more than one year after acute infection), so only avidity tests should not be used (1, 5). In our daily practice, we account the gestational week, the Ultrasonograhic findings with maternal serum results into account. In case of IgM(+)/IgG(+); we also perform IgG avidity test. We initiate medical treatment and repeat the tests in 3 weeks. A significant increase in IgG titers (3-4 times) together with low-avidity IgG is suggestive for an acute infection. Fetal infection should be checked with amniocentesis

Evolution and Innovations of the National Neonatal and High Risk Screening Program in Costa Rica

We present the evolution, organization and results of the National Neonatal and High Risk Screening Program in Costa Rica (PNT). This program has been working uninterruptedly for more than fourteen years. Costa Rica currently has a literacy rate of 95%. To August 2004 the rate of infant mortality was 9.74 per 1000 births and to 2003, life expectancy was 76.3 years for men and 81.1 years for women. The control of infectious and parasitic diseases, as well as of severe malnutrition, has given room to a prevalence of chronic diseases with a pathology profile similar to that of a developed country. The clinical observation, mainly starting from early 70s, of a growing number of patients with mental retardation and other disabilities caused by congenital hypothyroidism and hereditary metabolic diseases that could have been prevented in many cases with an early diagnosis and opportune treatment, led us to the decision to implement a systematically massive neonatal screening for these diseases. The presence of a single Public System of Social Security in Costa Rica, which currently includes from primary health care up to the hospitals of tertiary attention, with a single Children's Hospital for the whole country, as well as communication facilities, are factors that offered, in principle, favorable conditions for this effort, even for a developing country. To September 2004, 835,217 children have been screened. There is a coverage of 95.1% of the newborns in the country. Also to this date, 259 children with congenital hypothyroidism, 18 with phenylketonuria, 20 with the maple syrup disease, 30 with congenital adrenal hyperplasia and 10 with galactosemia have been detected, confirmed and treated, for a total of 337 children that were spared of mental retardation, other disabilities and even death. Massive neonatal screening for organic acidemias recently started in June of 2004. Cystic fibrosis is under a pilot study and the screening for hemoglobinopathies and toxoplasmosis is planned. The Center for Prevention of Disabilities, which started its functions on September 23, 2002, made feasible to integrate neonatal screening, high risk screening and diagnostic confirmation of the diseases now included in the national screening program as well as those to be added in the future.

Dried blood spot testing for the antenatal screening of HTLV, HIV, syphilis, toxoplasmosis and hepatitis B and C: prevalence, accuracy and operational aspects

IntroductionScreening for vertically transmitted infection is mandatory and must be conducted at the first prenatal consultation. The most vulnerable women's groups are those at the lowest socio-economic level. Dried blood spot testing on filter paper could represent a secure way to screen pregnant women in the prenatal period. MethodsA cross-sectional study was conducted between November 2009 and March 2010, in the Metropolitan Region of Salvador, Bahia, Brazil, to compare the accuracy of the dried blood spot in filter paper and venipuncture serological as screening methods for HIV, HTLV, VHB, VHC, Treponema pallidum, and Toxoplasma gondii during prenatal period. Results of the venous blood sample collected in tubes were considered the gold standard. ResultsSerum samples and dried blood spot were obtained from 692 pregnant women aged between 14 and 42 years, with a median age of 26. Thirteen women were seropositive for T. gondii (1.88%; 95% CI: 0.60–2.71%), five for T. pallidum (0.72%; 95% CI: 0.15–1.61%), two for HBV (0.29%; 95% CI: 0.050.95%) and one for HTLV-1 (0.14%; 95% CI: 0.01–0.71%). No one was positive for HCV and HIV. The dried blood spot accuracy for syphilis and HTLV were 100% (95% CI: 99.25–100) and 100% (95% CI: 99.45–100%), respectively. The average time between blood collection and recording of the sample in the reference laboratory was 4.93 (3.82) days and between dried blood spot processing and active search for pregnant women was 3.44 (4.27) days. ConclusionsThe use of dried blood spot may represent a secure way to expedite access to results of vertically transmitted diseases in the prenatal period, particularly in regions with scarce healthcare resources.

Serological Screening for Ante-Natal Toxoplasmosis in Maiduguri Municipal Council, Borno State, Nigeria

Toxoplasma gondii infection causes devastating defects including, blindness, neurological impairment and mental retardation in congenitally infected children. Congenital infection occurs when a woman becomes infected during pregnancy; and the severity of the illness is related to the trimester period. This research was designed to evaluate the seroprevalence of toxoplasmosis amongst pregnant women (n=90) using enzyme linked immunosorbent assay (ELISA) kit (Cortez Diagnostics Inc. USA). A structured questionnaire was used to collect socio-demographic data. A significant (x2 Cal 233.0/ x2 tab 124.1, p=0.01) overall prevalence of 22.2% (20/90) was obtained. Pregnant women within 25-29years had the highest prevalence of 33.3% (3/9); this was significant (x2 Cal 35.85/ x2 tab 9.21, p=0.01). An association between high levels of toxoplasma IgG and miscarriage was established in four of twenty five women who had suffered miscarriage (t cal 5.3/t tab 2.81, p=0.01). The results presented indicate that toxoplasmosis is a significant public health burden in the area of study, which requires drastic remedial measures.Key words: Toxoplasmosis, pregnant women, miscarriage, Nigeria L’infection de Toxoplasma gondii provoque des malformations dévastatrices, y compris, la cécité, des troubles neurologiques et un retard mental chez les enfants infectés congénitalement. L'infection congénitale se produit quand une femme est infectée au cours de la grossesse, et la gravité de la maladie est liée à la période de trimestre. Cette recherche a été conçue pour évaluer la séroprévalence de la toxoplasmose chez les femmes enceintes (n = 90) à l'aide de dosage immunoenzymatique (ELISA) (Cortez Diagnostics Inc. USA). Un questionnaire structuré a été utilisé pourrecueillir des données socio- démographiques. Une prévalence importante globale de 22,2 % (20/ 90) a été obtenu (p =0,01). Les femmes enceintes dans les tranche d’âge25- 29 ans ont eu la plus forte prévalence de 33,3 % (3/9)qui était significative (p = 0,01). Une association entre des niveaux élevés de Toxoplasme IgG et fausse couche a été établie dans quatre des vingt-cinq femmes qui avaient subi une fausse couche (p = 0,01). Les résultats présentés indiquent que la toxoplasmose est un problème de santé publique dans cette localité, ce qui nécessite des mesures correctives drastiques.Mots clés: Toxoplasmose, femmes enceintes, fausses couches, Nigeria

452Pseudo-Outbreak of Fulminant Toxoplasmosis in Hematopoietic Stem Cell Transplant [HSCT] Recipients

Recent guidelines have suggested PCR screening for toxoplasmosis in high risk patients.6 Use of PCR as a standard part of fever work up in seropositive allogeneic stem cell transplant recipients has also been recommended.5 Pseudo-Outbreak of Fulminant Toxoplasmosis in Hematopoietic Stem Cell Transplant [HSCT] Recipients Flonza Isa, MD, Mini Kamboj, MD, Kohta Saito, MD, Koen Van Besien, MD, Sergio A. Giralt, MD, Audrey N. Schuetz, MD, Steven Salvatore, MD, Genovefa Papanicolaou, MD, and Rosemary Soave, MD New York Presbyterian Hospital [NYPH]/Weill Cornell and Memorial-Sloan Kettering Cancer Center [MSKCC], New York, NY

Integrated screening for HIV, syphilis, and toxoplasmosis among pregnant women in the Central African Republic

The aim of this study was to determine the prevalence of syphilis and toxoplasmosis infection in pregnant women in the Central African Republic who were and were not HIV-infected, in the framework of HIV surveillance. This case-control study included 270 HIV(+) and 217 HIV(-) pregnant women among 4 750 women who attended prenatal-care clinics throughout the Central African Republic from November 2011 through January 2012. Blood specimens were collected and serological evidence of HIV1/2 was analyzed by ELISA1 and ELISA2. The Toxoplasma gondii antibody was detected with the Toxo-Hai Fumouze(®) diagnostic kit. A VDRL test was performed to screen for syphilis in all study participants. Of the 434 samples tested, 33 (7.60%) were positive for syphilis: 21 (9.7%) among HIV(+) and 12 (5.5%) among HIV(-) women (p = 0.1031); 221 (50.90%) were positive for toxoplasmosis: 117 (53.9%) among HIV(+) and 104 (47.9%) among HIV(-) women (p = 0, 2119). Coinfection with HIV, syphilis, and toxoplasmosis was found in 6.00%. No association was found between coinfection and age, parity, and residence area. The rate of syphilis infection was very high in pregnant women living in rural areas (ORcrude = 4.37; 95% CI = 2,11, 9.05). This study showed a high prevalence of toxoplasmosis and syphilis in pregnant women in the Central African Republic, regardless of their HIV infection status. Sexually transmitted infections (STIs) are common in pregnant women living in rural areas. It may be appropriate to include routine serological screening tests to determine of toxoplasmosis, syphilis and HIV in pregnant women in this country.