Serology for Toxoplasma in Immunocompromised Patients: Still Useful?

Dupont, Damien; Fricker‐Hidalgo, Hélène; Brenier-Pinchart, Marie-Pierre; Garnaud, Cécile; Wallon, Martine; Pelloux, H

doi:10.1016/j.pt.2020.09.006

Cited by 22 publications

(20 citation statements)

References 74 publications

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“…Our diagnostic strategy was based on qPCR targeting the 529 bp repeat element, validated in numerous studies [12,24,25] to provide the best performance for the diagnosis of toxoplasmosis in immunosuppressed patients. We have also performed simultaneous serological testing because it was reported useful even after HSCT [5,26,27], while being feasible and inexpensive. However, our results do not favour this practice since we did not detect specific IgM in any patient.…”

Section: Discussionmentioning

confidence: 99%

Risk of reactivated toxoplasmosis in haematopoietic stem cell transplant recipients: a prospective cohort study in a setting withholding prophylaxis

Štajner

Vujić

Srbljanović

et al. 2022

Clinical Microbiology and Infection

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Objectives: Reactivation of latent toxoplasmosis may be life-threatening in haematopoietic stem cell transplant (HSCT) recipients. We conducted an 8-year-long prospective study on the diagnosis and monitoring of reactivated toxoplasmosis in paediatric HSCT recipients. The primary objective was to determine the incidence of reactivated toxoplasmosis in a setting that withholds prophylaxis until engraftment. The second objective was to identify the subgroups of HSCT recipients particularly prone to reactivation who may benefit the most from regular PCR follow-up. Methods: Serological and qPCR screening targeting the Toxoplasma 529 bp gene was performed before HSCT, and continued by weekly monitoring after HSCT for a median time of 104 days. Results: Reactivated toxoplasmosis was diagnosed in 21/104 (20.2%), predominantly in allo-(19/75) and rarely in auto-HSCT (2/29) recipients. Over 50% (14/21) of cases were diagnosed during the first month after HSCT, while awaiting engraftment without prophylaxis. Toxoplasma disease evolved in only three (14.3%, 3/21) patients, all treated by allo-HSCT. Reactivation was more frequent in patients treated for acute lymphoblastic leukaemia (3/27, p 0.03) and especially, in recipients of haploidentical stem cells (10/ 20, p 0.005). Seronegative status of the donor (where was known) contributed to 75% (12/16) cases of reactivated toxoplasmosis after allo-HSCT. Discussion: The presented results show that peripheral blood-based qPCR, both before and after HSCT, is a valuable asset for the diagnosis of reactivated toxoplasmosis, whereas the results of serology in recipients should be interpreted with caution. Weekly qPCR monitoring, at least until successful engraftment and administration of prophylaxis, allows for prompt introduction of specific treatment.

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Section: Discussionmentioning

confidence: 99%

Risk of reactivated toxoplasmosis in haematopoietic stem cell transplant recipients: a prospective cohort study in a setting withholding prophylaxis

Štajner

Vujić

Srbljanović

et al. 2022

Clinical Microbiology and Infection

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“…T. gondii leads to severe congenital disabilities such as hydrocephaly. In immunocompromised patients, toxoplasmosis presents symptoms such as apathy, seizures, confusion, visual disorder, dyspnea, personality changes, and diarrhea [17,18]. Up to 40% of patients with AIDS develop T. gondii encephalitis [3].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Toxoplasmosis among the Pakistani Population: A Systematic Review and Meta-Analysis

et al. 2022

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Toxoplasma gondii is an intracellular obligate parasite that causes toxoplasmosis, a zoonotic infection that affects warm-blooded animals and humans worldwide. To comprehensively characterize the disease condition in Pakistan for future reference, we ascertained the prevalence of Toxoplasma infection and predisposing factors in the Pakistani population over a 20-year period. We systematically reviewed research articles published in English (2000–2020) from PubMed and Google Scholar. The search results 26 publications involving 10,924 people and 2611 seropositive cases. The toxoplasmosis seropositivity rate was higher in women (25.44%) as compared to men (21.48%) and were statistically significant (p < 0.001). Furthermore, seropositivity was high among people with direct contact with cats, who consumed uncooked meat and raw vegetables, had poor education, and lived in rural areas. The 35–65-year age group had the highest prevalence rate of T. gondii infection. Toxoplasma infection was significantly more prevalent in Khyber Pakhtunkhwa province (25.87%) than in Punjab (20.42%) (p < 0.001). This is the first comprehensive analysis of T. gondii infection epidemiology in Pakistan. It reveals a high frequency of infection among women. We strongly encourage further research to aid patient care and the development of more efficient diagnostic tests and preventative techniques.

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“…The isolated detection of IgG antibodies has limited utility in the characterization of the infection phase in a blood or transplant donor. Unfortunately, in Poland, there are no clear guidelines regarding the qualification of blood donors based on the markers of the T. gondii infection, while, e.g., in France, diagnostic recommendations have been developed and depend largely on a specific group (blood donors, pregnant women, or immunocompromised hosts) [16,45,46]. Given a relatively low predictive value of serologic tests in patients with immune disorders, including HIV-infection with CD4 + count <100 cells/mm 3 and molecular testing characterized by higher sensitivity and specificity, is proposed [16,36,40,46].…”

Section: Discussionmentioning

confidence: 99%

Seronegative Infection with Toxoplasma gondii in Asymptomatic Human Immunodeficiency Virus Type 1 (HIV-1)-Infected Patients and in Blood Donors

Bednarska

Cortés

Glamkowska-Sady

et al. 2022

JCM

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Background: Toxoplasmosis is a common opportunistic infection in AIDS patients. The routine diagnostics is based on serologic testing and IgG avidity index, but it may have limited utility in immunodeficient patients; thus, it is recommendable to detect T. gondii DNA in subjects with advanced HIV disease. The results of the studies published so far focused on patients with clinical symptoms of toxoplasmosis. Our study encompassed a group of HIV-infected subjects on cART therapy, without immunological disturbances and clinical symptoms of T. gondii infection. Methods: The study was retrospective, and samples were collected between 2013 and 2016. We evaluate the prevalence of serological (IgM, IgG, and avidity IgG) and molecular (DNA) T. gondii infection markers in asymptomatic HIV-infected patients and the control group using serologic (ELISA) and quantitative (real-time PCR) molecular testing. Results: Of 152 HIV-infected in routine follow-up tested for T. gondii IgM and IgG, 6 (3.9%) and 50 (32.9%) were positive, respectively. Of 168 serum samples from blood donors, 1 (0.6%) and 49 (29.2%) were IgM+ and IgG+ positive, respectively. IgM seroprevalence in HIV-infected patients was significantly higher than in blood donors. T. gondii DNA (genotype II) was identified in 47 (30.9%) HIV-infected patients, with 13 (8.6%) IgM−IgG− samples. In blood donors, T. gondii DNA was present in 15 (8.9%) IgM−IgG−. Conclusions: In both groups, T. gondii DNA was detectable in seronegative subjects, implying the need to supplement the routine serological testing via the molecular method. It can help the accurate monitoring of the reactivation of infection in asymptomatic HIV-infected persons, and the quick introduction of specific therapy, in blood donors, would be of high importance for safe blood donations.

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Serology for Toxoplasma in Immunocompromised Patients: Still Useful?

Cited by 22 publications

References 74 publications

Risk of reactivated toxoplasmosis in haematopoietic stem cell transplant recipients: a prospective cohort study in a setting withholding prophylaxis

Risk of reactivated toxoplasmosis in haematopoietic stem cell transplant recipients: a prospective cohort study in a setting withholding prophylaxis

Epidemiology of Toxoplasmosis among the Pakistani Population: A Systematic Review and Meta-Analysis

Seronegative Infection with Toxoplasma gondii in Asymptomatic Human Immunodeficiency Virus Type 1 (HIV-1)-Infected Patients and in Blood Donors

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