A comparative evaluation of the Vidas system (bioMérieux, Marcy l'Etoile, France) and the Immulite System (Diagnostic Products Corporation) was performed using 500 prospectively collected serum samples. As part of a routine antenatal screening program, these samples were tested for hepatitis B surface antigen, and immunoglobulin G (IgG) and IgM antibodies to Toxoplasma gondii and rubella virus. The overall agreement between the two assay systems ranged from 98.0 to 99.8%. After discrepancy analysis the outcome in terms of relative sensitivity and specificity varied from 97.5 to 100%.Primary infection caused by Toxoplasma gondii or rubella virus in pregnant women can lead to congenital infection, with serious sequelae for the newborn (4). Although rubella vaccination has reduced the incidence of rubella virus infection substantially, maternal infection in industrialized countries is still estimated to occur in 1 out of 6,000 to 10,000 pregnancies (3).Due to a high proportion of seronegative results to T. gondii during pregnancy, it is important to clearly understand the woman's serological status in the first trimester (8). Symptoms such as chorioretinitis and delay in development of the fetus can be prevented if timely treatment with spiramycin is initiated (6). Detection of immunoglobulin M (IgM) antibodies is problematic because of the reported low degree of test specificity and the clinical implications of a false-positive result, which can lead to unnecessary therapeutic intervention.It is therefore of utmost importance to identify susceptible women in order to offer early treatment. Screening programs for pregnant woman are now available in various Western countries (9, 16). Most recently, hepatitis B has been added to the screening program since hepatitis B vaccination (passive and active) of the newborn can actually prevent transmission from a HBsAg-positive mother to her child (14).Antenatal screening programs produce a substantial workload for the microbiological laboratory. Testing of large numbers of serum samples has shifted in recent years, from batch processing with enzyme immunoassays to sophisticated random-access systems capable of processing a variety of tests simultaneously (2).In this study, we compare the results of antenatal screening for T. gondii and rubella virus antibodies and HBsAg using the bioMérieux (Marcy l'Etoile, France) Vidas and Diagnostic Products Corporation (DPC) (Los Angeles, Calif.) Immulite systems. MATERIALS AND METHODSIn June and July 1999, a total of 500 serum samples, prospectively collected from women in their first trimester of pregnancy, were tested using the Vidas (bioMérieux) and DPC Immulite systems, for the presence of HBsAg, and for IgG and IgM antibodies to rubella virus and T. gondii. Analysis of both immunoassay systems was performed according to the manufacturers' instructions. An aliquot of 2 ml of each serum sample was frozen at Ϫ20°C for retesting and/or confirmatory procedures.The Vidas immunoassay system is based on the enzyme-linked fluorescent assay...
Thrombotic thrombocytopenic purpura (TTP) is a clinical entity caused by deficiency of the ADAMTS13 protease, either due to hereditary deficiency or autoantibody formation. ADAMTS13 deficiency results in the persistence of ultralarge von Willibrand factor (vWF) multimers in the blood, which cling to the endothelial surface, resulting in the deposition of platelet-rich vaso-occlusive thrombi. Occlusion and mechanical shearing caused by these thrombi result in the clinical manifestations of thrombocytopenia, microangiopathic hemolytic anemia, renal injury, neurologic manifestations, and fever. TTP is an extremely rare disease, with incidence of approximately 3 per million people in adults, and 1 per 10 million in children. While mortality rates in the past reached as high as 90-100%, the advent of effective treatment, most notably with corticosteroids and plasma exchange therapy, has resulted in a significant improvement in outcomes, with survival rates of 70-90%.
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