Diagnosis of congenital toxoplasmosis in the neonatal period: A multicenter evaluation

Naessens, Anne; Jenum, Pål A.; Pollak, Arnold; Decoster, A.; Lappalainen, Maija; Villena, Isabelle; Lebech, Morten; Stray‐Pedersen, Babill; Hayde, Michael; Pinon, J. M.; Petersen, Eskild; Foulon, Walter

doi:10.1016/s0022-3476(99)70090-9

Cited by 84 publications

(52 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Maternofetal treatment had no clear influence on neonatal IgE detection. Naessens et al came to the same conclusion regarding IgM and IgA in a multicenter study (11). The diagnostic value of IgE detection at birth is slightly better than that of IgA but lower than that of IgM (respective specificities, 91.9, 88, and 96.8%).…”

Section: Discussionmentioning

confidence: 71%

“…Interestingly, IgE was found at birth in infants with congenital toxoplasmosis whose mothers had been infected during the first trimester of pregnancy, a situation in which maternal transmission to the fetus is thought to occur early. Given its generally short-lived nature, the presence of IgE at birth points to recent fetal synthesis resulting from late maternal transmission, or placental passage (during delivery) of long-lived maternal IgE (7,11). Maternofetal treatment had no clear influence on neonatal IgE detection.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Clinical Value of Specific Immunoglobulin E Detection by Enzyme-Linked Immunosorbent Assay in Cases of Acquired and Congenital Toxoplasmosis

et al. 2003

View full text Add to dashboard Cite

The clinical value of immunoenzymatic (enzyme-linked immunosorbent assay) detection of anti-Toxoplasma immunoglobulin E (IgE) was assessed by studying 2,036 sera from 792 subjects, comprising seronegative controls and subjects with acute, active, reactivated, or congenital toxoplasmosis. Included were nonimmunized adults; pregnant women with recently acquired infection (acute toxoplasmosis); immunocompetent subjects with recently acquired severe infection (active toxoplasmosis) expressed as fever, adenopathies, splenomegaly, pneumonia, meningitis, or disseminated infection; subjects-some of them immunocompromised-whose previously moderate IgG antibody levels rose, suggesting a reactivation of quiescent toxoplasmosis; and infants born to seroconverted mothers and evaluated for diagnosis of congenital infection and therapeutic management. Specific IgE antibodies were never detected in seronegative subjects. They were present in 85.7% of asymptomatic seroconverters and in 100% of seroconverters with overt toxoplasmosis, following two different kinetics: in the former, the specific IgE titer generally presented a brief peak 2 to 3 months postinfection and then fell rapidly, whereas specific IgE persisted at a very high titer for several months in the latter. IgE emerged concomitantly with the increase in IgG during toxoplasmic reactivation. For neonatal diagnosis of congenital toxoplasmosis, IgE was less informative than IgM and IgA (sensitivities, 59.5, 64.3, and 76.2%, respectively) and had a specificity of 91.9%. Nevertheless, simultaneous measurement of the three isotypes at birth improved the diagnostic yield to 81% relative to the combination of IgA and IgM. Emergence of specific IgE during postnatal treatment for congenital toxoplasmosis is a sign of poor adherence or inadequate dosing.Toxoplasmosis, a cosmopolitan protozoan disease, is often asymptomatic in humans. Its diagnosis is mainly based on serological tests. Classically, serodiagnosis includes titration of specific immunoglobulin G (IgG) (showing past exposure) and screening for specific IgM, which is suggestive of recent exposure or ongoing active infection (17). However, IgM antibody detection can be due to naturally interfering IgM (15) or to the persistence of IgM for a long time after primary infection. Conversely, the IgM assay can be negative in patients with secondary reactivation or congenital toxoplasmosis (3, 6). Although anti-Toxoplasma IgA antibodies are also informative (i.e., no natural IgA), they can persist for Ͼ6 months after infection, making it difficult to determine the precise date of infection in pregnant women (8, 9). There is therefore growing interest in the use of IgE in this setting (1,10,14,18,22). Given the major role of Toxoplasma gondii P30 membrane protein in early antibody synthesis (4), we have used an enzyme-linked immunosorbent assay (ELISA) based on a monoclonal anti-P30 antibody to screen for specific IgE.The aim of this study was to determine the kinetics of antiToxoplasma IgE in ELISA and the clinical value of...

show abstract

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 98%

Clinical Value of Specific Immunoglobulin E Detection by Enzyme-Linked Immunosorbent Assay in Cases of Acquired and Congenital Toxoplasmosis

et al. 2003

View full text Add to dashboard Cite

show abstract

“…Detection of a specific IgM antibody has limited the sensitivity in diagnosing other congenital infections, and it is possible that in utero production of an antibody is impaired such that congenitally infected infants might fail to produce a sufficient WNV-specific antibody to be detected with standard assays, particularly if they were infected early in pregnancy. [39][40][41][42] In such cases, and without the detection of viral RNA or antigen, the diagnosis of congenital WNV infection would need to be made based on clinical abnormalities, but without knowledge of the clinical spectrum of congenital WNV infection this is problematic.…”

Section: Discussionmentioning

confidence: 99%

Birth Outcomes Following West Nile Virus Infection of Pregnant Women in the United States: 2003-2004

et al. 2006

View full text Add to dashboard Cite

“…A study by Lebech et al (14) documented that neonatal screening based on detection of specific IgM alone is able to diagnose more than 75% of infected infants who have not received antenatal therapy. Naessens et al (16) have found IgM antibody in neonatal blood in 85% of congenitally infected children born to untreated mothers but in only 25% of infants who were treated prenatally. Similarly, the sensitivities of diagnosing IgA in untreated and treated infants were 80 and 57%, respectively, although the impact of maternal-fetal treatment on the suppression of the newborn's immunological response has not been proven.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of CongenitalToxoplasma gondiiInfection among Newborns from the Poznań Region of Poland: Validation of a New Combined Enzyme Immunoassay forToxoplasma gondii-Specific Immunoglobulin A and Immunoglobulin M Antibodies

2001

Self Cite

View full text Add to dashboard Cite

We determined the value of a new serological assay detecting Toxoplasma-specific immunoglobulin M (IgM) and IgA antibodies at birth for use in mass neonatal screening. The incidence of congenital infection in newborns was compared with data from an epidemiological investigation on the seroprevalence of Toxoplasma in the studied population. Peripheral blood was collected on Guthrie cards during the first 3 days of life and tested for anti-Toxoplasma IgA and IgM using a noncommercial immunocapture enzyme-linked immunosorbent assay (ELISA). When the screening assay was positive, serum samples from the child and the mother were collected for use in Western blotting comparative immunological profile analysis and traditional serological tests for determination of specific IgG, IgM, and IgA antibodies. From December 1998 to April 2000, 17,653 filter paper samples from live-born neonates were successively screened. Congenital T. gondii infection was finally confirmed in 19 newborns. In traditional assays, 13 of 19 infants were IgM and IgA positive using filter paper eluates at birth, 1 child was positive only for IgM, 1 patient was positive for IgM and borderline for IgA, 1 had an equivocal level of IgA, and 3 cases were confirmed only by the Western blot assay. The prevalence of Toxoplasma-specific IgA and/or IgM in filter paper samples at birth was 1 per 929 live-born neonates (1.08/ 1,000) or about 1 per 523 children (1.9/1,000) born to nonimmune women with a potential risk of primary T. gondii infection during pregnancy, compared to the actual seropositivity rate of 43.7%. The diagnostic sensitivity of the combined IgA-IgM ELISA using neonatal filter paper specimens was not more than 95%, the positive predictive value of the test was 82.6%, and the diagnostic specificity was calculated to be 99.9%. The combined IgA-IgM ELISA is a valuable method for the diagnosis of congenital toxoplasmosis at birth and fulfills criteria for neonatal screening programs. The method showed a good diagnostic sensitivity in neonates untreated prenatally who were born in an area of high seroprevalence of T. gondii infection.

show abstract

Diagnosis of congenital toxoplasmosis in the neonatal period: A multicenter evaluation

Cited by 84 publications

References 29 publications

Clinical Value of Specific Immunoglobulin E Detection by Enzyme-Linked Immunosorbent Assay in Cases of Acquired and Congenital Toxoplasmosis

Clinical Value of Specific Immunoglobulin E Detection by Enzyme-Linked Immunosorbent Assay in Cases of Acquired and Congenital Toxoplasmosis

Birth Outcomes Following West Nile Virus Infection of Pregnant Women in the United States: 2003-2004

Prevalence of CongenitalToxoplasma gondiiInfection among Newborns from the Poznań Region of Poland: Validation of a New Combined Enzyme Immunoassay forToxoplasma gondii-Specific Immunoglobulin A and Immunoglobulin M Antibodies

Contact Info

Product

Resources

About