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      Evaluation of Confounders in Toxoplasmosis Indirect Fluorescent Antibody Assay

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          Abstract

          Background

          The IFA test is one of the most usual methods for detecting anti- Toxoplasma antibodies, although it has not any unique standardization. It seems that the microscopic judgment of results is an important confounder in IFA test. Therefore, we conducted the present study to clarify the role of microscopic observer, and other confounders on the test.

          Methods

          Eighty sera were collected from patients suspicious to toxoplasmosis for detection IgG anti- T. gondii by this test. Samples were examined against different series of antigens, IgG anti-human conjugates, and observers.

          Results

          There were no significant differences between the two series of antigens and conjugates. For the observers groups the kappa coefficient of the test results in the experts group (0.97, 0.94–1.00) were significantly higher than the less experienced observers (0.77, 0.68–0.87).

          Conclusion

          We recommend the IFA test to be performed only in reference laboratories and by laboratory technicians that have enough experience for this test. Otherwise, we suggest the substitution of this test with other tests like ELISA for the diagnosis and epidemiological studies.

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          Most cited references18

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          Congenital toxoplasmosis--prenatal aspects of Toxoplasma gondii infection.

          Irena Rilkis, Chen Stein-Zamir, E Rorman … (2006)
          Toxoplasma gondii (T. gondii) is the cause of toxoplasmosis. Primary infection in an immunocompetent person is usually asymptomatic. Serological surveys demonstrate that world-wide exposure to T. gondii is high (30% in US and 50-80% in Europe). Vertical transmission from a recently infected pregnant woman to her fetus may lead to congenital toxoplasmosis. The risk of such transmission increases as primary maternal infection occurs later in pregnancy. However, consequences for the fetus are more severe with transmission closer to conception. The timing of maternal primary infection is, therefore, critically linked to the clinical manifestations of the infection. Fetal infection may result in natural abortion. Often, no apparent symptoms are observed at birth and complications develop only later in life. The laboratory methods of assessing fetal risk of T. gondii infection are serology and direct tests. Screening programs for women at childbearing age or of the newborn, as well as education of the public regarding infection prevention, proved to be cost-effective and reduce the rate of infection. The impact of antiparasytic therapy on vertical transmission from mother to fetus is still controversial. However, specific therapy is recommended to be initiated as soon as infection is diagnosed.
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            Meta-analysis of three case controlled studies and an ecological study into the link between cryptogenic epilepsy and chronic toxoplasmosis infection.

            Matthew B Palmer (2007)
            A meta-analysis was performed on three case controlled studies which examined the relationship between latent toxoplasmosis gondii infection in the immunocompetent host and cryptogenic epilepsy. Further comparison was also made by examining the seroprevalence of toxoplasmosis rates for 17 various countries, cities or regions against the prevalence rates for epilepsy in those regions. The results for the meta-analysis showed a log-odds ratio of 4.8 which approximates to a similar relative risk, (CI 2.6 to 7.8), with CI for all three studies being above 1. Seroprevalence rates for toxoplasmosis and prevalence rates of epilepsy showed a strong association (p<0.001). The prevalence of toxoplasmosis is an important factor in the prevalence of epilepsy with a probable link in the cryptogenic epilepsies. An area with a reduced burden of toxoplasmosis will also have a reduced burden of epilepsy. Neuropathophysiology findings from various studies show a common physical relationship of microglial nodule formation in Toxoplasma gondii infection and epilepsy. This analysis raises the possibility that one of the many causes of epilepsy may be an infectious agent, or that cryptogenic epilepsy may be a consequence of latent toxoplasmosis infection. This raises the possibility that public health measures to reduce toxoplasmosis infection may also result in a reduction in epilepsy.
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              [Toxoplasmosis in Iran. Results of a seroepidemiological study].

              N Piazak, A Kooloobandi, M Assmar … (1996)
              A toxoplasmosis seroepidemiological survey was effected with 13,018 sera collected by stratified cluster random sampling method from 12 provinces in Iran. The samples were studied by indirect immunofluorescent assay (IFA) for the presence of Toxoplasma. In this study, 52.6% of the subjects were male and the remaining 47.4% were female. Anti-Toxoplasma antibody was detected in a total of 51.8% of the samples with no significant difference between male and female affected subjects. The distribution of the infected samples was also investigated in various age groups, the level of infection to Toxoplasma increasing from childhood, culminating to 30 years of age and gradually declining from there after. Between the various age groups, the 10-19 years old demonstrated a 50% increase in relative risk to the infection with high antibody titer. Within the provinces under study, the highest relative frequency of Toxoplasma antibody titer was indicated in Mazandaran province (20.5%), while the lowest frequency was detected in Hormozgan (2.9%). In general, there was a decrease in the number of infected samples from humid areas in north to dry provinces in south of Iran. In the clinical symptoms study, no significant difference between male and female patients was demonstrated. According to the type of clinical manifestation, lymphadenopathy and central nervous system symptoms (encephalitis) were respectively the most and the least frequent manifestations.
              Article 0 comments Cited 17 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Iran J Parasitol
                Journal ID (publisher-id): IJP
                Title: Iranian Journal of Parasitology
                Publisher: Tehran University of Medical Sciences
                ISSN (Print): 1735-7020
                ISSN (Electronic): 2008-238X
                Publication date (Print): December 2010
                Volume: 5
                Issue: 4
                Pages: 55-62
                Affiliations
                [1 ]Dept. of Medical Parasitology and Mycology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
                [2 ]Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
                [3 ]Dept. of Medical Parasitology, Pasture Institute, Tehran, Iran
                [4 ]Dept. of Biostatistics, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
                Author notes
                [* ] Corresponding author: Email: Shojaee1980@ 123456yahoo.com
                Article
                Publisher ID: IJP-5-055
                PMC ID: 3279858
                PubMed ID: 22347267
                SO-VID: 4d0b0c5f-1f9c-4246-bcea-7cf9a2273199
                Copyright © © 2010 Iranian Society of Parasitology & Tehran University of Medical Sciences
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                Date received : 15 March 2010
                Date accepted : 25 November 2010
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Parasitology
                Keywords: ifa,serology,toxoplasma gondii
                Data availability:
                ScienceOpen disciplines: Parasitology
                Keywords: ifa, serology, toxoplasma gondii

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