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50 C. Contini - management of toxoplasmosis in immunocompromised patients Bourland DD et al (1993). Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. Members of the ACTG 077p/ANRS 009 Study Team. N Engl J Med; 329:995- 1000. Martino R, Bretagne S, Einsele H, Maertens J, Ullmann AJ, Parody R, et al (2005). Early detection of Toxoplasma infection by molecular monitoring of Toxoplasma gondii in peripheral blood samples after allogeneic stem cell transplantation. Clin Infect Dis; 40:67-78. Mechain B, Garin JGF, Gagneux FR, Camet JD, Derouin F (2000). Lack of Utility of Specific Immunoglobulin G Antibody Avidity for Serodiagnosis of Reactivated Toxoplasmosis in Immunocompromised Patients. Clin Diagn Lab Immunol; 7: 703–705. Meisel R, Stachelhaus S, Mevelec MN, Reichman G, Dubermetz JF, Fischer HG (1996). 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Parassitologia 50: 51-53, 2008 Toxoplasmosis in pregnancy: evaluation of diagnostic methods V. Meroni, F. Genco Infectious Diseases Department University of Pavia, Foundation IRCCS Policlinico San Matteo Pavia Introduction Abstract. Toxoplasmosis in pregnancy is usually subclinic or associated with non specific symptoms. Diagnosis and timing of infection are usually based on serological tests. In this short review we tried to summarize the serological patterns we can encounter and to discuss the interpretation of test results Toxoplasma gondii is an obligate intracellular protozoan that infects almost a third of the world’s population. Primary infection with T. gondii in pregnant women may result in congenital toxoplamosis via transplacental transmission. The extent of damage depends mainly on when the mother gets infected, with consequences being more severe during the early phases of gestation. However, transmission is more frequent during late pregnancy (Dunn et al., 1999). As parasitaemia lasts only few days and infection is often asymptomatic, the diagnosis relies mainly on serology (Montoya and Liesenfeld, 2004). Diagnosis of toxoplasmosis in pregnancy has two goals: to evaluate the immune status of the woman, and in case of acute infection, to date the time of infection. It is therefore advisable to perform serological tests before or at the beginning of pregnancy. Serological Tests Key words: toxoplasmosis in pregnancy, serological tests, prenatal diagnosis Given the kinetics of antibody production, the screening tests for toxoplasmosis are based on measurement of specific anti-Toxoplasma IgG and IgM antibodies with automated tests, which usually have a good sensitivity and specificity. Anti–Toxoplasma IgG antibodies are produced throughout life after infection. Detection in a single sample at any titre with any test is a marker of previous infection. IgM antibodies are detected in recently acquired infections but may persist for more than a year. Furthermore false positive, aspecific reaction may be recorded in IgG negative patients. Four different serological patterns may be seen (Montoya and Liesenfeld, 2004; Sensini 2006). Correspondence: Valeria Meroni Infectious Diseases Department University of Pavia, Foundation IRCCS Policlinico San Matteo Pavia, e-mail: v.meroni@smatteo.pv.it 1-IgG negative IgM negative No immunity. Hygienic alimentary prophylaxis and monthly follow up (if possible until one month after delivery) in order to avoid seroconversion are advised. Indeed there is some evidence that health education may reduce the risk of seroconversion and consequently of congenital toxoplasmosis. (Gollub et al., 2008). In Italy, the screening test in pregnancy is not mandatory but National Health System pays for a preconceptional test and for the follow-up of negative women (DPR245 10/09/98) so most of pregnant women undergo the monthly controls. 2-IgG positive IgM negative. Previous immunity, if the tests have been done before or at the beginning of pregnancy. No further sampling including further pregnancies is required. In the third trimester, a negative IgM test cannot exclude an infection in the first trimester; in these cases it is necessary to perform other tests such as IgG avidity and further testing one month later to evaluate serological stability. 3-IgG negative IgM positive. Early seroconversion or false positive result (Gussetti et al., 1990). In any seroconversion, IgG must must be produced, so it is mandatory to repeat a weekly sampling to detect IgG. If the patient has been treated, however, IgG production might be delayed and decreased. If this is the case, it is preferable to employ different tests (IgG-IgM Immunoblot, cellular immunity tests ) to obtain a diagnosis as early as possible. If a seroconversion has been proved, by using additional tests ,the clinician should prescribe the correct therapy. This also allows to advice the woman for prenatal diagnosis. If seroconversion is not confirmed ,treatment can be safely discontinued.. Immunoblot for IgG and IgM is a very specific test when purified antigens (not commercially available) are employed. The presence of 3 bands for IgG and two bands for IgM against 30-40 kD proteins can confirm seroconversion earlier than any other test (Sharma et al., 1983).
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PARASSITOLOGIA A publication of the
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100 pyriproxyfen is twice as biolog
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fall recorded in the considered per
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SIMPOSIO 4 IL RUOLO DELLA RICERCA N
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136 Program financed by ANTIMAL. S.
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148 geographic distribution in sub-
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150 K.E., Beldjord, C., Nagel, R.L.
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