scholarly journals Role ofToxoplasmaIgA as Part of a Reference Panel for the Diagnosis of Acute Toxoplasmosis during Pregnancy

2018 ◽  
Vol 57 (2) ◽  
Author(s):  
Tudor Rares Olariu ◽  
Brian G. Blackburn ◽  
Cindy Press ◽  
Jeanne Talucod ◽  
Jack S. Remington ◽  
...  
Keyword(s):  
Pregnant Women ◽  
The United States ◽  
Reference Laboratory ◽  
Content Type ◽  
Igm Antibody ◽  
Iga Antibodies ◽  
Iga Antibody ◽  
Acute Toxoplasmosis ◽  
Antibody Tests ◽  
Toxoplasmosis During Pregnancy

ABSTRACTThis study evaluated the usefulness of adding theToxoplasma gondiiIgA antibody enzyme-linked immunosorbent assay (ELISA) to the serologic panel of tests done for the diagnosis of acute toxoplasmosis in pregnant women in a reference laboratory in the United States. We conducted a retrospective study of 690 consecutive pregnant women with positiveT. gondiiIgG antibody test results who also hadT. gondiiIgA and IgM antibody tests performed. Patients were defined as acutely or chronically infected withT. gondiibased on a panel of serologic tests performed at the Palo Alto Medical Foundation Toxoplasma Serology Laboratory (PAMF-TSL). Among the 81 women who were positive byT. gondiiIgA antibody ELISA testing, 61 (75.3%) were acutely infected withT. gondii, while of the 547 who were negative by IgA testing, only 24 (4.4%) were acutely infected (P < 0.001). Among the 71 women who were positive by both IgA and IgM antibody tests, 61 (85.9%) were acutely infected, whereas 24 (19.2%) of the 125 women who were positive by only the IgM ELISA were acutely infected (P < 0.001). These results demonstrate that pregnant women withT. gondiiIgA antibodies are more likely than pregnant women withoutT. gondiiIgA antibodies to have had a recent infection withT. gondii.ToxoplasmaIgA antibody testing can therefore improve the accuracy of a serologic panel for the diagnosis of acute toxoplasmosis during pregnancy. Physicians who ordered testing only forT. gondiiIgG and IgM should also request additional testing for IgA and IgG avidity, if both IgG and IgM are positive. This further testing should, ideally, be performed in a reference laboratory.

scholarly journals The Mucosal Vaccine Adjuvant LT(R192G/L211A) or dmLT

mSphere ◽  
2018 ◽  
Vol 3 (4) ◽  
Author(s):  
John D. Clements ◽  
Elizabeth B. Norton
Keyword(s):  
Cytotoxic T Lymphocytes ◽  
The United States ◽  
Mechanisms Of Action ◽  
Mucosal Vaccine ◽  
Vaccine Adjuvant ◽  
Specific Response ◽  
Preclinical Studies ◽  
Content Type ◽  
Clinical Investigations ◽  
Iga Antibodies

ABSTRACTPerhaps the best-studied mucosal adjuvants are the bacterially derived ADP-ribosylating enterotoxins. This adjuvant family includes heat-labile enterotoxin ofEscherichia coli(LT), cholera toxin (CT), and mutants or subunits of LT and CT. These proteins promote a multifaceted antigen-specific response, including inflammatory Th1, Th2, Th17, cytotoxic T lymphocytes (CTLs), and antibodies. However, more uniquely among adjuvant classes, they induce antigen-specific IgA antibodies and long-lasting memory to coadministered antigens when delivered mucosally or even parenterally. The purpose of this minireview is to describe the general properties, history and creation, preclinical studies, clinical studies, mechanisms of action, and considerations for use of the most promising enterotoxin-based adjuvant to date, LT(R192G/L211A) or dmLT. This review is timely due to completed, ongoing, and planned clinical investigations of dmLT in multiple vaccine formulations by government, nonprofit, and industry groups in the United States and abroad.

scholarly journals Serotype Distribution, Population Structure, and Antimicrobial Resistance of Group B Streptococcus Strains Recovered from Colonized Pregnant Women

2016 ◽  
Vol 55 (2) ◽  
pp. 412-422 ◽  
Author(s):  
Sarah Teatero ◽  
Patricia Ferrieri ◽  
Irene Martin ◽  
Walter Demczuk ◽  
Allison McGeer ◽  
...  
Keyword(s):  
Population Structure ◽  
Pregnant Women ◽  
Antimicrobial Agents ◽  
Vaccine Development ◽  
Group B Streptococcus ◽  
Tetracycline Resistance ◽  
The United States ◽  
High Rate ◽  
Content Type ◽  
Group B

ABSTRACTUsing serotyping, multilocus sequence typing, and whole-genome sequencing (WGS) of selected strains, we studied the population structure of 102 group BStreptococcus(GBS) isolates prospectively sampled in 2014 from vaginal/rectal swabs of healthy pregnant women in metropolitan Toronto, Canada. We also determined the susceptibilities of each of the colonizing isolates to penicillin, erythromycin, clindamycin, tetracycline, and other antimicrobial agents. Overall, we observed a high rate of tetracycline resistance (89%) among colonizing GBS isolates. We found resistance to erythromycin in 36% of the strains, and 33% were constitutively or inducibly resistant to clindamycin. The most frequently identified serotypes were III (25%), Ia (23%), and V (19%). Serotype IV accounted for 6% of the colonizing isolates, a rate consistent with that observed among patients with invasive GBS infections in metropolitan Toronto. The majority of serotype IV isolates belonged to sequence type (ST)459, a tetracycline-, erythromycin-, and clindamycin-resistant ST first identified in Minnesota, which is considered to be the main driver of serotype IV GBS expansion in North America. WGS revealed that ST459 isolates from Canada are clonally related to colonizing and invasive ST459 organisms circulating in regions of the United States. We also used WGS to study recombination in selected colonizing strains from metropolitan Toronto, which revealed multiple episodes of capsular switching. Present and future circulating GBS organisms and their genetic diversity may influence GBS vaccine development.

scholarly journals Significance of a Positive Toxoplasma Immunoglobulin M Test Result in the United States

2015 ◽  
Vol 53 (11) ◽  
pp. 3601-3605 ◽  
Author(s):  
Reshika Dhakal ◽  
Kiran Gajurel ◽  
Christelle Pomares ◽  
Jeanne Talucod ◽  
Cynthia J. Press ◽  
...  
Keyword(s):  
United States ◽  
Chronic Infection ◽  
Serological Test ◽  
Acute Infection ◽  
The United States ◽  
Immunoglobulin M ◽  
Reference Laboratory ◽  
Test Results ◽  
Chronic Infections ◽  
Content Type

A positiveToxoplasmaimmunoglobulin M (IgM) result is often interpreted as a marker of an acute infection. However, IgM can persist for several years, andToxoplasmacommercial IgM diagnostic test kits can yield a number of false-positive results. For these reasons, a chronicToxoplasmainfection can be erroneously classified as an acute infection, resulting in serious adverse consequences, especially in pregnant women, leading to emotional distress and unnecessary interventions, including termination of pregnancy. Interpretation ofToxoplasmaserology at a reference laboratory can help differentiate a recently acquired infection from a chronic infection. Serological test results for 451 patients with positiveToxoplasmaIgM and IgG test results obtained at nonreference laboratories (NRLs) that were referred to Palo Alto Medical Foundation Toxoplasma Serology Laboratory (PAMF-TSL) to determine whether the patient was acutely or chronically infected were retrospectively reviewed. PAMF-TSL results established that of the 451 patients, 335 (74%) had a chronic infection, 100 (22%) had an acute infection, and 7 (2%) were not infected, and for 9 (2%), results were indeterminate. PositiveToxoplasmaIgM and IgG test results obtained at NRLs cannot accurately distinguish between acute and chronic infections. To do so, testing at reference laboratories is required, as mandated in 1997 in a letter from the Food and Drug Administration (FDA) to clinicians and laboratories in the United States.

scholarly journals Prospective Evaluation of an Australian Pertussis Toxin IgG and IgA Enzyme Immunoassay

2011 ◽  
Vol 19 (2) ◽  
pp. 190-197 ◽  
Author(s):  
Meryta L. May ◽  
Suhail A. Doi ◽  
David King ◽  
Jenny Evans ◽  
Jennifer M. Robson
Keyword(s):  
Pertussis Toxin ◽  
Serological Test ◽  
The United States ◽  
Case Definition ◽  
Serum Samples ◽  
Pertussis Infection ◽  
Content Type ◽  
Australian Community ◽  
Iga Response ◽  
Iga Antibody

ABSTRACTSerological diagnosis of recent pertussis infection is an important part of both clinical assessment and epidemiological documentation of this disease. Standardization of serological testing and interpretation remains challenging despite international efforts to improve it. Currently, determining the anti-pertussis toxin (PT) IgG titer is recommended as the most accurate serological test in Europe and the United States, while Australia relies predominantly on measurement ofBordetella pertussisIgA antibody responses. UsingB. pertussisPCR and the WHO clinical case definition as reference standards, the diagnostic utility of in-house anti-PT IgG and anti-PT IgA assays was evaluated prospectively in an Australian community-based cohort (n= 327). Patients provided up to four consecutive serum samples to document the kinetics of antibody response and decay. Previously validated cutoffs for positivity were converted to international units by using WHO-approved reference sera. At currently used cutoffs, both anti-PT IgG (>94 IU/ml) and anti-PT IgA (>20 IU/ml) assays had good specificity (80% [95% confidence interval {95% CI}, 68 to 88%] and 87% [95% CI, 77 to 94%]), but anti-PT IgG assay was consistently more sensitive than anti-PT IgA assay across a range of cutoffs (60 to 79% [95% CI, 53 to 84%] versus 41 to 62% [95% CI, 34 to 69%]). The combination of anti-PT IgG and anti-PT IgA assays performed no better than anti-PT IgG assay alone. The anti-PT IgA response in children under 12 years of age was poor. The accuracy of serology was optimal between 2 and 8 weeks after symptom onset. Cutoffs of >94 IU/ml for anti-PT IgG and >20 IU/ml for anti-PT IgA correlated well with recent pertussis infection and were consistent with recent recommendations from the EU Pertstrain group. Anti-PT IgG assay was superior to anti-PT IgA assay as the test of choice for the diagnosis of pertussis from a single sample.

scholarly journals Screening for toxoplasmosis during pregnancy: One-year experience in an Italian reference laboratory

2010 ◽  
Vol 20 (1) ◽  
pp. 35 ◽  
Author(s):  
Valeria Meroni ◽  
Francesca Genco
Keyword(s):  
Pregnant Women ◽  
Acute Infection ◽  
Congenital Toxoplasmosis ◽  
Reference Laboratory ◽  
Toxoplasma Infection ◽  
Igg Avidity ◽  
Acute Toxoplasmosis ◽  
One Year ◽  
First Time

AIMS: To describe the experience of the Toxoplasmosis Laboratory of Infectious Disease Department University of Pavia, IRCCS Foundation, San Matteo Polyclinic Pavia, a reference laboratory for diagnosis of toxoplasmosis, in the investigation of pregnant women with suspected acute toxoplasmosis. METHODS: All sera were tested with LIAISON® Toxo IgM and IgG II, Toxo IgG Avidity II kits (DiaSorin, Saluggia, Italy), VIDAS Toxo IgG II and Toxo IgG Avidity (bioMérieux, Marcy l’Etoile, France ), IgM ISAGA (bioMérieux, Marcy l’Etoile, France) and ETI-TOXOK-A reverse PLUS (DiaSorin, Saluggia, Italy). When required (IgG negative/IgM positive women), IgG/IgM Western Blot II (LDBio, Lyon, France) was also performed. Prenatal diagnosis on amniotic fluid was done by nested PCR. All newborns were followed up to one year of age in order to exclude or confirm the diagnosis of congenital toxoplasmosis. All pregnant women with acute or undetermined stages of infection were treated. RESULTS: In the course of 2007, 236 women with suspected acute (IgM-positive) Toxoplasma infection were followed up. In the reference laboratory, 91 women had test results indicating acute toxoplasmosis, and 10 had undetermined status of infection. These 101 patients represented 42.8% of the 236 women referred. Acute toxoplasmosis could be excluded in the remaining 135 patients, of whom 53 were non-immune. Three infected newborns were observed, all from mothers tested for the first time during the third trimester of pregnancy. CONCLUSIONS: The role of a reference laboratory in suspected toxoplasmosis acquired during pregnancy is crucial to date the infection and discriminate between seroconversion and false positive anti-Toxoplasma IgM antibodies. This avoids unnecessary anxiety in immune women, provides correct counseling about primary prevention and periodic testing for seronegative ones, and allows early treatment and follow-up of pregnant women with acute infection and their newborns.

Seasonal variation of acute toxoplasmic lymphadenopathy in the United States

2014 ◽  
Vol 143 (9) ◽  
pp. 1893-1897 ◽  
Author(s):  
D. CONTOPOULOS-IOANNIDIS ◽  
J. TALUCOD ◽  
Y. MALDONADO ◽  
J. G. MONTOYA
Keyword(s):  
United States ◽  
Seasonal Variation ◽  
Rural Areas ◽  
Acute Infection ◽  
The United States ◽  
Circular Statistics ◽  
Reference Laboratory ◽  
Serological Tests ◽  
Factors Associated ◽  
Acute Toxoplasmosis

SUMMARYWe describe the seasonal variation of acute toxoplasmosis in the United States. Acute toxoplasmic lymphadenopathy (ATL) can be a surrogate of acute toxoplasmosis in patients in whom the date of onset of lymphadenopathy matches the window of acute infection predicted by serological tests performed at a reference laboratory. We used the electronic database of the Palo Alto Medical Foundation Toxoplasma Serology Laboratory (PAMF-TSL) (1997–2011) to identify cases of ATL. We tested the uniformity of distribution of ATL cases per month, across the 12 calendar months, using circular statistics uniformity tests. We identified 112 consecutive cases of ATL. The distribution of cases was not uniform across the 12 calendar months. We observed the highest peak of cases in December and a second highest peak in September. Similar months were identified in patients with acute toxoplasmosis in rural areas in France. The results were similar when we performed weighted analyses, weighting for the total number of Toxoplasma gondii IgG tests performed per month in the PAMF-TSL laboratory. This is the largest study to date of the seasonal variation of ATL in the United States. Physicians should advise high-risk individuals to avoid risk factors associated with T. gondii infections especially around those months.

scholarly journals Survey of Obstetrician-Gynecologists in the United States About Toxoplasmosis

2001 ◽  
Vol 9 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Jeffrey L. Jones ◽  
Vance J. Dietz ◽  
Michael Power ◽  
Adriana Lopez ◽  
Marianna Wilson ◽  
...  
Keyword(s):  
United States ◽  
Pregnant Women ◽  
False Positive ◽  
Universal Screening ◽  
The United States ◽  
Research Network ◽  
Educational Materials ◽  
The Past ◽  
Control And Prevention ◽  
Acute Toxoplasmosis

Background:Although the incidence of toxoplasmosis is low in the United States, up to 6000 congenital cases occur annually. In September 1998, the Centers for Disease Control and Prevention held a conference about toxoplasmosis; participants recommended a survey of the toxoplasmosis-related knowledge and practices of obstetrician-gynecologists and the development of professional educational materials for them.Methods:In the fall of 1999, surveys were mailed to a 2% random sample of American College of Obstetricians and Gynecologists (ACOG) members and to a demographically representative group of ACOGmembers known as theCollaborative Ambulatory Research Network(CARN). Responses were not significantly different for the random and CARN groups for most questions (pvalue shown when different).Results:Among 768 US practicing ACOG members surveyed, 364 (47%) responded. Seven per cent (CARN 10%, random 5%) had diagnosed one or more case(s) of acute toxoplasmosis in the past year. Respondents were well-informed about how to prevent toxoplasmosis. However, only 12% (CARN 11%, random 12%) indicated that a positiveToxoplasmaIgM test might be a false–positive result, and only 11% (CARN 14%, random 9%) were aware that the Food and Drug Administration sent an advisory to all ACOG members in 1997 stating that someToxoplasmaIgM test kits have high false–positive rates. Most of those surveyed (CARN 70%, random 59%;X2p< 0.05) were opposed to universal screening of pregnant women.Conclusions:Many US obstetrician-gynecologists will encounter acute toxoplasmosis during their careers, but they are frequently uncertain about interpretation of the laboratory tests for the disease. Most would not recommend universal screening of pregnant women.

scholarly journals Diagnosis of Acute Toxoplasmosis by IgG and IgM Antibodies and IgG Avidity in Pregnant Women from Mashhad, Eastern Iran

2019 ◽  
Author(s):  
Karam SHARIFI ◽  
Bibi Razieh HOSSEINI FARASH ◽  
Fatemeh TARA ◽  
Azad KHALEDI ◽  
Karim SHARIFI ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Acute Infection ◽  
P Value ◽  
High Avidity ◽  
Toxoplasma Infection ◽  
Cross Sectional ◽  
Igm Antibody ◽  
Igg Avidity ◽  
Total Prevalence ◽  
Acute Toxoplasmosis

Background: We aimed to evaluate the diagnosis of acute toxoplasmosis by IgG avidity test in pregnant women. Methods: In this cross-sectional study, 250 blood samples were collected from pregnant women with the first month of their pregnancy referring to health centers of University in Mashhad during 2016. Samples were centrifuged at 3000 rpm for 5 min for separation of serum and were kept in the -20 until use. To detection of acute and chronic toxoplasmosis, anti-Toxoplasma antibodies (IgG and IgM, and IgG avidity tests were performed using ELISA. Then, data analyzed using SPSS software by Frequency, Pearson Chi-Square, Likelihood Ratio, and Exact tests. And P-value<0.05 was statistically considered as significant. Results: Total prevalence of IgG and IgM was 23.2% and 7.2%, respectively. A significant correlation was observed between the mean age and IgG level (P<0.05). It was not found any correlation between the history of raw meat consumption, cats keeping, education, and residency site. Moreover, 16 people (6.4%) had IgM antibody, of which, 10 cases (62.5%) with low avidity for IgG and 1 people (6.2%) with moderate avidity and 5 cases (31.3%) with high avidity for IgG. Moreover, 76% of pregnant women were seronegative. Conclusion: More than half of the women (62.5%) with positive IgM antibody in their serum had a low avidity for IgG which revealed an acute infection among pregnant women. Toxoplasma infection should be considered as an important factor that affects the pregnancy and IgG avidity as an important test for screening the women who need the treatment.

Role of gatekeeping on Facebook in creating information benefits for vulnerable, pregnant women in the rural United States

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Devendra Dilip Potnis ◽  
Macy Halladay
Keyword(s):  
United States ◽  
Pregnant Women ◽  
Value Chain ◽  
The United States ◽  
Information Value ◽  
Sociological Study ◽  
Content Type ◽  
Qualitative Approaches ◽  
Types Of Information

PurposeThe purpose of this study is to investigate why and how gatekeepers on social networking sites (SNS) create what types of information benefits for gated, vulnerable, pregnant women in the rural United States.Design/methodology/approachThis qualitative study adopts “network gatekeeping” as a theoretical lens to implement a combination of deductive and inductive qualitative approaches for analyzing in-depth interviews with members and administrators of a Vaginal Birth After Cesarean (VBAC) Group on Facebook with a membership of over 500 pregnant women in rural Appalachia in the United States.FindingsThe VBAC group administrators' (a) vision of transforming the existing doctor-centric birth culture to a more mother-centric birth culture in the rural United States, (b) expertise and experience in healthcare and (c) valuing scientific, evidence-based information lead to recurring, authoritative but evolving manifestations of combinations of nine network gatekeeping mechanisms. Implementations of nine network gatekeeping mechanisms (i.e. localization, infrastructure, cost effect, channeling, censorship, regulation, editorial, user-interaction and value adding mechanisms) help VBAC group administrators control interactions and information on the group, thereby creating 16 information benefits for the gated, vulnerable women before, during and after pregnancy.Originality/valueThis sociological study of network gatekeeping posits and proves an “information value chain” (i.e. Why to create information benefits? – How to create information benefits? – What types of information benefits?) for vulnerable, pregnant women on Facebook. Rarely any study shows the role of network gatekeeping mechanisms in implementing an information value chain.

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