Olariu Tudor R, Remington Jack S, Montoya Jose G
From the *Palo Alto Medical Foundation Toxoplasma Serology Laboratory, Palo Alto; †Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA; and ‡Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
Pediatr Infect Dis J. 2014 Jun;33(6):566-70. doi: 10.1097/INF.0000000000000256.
Congenital toxoplasmosis can result in visual impairment, hearing loss, serious neurologic sequelae and death in the infant. We studied the potential of the polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) for diagnosis of congenital toxoplasmosis.
For this purpose, we studied both congenitally infected (diagnosed clinically and serologically) and noninfected infants born to untreated mothers.
The infants ranged in age from 0 to 180 days. CSF PCR was positive in 27 of the 58 (46.5%) congenitally infected infants and was negative in each of the 103 infants without congenital toxoplasmosis. The frequency of positive CSF PCR varied according to whether infants had major clinical signs of the disease; PCR was positive in 70.9%, 53.3% and 50.9% of those with hydrocephalus, cerebral calcifications and/or eye disease, respectively. Of 6 infants who were negative for both IgM and IgA antibodies, 3 had a positive PCR in their CSF as the confirmatory test for diagnosis of congenital toxoplasmosis. IgM and IgA antibodies and CSF PCR, when combined, yielded a higher sensitivity for diagnosis of congenital toxoplasmosis when compared with the performance of each test alone.
Our findings reveal that in infants with clinical and serologic findings suggestive of congenital toxoplasmosis and born to untreated mothers, CSF PCR has the potential to increase the frequency of cases in which the diagnosis is confirmed.
先天性弓形虫病可导致婴儿视力障碍、听力丧失、严重的神经后遗症及死亡。我们研究了脑脊液（CSF）中聚合酶链反应（PCR）用于诊断先天性弓形虫病的潜力。
为此，我们研究了未接受治疗的母亲所生的先天性感染（临床和血清学诊断）及未感染的婴儿。
婴儿年龄范围为0至180天。58例先天性感染婴儿中，27例（46.5%）脑脊液PCR呈阳性，103例无先天性弓形虫病的婴儿脑脊液PCR均为阴性。脑脊液PCR阳性频率因婴儿是否有该疾病的主要临床体征而异；患有脑积水、脑钙化和/或眼病的婴儿中，PCR阳性率分别为70.9%、53.3%和50.9%。在6例IgM和IgA抗体均为阴性的婴儿中，3例脑脊液PCR呈阳性，作为先天性弓形虫病诊断的确证试验。与单独进行每项检测相比，IgM和IgA抗体及脑脊液PCR联合检测对先天性弓形虫病诊断的敏感性更高。
我们的研究结果表明，对于临床和血清学检查结果提示先天性弓形虫病且母亲未接受治疗的婴儿，脑脊液PCR有可能提高确诊病例的比例。
