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产后先天性弓形虫病和妊娠疟疾检测:有效诊断及其对先天性感染高效管理的意义。

Congenital toxoplasmosis and pregnancy malaria detection post-partum: Effective diagnosis and its implication for efficient management of congenital infection.

作者信息

Blay Emmanuel Awusah, Ghansah Anita, Otchere Joseph, Koku Roberta, Kwofie Kofi Dadzie, Bimi Langbong, Takashi Suzuki, Ohta Nobuo, Ayi Irene

机构信息

Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P.O. Box LG581 Legon, Accra, Ghana; Section of Environmental Parasitology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku Tokyo 113-8519, Japan.

Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P.O. Box LG581 Legon, Accra, Ghana.

出版信息

Parasitol Int. 2015 Dec;64(6):603-8. doi: 10.1016/j.parint.2015.08.004. Epub 2015 Aug 8.

Abstract

Congenital toxoplasmosis (CT) and pregnancy malaria (PM) have been individually reported to cause severe negative outcomes in pregnancies but the diagnostic method is still debatable. This study sought to estimate the prevalence of PM and CT single and co-infections in pregnant women by using various specimens including plasma and placental tissues. Genomic DNA extracted from the placenta, cord blood or blood of mothers was tested by PCR. Conventional method of immunodiagnosis was done for CT. We tested 79 pregnant women aged 18-42 years (mean: 28±1.06). Prevalence of Plasmodium falciparum infection determined by PCR on mother's peripheral blood specimen was 6.3% whiles 57.3% was recorded for placental tissues (p<0.01). PCR testing for placental tissues showed 29.2% positive for Toxoplasma gondii, whiles 76.0% of mothers had serum IgG against T. gondii. It should be noted that 6.3% of the placental tissues showed PCR positive for SAG 3, a marker of active infection in T. gondii. Although there were no enhanced foetal disorders at birth in our study, there is a possibility of active transmission of T. gondii from mothers to foetuses even in immune mothers. Our study suggests that foetuses were exposed to P. falciparum and T. gondii in utero, and placenta is a better specimen for PCR in detecting such episodes. In cases of PCR-positive samples, clinical follow-up after birth may be important.

摘要

先天性弓形虫病(CT)和妊娠疟疾(PM)分别被报道可导致妊娠出现严重不良后果,但诊断方法仍存在争议。本研究旨在通过使用包括血浆和胎盘组织在内的各种标本,估计孕妇中PM和CT单一感染及合并感染的患病率。从胎盘、脐带血或母亲血液中提取的基因组DNA通过聚合酶链反应(PCR)进行检测。对CT采用常规免疫诊断方法。我们检测了79名年龄在18至42岁(平均:28±1.06岁)的孕妇。通过对母亲外周血标本进行PCR检测,恶性疟原虫感染的患病率为6.3%,而胎盘组织的患病率为57.3%(p<0.01)。对胎盘组织进行PCR检测显示,弓形虫阳性率为29.2%,而76.0%的母亲血清中抗弓形虫IgG呈阳性。需要注意的是,6.3%的胎盘组织弓形虫速殖子抗原3(SAG 3)PCR检测呈阳性,SAG 3是弓形虫活跃感染的标志物。尽管在我们的研究中出生时未发现胎儿疾病加重的情况,但即使是免疫母亲,也有可能发生弓形虫从母亲到胎儿的活跃传播。我们的研究表明,胎儿在子宫内接触了恶性疟原虫和弓形虫,胎盘是PCR检测此类感染的更好标本。对于PCR阳性样本,出生后的临床随访可能很重要。

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