Université de Rennes, CHU Rennes, Inserm, EHESP, Irset-UMR_S 1085, Rennes, France.
National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, Belgrade, Serbia.
J Clin Microbiol. 2021 Jan 21;59(2). doi: 10.1128/JCM.01368-20.
Neonatal diagnosis of congenital toxoplasmosis is based on a combination of serological and molecular tests. Maternal screening and treatment differ according to national policies and may impact the sensitivity of diagnostic methods in infants at birth. In this multicenter study, 115 neonates born to 61 treated (53%) and 54 (47%) untreated women were retrospectively included in three centers (France, Serbia, and the United States) to assess the impact of maternal anti- treatment on the performance of neonatal workup at birth (neosynthesized anti- IgM, IgA, and IgG and quantitative PCR [qPCR]) using univariate and multivariate approaches. Independently of the time of maternal seroconversion, the serological techniques were impacted differently by maternal treatment. The detection of IgM by immunosorbent agglutination assay (ISAGA) and Western blotting (WB) dropped from 90.7% and 88.2% in untreated neonates to 53.3% and 51.9% in treated neonates ( < 0.05), whereas IgM enzyme-linked immunosorbent assay (ELISA) and IgA ISAGA were not significantly affected by maternal treatment. A 2-fold reduction in the sensitivity of neosynthesized IgG by WB was also observed in the case of treatment during pregnancy (37.7% versus 82.3%). Interestingly, the effect of treatment was shown to be duration dependent, especially for IgM detection, when the treatment course exceeded 8 weeks, whatever the therapy. The sensitivity of PCR in blood was also lowered by maternal treatment from 39.1% to 23.2%. These results highlight that anti- therapy during pregnancy may set back biological evidence of neonatal infection at birth and underline the need for a careful serological follow-up of infants with normal workup.
先天性弓形虫病的新生儿诊断基于血清学和分子检测的联合应用。根据各国政策，母体筛查和治疗有所不同，这可能会影响出生时婴儿诊断方法的敏感性。在这项多中心研究中，回顾性纳入了来自三个中心（法国、塞尔维亚和美国）的 61 例接受治疗（53%）和 54 例未接受治疗（47%）孕妇所生的 115 例新生儿，以评估母体抗治疗对出生时新生儿检查（新合成的抗 IgM、IgA 和 IgG 以及定量 PCR[qPCR]）的影响。采用单变量和多变量方法，无论母体血清学转换时间如何，血清学技术都会受到母体治疗的不同影响。免疫吸附凝集试验（ISAGA）和 Western blot（WB）检测的 IgM 从未治疗新生儿的 90.7%和 88.2%下降到治疗新生儿的 53.3%和 51.9%（ < 0.05），而酶联免疫吸附试验（ELISA）和 IgA ISAGA 不受母体治疗的显著影响。如果在怀孕期间进行治疗，WB 检测的新合成 IgG 的敏感性也会降低 2 倍（37.7%对 82.3%）。有趣的是，治疗效果显示与治疗持续时间有关，特别是在治疗疗程超过 8 周时，无论采用何种治疗方法，IgM 检测均如此。血液中 qPCR 的敏感性也因母体治疗而降低，从 39.1%降至 23.2%。这些结果表明，怀孕期间的抗治疗可能会使出生时新生儿感染的生物学证据倒退，并强调需要仔细监测检查正常的婴儿的血清学变化。
