Franco Priscila Silva, Scussel Ana Carolina Morais Oliveira, Silva Rafaela José, Araújo Thadia Evelyn, Gonzaga Henrique Tomaz, Marcon Camila Ferreira, Brito-de-Sousa Joaquim Pedro, Diniz Angélica Lemos Debs, Paschoini Marina Carvalho, Barbosa Bellisa Freitas, Martins-Filho Olindo Assis, Mineo José Roberto, Ferro Eloisa Amália Vieira, Gomes Angelica Oliveira
Universidade Federal de Uberlândia, Avenida João Naves de Ávila 2121, Uberlândia, Santa Mônica 38408-100, MG, Brazil.
Universidade Federal do Triângulo Mineiro, Rua Frei Paulino, 30, Nossa Sra. da Abadia 38025-180, Uberaba, MG, Brazil.
J Trop Med. 2024 Feb 21;2024:1514178. doi: 10.1155/2024/1514178. eCollection 2024.
To understand how congenital toxoplasmosis (CT) diagnosis has evolved over the years, we performed a systematic review and meta-analysis to summarize the kind of analysis that has been employed for CT diagnosis.
PubMed and Lilacs databases were used in order to access the kind of analysis that has been employed for CT diagnosis in several samples. Our search combined the following combining terms: "congenital toxoplasmosis" or "gestational toxoplasmosis" and "diagnosis" and "blood," "serum," "amniotic fluid," "placenta," or "colostrum." We extracted data on true positive, true negative, false positive, and false negative to generate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Random-effects models using MetaDTA were used for analysis.
Sixty-five articles were included in the study aiming for comparisons (75.4%), diagnosis performance (52.3%), diagnosis improvement (32.3%), or to distinguish acute/chronic infection phases (36.9%). Amniotic fluid (AF) and placenta were used in 36.9% and 10.8% of articles, respectively, targeting parasites and/or DNA. Blood was used in 86% of articles for enzymatic assays. Colostrum was used in one article to search for antibodies. In meta-analysis, PCR in AF showed the best performance for CT diagnosis based on the highest summary sensitivity (85.1%) and specificity (99.7%) added to lower magnitude heterogeneity.
Most of the assays being researched to diagnose CT are basically the same traditional approaches available for clinical purposes. The range in diagnostic performance and the challenges imposed by CT diagnosis indicate the need to better explore pregnancy samples in search of new possibilities for diagnostic tools. Exploring immunological markers and using bioinformatics tools and recombinant antigens should address the research needed for a new generation of diagnostic tools to face these challenges.
为了解先天性弓形虫病（CT）诊断方法多年来的演变情况，我们进行了一项系统综述和荟萃分析，以总结用于CT诊断的分析类型。
使用PubMed和Lilacs数据库，以获取多个样本中用于CT诊断的分析类型。我们的搜索组合了以下联合术语：“先天性弓形虫病”或“妊娠期弓形虫病”以及“诊断”和“血液”“血清”“羊水”“胎盘”或“初乳”。我们提取了真阳性、真阴性、假阳性和假阴性的数据，以生成合并敏感性、特异性和诊断比值比（DOR）。使用MetaDTA的随机效应模型进行分析。
65篇文章纳入了旨在进行比较（75.4%）、诊断性能（52.3%）、诊断改进（32.3%）或区分急性/慢性感染阶段（36.9%）的研究。分别有36.9%和10.8%的文章使用羊水（AF）和胎盘来检测寄生虫和/或DNA。86%的文章使用血液进行酶检测。有一篇文章使用初乳来检测抗体。在荟萃分析中，基于最高的汇总敏感性（85.1%）和特异性（99.7%）以及较低程度的异质性，AF中的PCR显示出对CT诊断的最佳性能。
大多数用于诊断CT的检测方法基本上都是临床上可用的传统方法。诊断性能的范围以及CT诊断带来的挑战表明，需要更好地探索妊娠样本，以寻找诊断工具的新可能性。探索免疫标志物、使用生物信息学工具和重组抗原来应对新一代诊断工具面对这些挑战所需的研究。
