Diagnostic testing for toxoplasmosis infection
- Joseph D Schwartzman, MD
Joseph D Schwartzman, MD
- Professor of Pathology
- Dartmouth Hitchcock Medical Center
- Eskild Petersen, MD, DMSc, DTM&H
Eskild Petersen, MD, DMSc, DTM&H
- Associate Professor, Consultant
- Specialist of Infectious Diseases and Tropical Medicine
- Department of Infectious Diseases
- Aarhus University Hospital Skejby, Denmark
Toxoplasmosis is a worldwide zoonosis caused by the intracellular protozoan parasite Toxoplasma gondii (T. gondii). Infection in humans most commonly occurs through the ingestion of raw or undercooked meat that contains tissue cysts, through ingestion of water or food contaminated with oocysts, or congenitally through transplacental transmission from a mother who acquired infection during pregnancy. Transmission has also been reported through solid organ transplantation.
Laboratory testing is usually necessary to establish the diagnosis of toxoplasmosis because the clinical manifestations of infection are so protean. The diagnostic methodology requires careful consideration based on the patient’s clinical presentation. Available diagnostic modalities for T. gondii include serologic assays, molecular-based techniques (eg, polymerase chain reaction-based assays), and histopathology.
This topic will address diagnostic techniques for toxoplasmosis in the immunocompetent and immunocompromised adult. Additional topic reviews that discuss toxoplasmosis include:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Montoya JG, Remington JS. Studies on the serodiagnosis of toxoplasmic lymphadenitis. Clin Infect Dis 1995; 20:781.
- Montoya JG. Laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis. J Infect Dis 2002; 185 Suppl 1:S73.
- Montoya JG, Liesenfeld O. Toxoplasmosis. Lancet 2004; 363:1965.
- Garcia LS, Bruckner DA. Tissue protozoa. In: Diagnostic Medical Parasitology, Third Edition, ASM Press, Washington, DC 1997. p.111.
- Remington JS, McLeod R, Desmonts G. Toxoplasmosis. In: Infectious Diseases of the Fetus and Newborn Infant, Fourth Edition, Remington JS, Klein JO (Eds), WB Saunders, Philadelphia 1995. p.140.
- Sabin AB, Feldman HA. Dyes as Microchemical Indicators of a New Immunity Phenomenon Affecting a Protozoon Parasite (Toxoplasma). Science 1948; 108:660.
- Walton BC, Benchoff BM, Brooks WH. Comparison of the indirect fluorescent antibody test and methylene blue dye test for detection of antibodies to Toxoplasma gondii. Am J Trop Med Hyg 1966; 15:149.
- Roos T, Martius J, Gross U, Schrod L. Systematic serologic screening for toxoplasmosis in pregnancy. Obstet Gynecol 1993; 81:243.
- Skinner LJ, Chatterton JM, Joss AW, et al. The use of an IgM immunosorbent agglutination assay to diagnose congenital toxoplasmosis. J Med Microbiol 1989; 28:125.
- Naot Y, Desmonts G, Remington JS. IgM enzyme-linked immunosorbent assay test for the diagnosis of congenital Toxoplasma infection. J Pediatr 1981; 98:32.
- Verhofstede C, Van Renterghem L, Plum J. Comparison of six commercial enzyme linked immunosorbent assays for detecting IgM antibodies against Toxoplasma gondii. J Clin Pathol 1989; 42:1285.
- Hsu HW, Grady GF, Maguire JH, et al. Newborn screening for congenital Toxoplasma infection: five years experience in Massachusetts, USA. Scand J Infect Dis Suppl 1992; 84:59.
- Lappalainen M, Koskela P, Koskiniemi M, et al. Toxoplasmosis acquired during pregnancy: improved serodiagnosis based on avidity of IgG. J Infect Dis 1993; 167:691.
- Wilson M, Remington JS, Clavet C, et al. Evaluation of six commercial kits for detection of human immunoglobulin M antibodies to Toxoplasma gondii. The FDA Toxoplasmosis Ad Hoc Working Group. J Clin Microbiol 1997; 35:3112.
- Kaiser K, Van Loon AM, Pelloux H, et al. Multicenter proficiency study for detection of Toxoplasma gondii in amniotic fluid by nucleic acid amplification methods. Clin Chim Acta 2007; 375:99.
- Liesenfeld O, Press C, Montoya JG, et al. False-positive results in immunoglobulin M (IgM) toxoplasma antibody tests and importance of confirmatory testing: the Platelia Toxo IgM test. J Clin Microbiol 1997; 35:174.
- Naot Y, Remington JS. An enzyme-linked immunosorbent assay for detection of IgM antibodies to Toxoplasma gondii: use for diagnosis of acute acquired toxoplasmosis. J Infect Dis 1980; 142:757.
- Hedman K, Lappalainen M, Seppäiä I, Mäkelä O. Recent primary toxoplasma infection indicated by a low avidity of specific IgG. J Infect Dis 1989; 159:736.
- Bobic B, Klun I, Vujanic M, et al. Comparative evaluation of three commercial Toxoplasma-specific IgG antibody avidity tests and significance in different clinical settings. J Med Microbiol 2009; 58:358.
- Jenum PA, Stray-Pedersen B, Gundersen AG. Improved diagnosis of primary Toxoplasma gondii infection in early pregnancy by determination of antitoxoplasma immunoglobulin G avidity. J Clin Microbiol 1997; 35:1972.
- Beghetto E, Buffolano W, Spadoni A, et al. Use of an immunoglobulin G avidity assay based on recombinant antigens for diagnosis of primary Toxoplasma gondii infection during pregnancy. J Clin Microbiol 2003; 41:5414.
- Villard O, Breit L, Cimon B, et al. Comparison of four commercially available avidity tests for Toxoplasma gondii-specific IgG antibodies. Clin Vaccine Immunol 2013; 20:197.
- Robert-Gangneux F, Dardé ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev 2012; 25:264.
- Dannemann BR, Vaughan WC, Thulliez P, Remington JS. Differential agglutination test for diagnosis of recently acquired infection with Toxoplasma gondii. J Clin Microbiol 1990; 28:1928.
- Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 2004; 42:941.
- Montoya JG, Berry A, Rosso F, Remington JS. The differential agglutination test as a diagnostic aid in cases of toxoplasmic lymphadenitis. J Clin Microbiol 2007; 45:1463.
- Dupouy-Camet J, de Souza SL, Maslo C, et al. Detection of Toxoplasma gondii in venous blood from AIDS patients by polymerase chain reaction. J Clin Microbiol 1993; 31:1866.
- Mele A, Paterson PJ, Prentice HG, et al. Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature. Bone Marrow Transplant 2002; 29:691.
- Bastien P. Molecular diagnosis of toxoplasmosis. Trans R Soc Trop Med Hyg 2002; 96 Suppl 1:S205.
- Belaz S, Gangneux JP, Dupretz P, et al. A 10-year retrospective comparison of two target sequences, REP-529 and B1, for Toxoplasma gondii detection by quantitative PCR. J Clin Microbiol 2015; 53:1294.
- Frenkel JK. Toxoplasmosis. In: Pathology of Infectious Diseases, Connor DH, Chandler FW, Schwartz DA, et al (Eds), Appleton & Lange, Stamford, CT 1997. p.1261.
- Laibe S, Ranque S, Curtillet C, et al. Timely diagnosis of disseminated toxoplasmosis by sputum examination. J Clin Microbiol 2006; 44:646.
- Conley FK, Jenkins KA, Remington JS. Toxoplasma gondii infection of the central nervous system. Use of the peroxidase-antiperoxidase method to demonstrate toxoplasma in formalin fixed, paraffin embedded tissue sections. Hum Pathol 1981; 12:690.
- McCabe RE, Brooks RG, Dorfman RF, Remington JS. Clinical spectrum in 107 cases of toxoplasmic lymphadenopathy. Rev Infect Dis 1987; 9:754.
- Eapen M, Mathew CF, Aravindan KP. Evidence based criteria for the histopathological diagnosis of toxoplasmic lymphadenopathy. J Clin Pathol 2005; 58:1143.
- Maldonado YA, Read JS, COMMITTEE ON INFECTIOUS DISEASES. Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States. Pediatrics 2017; 139.
- APPROACH TO DIAGNOSIS
- SEROLOGIC TESTING
- Diagnosing acute infection
- - Initial tests
- - Interpretation of initial results
- - Additional testing
- Confirmatory IgM testing
- Avidity testing
- Agglutination assays
- Reactivation infection
- POLYMERASE CHAIN REACTION ASSAYS
- CONSIDERATIONS IN PREGNANT WOMEN
- When testing should be performed
- Which tests should be performed
- SUMMARY AND RECOMMENDATIONS