Toxoplasmosis laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings=====Interpretation of Serological Tests=== | ||
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{{familytree | | | | | | | A01 | | | | | | | | | | | | | | | | |A01=IgG/IgM(ideally performed in the first trimester}} | |||
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{{familytree | B01 | | B02 | | B03 | | B04 | | | | | | | | | | |B01='''Negative IgG and IgM'''|B02='''Positive IgG''' <br>'''Negative IgM'''|B03='''Positive IgM'''<br>'''Negative IgG'''|B04='''Positive IgG and IgM'''}} | |||
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{{familytree | C01 | | C02 | | C03 | | C04 | | | | | | | | | | | C01= ❑ No serologic evidence of Toxoplasma infection<br>❑ Risk of congenital Toxoplasmosis only if the woman aquires infection during the pregnancy<br>❑ Counsel about the preventive measures for T.gondii| C02= '''<18 weeks of gestation''' Infection aquired in the past and prior to the pregnancy<br>❑ Risk of infection is zero unless the patient is immunocompromised<br> '''≥18 weeks of gestation'''<br>❑ It is difficult to establish the timing of infection|C03=Repeat IgG and IgM in 1 to 3weeks|C04=Serum should be sent to reference laboratory for confirmatory testing<br>❑ If the confirmatory test is positive initiate treatment and if negative follow up for 12 months}} | |||
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{{familytree | D01 | | D02 | |D03| | | | | | | | | | D04 | | | | | | |D01= Follow up testing is indicated during gestation to detect seroconversion|D02= '''≤ 18 weeks of gestation'''<br> ❑ No further action indicated <br> '''>18 weeks of gestation'''<br>❑ Compare to previous serological tests and send samples to a reference laboratory to confirm the timing of infection| D03= ❑ '''Negative IgG''' and '''Positive IgM''' <br>❑ Does not have clinical relevance<ref name="pmid8968902">{{cite journal| author=Liesenfeld O, Press C, Montoya JG, Gill R, Isaac-Renton JL, Hedman K et al.| title=False-positive results in immunoglobulin M (IgM) toxoplasma antibody tests and importance of confirmatory testing: the Platelia Toxo IgM test. | journal=J Clin Microbiol | year= 1997 | volume= 35 | issue= 1 | pages= 174-8 | pmid=8968902 | doi= | pmc=229533 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8968902 }} </ref>|D04= ❑ '''Positive IgG and IgM'''<br> ❑ Seroconverted and fetus is at risk<br> ❑ Initiate treatment and consider PCR}} | |||
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<small>Table adopted from Management of Toxoplasma gondii Infection during Pregnancy<ref name="MontoyaRemington2008">{{cite journal|last1=Montoya|first1=Jose G.|last2=Remington|first2=Jack S.|title=Clinical Practice: Management ofToxoplasma gondiiInfection during Pregnancy|journal=Clinical Infectious Diseases|volume=47|issue=4|year=2008|pages=554–566|issn=1058-4838|doi=10.1086/590149}}</ref> </small> | |||
===Microscopy=== | ===Microscopy=== | ||
'''A''': Toxoplasma gondii tachyzoites, stained with Giemsa, from a smear of peritoneal fluid obtained from a mouse inoculated with T. gondii. Tachyzoites are typically crescent shaped with a prominent, centrally placed nucleus. | '''A''': Toxoplasma gondii tachyzoites, stained with Giemsa, from a smear of peritoneal fluid obtained from a mouse inoculated with T. gondii. Tachyzoites are typically crescent shaped with a prominent, centrally placed nucleus. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Laboratory Findings=====Interpretation of Serological Tests=
| IgG/IgM(ideally performed in the first trimester | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Negative IgG and IgM | Positive IgG Negative IgM | Positive IgM Negative IgG | Positive IgG and IgM | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ❑ No serologic evidence of Toxoplasma infection ❑ Risk of congenital Toxoplasmosis only if the woman aquires infection during the pregnancy ❑ Counsel about the preventive measures for T.gondii | <18 weeks of gestation Infection aquired in the past and prior to the pregnancy ❑ Risk of infection is zero unless the patient is immunocompromised ≥18 weeks of gestation ❑ It is difficult to establish the timing of infection | Repeat IgG and IgM in 1 to 3weeks | Serum should be sent to reference laboratory for confirmatory testing ❑ If the confirmatory test is positive initiate treatment and if negative follow up for 12 months | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Follow up testing is indicated during gestation to detect seroconversion | ≤ 18 weeks of gestation ❑ No further action indicated >18 weeks of gestation ❑ Compare to previous serological tests and send samples to a reference laboratory to confirm the timing of infection | ❑ Negative IgG and Positive IgM ❑ Does not have clinical relevance[1] | ❑ Positive IgG and IgM ❑ Seroconverted and fetus is at risk ❑ Initiate treatment and consider PCR | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Table adopted from Management of Toxoplasma gondii Infection during Pregnancy[2]
Microscopy
A: Toxoplasma gondii tachyzoites, stained with Giemsa, from a smear of peritoneal fluid obtained from a mouse inoculated with T. gondii. Tachyzoites are typically crescent shaped with a prominent, centrally placed nucleus.
B: Toxoplasma gondii cyst in brain tissue stained with hematoxylin and eosin (100×). C: Zoom of Image B, T. gondii cyst.
References
- ↑ Liesenfeld O, Press C, Montoya JG, Gill R, Isaac-Renton JL, Hedman K; et al. (1997). "False-positive results in immunoglobulin M (IgM) toxoplasma antibody tests and importance of confirmatory testing: the Platelia Toxo IgM test". J Clin Microbiol. 35 (1): 174–8. PMC 229533. PMID 8968902.
- ↑ Montoya, Jose G.; Remington, Jack S. (2008). "Clinical Practice: Management ofToxoplasma gondiiInfection during Pregnancy". Clinical Infectious Diseases. 47 (4): 554–566. doi:10.1086/590149. ISSN 1058-4838.