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Objective: Toxoplasmosis acquired in early pregnancy is a potentially severe complication for the fetus. Evaluating the risk of transplacental infection in pregnant women accessing the Tuscany Reference Center for Infectious Diseases in Pregnancy during the last 20 years with suspected or confirmed toxoplasmosis acquired in early pregnancy was the aim of the study.Study Design: We retrospectively enrolled all pregnant women undergoing amniocentesis for toxoplasmosis acquired in the first 16 gestational weeks in the period 1999-2019, comparing patients with certain acute infection (seroconversion occurred in pregnancy, CAIP) with those with suspected acute infection (IgG positive with low/intermediate IgG avidity index, SAIP).Results: 237 patients were enrolled, 187 (78.9%) with SAIP and 50 (21.1%) with CAIP. Specific IgM was detected in 47.5% and 76.7% (p-value 0.001), and the mean IgG avidity index was 22.7% and 7.1% (p-value < 0.001) in the SAIP and in the CAIP group, respectively. The mean delay from diagnosis to antibiotic initiation was 14.6 in SAIP and 11 days in CAIP group. Toxoplasma DNA was detected in the amniotic fluid in one case in a patient with CAIP. Excluding 24 newborns with not available data, prevalence of congenital infection was 0.47% [1/213 (95% CI 0.08%-2.61%)], 0% [0/178 (95% CI 0%-2.11%)] in SAIP and 2.8% [1/35 (95% CI 0.51%-14.53%)] in CAIP group.Conclusions: Toxoplasmosis acquired in early pregnancy has a low risk of fetal infection. Actively discussing case-by-case amniocentesis indication with patients, especially when a recent toxoplasmosis is not properly confirmed, is desirable. [ABSTRACT FROM AUTHOR]

Proper diagnosis of toxoplasmosis is very important for proper treatment in manifested cases and to prevent congenital toxoplasmosis in case of pregnancy. Screening of 180 pregnant females by automated immune assay for Toxoplasma IgG and IgM Abs was done first then positive cases and some of negative cases were evaluated for the Toxoplasma IgG avidity test versus Toxoplasma IgM and IgA Abs using ELISA technique for the detection of active toxoplasmosis during gestation using IHA rising titer as reference test. Assessment of Toxoplasma IgM by ELISA compared with rising titer of IHA as a reference test revealed that the sensitivity, specificity, PPV, and NPP of IgM by ELISA were 66.67, 88.73, 42.86, and 95.45%, respectively. Assessment of Toxoplasma IgA Abs by ELISA compared with rising titer IHA as a reference test showed that the sensitivity, specificity, PPV, and NPP of IgA Abs by ELISA were 44.4, 92.96, 44.4, and 92.96%, respectively. Additionally, by assessment of Toxoplasma IgG avidity compared with rising titer of IHA as a reference test, the sensitivity, specificity, PPV, and NPP of Toxoplasma IgG avidity were 100, 98.59, 90%, and 100%, respectively. Detection of specific Toxoplasma IgM by ELISA is not always sufficient in the diagnosis of early and late during pregnancy, because Toxoplasma-specific IgM antibodies may persist as long as 18 months after acute acquired infection. Thus, the specific IgG avidity test should be used as more or less low cost tool to detect acute . [ABSTRACT FROM AUTHOR]

Abstract: The preliminary diagnostic utility of two mixtures of Toxoplasma gondii recombinant antigens (rROP1+rSAG2 and rROP1+rGRA6) in IgG ELISA and IgG avidity test has been evaluated. A total of 173 serum samples from patients with toxoplasmosis and seronegative people were examined. The sensitivity of IgG ELISA for rROP1+rSAG2 and rROP1+rGRA6 was 91.1% and 76.7%, respectively, while the reactivity for sera from patients where acute toxoplasmosis was suspected was higher, at 100% and 95.4%, respectively, than for people with chronic infection, at 88.2% and 70.6%. In this study a different trend in avidity maturation of IgG antibodies for two mixtures of proteins in comparison with native antigen was observed. The results suggest that a new IgG avidity test using the mixtures of recombinant antigens may be useful for the diagnosis of difficult-to-identify phases of toxoplasmosis. For this reason, selected mixtures after the additional tests on groups of sera with well-defined dates of infection could be used as a better alternative to the native antigens of the parasite in the serodiagnosis of human T. gondii infection. [Copyright &y& Elsevier]

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