Document Detail


Novel interpretation of molecular diagnosis of congenital toxoplasmosis according to gestational age at the time of maternal infection.
MedLine Citation:
PMID:  23035201     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
From a prospective cohort of 344 women who seroconverted for toxoplasmosis during pregnancy, 344 amniotic fluid, 264 placenta, and 216 cord blood samples were tested for diagnosis of congenital toxoplasmosis using the same PCR assay. The sensitivity and negative predictive value of the PCR assay using amniotic fluid were 86.3% and 97.2%, respectively, and both specificity and positive predictive value were 100%. Using placenta and cord blood, sensitivities were 79.5% and 21.2%, and specificities were 92% and 100%, respectively. In addition, the calculation of pretest and posttest probabilities and the use of logistic regression allowed us to obtain curves that give a dynamic interpretation of the risk of congenital toxoplasmosis according to gestational age at maternal infection, as represented by the three sample types (amniotic fluid, placenta, and cord blood). Two examples are cited here: for a maternal infection at 25 weeks of amenorrhea, a negative result of prenatal diagnosis allowed estimation of the probability of congenital toxoplasmosis at 5% instead of an a priori (pretest) risk estimate of 33%. For an infection at 10 weeks of amenorrhea associated with a pretest congenital toxoplasmosis risk of 7%, a positive PCR result using placenta at birth yields a risk increase to 43%, while a negative result damps down the risk to 0.02%. Thus, with a molecular diagnosis performing at a high level, and in spite of the persistence of false negatives, posttest risk curves using both negative and positive results prove highly informative, allowing a better assessment of the actual risk of congenital toxoplasmosis and finally an improved decision guide to treatment.
Authors:
Yvon Sterkers; Francine Pratlong; Sahar Albaba; Julie Loubersac; Marie-Christine Picot; Vanessa Pretet; Eric Issert; Pierre Boulot; Patrick Bastien
Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2012-10-03
Journal Detail:
Title:  Journal of clinical microbiology     Volume:  50     ISSN:  1098-660X     ISO Abbreviation:  J. Clin. Microbiol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-19     Completed Date:  2013-04-17     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  7505564     Medline TA:  J Clin Microbiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3944-51     Citation Subset:  IM    
Affiliation:
Centre Hospitalier Régional Universitaire (CHRU) of Montpellier and University Montpellier I (Faculty of Medicine), Department of Parasitology-Mycology and Molecular Biology Pole of the French National Reference Centre for Toxoplasmosis, Montpellier, France.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Amniotic Fluid / parasitology
Female
Fetal Blood / parasitology
Gestational Age*
Humans
Infant, Newborn
Male
Molecular Diagnostic Techniques / methods*
Placenta / parasitology
Polymerase Chain Reaction
Pregnancy
Pregnancy Complications, Infectious / diagnosis*
Sensitivity and Specificity
Time Factors
Toxoplasmosis, Congenital / diagnosis*
United States
Young Adult
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