PDF(Pubmed)
Abstract：
Toxoplasma gondii is a parasitic infection that can be transmitted in utero, resulting in fetal chorioretinitis and other long-term neurological outcomes. If diagnosed early, pregnancy-safe chemotherapeutics can prevent vertical transmission. Unfortunately, diagnosis of acute, primary infection among pregnant women remains neglected, particularly in low-and-middle-income countries. Clinically actionable diagnosis is complex due to the commonality of infection during childhood and early adulthood which spawn long-last antibody titers and historically unreliable direct molecular diagnostics. The current study employed a cross-sectional T. gondii perinatal surveillance study using digital PCR, a next generation molecular diagnostic platform, and a maternal-fetal outcomes survey to ascertain the risk of vertical toxoplasmosis transmission in the Western Region of El Salvador. Of 198 enrolled mothers at the time of childbirth, 6.6% had evidence of recent T. gondii infection-85% of these cases were identified using digital PCR. Neonates born to these acutely infected mothers were significantly more likely to meconium aspiration syndrome and mothers were more likely to experience labor and delivery complications. Multivariable logistic regression found higher maternal T. gondii infection odds were associated with the presence of pet cats, the definitive T. gondii host. In closing, this study provides evidence of maternal T. gondii infection, vertical transmission and deleterious fetal outcomes in a vulnerable population near the El Salvador-Guatemala border. Further, this is the first published study to show clinical utility potential of digital PCR for accurate diagnosis of congenital toxoplasmosis cases.
摘要：
弓形虫是一种寄生虫感染，可以在子宫内传播，导致胎儿脉络膜视网膜炎和其他长期神经系统结局。如果早期诊断，怀孕安全的化学疗法可以防止垂直传播。不幸的是,急性诊断，孕妇的原发性感染仍然被忽视，特别是在中低收入国家。临床可操作的诊断是复杂的，因为儿童和成年早期感染的共性会产生持久的抗体滴度和历史上不可靠的直接分子诊断。当前的研究采用了使用数字PCR的横断面弓形虫围产期监测研究，下一代分子诊断平台，以及一项母婴结局调查，以确定萨尔瓦多西部地区垂直弓形虫病传播的风险。在198名分娩时登记的母亲中，6.6%的人有最近弓形虫感染的证据-85%的病例是使用数字PCR鉴定的。这些急性感染母亲所生的新生儿更有可能发生胎粪吸入综合征，母亲更有可能经历分娩和分娩并发症。多变量逻辑回归发现，较高的母体弓形虫感染几率与宠物猫的存在有关，确定的弓形虫宿主。在结束时,这项研究提供了母体弓形虫感染的证据，在萨尔瓦多-危地马拉边界附近的脆弱人群中，垂直传播和有害的胎儿结局。Further,这是第一项发表的研究，显示数字PCR在先天性弓形虫病病例的准确诊断中的临床应用潜力。
