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Volume 19, Number 12—December 2013

Dispatch

Acute Toxoplasma gondii Infection among Family Members in the United States

Despina G. Contopoulos-IoannidisComments to Author , Yvonne Maldonado, and Jose G. Montoya
Author affiliations: Stanford University School of Medicine, Stanford, California, USA (D.G. Contopoulos-Ioannidis, Y. Maldonado, J.G. Montoya); Palo Alto Medical Foundation Toxoplasma Serology Laboratory, Palo Alto, California, USA (D.G. Contopoulos-Ioannidis, J.G. Montoya)

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Table 2

Serologic test results for family index case-patients and additionally tested household members in the 18 group 1 study families*

Index case-patients (clinical information) and additional household members tested IgG by dye test ELISA results
AC/HS pattern Avidity Interpretation of infection type
IgM IgA IgE
IC-1 (LN) 512 8.3 8.5 3.1 Acute ND Acute
Wife† 4,096 3.2 10.3 1.1 Acute ND Acute
Daughter <16 0.5 0.2 0 Nonreactive ND None
Baby girl 2,048 0 (ISAGA) 2 0.2 ND ND Status NA
IC-2 (8 wks pregnant) 8,000 5.7 13.9 2.6 Acute ND Acute
Husband 16,000 4.1 3.2 3.2 Acute ND Acute
Fetus ND ND ND ND ND ND Status NA
IC-3 (8 wks pregnant) 16,000 4.6 3.4 1.1 Acute Low (7.8) Acute
Husband 8,000 7.3 >11 2.4 Acute Low (4.4) Acute
Baby boy 2,048 0 (ISAGA) 0 ND ND ND Status NA
IC-4 (27 wks pregnant) 512 5.3 5.6 0.4 Equivocal Low (2.8) Acute
Husband 1,024 5.9 12.4 Negative Acute Low (5.4) Acute
Son 16,000 7.2 >24 4.2 Acute Low (10.5) Acute
Fetus ND ND ND ND ND ND Status NA
IC-5 (11 wks pregnant) 2,048 5.8 2 0.2 Acute Low (6.7) Acute
Husband 1,024 5.8 2.3 0 Acute Low (13.2) Acute
Fetus ND ND ND ND ND ND AF PCR–
IC-6 (infant with CT) 32,000 12 (ISAGA) >24 9.5 ND ND Congenital
Mother 32,000 10.5 >24 4.6 Acute ND Acute
Father 8,000 4.9 11 1.1 Acute ND Acute
Brother 2,048 5.4 5.1 0.2 Acute ND Acute
IC-7 (LN, fever, headache) 8,000 9.9 >11.2 >20 Acute Low (1.3) Acute
Wife 32,000 5.2 9.4 1.3 Acute Low (1.0) Acute
Daughter 1 1,024 >10.0 7.2 5.3 Acute Low (1.2) Acute
Household member 512 0.9 ND ND ND ND Chronic
IC-8 (13 wks pregnant) 512 7.9 5.7 ND Acute Low (7.4) Acute
Husband 4,096 7.2 1.8 1.9 Acute Low (11.0) Acute
Baby boy A 1,024 0 (ISAGA) 0.2 ND ND ND Status NA
Baby boy B 1,024 0 (ISAGA) 0 ND ND ND Status NA
IC-9 (22 wks pregnant) 2,048 7.8 1.3 0.8 Acute Low (1.8) Acute
Husband 4,096 9.8 6.4 3.9 Acute Low (6.6) Acute
IC-10 (pregnant, third trimester) 4,096 5.4 9.4 2.9 Acute Low (5.9) Acute
Baby girl A 8,000 0 (ISAGA) 0.9 0.8 ND ND Status NA
Baby girl B 8,000 7 (ISAGA) 1.6 0.3 ND ND Congenital
Daughter 1 8,000 0.4 0.7 1.2 Equivocal Low (12.5) Recent
Daughter 2 8,000 0.7 >11.2 1.5 Acute Low (15.9) Acute
IC-11 (infant with CT) 8,000 12 (ISAGA) 4.4 ND ND ND Congenital
Mother 8,000 2.7 ND ND Acute ND Recent
Father 8,000 0 0.4 0.8 Acute Low (16.2) Recent
Sister <16 0 ND ND ND ND None
IC-12 (LN) 4,096 11.2 11.4 14.1 Acute ND Acute
Wife 8,000 >10.0 11.2 >14.0 Acute Low (3.8) Acute
Household member 1 8,000 >10.0 >20.0 >14.0 Acute Low (2.4) Acute
Household member 2 1,024 >10.0 10.2 14.9 Acute Low (11.5) Acute
IC-13 (21 wks pregnant; abortion) 1,024 8.3 0.7 ND Acute ND Acute
Husband 4,096 8.6 6.5 ND Acute ND Acute
IC-14 (infant with CT) 32,000 7 (ISAGA) >11.2 ND ND ND Congenital
Mother 8,000 5.6 >11.2 4.4 ND Low (15.7) Acute
Father 8,000 3.7 3.8 1.4 Acute Low (16.3) Acute
IC-15 (9 wks pregnant) 2,048 6.6 1.7 3.1 Equivocal Low (4.3) Acute
Husband 128 5.2 0.4 0.8 Equivocal Low (8.0) Acute
Baby boy 256 0 0 ND ND ND Status NA
IC-16 (fibromyalgia; taking steroids; fever; patient died) 8,000 9.4 4.5 11 Acute Low (0.7) Acute
Daughter 1 2,048 3.2 3.8 ND Equivocal Low (4.6) Recent
Grandson <16 0 ND ND ND ND None
Daughter 2 <16 0 ND ND ND ND None
IC-17 (eye disease) 2,048 8.1 3.4 10 Acute Low (6.8) Acute
Son 32,000 9.8 ND ND ND ND Acute
Daughter 1 128,000 8 ND ND ND ND Acute
Daughter 2 <16 0 ND ND ND ND None
IC-18 (LN) 2,048 8.8 3.2 7.1 Acute ND Acute
Wife 1,024 2.6 1.2 0.4 Acute ND Recent

*Mother-infant pairs were counted as 1 unit/household member. Interpretation of results: IgG dye test, positive >16, negative <16; IgM ELISA, positive >2.0, equivocal 1.7–1.9, negative <1.6; IgM ISAGA (for infants <6 mo of age), positive 3–12, negative 0–2; IgA ELISA, positive >2.1, equivocal 1.5–2.0, negative ≤1.4; IgE ELISA, positive >1.9, equivocal 1.5–1.8, negative <1.4; avidity, low <20, equivocal 20–30, high >30. The categorization of AC/HS test results into acute, equivocal, and nonreactive is available at www.pamf.org/serology/images/achs_grid.html. AC/HS, differential agglutination; IC, index case-patient; LN, lymphadenopathy; ND, not done; ISAGA, immunosorbent agglutination assay; NA, not ascertained; AF, amniotic fluid; CT, congenital toxoplasmosis. Serologic test results, despite equivocal AC/HS, were consistent with acute infection in IC4 and IC15 and recent infection in daughter 1 of IC10 and IC16.
†Pregnant woman who was serologically tested for toxoplasmosis because of her husband’s toxoplasmic lymphadenitis.

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