Volume 19, Number 12—December 2013
Dispatch
Acute Toxoplasma gondii Infection among Family Members in the United States
, Yvonne Maldonado, and Jose G. Montoya
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.