Optimization and evaluation of a PCR assay for detecting toxoplasmic encephalitis in patients with AIDS

Joseph, P; Calderon, MM; Gilman, RH; Quispe, ML; Cok, J; Ticona, E; Chavez, V; Jimenez, JA; Chang, MC; Lopez, MJ; Evans, CA; (2002) Optimization and evaluation of a PCR assay for detecting toxoplasmic encephalitis in patients with AIDS. Journal of clinical microbiology, 40 (12). pp. 4499-503. ISSN 0095-1137 DOI: https://doi.org/10.1128/JCM.40.12.4499-4503.2002

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Toxoplasma gondii is a common life-threatening opportunistic infection. We used experimental murine T. gondii infection to optimize the PCR for diagnostic use, define its sensitivity, and characterize the time course and tissue distribution of experimental toxoplasmosis. PCR conditions were adjusted until the assay reliably detected quantities of DNA derived from less than a single parasite. Forty-two mice were inoculated intraperitoneally with T. gondii tachyzoites and sacrificed from 6 to 72 h later. Examination of tissues with PCR and histology revealed progression of infection from blood to lung, heart, liver, and brain, with PCR consistently detecting parasites earlier than microscopy and with no false-positive results. We then evaluated the diagnostic value of this PCR assay in human patients. We studied cerebrospinal fluid and serum samples from 12 patients with AIDS and confirmed toxoplasmic encephalitis (defined as positive mouse inoculation and/or all of the Centers for Disease Control clinical diagnostic criteria), 12 human immunodeficiency virus-infected patients with suspected cerebral toxoplasmosis who had neither CDC diagnostic criteria nor positive mouse inoculation, 26 human immunodeficiency virus-infected patients with other opportunistic infections and no signs of cerebral toxoplasmosis, and 18 immunocompetent patients with neurocysticercosis. Eleven of the 12 patients with confirmed toxoplasmosis had positive PCR results in either blood or cerebrospinal fluid samples (6 of 9 blood samples and 8 of 12 cerebrospinal fluid samples). All samples from control patients were negative. This study demonstrates the high sensitivity, specificity, and clinical utility of PCR in the diagnosis of toxoplasmic encephalitis in a resource-poor setting.

Item Type: Article
Keywords: AIDS-Related Opportunistic Infections/*diagnosis/parasitology, Animals, Cerebrospinal Fluid/parasitology, DNA, Protozoan/blood, Disease Models, Animal, Encephalitis/*diagnosis/parasitology, Humans, Mice, Polymerase Chain Reaction/*methods, Sensitivity and Specificity, Toxoplasma/genetics/*isolation & purification, Toxoplasmosis, Cerebral/*diagnosis/parasitology
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 12454142
Web of Science ID: 179631500016
URI: http://researchonline.lshtm.ac.uk/id/eprint/5214


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