Comparison of ELISA Diagnostic Methods (IgG, IgM) and Real Time PCR in Identifying Toxoplasma in Women with Abortion
-
Ayad Sakran Naeemah Alhubaish
,
haniyeh Bashi Zadeh Fakhar
,
Sara Taheri Neyestanaki
,
Parnian Sadat Shahidi
Abstract
Background: Toxoplasmosis as a frequent parasitic infection is caused by Toxoplasma gondii, transmitted through contaminated food or water. Maternal infection during pregnancy can lead to serious complications including miscarriage and congenital defects, requiring accurate diagnosis for proper management.
Methods: This study analyzed 120 women with spontaneous abortion (ages 18-45, gestational age 6-20 weeks) who were referred to Baqiyatallah Hospital in Tehran from February 2021 to February 2022. Blood samples were collected and assessed using ELISA for IgG/IgM antibodies and real-time PCR for T. gondii B1 gene detection, with statistical analysis performed using Stata software to evaluate diagnostic accuracy and associations.
Results: This study investigated Toxoplasma gondii infection in 120 females with abortion, revealing a 1.67% prevalence rate. Diagnostic performance analysis showed that both IgG and IgM antibodies demonstrated excellent sensitivity (100%) when compared to PCR as the gold standard, with IgG showing 83.90% specificity and IgM achieving 100% specificity. Clinical symptoms were significantly higher in infected women, and age-stratified analysis revealed 0% prevalence in women under 30 years versus 2.99% in older women.
Conclusion: This study revealed a low prevalence of Toxoplasma gondii infection (1.67%) among females with abortion, with higher rates in women over 30 years (2.99%). Clinical symptoms were significantly more common in infected women, and both IgG and IgM serology demonstrated excellent sensitivity (100%) compared to PCR, highlighting their reliability for initial screening despite low positive predictive values.
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2. Foroutan M, Fakhri Y, Riahi SM, et al. The global seroprevalence of Toxoplasma gondii in pigs: A systematic review and meta-analysis. Vet Parasitol 2019; 269:42-52.
3. Maleki B, Ahmadi N, Olfatifar M, et al. Toxoplasma oocysts in the soil of public places worldwide: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 115(5):471-81.
4. Foroutan M, Dalvand S, Daryani A, et al. Rolling up the pieces of a puzzle: a systematic review and meta-analysis of the prevalence of toxoplasmosis in Iran. Alex J Med 2018; 54(3):189-96.
5. Prandota J. T. gondii infection acquired during pregnancy and/or after birth may be responsible for development of both type 1 and 2 diabetes mellitus. J Diabetes Metab 2013; 4(2):255.
6. Belluco S, Mancin M, Conficoni D, et al. Investigating the determinants of Toxoplasma gondii prevalence in meat: a systematic review and meta-regression. PLosOne 2016; 11(4):e0153856.
7. Maani S, Rezanezhad H, Solhjoo I, et al. Genetic characterization of Toxoplasma gondii isolates from human spontaneous aborted fetuses in Jahrom, southern Iran. Parasitol Res 2021; 161(1):1-9.
8. Chen X, Chen B, Hou X, et al. Association between Toxoplasma gondii infection and psychiatric disorders in Zhejiang, Southeastern China. Acta Tropica 2019; 192:82-6.
9. M'rad S, Chaabane-Banaoues R, Lahmar I, et al. Parasitological contamination of vegetables sold in Tunisian retail markets with helminth eggs and protozoan cysts. J Food Protection 2020; 83(7):1104-09.
10. Lazar LTY, Al-Ammash MSJ, Abass KS. Toxoplasma gondii: life cycle, pathogenesis, immune response: a review. Plant Archives 2021; 21(1):1057-9.
11. Kheirandish F, Ezatpour B, Fallahi S, et al. Toxoplasma serology status and risk of miscarriage, a case-control study among women with a history of spontaneous abortion. Int J Fert Steril 2019; 13(3):184-9.
12. Kieffer FWM, Wallon M. Congenital toxoplasmosis. Handbook of Clinical Neurology. 2013;112:1099-1101.
13. Kimball AC, Kean BH, Fuchs F. Congenital toxoplasmosis: A prospective study of 4,048 obstetric patients. Am J Obstetrics Gynecol 1971; 111(2):211-18.
14. Lazar LTY, Al-Ammash MSJ, Abass KS. Toxoplasma gondii: life cycle, pathogenesis, immune response: a review. Plant Arch 2021; 21(1):1057-9.
15. Khan AH, Noordin R. Serological and molecular rapid diagnostic tests for Toxoplasma infection in humans and animals. Euro J Clin Microbiol Infect Dis 2020; 39(1):19-30.
16. Rostami A, Karanis P, Fallahi S. Advances in serological, imaging techniques and molecular diagnosis of Toxoplasma gondii infection. Infection 2018; 46(3):303-15.
17. Hameed Haddad MF, Zadeh Fakhar HB, Adnan Ahmed F, et al. Comparative analysis of ELISA (IgG, IgM) and Real-time PCR for accurate cytomegalovirus detection in women with abortion experiences. J Pioneering Med Sci 2024; 13(7):110-15.
18. Robert-Gangneux F, Guegan H. Anti-Toxoplasma IgG assays: What performances for what purpose? A systematic review. Parasite 2021; 28:39.
19. Villard O, Cimon B, L'Ollivier C, et al. Serological diagnosis of Toxoplasma gondii infection: recommendations from the French national reference center for toxoplasmosis. Diagn Microbiol Infect Dis 2016; 84(1):22-33.
20. de Oliveira Azevedo CT, do Brasil PEAA, Guida L, et al. Performance of polymerase chain reaction analysis of the amniotic fluid of pregnant women for diagnosis of congenital toxoplasmosis: a systematic review and meta-analysis. PLosOne 2016; 11(2):e0149938.
21. Fallahi SH, Kazemi B, Tabaei SJS, et al. Comparison of the RE and B1 gene for detection of Toxoplasma gondii infection in children with cancer. Parasitol Int 2014; 63(1):37-41.
22. Montoya JG, Liesenfeld O. Toxoplasmosis. Lancet 2004; 363(9425):1965-76.
23. Boothroyd JC. Toxoplasmosis. In: Schaechter M, editor. Encyclopedia of Microbiology. 3rd ed. Oxford: Elsevier; 2009. p. 732-43.
24. Dubey JP, Jones JL. Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 2008; 38(11):1257-78.
25. De Silva MG, Vinaud MC, de Castro AM. Prevalence of toxoplasmosis in pregnant women and vertical transmission of Toxoplasma gondii in patients from basic units of health from Gurupi, Tocantins, Brazil, from 2012 to 2014. PLosOne 2015; 10(11):e0141700.
26. Dubey JP. Toxoplasmosis. In: Collier L, Balows A, Sussman M, editors. Topley and Wilson's Microbiology and Microbial Infections. 9th ed. London: Arnold; 2005. p. 303.
27. Kieffer FWM, Wallon M. Congenital toxoplasmosis. Handbook of Clinical Neurology. 2013;112:1099-1101.
28. Ebrahimzadeh A, Mohammadi S, Salimi-Khorashad A, et al. Seroprevalence of toxoplasmosis among pregnant women referring to the reference laboratory of Zahedan, Iran. Zahedan Journal of Research in Medical Sciences 2013; 15(9):32-5.
29. Kalantari N, Ghaffari S, Bayani M, et al. Serological study of toxoplasmosis in pregnant women in the city of Babol, northern Iran, 2012-2013. Journal of Ilam University of Medical Sciences 2014; 22(5):102-08.
30. Soltani S, Ghaffari AD, Kahvaz MS, et al. Detection of anti-Toxoplasma gondii IgG and IgM antibodies and associated risk factors during pregnancy in Southwest Iran. Infect Dis Obstetrics Gynecol 2021; 2021:5547667.
31. Burg JL, Grover CM, Pouletty P, et al. Direct and sensitive detection of a pathogenic protozoan, Toxoplasma gondii, by polymerase chain reaction. J Clin Microbiol 1989; 27(8):1787-92.
32. Saki J, Zamanpour M, Najafian M, et al. Detection of Acute and Chronic Toxoplasma gondii Infection among Women with History of Abortion in the Southwest of Iran. Iranian J Parasitol 2021; 16(1):1-10.
33. Abdoli A, Dalimi A, Soltanghoraee H, et al. Molecular detection and genotypic characterization of Toxoplasma gondii in paraffin embedded fetoplacental tissues of women with recurrent spontaneous Abortion. Int J Fert Steril 2017; 11(4):327-34.
34. Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 2004; 42(3):941-5.
35. Al-Masoudi HK. Utilization of molecular and serological methods to investigation Toxoplasma gondii in healthy apparently students in Babylon province. Med J Babylon 2015; 12(4):934-42.
36. Saki J, Mohammadpour N, Moramezi F, et al. Seroprevalence of Toxoplasma gondii in women who have aborted in comparison with the women with normal delivery in Ahvaz, southwest of Iran. J Obstet Gynaecol 2015; 35(8):1-6.
37. Mohammed LJ, Al-Janabi MS. Seroprevalence of toxoplasmosis in aborted women in Babylon province, Iraq. Med J Babylon 2019; 16(2):188-91.
38. Mihu AG, Balta C, Marti DT, et al. Seroprevalence of Toxoplasma gondii infection among women of childbearing age in an endemic region of Romania, 2016-2018. Parasitol Res 2020; 119(1):59-65.
39. Mahmoudvand H, Saedi Dezaki E, Soleimani S, et al. Seroprevalence and risk factors of Toxoplasma gondii infection among healthy blood donors in south-east of Iran. Parasite Immunol 2015; 37(7):362-7.
40. Xiao Y, Yin J, Jiang N, et al. Seroepidemiology of human Toxoplasma gondii infection in China. BMC Infect Dis 2010; 10:4.
2. Foroutan M, Fakhri Y, Riahi SM, et al. The global seroprevalence of Toxoplasma gondii in pigs: A systematic review and meta-analysis. Vet Parasitol 2019; 269:42-52.
3. Maleki B, Ahmadi N, Olfatifar M, et al. Toxoplasma oocysts in the soil of public places worldwide: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 115(5):471-81.
4. Foroutan M, Dalvand S, Daryani A, et al. Rolling up the pieces of a puzzle: a systematic review and meta-analysis of the prevalence of toxoplasmosis in Iran. Alex J Med 2018; 54(3):189-96.
5. Prandota J. T. gondii infection acquired during pregnancy and/or after birth may be responsible for development of both type 1 and 2 diabetes mellitus. J Diabetes Metab 2013; 4(2):255.
6. Belluco S, Mancin M, Conficoni D, et al. Investigating the determinants of Toxoplasma gondii prevalence in meat: a systematic review and meta-regression. PLosOne 2016; 11(4):e0153856.
7. Maani S, Rezanezhad H, Solhjoo I, et al. Genetic characterization of Toxoplasma gondii isolates from human spontaneous aborted fetuses in Jahrom, southern Iran. Parasitol Res 2021; 161(1):1-9.
8. Chen X, Chen B, Hou X, et al. Association between Toxoplasma gondii infection and psychiatric disorders in Zhejiang, Southeastern China. Acta Tropica 2019; 192:82-6.
9. M'rad S, Chaabane-Banaoues R, Lahmar I, et al. Parasitological contamination of vegetables sold in Tunisian retail markets with helminth eggs and protozoan cysts. J Food Protection 2020; 83(7):1104-09.
10. Lazar LTY, Al-Ammash MSJ, Abass KS. Toxoplasma gondii: life cycle, pathogenesis, immune response: a review. Plant Archives 2021; 21(1):1057-9.
11. Kheirandish F, Ezatpour B, Fallahi S, et al. Toxoplasma serology status and risk of miscarriage, a case-control study among women with a history of spontaneous abortion. Int J Fert Steril 2019; 13(3):184-9.
12. Kieffer FWM, Wallon M. Congenital toxoplasmosis. Handbook of Clinical Neurology. 2013;112:1099-1101.
13. Kimball AC, Kean BH, Fuchs F. Congenital toxoplasmosis: A prospective study of 4,048 obstetric patients. Am J Obstetrics Gynecol 1971; 111(2):211-18.
14. Lazar LTY, Al-Ammash MSJ, Abass KS. Toxoplasma gondii: life cycle, pathogenesis, immune response: a review. Plant Arch 2021; 21(1):1057-9.
15. Khan AH, Noordin R. Serological and molecular rapid diagnostic tests for Toxoplasma infection in humans and animals. Euro J Clin Microbiol Infect Dis 2020; 39(1):19-30.
16. Rostami A, Karanis P, Fallahi S. Advances in serological, imaging techniques and molecular diagnosis of Toxoplasma gondii infection. Infection 2018; 46(3):303-15.
17. Hameed Haddad MF, Zadeh Fakhar HB, Adnan Ahmed F, et al. Comparative analysis of ELISA (IgG, IgM) and Real-time PCR for accurate cytomegalovirus detection in women with abortion experiences. J Pioneering Med Sci 2024; 13(7):110-15.
18. Robert-Gangneux F, Guegan H. Anti-Toxoplasma IgG assays: What performances for what purpose? A systematic review. Parasite 2021; 28:39.
19. Villard O, Cimon B, L'Ollivier C, et al. Serological diagnosis of Toxoplasma gondii infection: recommendations from the French national reference center for toxoplasmosis. Diagn Microbiol Infect Dis 2016; 84(1):22-33.
20. de Oliveira Azevedo CT, do Brasil PEAA, Guida L, et al. Performance of polymerase chain reaction analysis of the amniotic fluid of pregnant women for diagnosis of congenital toxoplasmosis: a systematic review and meta-analysis. PLosOne 2016; 11(2):e0149938.
21. Fallahi SH, Kazemi B, Tabaei SJS, et al. Comparison of the RE and B1 gene for detection of Toxoplasma gondii infection in children with cancer. Parasitol Int 2014; 63(1):37-41.
22. Montoya JG, Liesenfeld O. Toxoplasmosis. Lancet 2004; 363(9425):1965-76.
23. Boothroyd JC. Toxoplasmosis. In: Schaechter M, editor. Encyclopedia of Microbiology. 3rd ed. Oxford: Elsevier; 2009. p. 732-43.
24. Dubey JP, Jones JL. Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 2008; 38(11):1257-78.
25. De Silva MG, Vinaud MC, de Castro AM. Prevalence of toxoplasmosis in pregnant women and vertical transmission of Toxoplasma gondii in patients from basic units of health from Gurupi, Tocantins, Brazil, from 2012 to 2014. PLosOne 2015; 10(11):e0141700.
26. Dubey JP. Toxoplasmosis. In: Collier L, Balows A, Sussman M, editors. Topley and Wilson's Microbiology and Microbial Infections. 9th ed. London: Arnold; 2005. p. 303.
27. Kieffer FWM, Wallon M. Congenital toxoplasmosis. Handbook of Clinical Neurology. 2013;112:1099-1101.
28. Ebrahimzadeh A, Mohammadi S, Salimi-Khorashad A, et al. Seroprevalence of toxoplasmosis among pregnant women referring to the reference laboratory of Zahedan, Iran. Zahedan Journal of Research in Medical Sciences 2013; 15(9):32-5.
29. Kalantari N, Ghaffari S, Bayani M, et al. Serological study of toxoplasmosis in pregnant women in the city of Babol, northern Iran, 2012-2013. Journal of Ilam University of Medical Sciences 2014; 22(5):102-08.
30. Soltani S, Ghaffari AD, Kahvaz MS, et al. Detection of anti-Toxoplasma gondii IgG and IgM antibodies and associated risk factors during pregnancy in Southwest Iran. Infect Dis Obstetrics Gynecol 2021; 2021:5547667.
31. Burg JL, Grover CM, Pouletty P, et al. Direct and sensitive detection of a pathogenic protozoan, Toxoplasma gondii, by polymerase chain reaction. J Clin Microbiol 1989; 27(8):1787-92.
32. Saki J, Zamanpour M, Najafian M, et al. Detection of Acute and Chronic Toxoplasma gondii Infection among Women with History of Abortion in the Southwest of Iran. Iranian J Parasitol 2021; 16(1):1-10.
33. Abdoli A, Dalimi A, Soltanghoraee H, et al. Molecular detection and genotypic characterization of Toxoplasma gondii in paraffin embedded fetoplacental tissues of women with recurrent spontaneous Abortion. Int J Fert Steril 2017; 11(4):327-34.
34. Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 2004; 42(3):941-5.
35. Al-Masoudi HK. Utilization of molecular and serological methods to investigation Toxoplasma gondii in healthy apparently students in Babylon province. Med J Babylon 2015; 12(4):934-42.
36. Saki J, Mohammadpour N, Moramezi F, et al. Seroprevalence of Toxoplasma gondii in women who have aborted in comparison with the women with normal delivery in Ahvaz, southwest of Iran. J Obstet Gynaecol 2015; 35(8):1-6.
37. Mohammed LJ, Al-Janabi MS. Seroprevalence of toxoplasmosis in aborted women in Babylon province, Iraq. Med J Babylon 2019; 16(2):188-91.
38. Mihu AG, Balta C, Marti DT, et al. Seroprevalence of Toxoplasma gondii infection among women of childbearing age in an endemic region of Romania, 2016-2018. Parasitol Res 2020; 119(1):59-65.
39. Mahmoudvand H, Saedi Dezaki E, Soleimani S, et al. Seroprevalence and risk factors of Toxoplasma gondii infection among healthy blood donors in south-east of Iran. Parasite Immunol 2015; 37(7):362-7.
40. Xiao Y, Yin J, Jiang N, et al. Seroepidemiology of human Toxoplasma gondii infection in China. BMC Infect Dis 2010; 10:4.
| Issue | Vol 13 No 4 (2025) | |
| Section | Original Articles | |
| Keywords | ||
| ELISA IgG IgM Real time PCR Toxoplasma. | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sakran Naeemah Alhubaish A, Bashi Zadeh Fakhar haniyeh, Taheri Neyestanaki S, Shahidi PS. Comparison of ELISA Diagnostic Methods (IgG, IgM) and Real Time PCR in Identifying Toxoplasma in Women with Abortion. J Med Bacteriol. 2025;13(4):25-35.
