The significance of complement fixation test in clinical diagnosis of toxoplasmosis.

BACKGROUND: The complement fixation test (CFT) is the basic method in the diagnosis of toxoplasmosis. Despite its standard and reproducible results, it is rarely used in routine diagnosis of toxoplasmosis where the detection of IgG by means of EIA tests is widely used. OBJECTIVE: The study is focused on the verification of CFT value within the spectrum of specific classes of immunoglobulins IgG, IgM, IgA antibodies and avidity of IgG antibodies, as well as on the clinical diagnosis of toxoplasmosis. METHOD: The study analysed 1705 samples of serum from patients suspected to be infected by Toxoplasma gondii. Out of these patients 451 suffered from acute lymphadenopathic toxoplasmosis (6 with seroconversion of both CFT and IgG antibodies) and 1254 serum samples were collected from patients with latent infection, out of whom 176 were with long-term persistence of IgM, or IgA antibodies after the elimination of disease. CONCLUSION: CFT is a reliable indicator of Toxoplasma infection and as opposed to IgG antibodies its levels enable a more objective determination of its course. However from the aspect of the determination of the stage of toxoplasmosis from a single sample of serum, the combination of CFT with IgM or IgA antibodies with quantitative order or test of avidity of IgG antibodies must be performed. (Tab. 4, Fig. 4, Ref. 30.).

[Laboratory diagnosis of toxoplasmosis]. / Postupy v laboratórnej diagnostike toxoplazmózy.

Toxoplasmosis is a world-wide spread parasitosis. The disease potentially highly affects two groups of patients: foetus and immunosuppressed patients. The determination of diagnosis and therapy on the basis of a single serum examination is very important; possible on the basis of a single serum sample. In most cases, it is possible to differentiate between recent and latent infections using a combination of suitable methods, which permit us to confirm particular antibody classes. In the presented paper the authors suggest diagnostic procedures for 4 groups of patients: pregnant, neonates with suspected congenital toxoplasmosis, immunodeficient patients and immunocompetent patients. The diagnostic methods consist of a combination of basic and supplemented diagnostic methods. Each patient's serum should be tested by basic tests which include the detection of total antibodies with CFT or IFT and specific classes of IgM and IgG antibodies by ELISA. The potential activity of toxoplasma infection can be determined by supplementary methods of e.g. IgG avidity antibodies, establishment of IgA antibodies, western blotting method and monitoring of antibodies production. For each situation the authors present interpretations of suspected cases including proposals for clinicians. These procedures are suggested for practical use in laboratories of various diagnostic levels in order to help to the diagnostic procedures in a particular situation as well as for clinical evaluation of established results. (Fig. 4, Ref. 65).

[Morphology and diagnosis of the oral protozoans Trichomonas tenax and Entamoeba gingivalis using the Giemsa-Romanovsky stain]. / Morfológia a diagnostika ústnych prvokov Trichomonas tenax a Entamoeba gingivalis zafarbených podl'a Giemsu-Romanovského.

In the microscopic diagnosis of Trichomonas tenax and Entamoeba gingivalis is the technically and time not demanding native preparation of a culture, in which both protozoans can be detected according to their typical motility, determining. In the permanent preparation of the culture stained according to Giemsa-Romanovsky, which has also documentary character, are all of the characteristic cell organelles stainable, enabling so their detection without their typical motility. Staining according to Giemsa-Romanovsky is technically simple and not time consuming, not very laborious, low cost and the coloration is permanent, that means optimal for the diagnostic of oral protozoans in permanent preparations. (Fig. 5, Ref. 4.)

[Toxoplasma gondii]. / Toxoplasma gondii.

The authors offered a general view on Toxoplasma gondii from the historical, taxonomic, biological and epidemiological point of view. They also studied the problems of pathogenesis, pathology, clinics, diagnosis, as well as therapy and prevention. (Tab. 1, Ref. 9)

[Pathologic karyotypes in autopsy material]. / Patologické karyotypy v súbore nekroptického materiálu.

In 1986-1989 the authors were concerned with the cultivation of necroptic material. Material was collected from five indication groups outlined in advance. A total of 231 specimens of necroptic material were cultivated, incl. 143 specimens subjected to cytological evaluation. From the above material 20 pathological karyotypes were diagnosed. The results of cytogenetic analysis of chromosome abnormalities were compared with the clinical and pathological diagnosis. Post-mortem chromosome analysis is important for elucidation of the aetiopathogenesis of perinatal deaths and for a comprehensive approach to families with genetic risk.

[Postmortem chromosome analysis and its significance]. / Postmortálna chromozómová analýza a jej význam.

Cultivation of necroptic material taken by pathologist or obstetrician according to determined indicative groups was performed during the years 1986-1990. Cytogenetical evaluation was feasible in 157 cultivated samples from the total of 252. There were found 32 pathological karyotypes among them.

[Occurrence of the protozoa, Entamoeba gingivalis and Trichomonas tenax in the mouths of children and adolescents with hyperplastic gingivitis caused by phenytoin]. / K výskytu prvokov Entamoeba gingivalis a Trichomonas tenax v ústach detí a mládeze s hyperplastickou gingivitídou po fenytoíne.

The oral protozoa Entamoeba gingivalis and Trichomonas tenax do not occur in small children and are rarely found in older ones. In adolescents their occurrence rate keeps increasing with age. They parasitize in an oral cavity changed by inflammation, yet also in a healthy mouth. Their highest occurrence rate has been recorded in adults with periodontosis and atrophy of the periodontium, a somewhat lower one in adults with gingivitis. The authors addressed the question whether the presumed low occurrence rate of oral protozoa in children becomes increased in drug-induced gingivitis after treatment with the antiepileptic 5,5-diphenylhydantoin. Cultivation for oral protozoa was performed in 231 children and adolescents. Of these 59 were epileptics. Drug-induced gingivitis was present in 66% of the epileptics. Drug-induced gingivitis did not increase the occurrence rate of oral protozoa as compared to the findings in the rest of the series studied. (Tab. 9, Ref. 7.).

[The role of Toxoplasma gondii in the etiology of chronic tonsillitis in children]. / K podielu Toxoplasma gondii v etiológii chronickej tonzilitídy u detí.

Toxoplasma gondii is known to have an affinity to lymphatic tissue. A series of 506 children with chronic tonsillitis were examined serologically for toxoplasmosis by means of CBR, IIR and ELISA. In 7.7% of the children examined low toxoplasma antibody titers were recorded. Isolation experiments performed on tonsillar tissue of the children with the highest toxoplasma antibody titers were negative. Direct microscopic evidence of tissue toxoplasma cysts failed to be established and the cytopathologic picture characteristic of nodal toxoplasmosis was not present in smears of cells aspirated from lymphatic nodes regional to palatine tonsils. The authors assumed that chronic toxoplasma tonsillitis did not occur in the series studied. In our ecological conditions, T. gondii may not be involved in the etiology of chronic tonsillitis, or it may participate to an extent which is epidemiologically negligible. (Tab. 4, Ref. 14).

[The role of Toxoplasma gondii in the etiology of chronic tonsillitis in children]. / Sledovanie podielu Toxoplasma gondii v etiológii chronickej tonzilitídy u detí.

Toxoplasma gondii is know to have an affinity to lymphatic tissue. The authors studied whether after infection of the child's body T. gondii does or does not determine the chronic course of tonsillitis. In 712 children with chronic tonsillitis serological examinations for toxoplasmosis were carried out by means of RVK, NIR and ELISA. Low titers of toxoplasme antibodies were found in 8.0% of the children examined. In light of the following findings the authors conclude that toxoplasme tonsillitis did not occur in their series: toxoplasma antibodies failed to be increased; their titers in seropositive children were low; toxoplasma was not isolated from tonsillar tissue; no direct microscopic evidence of the parasite could be established in smears of cell aspirate from lymph nodes regional to the palatine tonsils; the same smears failed to present the cytopathologic picture characteristic of nodal toxoplasmosis. In our ecologic conditions T. gondii is presumably not involved in the etiology of chronic tonsillitis, or it may be involved but to an epidemiologically not appreciable extent. (Tab. 10, Ref. 18).

[Morphology and diagnosis of Entamoeba gingivalis and Trichomonas tenax and their occurrence in children and adolescents]. / Morfológia a diagnostika Entamoeba gingivalis a Trichomonas tenax a ich výskyt u detí a mládeze.

Specimens obtained from 176 eight- to nineteen-year-old subjects were cultured for oral protozoa. Of the given series, 25 subjects (14.2%) had in their mouth only E. gingivalis, 5 (2.9%) had a mixed invasion of E. gingivalis and T. tenax, and 2 subjects (1.1%) had only T. tenax. A total of 32 subjects (18.2%) were infested by oral protozoa. The following conclusions were made: oral protozoa occur also in children and teenagers with a cured or intact dentition; their occurrence rate was higher in 11- to 19-year-old subjects than in the lower age groups; both protozoa can occur simultaneously; their occurrence rate was age dependent (increasing with age) with the rate of E. gingivalis rising significantly more rapidly with age than that of T. tenax; their occurrence was found to be sex dependent with higher rates in boys than in girls. In the light of the high recovery rate (83.3%) of E. gingivalis from dental and periodontal swabs, not only specimens of saliva should be collected but also dental nad periodontal swabs should be taken and cultured when studying the occurrence of oral protozoa in the population. (Tab.4,Fig.2,Ref.7).

[Cytogenetic examination of amniotic fluid specimens in the 2d trimester of pregnancy (personal experience 1981-1989)]. / Cytogenetické vysetrenie vzoriek plodovej vody v II. trimestri gravidity (nase skúsenosti za roky 1981-1989).

The authors analyze a group of pregnant women examined at the Chair of Biology and Parasitology of the Medical Faculty J. A. Komensky's University between 1981 and the end of August 1989. During this period they cultivated cells from 1755 specimens of amniotic fluid. In the article they evaluate the detection rate of pathological conditions during this period.

[Experience with postmortem chromosome analysis]. / Skúsenosti s postmortálnou chromozómovou analýzou.

Over the years 1986-1988 necroptic material, collected according to 5 established indication groups, was cultured. A total of 202 samples of necroptic material cultured and 122 of these samples were analyzed cytogenetically. Seventeen pathologic karyotypes were diagnosed in the material, namely 7 cases of Down's syndrome, 2 cases of Klinefelter's syndrome, 2 cases of D/D translocation, 1 case of Turner's syndrome, 1 case of gonosomal mosaicism, and 1 case of Patau's syndrome.

[Ethico-philosophic and socio-legal aspects of AIDS]. / K niektorým eticko-filozofickým a spolocensko-právnym aspektom AIDS.

The authors analyze ethico-philosophical and socio-legal problems of patients with AIDS in their relation to people they are in frequent contact with, i.e. family, relatives, sexual partners, as well as medical and paramedical staff. They deal with the problem of compulsory notification of the disease on the one hand, and of secrecy compelling for health care workers on the other hand. The potential penojudicial responsibility of subjects infected with AIDS in spreading the infection is being considered, as well as the problem of enforced diagnotic examination and hospitalization. The obligation of the doctor to provide therapeutic and preventive care to each citizen, and thus also to patients with AIDS, is being emphasized.

[Toxoplasma antibodies in children in Slovakia with potential toxoplasmosis]. / Toxoplazmové protilátky u detí v SSR s potenciálnou toxoplazmózou.

Over the years 1984-1987, 829 children from the Slovak Socialist Republic, aged from 0 to 15 years, with suspect toxoplasmosis were examined for the presence of toxoplasma antibodies by the serodiagnostic methods RVK, NIR, and ELISA. The percentage of toxoplasma antibodies yielded by the individual methods was as follows: RVK--39.5%; NIR--74.4%; ELISA-IgG--67.7%; ELISA-IgM--60.4%. Based on these results the authors conclude that the child population up to the age of 15 years is an at risk group with an increased possibility of contracting toxoplasmosis by frequent contact with the soil, sand, water, and animals, as well as by consuming not adequately cleaned fruit and vegetables. To protect the child population from toxoplasmosis greater attention is to be given to hygienic, nutritional and serodiagnostic prevention.