Jornal de Bacteriologia e Parasitologia

Abstrato

Screening of Maternal Toxoplasmosis in Pregnancy: Laboratory Diagnostics from the Perspective of Public Health Requirements

Sagel U and Krämer A

Serological screening for maternal Toxoplasma infections in pregnancy has been questioned recently. We analyze some diagnostic difficulties for routine laboratories, poor public health guidance of existing screening programs, and their mutual worsening impact on the efficacy of the programs and on toxoplasmosis research. False positive screening tests may be more likely than true maternal Toxoplasma infections and diagnosis often depends on confirmatory testing in experienced reference laboratories. Apart from clear seroconversions, any marker to assign the time point of infection
to the ongoing pregnancy (IgM, IgG avidity, etc.) suffers from important limitations. With poor screening compliance, many screening alerts come from first serum samples in pregnancy that are cumbersome to test, while seroconversions are seldom observed due to missing follow-up samples in late pregnancy. From a public health perspective, inadequate epidemiological assessment and research, insufficient quality control for compliance and little consideration of diagnostic peculiarities for the design of more effective preventive programs has resulted in poor performance. These shortcomings have contributed to the present doubts about preventive Toxoplasma screening in pregnancy. We
recommend that a team of public health decision makers, epidemiologists and experts from toxoplasmosis reference laboratories reevaluates the existing activities in a given country to build up a well-designed preventive program that avoids these drawbacks.