title: Performance Testing of PCR Assay in Blood Samples for the Diagnosis of Toxoplasmic Encephalitis in AIDS Patients from the French Departments of America and Genetic Diversity of Toxoplasma gondii: A Prospective and Multicentric Study.
abstract: Toxoplasmic encephalitis in patients with AIDS is a life-threatening disease mostly due to reactivation of Toxoplasma gondii cysts in the brain. The main objective of this study was to evaluate the performance of real-time PCR assay in peripheral blood samples for the diagnosis of toxoplasmic encephalitis in AIDS patients in the French West Indies and Guiana.
  
  
  
  Adult patients with HIV and suspicion of toxoplasmic encephalitis with start of specific antitoxoplasmic therapy were included in this study during 40 months. The real-time PCR assay targeting the 529 bp repeat region of T. gondii was performed in two different centers for all blood samples. A Neighbor-Joining tree was reconstructed from microsatellite data to examine the relationships between strains from human cases of toxoplasmosis in South America and the Caribbean. A total of 44 cases were validated by a committee of experts, including 36 cases with toxoplasmic encephalitis. The specificity of the PCR assay in blood samples was 100% but the sensitivity was only 25% with moderate agreement between the two centers. Altered level of consciousness and being born in the French West Indies and Guiana were the only two variables that were associated with significantly decreased risk of false negative results with the PCR assay.
  
  
  
  Our results showed that PCR sensitivity in blood samples increased with severity of toxoplasmic encephalitis in AIDS patients. Geographic origin of patients was likely to influence PCR sensitivity but there was little evidence that it was caused by differences in T. gondii strains.
  
  
  
  ClinicalTrials.gov NCT00803621.
authors.affiliation: INSERM, UMR_S 1094, Neuroépidémiologie Tropicale, Université de Limoges; Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ajzenberg
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lamaury
authors.affiliation: Equipe EA3593-Ecosystemes Amazoniens et Pathologie Tropicale, Université de la Guyane, Guyane française, Cayenne, France; Laboratoire de Parasitologie-Mycologie, Centre hospitalier de Cayenne, Cayenne, Guyane française, France.
authors.forename: Magalie
authors.initials: M
authors.lastname: Demar
authors.affiliation: Service de Médecine, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, Guyane française, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Vautrin
authors.affiliation: INSERM CIC1425, Centre Hospitalier Universitaire de Martinique, Fort de France, Martinique, France.
authors.forename: André
authors.initials: A
authors.lastname: Cabié
authors.affiliation: Equipe EA3593-Ecosystemes Amazoniens et Pathologie Tropicale, Université de la Guyane, Guyane française, Cayenne, France; Laboratoire de Parasitologie-Mycologie, Centre hospitalier de Cayenne, Cayenne, Guyane française, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Simon
authors.affiliation: Laboratoire de Microbiologie, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Nicolas
authors.affiliation: Laboratoire de Parasitologie-Mycologie-Immunologie, Centre Hospitalier Universitaire de Martinique, Fort de France, Martinique, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Desbois-Nogard
authors.affiliation: Service de Biologie Médicale, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, Guyane française, France.
authors.forename: Rachida
authors.initials: R
authors.lastname: Boukhari
authors.affiliation: Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Riahi
authors.affiliation: INSERM, UMR_S 1094, Neuroépidémiologie Tropicale, Université de Limoges; Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Dardé
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Hôpital Purpan, Centre hospitalier universitaire de Toulouse, Toulouse, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Massip
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Centre hospitalier universitaire de Bordeaux, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Dupon
authors.affiliation: INSERM, UMR_S 1094, Neuroépidémiologie Tropicale, Université de Limoges; Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche (CEBIMER), Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Preux
authors.affiliation: INSERM, UMR_S 1094, Neuroépidémiologie Tropicale, Université de Limoges; Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche (CEBIMER), Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Labrunie
authors.affiliation: INSERM, UMR_S 1094, Neuroépidémiologie Tropicale, Université de Limoges; Service de Neuroradiologie, Centre Hospitalier Universitaire de Limoges, Limoges, France.
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Boncoeur
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D000328:Adult; D016000:Cluster Analysis; D005260:Female; D005616:French Guiana / Q000453:epidemiology; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014122:Toxoplasma / Q000145:classification / Q000235:genetics*; D016781:Toxoplasmosis, Cerebral / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology