Toxoplasmosis Serologic Testing for Pregnant Women

(modified from algorithm Montoya, 2008)

Click here for topics associated with this algorithm

SCREEN
Toxoplasma gondii Antibodies, IgG and
IgM

IgG+, IgM- IgG-, IgM- IgG?, IgM- IgG?, IgM? IgG+, IgM? IgG+, IgM+
IgG-, IgM? IgG-, IgM+
Indeterminate Indeterminate Most likely: Most likely:
Possible early Possible early IgG?, IgM+
Chronic Infection Chronic
acute infection or acute infection or Possible acute
False positive infection <12
false-positive result false-positive result infection
reaction months
Early acute False positive
reaction
Early acute
No current
infection; retest at Obtain follow-up specimen 3 weeks later; use as a comparator with first test
18 wks gestation
and again near
term Same result Same result
Infected with Avoid exposure to Same result Same result Same result Same result (IgG+, IgM?) (IgG?, IgM+) or if
Toxoplasma for parasite through (IgG-, IgM?) (IgG-, IgM+) (IgG?, IgM-) (IgG?, IgM?) Send both IgG becomes + Send to
>1 year o Raw infected Patient most Most likely Patient most Patient most specimens to Send both reference
No further meat likely not false positive likely not likely not reference specimens to laboratory
action o Oocysts from infected reaction infected infected laboratory* reference
soil laboratory*
contaminated
with cat feces

Send to reference laboratory if Toxoplasma Serologic Profile (TSP)

confirmation is required* (available only at reference lab*) +/-
avidity testing

Results Key
? = equivocal
TSP consistent with recently acquired infection If TSP
- = negative
Treat consistent with
+ = positive infection
Recommend Toxoplasma gondii by PCR on
* = Toxoplasma Serology Laboratory at Palo Alto acquired in the
amniotic fluid at 18 weeks gestation
Medical Foundation (reference lab for CDC) distant past, no
further action
necessary
References Negative Positive
Montoya JG, Remington JS. Management of Toxoplasma gondii infection during
pregnancy. Clin Infect Dis. 2008 Aug 15;47(4):554-66.
Continue treatment until term Discuss options:
Thorough evaluation of Treatment
newborn Therapeutic abortion

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