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Determination of Low IgG Class Antibody Avidity Percentage by IgM Levels Specific to Toxoplasma Gondii by Ayfer Bakir, Mustafa Guney

Background: Ig (Immunglobulin) M detection and low avidity index are markers of recent infection in differentiating acute and chronic stages of Toxoplasma gondii (T. gondii) infections. In this study, we aimed to evaluate whether the anti-T. gondii IgM antibody index threshold value could be a predictive factor in the estimation of low avidity and its use in improving the diagnosis of early toxoplasma infection.
Methods: Anti-T. gondii IgM, IgG antibody and IgG avidity results were analyzed. Anti-T. gondii IgG and IgM antibodies in blood samples were studied with chemiluminescent microparticle immunoassay (CMIA), and IgG avidity test was performed with Enzyme Linked Fluorescent Assay (ELFA) technique.
Results: The overall seroprevalence of anti-T. gondii antibodies (IgG and/or IgM) was 19.4%. Of the 64 patients whose avidity tests were studied, 47 (73.4%) were female. Twenty seven (57.4%) of the women were pregnant. In the IgG avidity test, 7.8% low avidity was detected. Low avidity was detected in only 4 (15.4%) of 26 IgM positive cases. IgM analysis of a case (6-month-old baby) with low avidity was found to be negative. In the prediction of low avidity, the assay’s IgM positivity cutoff value was ≥ 0.6, its sensitivity, specificity, positive predictive value, and negative predictive value were 80%, 62.7%, 2.3%, and 99.7%, respectively. With Architect, 37.3% of samples were false positive. Determining the IgM index cutoff value was unsuccessful in distinguishing low avidity. The area under the ROC curve was 0.574 (p = 0.60).
Conclusions: In our study, the positive predictive value of the IgM test kit in estimating low avidity was low and the false positivity rate was 37.3%. It is thought that the index cutoff value of the anti-T. gondii IgM antibody test kit cannot be considered as a good predictor of recent infection. Studies with larger patient groups are needed.

DOI: 10.7754/Clin.Lab.2021.211112