Development of a Novel Protocol Based on Blood Clot to Improve the Sensitivity of qPCR Detection of Toxoplasma gondii in Peripheral Blood Specimens

Renzo Gutierrez-Loli Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Cusi Ferradas Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Andrea Diestra Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Aliki Traianou Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Natalie Bowman Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;

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Jeroen Bok Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;

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Melissa Reimer-McAtee Tulane University Medical Center, New Orleans, Louisiana;

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Cesar Ramal Hospital Regional de Loreto “Felipe Santiago Arriola Iglesias,” Iquitos, Peru;

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Eduardo Ticona Infectious Diseases and Tropical Medicine Unit, Hospital Nacional Dos de Mayo, Lima, Peru;

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Hannah Steinberg Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;

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Holger Mayta Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Maritza Calderon Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Jaeson S. Calla-Choque Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru;

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Charles Sterling School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona

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Robert H. Gilman Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;

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for the Toxoplasmosis Working Group in Peru and Bolivia† Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru;
Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;
Tulane University Medical Center, New Orleans, Louisiana;
Hospital Regional de Loreto “Felipe Santiago Arriola Iglesias,” Iquitos, Peru;
Infectious Diseases and Tropical Medicine Unit, Hospital Nacional Dos de Mayo, Lima, Peru;
School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona

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Quantitative polymerase chain reaction (qPCR) for Toxoplasma gondii multicopy genes has emerged as a promising strategy for sensitive detection of parasite DNA. qPCR can be performed from blood samples, which are minimally invasive to collect. However, there is no consensus about what type of blood specimen yields the best sensitivity. The development of a novel protocol for qPCR detection of T. gondii using blood clot, involving an appropriate DNA extraction method and the use of an internal amplification control to monitor the reaction is presented in the current study. Assays directed to the B1 and REP529 genes were performed in spiked specimens of whole blood, guanidine–ethylenediaminetetraacetic acid blood, and clot. The clot-based qPCR was shown to be more sensitive when compared with other types of specimens, detecting five and 0.05 T. gondii genomes, using B1 and REP529 targets, respectively. Finally, a comparative analysis with samples from HIV patients with clinical suspicion of toxoplasmosis was performed, demonstrating the detection of four positive suspected cases with clots compared with only one using guanidine–ethylenediaminetetraacetic acid blood. The high analytical sensitivity and the cost-effective advantages offered by clot supports this methodology as a good laboratory tool to monitor parasite burden.

Author Notes

Address correspondence to Renzo Gutierrez-Loli, Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, SMP 15102, Lima, Peru. E-mail: renzo.gutierrez@upch.pe

Financial support: This work was partially funded with the support of “Programa Nacional de Innovación para la Productividad y Competitividad” (Innóvate Perú), contract No. 137-PNICP-PIAP-2015. R. G. is supported by a training grant from NIH-Fogarty (2D43TW007120-11A1). Dr. Gilman’s NIH grant 1D43TW010074-01 supported the training of many of the Peruvian and Bolivian authors and working group members.

Prior presentation of findings: A poster titled “Real-time PCR strategy for detection of Toxoplasma gondii from peripheral blood clot” (Abstract Number: 3331-1882) was presented in November 2017 at the Annual Meeting of the American Society of Tropical Medicine and Hygiene in Baltimore, MD.

Authors’ addresses: Renzo Gutierrez-Loli, Cusi Ferradas, Andrea Diestra, Aliki Traianou, Holger Mayta, Maritza Calderon, and Jaeson S. Calla-Choque, Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: renzo.gutierrez@upch.pe, cusi.ferradas@upch.pe, andreadiestra13@gmail.com, aliki.traianou@gmail.com, holger.mayta@upch.pe, mmcalderons@yahoo.es, and jcalla@ucsd.edu. Natalie Bowman, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: natalie.bowman@gmail.com. Jeroen Bok, Hannah Steinberg, and Robert H. Gilman, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, E-mails: jeroenbok87@gmail.com, hannahsteinberg08@gmail.com, and gilmanbob@gmail.com. Melissa Reimer-McAtee, Tulane University Medical Center, New Orleans, LA, E-mail: mreimer2@tulane.edu. Cesar Ramal, Hospital Regional de Loreto “Felipe Santiago Arriola Iglesias,” Iquitos, Peru, E-mail: ramalasayag@yahoo.fr. Eduardo Ticona, Infectious Diseases and Tropical Medicine Unit, Hospital Nacional Dos de Mayo, Lima, Peru, E-mail: eticonacrg@gmail.com. Charles Sterling, School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, E-mail: csterlin@email.arizona.edu.

Working Group: Linda Chanamé Pinedo, Gaston Valencia, Lenny Sanchez, Edith Málaga, Deanna Zhu, Juan Jiménez, Caryn Bern, Noelia Angulo, Francesca Schiaffino, Janet Acosta, Meredith Holtz, Daniel Clark, Taryn Clark, Grace Trompeter, Jeong Choi, Omar Gandarilla, Mauricio Dorn, Enzo Fortuny, Gerson Galdos, and Roni Colanzi.

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