Infection with T. gondii is asymptomatic in the majority (80 - 90%) of cases.

The
AccuDiag™ most common clinical manifestation of acute toxoplasmosis in the adult is
asymptomatic lymphadenopathy involving single or multiple nodes.
Toxoplasma IgM (T-gondii) Lymphadenopathy may be accompanied by fever, malaise, and atypical
lymphocytosis symptoms which mimic infectious mononucleosis. Very rarely will
IFA Kit more serious complications, such as encephalitis, myocarditis or pneumonitis, be
seen in the normal host.
Cat# 431508-MD
Although the normal host usually suffers no ill effects from infection with T. gondii,
infection in an immunocompromised host is often fatal. Immunocompromised
patients may develop severe disseminated toxoplasmosis or toxoplasmic
See external Label 10x 8 wells encephalitis, or both. Toxoplasma is a common opportunistic infection of the central
nervous system in patients with acquired immunodeficiency syndrome (AIDS).
Serologic evidence indicates that toxoplasmic encephalitis in AIDS patients results
Toxoplasma IgM from reactivation of latent infections. Approximately 30% of AIDS patients who are
Test
(T-gondii)IFA toxoplasma antibody positive will develop toxoplasmic encephalitis.
Indirect Fluorescent
Method When a seronegative woman becomes infected with T. gondii during pregnancy, the
Antibody Method
organism is often transmitted across the placenta to the fetus. The severity of
Principle Qualitative infection in the fetus varies with the trimester during which the infection was
acquired. Infection during the first trimester may lead to spontaneous abortion,
Sample 10 µL serum stillbirth, or overt disease in the neonate. Infection acquired later during pregnancy is
Sensitivity 92.3 % usually asymptomatic in the neonate, and may not be recognized. Approximately
Specificity 100 % 75% of congenitally infected newborns are symptomatic. However, nearly all
Total Time ~ 130 min. children born with subclinical toxoplasmosis will develop adverse ocular or
12 Months from the neurologic sequelae later in life. Approximately 80 - 85% develop chorioretinitis and
Shelf Life some may also experience blindness or mental retardation.
manufacturing date
A variety of serologic tests for antibodies to T. gondii have been used as an aid in
diagnosis of acute infection and to assess previous exposure to the organism. The
INTENDED USE more widely used tests include the Sabin-Feldman dye test, direct agglutination,
The Diagnostic Automation, Inc. Toxoplasma IgM(T-gondii) IFA Kit Test System is indirect hemagglutination, latex agglutination, indirect immunofluorescence, and
an indirect fluorescent antibody assay designed for the presumptive qualitative ELISA. Serologic procedures that measure IgM class antibodies to T. gondii include
detection of IgM antibodies to T. gondii in human serum and for the presumptive indirect immunofluorescence, immunosorbent agglutination, and ELISA. High
diagnosis of acute, recent, or reactive T. gondii infection. To adquately assess the affinity IgG antibodies to T. gondii, if present in a sample, may interfere with the
patient’s serological status; testing must be performed in conjunction with an anti-T. detection of IgM specific antibody. High affinity IgG antibody may preferentially
gondii IgG antibody assay. This product is not FDA cleared (approved) for use in bind to T. gondii antigen leading to false negative IgM results; also, rheumatoid
testing (i.e., screening) blood or plasma donors. Performance characteristics have not factor, if present along with antigen-specific IgG, may bind to the IgG causing false
been established for screening sera from prenatal women or newborns. positive IgM results.

Both of the above problems can be eliminated by removing IgG from the sample
SUMMARY AND EXPLANATION before testing for IgM. Several different methods of separating IgG have been used.
These include gel filtration, absorption with protein A ion exchange
T. gondii is an obligate intracellular protozoan parasite with a worldwide chromatography, precipitation of IgG with anti-human IgG serum, or the use of IgG
distribution. Although cats are the definitive host, the organism can infect almost all Removal Regent.
mammals and birds. Serological data indicates that approximately 30% of the
population of most industrialized nations is chronically infected with the organism,
although the prevalence varies among different populations. TEST PRINCIPLE
The Diagnostic Automation, Inc. T. gondii IgM Test System is designed to detect
Toxoplasma exists in three forms: trophozoite, cysts, and oocysts. The trophozoite is IgM class antibodies to the T. gondii antigen. The assay employs T. gondii
the invasive form present during the acute phase of infection. Tissue cysts are organisms and fluorescein labeled anti-human IgM (µ chain specific). The procedure
formed after multiplication of the organism within the host cell cytoplasm and may involves three steps:
contain up to several thousand organisms. Oocysts develop in the intestinal epithelial
cells of cats and are not found in other hosts. Oocysts are excreted in the feces of cats 1. Test sera are first treated to remove IgG and rheumatoid factor.
and mature after a few days. 2. Test sera, properly treated and diluted, are added to the wells and incubated.
Antigen specific IgM antibody will bind to T. gondii substrate immobilized on
Infection of man and other animals occurs after ingestion of either cysts in raw or the slide. The Slides are washed to remove unbound antibody and other serum
undercooked meat, or mature oocysts in material contaminated with cat feces. Once components.
ingested, the parasites are liberated from cysts or oocysts by digestive enzymes and 3. Fluorescein labeled anti-human IgM Conjugate is added to the wells and the
invade the intestinal mucosa. The parasites multiply locally and are then transported Slides are incubated. The Conjugate will react with the antigen specific IgM
to other organs forming tissue cysts which persist for the life of the host. Cysts are antibodies bound to the slides in step 2. The Slides are washed to remove
found predominantly in brain, heart, and skeletal muscle. unbound Conjugate. The Slides are then mounted with a coverslip and read
under a fluorescence microscope.

DAI CODE #2 Page 1 of 6

 11. Disposal basin and disinfectant (i.e: 10% household bleach – 0.5% Sodium
Hypochlorite).
12. Incubation 35-37ºC.
SPECIMEN COLLECTION AND PREPARATION 13. IgG Removal System (see Limitations of Procedure)
1. DAI recommends that the user carry out specimen collection in accordance
with CLSI document M29: Protection of Laboratory Workers from The following filter systems or their equivalent have been found to be satisfactory
Occupationally Acquired infectious Diseases. No known test method can offer for routine use with transmitted or incident light darkfield assemblies:
complete assurance that human blood samples will not transmit infection.
Therefore, all blood derivatives should be considered potentially infectious.
TRANSMITTED LIGHT
2. Only freshly drawn and properly refrigerated sera obtained by approved aseptic Light Source: Mercury vapor 200W or 50W
venipuncture procedures should be used in this assay. No anticoagulants or Excitation Barrier Filter Red Suppression Filter
preservatives should be added. Avoid using hemolyzed, lipemic, or bacterially Filter
contaminated sera.
KP490 K510 or K530 BG38
3. Store sample at room temperature for no longer than 8 hours. If testing is not
performed within 8 hours, sera may be stored between 2-8°C for no longer than BG12 K510 or K530 BG38
48 hours. If delay in testing is anticipated, store test sera at –20°C or lower. FITC K520 BG38
Avoid multiple freeze/thaw cycles that may cause loss of antibody activity and Light Source: Tungsten – Halogen 100W
give erroneous results.
KP490 K510 or K530 BG38
MATERIALS AND COMPONENTS
Materials provided with the test kits INCIDENT LIGHT
Each Test System contains the following components in sufficient quantities to Light Source: Mercury Vapor 200, 100, 50 W
perform the number of tests indicated on packaging label. NOTE: Conjugate Excitation Dichroic Barrier Filter Red
and Controls contain a combination of Proclin (0.05% v/v) and Sodium Filter Mirror Suppression
Azide (<0.1% w/v) as preservatives. Sorbent contains Sodium Azide
(<0.1% w/v) as a preservative. Filter
Reactive Reagents KP500 TK510 K510 OR K530 BG38
1. Toxoplasma gondii Antigen Substrate Slides: Ten, 8 - well Slides FITC TK510 K530 BG38
containing T. gondii organisms (strain RH). Also includes a desiccant pouch. Light Source: Tungsten – Halogen 50 and 100 W
2. Conjugate: Anti-human IgM (µ chain specific) labeled with fluorescein KP500 TK510 K510 or K530 BG38
isothiocyanate (FITC). Contains phosphate buffer with BSA and counterstain.
One, 3.5mL, clear-capped, bottle. Ready to use. FITC TK510 K530 BG38
3. Positive Control (Human Serum): Will produce positive apple-green
staining around the periphery of the organisms. One, 0.5mL, red-capped, vial. ASSAY PROCEDURE
Ready to use.
4. Negative Control (Human Serum) Will produce no detectable staining of 1. Remove slides from storage and allow them to warm to room temperature (20-
the organism. One, 0.5mL, green-capped, vial. Ready to use. 25ºC.) Tear open the protective envelope and remove slides. DO NOT
5. Sample Diluent: One, 30mL, green-capped, bottle containing phosphate- APPLY PRESSURE TO FLAT SIDES OF PROTECTIVE ENVELOPE.
buffered-saline. Ready to use. Note: The Sample Diluent will change color 2. Identify each well with the appropriate patient sera and Controls. NOTE: The
when combined with serum. Controls are intended to be used undiluted.
6. Phosphate-buffered-saline (PBS): pH 7.6 ± 0.2. Empty contents of each
buffer packet into one liter of distilled or deionized water. Mix until all salts are 3. Diluting Patient Sera:
thoroughly dissolved. Four packets, sufficient to prepare 4 liters. a. It is recommended that test sera are pre-treated to remove IgG.
7. Mounting media (Buffered Glycerol): Two, 3.0 mL, white-capped, Precipitation with anti-human IgG is recommended because this
dripper tipped vials. procedure is effective in removing all subclasses of human IgG and is less
cumbersome to perform than other methods. After the pretreatment step,
test sera should be at a 1:10 screening dilution. (e.g.: 10µL of serum + 90
Note: Kit also contains: µL of Sample Diluent or PBS).
1. Component list containing lot specific information is inside the kit box. b. If patient samples are to be titrated to endpoint, one should pre-treat the
2. Package insert providing instructions for use. serum to remove IgG and then make any subsequent dilutions with
Diluent. NOTE: The Diluent will undergo a color change confirming
the combination of specimen with Diluent.
Materials required but not provided c. As an option, users may titrate the Positive Control to endpoint to serve
1. Small serological, Pasteur, capillary, or automatic pipettes. as a semi-quantitative (1+ Minimally Reactive) Control. In such cases,
2. Disposable pipette tips. the Control should be diluted two-fold in Sample Diluent. When
3. Small test tubes, 13 x 100mm or comparable. evaluated by DAI an endpoint dilution is established and printed on the
4. Test tube racks. Positive Control vial (± one dilution). It should be noted that due to
5. Staining dish. A large staining dish with a small magnetic mixing set-up variations within the laboratory (equipment, etc.), each laboratory should
provides an ideal mechanism for washing slides between incubation steps. establish its own expected end-point titer for each lot of Positive Control
6. Cover slips, 24x60mm, thickness No. 1.
7. Distilled or deionized water. 4. With suitable dispenser (listed above), dispense 20µL of each Control and each
8. Properly equipped fluorescence microscope. diluted patient sera in the appropriate wells.
9. 1 Liter Graduated Cylinder. 5. Incubate Slides at room temperature (35 - 37°C) for 60 ± 5 minutes.
10. Laboratory timer to monitor incubation steps. 6. Gently rinse Slides with PBS. Do not direct a stream of PBS into the
test wells.

DAI CODE #2 Page 2 of 6

7. Wash Slides for two, 5 minute intervals, changing PBS between washes. Equivocal Positive Obtain a new specimen for
determination of IgM antibodies
8. Remove Slides from PBS. Rinse Slides briefly with deionized or distilled water to T. gondii. It cannot be
and air dry Slides. Do not disturb the organism in the wells. determined if the patient is
9. Add 20 µL of Conjugate to each well. Incubate Slides at 35-37°C for 30 ± 5 undergoing or has undergone an
acute T. gondii infection. It
minutes. appears the patient has been
10. Repeat steps 6 through 8. previously infected with T. gondii.
11. Apply 3- 5 drops of Mounting Media to each Slide (between the wells) and If the new specimen result is
equivocal or positive for IgM
coverslip. Examine Slides immediately with an appropriate fluorescence antibodies, the specimen should be
microscope. sent to a reference laboratory with
NOTE: If delay in examining Slides is anticipated, seal coverslip with clear nail experience in the diagnosis of
toxoplasmosis for further testing.
polish and store in refrigerator. It is recommended that Slides be examined on Equivocal Equivocal Obtain a new specimen for further
the same day as testing. testing. It cannot be determined if
the patient is undergoing an acute
infection or has been previously
infected with T. gondii. If the new
RESULTS specimen result is equivocal or
positive for IgM antibodies, the
Titer Clinical Significance specimen should be sent to a
reference laboratory with
<1:10 Negative: No detectable IgM antibody to T. gondii. A negative result experience in the diagnosis of
indicates no primary or recent infection with T. gondii and implies that toxoplasmosis for further testing.
such individuals are presumed to be susceptible to primary infection. Positive Negative Obtain a new specimen for further
testing. The patient may or may
However, specimens taken too early during a primary infection may not be acutely infected with T.
not have detectable levels of IgM antibody. If a primary infection is gondii. Since the IgG antibodies to
suspected, another specimen should be taken within 7 days to look for T. gondii are negative, the
specimen may have been obtained
the presence of T. gondii specific IgM. If the second specimen is too early in the disease process for
positive, a primary or recent infection with T. gondii is indicated. an accurate determination. Retest
Alternatively, additional samples may be drawn 2-8 weeks later and the new specimen with a different
anti-T. gondii IgM assay. If the
analyzed for the presence of Toxo-specific IgG. The appearance of new specimen result is still
Toxo-specific IgG in a patient previously shown to be negative for T. positive for IgM antibodies, the
gondii IgG indicates that a primary infection has occurred. A polar specimen should be sent to a
reference laboratory with
staining reaction is considered negative for specific antibody to T. experience in the diagnosis of
gondii. Finally, it should be noted that a non-confluent or beaded toxoplasmosis for further testing.
fluorescent pattern is also considered negative for specific antibody to Positive Positive The patient may or may not be
T. gondii. acutely infected with T. gondii.
Obtain a new specimen for further
>1:10 Positive: Detectable IgM antibody to T. gondii. This indicates a testing. Since the IgG antibodies
primary or recent infection with T. gondii. Such individuals are to T. gondii are positive, it appears
the patient may be acutely infected
presumed to be at risk of transmitting T. gondii infection. with T. gondii. The new specimen
should be repeated with a different
anti-T. gondii IgM assay. If the
new specimen result is still
Anti-T. gondii IgM Result Anti-T. gondii IgG Result Report/Interpretation positive for IgM and IgG
antibodies to T. gondii, the
Negative Negative It is presumed the patient has not specimen should be sent to a
been infected with and is not reference laboratory with
undergoing an acute infection with experience in the diagnosis of
T. gondii. If symptoms persist toxoplasmosis for further testing.
submit a new specimen within Positive Equivocal It cannot be determined if the
three weeks. patient is acutely infected with T.
Negative Positive From this testing it cannot be gondii. Obtain a new specimen for
determined whether the patient is further testing. Determining
or is not undergoing a reactivated whether the patient has been
T. gondii infection. It appears the previously infected with T. gondii
patient has been previously is not possible. The specimen may
infected with T. gondii. Infection have been collected too early
occurred more than one year ago. during the disease process for an
Negative Equivocal Obtain a new specimen for further accurate determination. Retest the
testing. Patient may not be new specimen with a different
undergoing an acute infection with anti-T. gondii IgM assay. If the
T. gondii. Determining whether new specimen result is still
the patient has been previously positive for IgM and the IgG is
infected with T. gondii is not positive/negative/equivocal for
possible. antibodies to T. gondii the
Equivocal Negative Obtain a new specimen for specimen should be sent to a
determination of IgM antibodies reference laboratory with
to T. gondii. It cannot be experience in the diagnosis of
determined if the patient is toxoplasmosis for further testing.
undergoing an acute T. gondii
infection. It appears the patient
has not been previously infected
with T. gondii. If the new PERFORMANCE CHARACTERISTICS
specimen result is positive or
equivocal for IgM antibodies, the
specimen should be sent to a 1. Comparative Study:
reference laboratory with
experience in the diagnosis of The DAI T. gondii IgM Test System was compared to a commercially available IgM
toxoplasmosis for further testing. Capture ELISA for the detection of IgM antibodies to T. gondii. In this study, a total
of 156 serum samples were evaluated. Twenty-six T. gondii IgM positive samples
were obtained from a Toxoplasma Reference lab, and 130 samples were from normal

DAI CODE #2 Page 3 of 6

plasma donors from Southeastern United States. For all IgM IFA testing, IgG was
removed IgG Removal Reagent. The presence of T. gondii-specific IgM in the Table 5: Comparison After Resolution of Discrepant Results
samples from the reference laboratory was supported by the following information:
positive by the Sabin-Feldman dye test, positive by reference laboratory Toxo IgM Relative Sensitivity: 24/26 = 92.3%
capture ELISA, and clinical diagnosis. Discrepant samples were evaluated using a Relative Specificity: 123/123 = 100%
commercial T. gondii IgM IFA test system. The results of these studies are Percent Agreement: 147/149 = 98.7%
summarized below: 2. Cross Reactivity:
Table 1: DAI T. gondii IgM IFA Test System initial Comparison to a Commercial Studies were performed to assess interference in the test procedure by rheumatoid
Toxo IgM Capture ELISA. factor (RF), EBV-IgM, CMV-IgM, Rubella IgM, and antibodies to nuclear antigens
(ANA). Nine samples containing EBV-IgM antibodies (IFA titer range = 1:10 to
Relative Sensitivity: 92.3% (24/26) 1:5120), and 33 samples positive for RF by latex agglutination (titer range = 1:20 to
Relative Specificity: 100% (112/112) 1:640) were negative when tested with the DAI T. gondii IgM IFA Test System. One
Percent Agreement: 98.6% (136/138) sample, strongly positive for T T. gondii IgG and Rheumatoid Factor (1:160)
produced a low to mid-positive IgM result when tested with the DAI T. gondii IgM
Samples that were equivocal on the IgM capture ELISA Test System were excluded IFA Test System prior to IgG absorption. Following IgG absorption, the DAI T.
from the calculations. gondii IgM IFA Test System result was clearly negative. Two samples positive for
CMV-IgM antibody by DAI ELISA, and four samples positive for Rubella-IgM
Table 2: Toxoplasma Reference Laboratory Samples (n=26) antibody by the DAI ELISA were tested on the DAI T. gondii IgM IFA Test System.
All CMV samples, and three of the four Rubella samples were clearly negative. One
T. gondii IgM IFA
Rubella IgM positive sample yielded a very weak (±) beaded fluorescent pattern.
Finally, four samples exhibiting antibodies to nuclear antigens were tested on the
Positive Negative Equivocal* Totals
DAI T. gondii IgM IFA Test System. All samples were clearly negative for
Commercial + 24 2ª 0 26
Toxo IgM
Toxoplasma IgM, yet two samples did display a very weak non-specific fluorescent
- 0 0 0 0 pattern. The results of the cross-reactivity investigation show that there exists little or
ELISA
Equivocal* 0 0 0 0 no cross-reactivity with the DAI T. gondii IgM IFA Test System.
(Capture)
Totals 24 2ª 0 26
Relative Sensitivity = 92.3 % (24/26) ªFor discrepant results, see Table 4
QUALITY CONTROL
1. Every time the assay is run, a Positive Control a Negative Control and a Buffer
Table 3: Normal Plasma Donor Samples (n=130) Control must be included.
T. gondii IgM IFA
2. It is recommended that one read the Positive and Negative Controls before
evaluating test results. This will assist in establishing the references required to
Positive Negative Equivocal* Totals
interpret the test sample. If Controls do not appear as described, results are
Commercial + 0 11ª 0 11
Toxo IgM
invalid.
- 0 112 0 112
ELISA
Equivocal* 0 7b 0 7
(Capture) a. Negative Control – Characterized by the absence of staining along the
Totals 0 130 0 130 periphery of the substrate organism. The organisms will appear reddish,
Relative Specificity = 100 % (112/112) ªFor discrepant results, see table 4
or dull green, with no yellow-green fluorescence. Use the reaction of the
b Equivocal results were excluded from calculations.
negative control serum as a guide for the interpretation of patient results.
NOTE: Please be advised that ‘relative’ refers to the comparison of this
b. Positive Control - Characterized by confluent 1 + to 4+ apple-green
assay’s results to that of a similar assay. There was not an attempt to
fluorescent staining along the periphery of the organisms. A 1+ reaction
correlate the assay’s results with disease presence or absence.
is one that shows weak but distinct apple-green fluorescence and
represents the endpoint reaction in a titration. A 4+ reaction is one that
shows very strong apple-green staining at the periphery of the organisms.
Table 4: Analysis of Discrepant Results by a Commercial IFA
Sample DAI T. Commercial Commercial* 3. Additional Controls may be tested according to guidelines or requirements of
ID gondii IgM Toxo IgM IFA Toxo IgM IFA local, state, and/or federal regulations or accrediting organizations.
IFA
120 - + -
121 - + - NOTES:
The intensity of the observed fluorescence may vary with the microscope and filter
122 - + -
system used.
123 - + -
124 - + -
125 - + - LIMITATIONS OF PROCEDURE
126 - + -
1. IgG antibodies, if present in the sample, may interfere with determination of
127 - + -
IgM titers to the organism. High affinity IgG antibodies may preferentially bind
128 - + - to antigenic determinants leading to false negative IgM titers. Also, IgM
129 - + - rheumatoid factor may bind to the antigen specific IgG leading to false positive
130 - + - IgM titers. Both of these problems can be eliminated by removing IgG from the
132 - + + samples before testing for IgM. Several different methods of separating IgG
156 - + + have been used. These include gel filtration, absorption with protein A, ion
*Samples 120 - 130 exhibited polar staining which is not indicative exchange chromatography, precipitation of IgG with anti-human IgG serum, or
of a specific positive reaction. These samples did not display a polar the use of IgG Removal Reagent.
staining reaction on the DAI T. gondii IgM IFA Test System.

DAI CODE #2 Page 4 of 6

2. Results of the DAI T. gondii IgM IFA Test System are not by themselves 4. The Controls are potentially bio-hazardous materials. Source materials from
diagnostic and should be interpreted in light of the patients clinical condition which these products were derived were found negative for HIV-1 antigen,
and the results of other diagnostic procedures. HBsAg and for antibodies against HCV and HIV by approved test methods.
3. Samples taken too early during the course of a primary infection with T. gondii However, since no test method can offer complete assurance that infectious
may not contain detectable levels of IgM-specific antibody. In some patients, agents are absent, these products should be handled at the Bio-safety Level 2 as
IgM specific antibody results may revert to negative levels within three weeks recommended for any potentially infectious human serum or blood specimen in
after infection with T. gondii. Measurement of T. gondii-specific IgG the Centers for Disease Control/National Institutes of Health manual
antibodies may also be of some value in the serological assessment of these “Biosafety in Microbiological and Biomedical Laboratories”: current edition;
patients. with T. gondii. Measurement of T. gondii-specific IgG antibodies may and OSHA’s Standard for Bloodborne Pathogens .
also be of some value in the serological assessment of these patients. 5. Adherence to the specified time and temperature of incubations is essential for
4. T. gondii-specific IgM antibody may not be demonstrable in patients who are accurate results. All reagents must be allowed to reach room temperature
immunocompromised and in some patients with congenital toxoplasmosis. (20 - 25°C) before starting the assay. Return unused reagents to their original
5. Naturally occurring T. gondii-specific IgM antibodies, with or without the containers immediately and follow storage requirements.
occurrence of IgG antibodies, have been reported. Neither the stimulus nor the 6. Improper washing could cause false positive or false negative results. Be sure
significance of naturally occurring IgM antibodies directed against T. gondii is to minimize the amount of any residual PBS, by blotting, before adding
understood at this time. Conjugate. Do not allow the wells to dry out between incubations.
6. Heterotypic IgM antibody responses may occur in patients infected with 7. The Sample Diluent, Conjugate, and Controls contain Sodium Azide at a
Epstein-Barr Virus and give false positive results on the DAI T. gondii IgM concentration of <0.1% (w/v). Sodium Azide has been reported to form lead or
IFA Test System. copper azides in laboratory plumbing which may cause explosions on
7. T. gondii-specific IgG antibody may compete with specific IgM for antibody hammering. To prevent, rinse sink thoroughly with water after disposing of
binding and cause false negative results. Rheumatoid factor (IgM), if present solution containing Sodium Azide. This preservative may by toxic if ingested.
with T. gondii-specific IgG, will cause false positive results. The absorbent 8. Dilution or adulteration of these reagents may generate erroneous results.
incubation step will functionally remove greater than 99% of IgG from the test 9. Never pipette by mouth. Avoid contact of reagents and patient specimens with
specimen and significantly reduce the possibility of false positive or negative skin and mucous membranes.
results. 10. Avoid microbial contamination of reagents. Incorrect results may occur.
8. False positive anti-T. gondii results have been reported for patients having 11. Cross contamination of reagents and/or samples could cause erroneous
autoimmune disease. results.
9. The performance of the DAI T. gondii IgM IFA Test System has not been 12. Reusable glassware must be washed and thoroughly rinsed free of all
validated using neonatal samples. detergents.
10. A negative result for Toxo IgM does not preclude the possibility of an acute 13. Avoid splashing or generation of aerosols.
infection in the immunocompromised patient. T. gondii-specific IgG antibodies 14. Do not expose reagents to strong light during storage or incubation.
are generally low and T. gondii-specific IgM antibodies may be undetectable in 15. Allowing the slide packet to equilibrate to room temperature prior to opening
patients who are immunocompromised. the protective envelope will protect the wells and blotter from condensation.
11. Due to the apparent low prevalence of anti-T. gondii IgM in the United States 16. Collect the wash solution in a disposal basin. Treat the waste solution with
the performance characteristics sited below may not be representative of the disinfectant (i.e.:10% household bleach - 0.5% Sodium Hypochlorite). Avoid
population at each users laboratory. exposure of reagents to bleach fumes.
12. With very low prevalence analytes, such as anti-T. gondii IgM there is the 17. Do not expose any of the reactive reagents to bleach-containing solutions or to
increased possibility that a positive result is truly a false positive, reducing the any strong odors from bleach-containing. Trace amounts of bleach (Sodium
assay’s positive predictive value. Hypochlorite) may destroy the biological activity of many of the reactive
reagents within this Test System.
18. Do not apply pressure to slide envelope. This may damage the substrate.
EXPECTED VALUES 19. The components of this Test System are matched from optimum sensitivity and
reproducibility. Reagents from other manufacturers should not be interchange.
T. gondii-specific IgM antibodies rise sharply just before or shortly after onset of Follow Package insert carefully.
symptoms, and reach peak titers within one month. T. gondii-specific IgM falls to 20. Unopened/ opened components are stable until the expiration date printed on
low levels in most patients within 4 to 6 months. In some patients, IgM-specific the label, provide the recommended storage conditions are strictly followed. Do
antibodies may be detectable for 8 months to one year. In a study conducted by DAI, not use beyond the expiration date. Do not freeze.
108 samples were tested for T. gondii IgM using the DAI T. gondii IgM IFA Test 21. Evans Blue Counterstain is a potential carcinogen. If skin contact occurs, flush
System. These samples (from Northeastern U.S.) were sent to a reference laboratory with water. Dispose of according to local regulations.
for routine Toxo serological analysis. Five of the 108 samples (4.6%) were reactive 22. Assay reproducibility has not been established.
for T. gondii IgM. As with any serological method, the expected values are highly 23. Depending upon lab conditions, it may be necessary to place slide in a moist
dependent upon the population type being tested. Each laboratory should establish chamber during incubations.
their own expected values based upon the population type tested. As part of the
clinical study, a group of 130 asymptomatic, ‘normal’ specimens were tested. A
summary of this testing is shown in Table 3. STORAGE
2-8°C Unopened Test System
PRECAUTIONS 2-8°C Mounting Media, Conjugate, Diluent,
Slides, Positive and Negative Controls,
1. For In Vitro Diagnostic Use.
2-8°C Rehydrated PBS (Stable for 30 days)
2. Follow normal precautions exercised in handling laboratory reagents. In case
of contact with eyes, rinse immediately with plenty of water and seek medical 2-25°C Phosphate-buffered-saline (PBS)
advice. Wear suitable protective clothing, gloves, and eye/face protection. Packets
Do not breathe vapor. Dispose of waste observing all local, state, and federal
laws.
3. The wells of the Slide do not contain viable organisms. However, consider the
Slide potentially bio-hazardous materials and handle accordingly.

DAI CODE #2 Page 5 of 6

 24. Galen RS:Predictive Value Theory, Diagnostic Medicine. pp. 23-31,
REFERENCES February, 1979.
25. Godyn JJ, Zmeijewski CM, Tomasezewski JE: Reference Value Changes
1. Krick JA, and Remington JS: Toxoplasmosis in the adult - An overview. New and Improvement of Test Performance. Lab. Med. Vol. 22, No. 6, pp.
Engl. J. Med. 298:550-553, 1978. 411-414, June, 1991.
2. Anderson SE, and Remington JS: The diagnosis of toxoplasmosis. So. Med. J. 26. Ilstrup DM:Statistical Methods in Microbiology. Clinical Microbiology
68:1433-1443, 1975. Reviews, Vol. 3, No. 6, pp. 219-226, July, 1990.
3. Feldman HA: Toxoplasmosis - An Overview. Bull. NY Acad. Med. 50:110- 27. McNeil BJ, Keeler E, Adelstein SJ: Primer on Certain Elements of
127, 1974. Medical Decision Making. New Eng. J. Med. Vol. 293, No.5, pp. 211-
4. Welch PC, Masur H, Jones TC, and Remington JS: Serologic diagnosis of 215, July, 31, 1975.
acute lymphadenopathic toxoplasmosis. J. Infect. Dis. 42:256-264, 1980.
5. Ruskin J, and Remington JS: Toxoplasmosis in the compromised host. Ann.
Intern. Med. 84:193-199, 1976. ISO 13485
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