Postnatal ocular toxoplasmosis in immunocompetent patients

Introduction: Ocular toxoplasmosis is the most common cause of infectious posterior uveitis worldwide. It can be prenatal or postnatal in origin. Despite estimations that postnatal ocular toxoplasmosis is more prevalent, only several cases of proven postnatal ocular toxoplasmosis have been reported in non-epidemic settings. Here, the clinical evolution of ocular toxoplasmosis of conclusively proven postnatal origin in immunocompetent patients is reported. Methodology: Postnatal ocular toxoplasmosis was diagnosed based on clinical diagnosis supported by the longitudinal detection of Toxoplasma gondii-specific IgG, IgM and IgA antibodies in the serum as well as by direct detection of the parasite (bioassay) and/or its DNA (real-time PCR) in aqueous humor. Results: Three cases involved adults in whom ocular toxoplasmosis developed during primary T. gondii infection, as part of the clinical presentation in two and as the sole manifestation in one patient. The fourth patient was a case of inactive ocular toxoplasmosis in a 14-year-old boy, where postnatal infection was confirmed by exclusion of maternal infection. The causative parasite strain was genotyped in only one case and it belonged to genotype II, the dominant type in Europe. One patient acquired the infection in Africa, suggesting an atypical strain. Conclusions: The distinction between prenatal and postnatal ocular toxoplasmosis is only possible in particular clinical situations, and requires extensive laboratory investigation. Genotyping of the parasite strain involved may be important, particularly if atypical strains are suspected, requiring tailored treatment approaches.

Download Full-text

Comparison of immunoblotting (IgA and IgG) and the Goldmann-Witmer coefficient for diagnosis of ocular toxoplasmosis in immunocompetent patients

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311528 ◽

2018 ◽

Vol 102 (10) ◽

pp. 1454-1458 ◽

Cited By ~ 6

Author(s):

Thibaud Mathis ◽

Sylvain Beccat ◽

Pascal Sève ◽

François Peyron ◽

Martine Wallon ◽

...

Keyword(s):

Symptom Onset ◽

Laboratory Tests ◽

Aqueous Humour ◽

Current Practice ◽

Inflammatory Diseases ◽

Posterior Uveitis ◽

Clinical Findings ◽

Ocular Toxoplasmosis ◽

The Difference ◽

Immunocompetent Patients

BackgroundOcular toxoplasmosis (OT) is a common cause of posterior uveitis worldwide. The diagnosis of OT is based on clinical findings, but in most cases, laboratory tests are required to confirm the aetiology, especially when other diseases are suspected. The aim of this study was to evaluate which methods, between the Goldmann-Witmer coefficient (GWC) and immunoblotting (IB) with both IgG and IgA, in aqueous humour (AH) samples, can be the most sensitive to diagnose OT, in current practice, especially in the first three weeks.MethodsRetrospectively reviewed records of 87 consecutive patients who had underwent AH and serum sample, 42 patients with suspected OT and 45 patients with suspected other ocular inflammatory diseases. All samples were analysed by both GWC and IB.ResultsThe GWC was significant in 47.6% of patients presenting with suspected OT. The intraocular production of specific antibody anti-Toxoplasma gondii IgG and IgA was revealed by IB in 71.4% of samples. The combination of these two methods increased the sensitivity to 76.2%. Based on the interval between symptom onset and paracentesis, IB had a greater sensitivity than GWC when sample of AH was taken in the first three weeks (64.7% vs 23.5%, P=0.039), while the difference between the sensitivity of IB and GWC was less important in cases with an interval >3 weeks (76% vs 64% P=0.625).ConclusionIB seems to be more useful than the GWC if only one of these methods can be performed, especially during the first three weeks after symptom onset.

Download Full-text

Toxoplasmosis Related Uveitis: Clinic, Diagnosis, and Treatment

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0171 ◽

2019 ◽

pp. 237-243

Keyword(s):

Toxoplasma Gondii ◽

Treatment Options ◽

Protozoan Parasite ◽

Posterior Uveitis ◽

Ocular Toxoplasmosis ◽

Diagnosis And Treatment ◽

Frequent Form

Ocular toxoplasmosis (OT) is considered the most frequent form of infectious posterior uveitis and is caused by the protozoan parasite Toxoplasma gondii. Despite large advances in the field of OT, large gaps still exist in our knowledge concerning the epidemiology and pathophysiology of this potentially blinding infectious old disease. In this review, we aimed to investigate the current clinical understanding of OT, diagnosis treatment options.

Download Full-text

When biology supports clinical diagnosis: review of techniques to diagnose ocular toxoplasmosis

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-313884 ◽

2019 ◽

Vol 103 (7) ◽

pp. 1008-1012 ◽

Cited By ~ 9

Author(s):

Valentin Greigert ◽

Elsa Di Foggia ◽

Denis Filisetti ◽

Odile Villard ◽

Alexander W Pfaff ◽

...

Keyword(s):

Diagnostic Algorithm ◽

High Specificity ◽

Posterior Uveitis ◽

Ocular Toxoplasmosis ◽

Specificity And Sensitivity ◽

Tremendous Progress ◽

Associated Symptoms ◽

Fast Procedure ◽

Common Infection ◽

Made In

Toxoplasmosis is a common infection whose worldwide prevalence is estimated at 30%, with large disparities across the world. Among infected subjects, the prevalence of ocular toxoplasmosis (OT) is, however, limited to about 2% in Europe and 17% in South America. In France, it is estimated that about 1 000 000 patients present either active OT or subsequent chorioretinal scars. Toxoplasmagondii is the first cause of posterior uveitis worldwide, responsible for retinochoroiditis, at times associated with anterior uveitis. To date, there is no consensus yet on how to diagnose OT, which is often based only on clinical presentation. Nevertheless, OT-associated symptoms are often atypical and misleading. Over the last 20 years, tremendous progress has been made in biological tools, enabling parasitologists to confirm the diagnosis in most suspected cases of OT. Using anterior chamber puncture, a safe and fast procedure, ophthalmologists sample aqueous humour for analysis using multiple techniques in order to reach high specificity and sensitivity in OT diagnosis. In this article, we present the different techniques available for the biological diagnosis of OT, along with their characteristics, and propose a diagnostic algorithm designed to select the best of these techniques if clinical examination is not sufficient to ascertain the diagnosis.

Download Full-text

Clinical feature and treatment outcome of active ocular toxoplasmosis in immunocompetent patients

Asian Pacific Journal of Tropical Medicine ◽

10.1016/s1995-7645(10)60138-1 ◽

2010 ◽

Vol 3 (7) ◽

pp. 571-573

Author(s):

Mohammad Nassaji ◽

Gholamreza Daraie ◽

Raheb Ghorbani

Keyword(s):

Treatment Outcome ◽

Ocular Toxoplasmosis ◽

Clinical Feature ◽

Immunocompetent Patients

Download Full-text

Is ocular toxoplasmosis caused by prenatal or postnatal infection?

British Journal of Ophthalmology ◽

10.1136/bjo.84.2.224 ◽

2000 ◽

Vol 84 (2) ◽

pp. 224-226 ◽

Cited By ~ 85

Author(s):

R. E GILBERT

Keyword(s):

Ocular Toxoplasmosis ◽

Postnatal Infection

Download Full-text

Development of a Novel Rapid Immunodiagnostic Kit Based on Flagellar 40 kDa Antigen Epitope for the Detection of Typhoid Fever in Indian Patients

The Scientific World JOURNAL ◽

10.1155/2013/363652 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Rahul Mitra ◽

Surya Bhan ◽

Gopal Nath ◽

Narender Kumar ◽

Ziledar Ali

Keyword(s):

Staphylococcus Aureus ◽

Typhoid Fever ◽

Direct Detection ◽

Febrile Illness ◽

Cross Reactivity ◽

Negative Results ◽

Kala Azar ◽

Primary Health Centres ◽

Test Kit ◽

Specific Igg

To aid the clinical diagnosis of typhoid fever in India, where most hospitals and primary health centres have no facilities for culture, we report on the development of a novel and rapid immunodiagnostic kit for the direct detection ofSalmonellaTyphi—specific IgG antibodies againstS. Typhi flagellar H antigen. The disease often does not show a specific clinical picture, and can be confused with other febrile illness such as malaria, dengue fever andStaphylococcus aureus. To overcome the problem of cross reactivity specific epitope of the flagellar H antigen was immobilised on the testing kit strip eliminating chances of cross reactivity and false positive results thereby increasing the specificity of the test. Since the immunodiagnostic kit, uses the flagellar H antigen from bacteria present in our country, the antibodies present in the serum of patients of our country will have maximum binding affinity, enhancing the sensitivity of our test kit. The immunodiagnostic kit on analysis gave a positive result with clinically diagnosed typhoid positive patient serum and negative results were obtained with the sera of clinically diagnosed malaria, abscess ofStaphylococcus aureusand Visceral leishmaniasis (Kala-azar) patients.

Download Full-text

The legacy of maternal SARS-CoV-2 infection on the immunology of the neonate

10.1101/2021.05.27.446014 ◽

2021 ◽

Author(s):

Sarah Gee ◽

Manju Chandiramani ◽

Jeffrey Seow ◽

Carlotta Modestini ◽

Abhishek Das ◽

...

Keyword(s):

In Utero ◽

Innate Immune ◽

Innate Immune Cells ◽

Maternal Infection ◽

Increased Risk ◽

Specific Igg ◽

Potential Impact ◽

Effector Response ◽

Ongoing Infection ◽

Pro Inflammatory Cytokines

Despite extensive and ongoing studies of SARS-CoV-2 and evidence that pregnant women are at increased risk of severe COVID-19, the effect of maternal infection on the developing infant remains unclear. To determine the potential impact of exposure to SARS-CoV-2 in utero on the neonate, we have assessed the immunological status of infants born to mothers with confirmed SARS-CoV-2 infection during gestation. No evidence of vertical transmission of SARS-CoV-2 was observed, but transfer of maternal SARS-CoV-2 specific IgG to infants was apparent, although to a lesser extent in cases of active or recent maternal infection. Infants born to mothers with recent/ongoing infection had elevated circulating pro-inflammatory cytokines and enhanced percentages of innate immune cells compared to that seen in infants born to uninfected mothers. In tandem, higher frequencies of FOXP3+ regulatory T cells and circulating IL-10 demonstrated a further nuance to the neonatal effector response. Interestingly, cytokine functionality was enhanced in infants born to mothers exposed to SARS-CoV-2 at any time during pregnancy. This indicates that maternal SARS-CoV-2 infection influences in utero priming of the fetal immune system.

Download Full-text