Impact of gender on clinical features and outcomes of ocular toxoplasmosis.

AIM: To investigate the effect of gender on the clinical features and outcomes of ocular toxoplasmosis. METHODS: 262 patients (139 women and 123 men) presenting to a tertiary referral uveitis service in Ribeirão Preto, Brazil, with serological and clinical evidence of ocular toxoplasmosis were prospectively enrolled in an observational study. Predefined data items including demographics, descriptors of uveitis and ocular toxoplasmosis, best-corrected visual acuity and ocular complications were disaggregated by gender and compared statistically. RESULTS: Approximately equal numbers of women and men had active versus inactive ocular toxoplasmosis. In both women and men, most infections were remotely acquired. Men were significantly more likely to present with primary active disease than women (24.4% vs 12.9%); conversely, women were significantly more likely to present with recurrent active disease than men (36.0% vs 28.5%). One toxoplasmic retinal lesion was observed in more eyes of men than eyes of women (50.4% vs 35.3%), while women's eyes were more likely to have multiple lesions than men's eyes (54.7% vs 39.8%). Lesions in women's eyes were significantly more likely to occur at the posterior pole compared with those in men's eyes (56.1% vs 39.8%). Measures of vision were similar for women and men. There were no significant differences in measures of visual acuity, ocular complications, and occurrence and timing of reactivations between the genders. CONCLUSION: Ocular toxoplasmosis has equivalent outcomes in women and men, with clinical differences in the form and type of disease, as well as characteristics of the retinal lesion.

Posterior segment findings by spectral-domain optical coherence tomography and clinical associations in active toxoplasmic retinochoroiditis.

Toxoplasmic retinochoroiditis is a common, potentially blinding parasitic infection. We sought to define the spectrum and frequency of signs of active toxoplasmic retinochoroiditis by spectral domain optical coherence tomography (SD-OCT), and to identify clinical associations. Ninety eyes of 90 individuals presenting consecutively to a tertiary referral uveitis service with active toxoplasmic retinochoroiditis and gradable SD-OCT scans were evaluated prospectively. SD-OCT features were collated, and associations with lesion location, primary versus recurrent episode, serological status, human immunodeficiency virus infection and best-corrected Snellen visual acuity were explored. Active toxoplasmic retinochoroiditis presented with thickened (65%) and hyperreflective (61%) retina, choroidal thickening (55%) and hyporeflectivity (61%), hyperreflective vitreous dots (80%) and deposits (36%), and posterior hyaloid thickening (35%) on SD-OCT. Most signs occurred with similar frequency across clinical groups. Retinal hyporeflectivity (17%) was significantly associated with a visual acuity of 20/200 or worse at resolution. Our observations demonstrate that active toxoplasmic retinochoroiditis has diverse SD-OCT signs and that none are universally present. Retinal hyporeflectivity-suggesting liquefactive necrosis-predicts poor visual outcome.

Clinical manifestations and visual outcomes associated with ocular toxoplasmosis in a Brazilian population.

Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide. We conducted an observational study of 262 consecutive individuals (n = 344 eyes) with ocular toxoplasmosis who were followed over a 34-month period. Most subjects were T. gondii IgG + /IgM- (n = 242; 92.4%; 317 eyes), and 140 eyes (40.7%) had active lesions. For eyes in which retinal lesions were active at recruitment and best-corrected visual acuity (BCVA) could be measured (n = 133), 21.0% (n = 28) remained blind (BCVA below 20/400) after inflammation resolved. In these eyes, atypical ocular toxoplasmosis (OR 4.99; 95% CI 1.14-22.85; p = 0.0330), macular lesion (OR 9.95; 95% CI 2.45-47.15; p = 0.0019) and any complication (OR 10.26; 95% CI 3.82-30.67; p < 0.0001) were associated with BCVA below 20/200. For eyes with only inactive lesions at recruitment and BCVA measured (n = 178), 28.1% (n = 50) were blind. In these eyes, having at least one lesion larger than one disc-diameter (OR 6.30; 95% CI 2.28-22.46; p = 0.0013) and macular lesion (OR 5.69; 95% CI 2.53-13.54; p < 0.0001) were associated with BCVA below 20/200. Older age (OR 1.02; 95% CI 1.00-1.05; p = 0.0493) and active disease at presentation (OR 4.74; 95% CI 1.95-12.91; p = 0.0011) were associated with recurrences. Additional clinical attention should be directed towards patients with risk factors for poor visual outcome.

Molecular Basis of The Retinal Pigment Epithelial Changes That Characterize The Ocular Lesion in Toxoplasmosis.

When a person becomes infected with Toxoplasma gondii, ocular toxoplasmosis is the most common clinical presentation. The medical literature describes retinitis with surrounding hyperpigmentation secondary to proliferative changes in the retinal pigment epithelium, which is sufficiently characteristic that investigation often is not needed to make the diagnosis. We aimed to establish the frequency of "typical" ocular toxoplasmosis and delineate its molecular basis. Among 263 patients presenting consecutively with ocular toxoplasmosis to Ribeirão Preto General Hospital in Brazil, where T. gondii infection is endemic, 94.2% of 345 eyes had retinal hyperpigmentation. In ARPE-19 and primary human retinal pigment epithelial cell monolayers exposed to minimal numbers of T. gondii tachyzoites, the proliferation marker-KI-67-was increased in uninfected cells, which also were rendered more susceptible to infection. RT-qPCR and ELISA detected increased expression of vascular endothelial growth factor A (VEGF) and insulin-like growth factor (IGF)1, and decreased expression of thrombospondin (TSP)1 by infected cells. Blockade of VEGF and IGF1-or supplementation of TSP1-reversed the proliferation phenotype in uninfected cells. Our findings confirm that hyperpigmentation is a characteristic feature of retinitis in ocular toxoplasmosis, and demonstrate that T. gondii-infected human retinal pigment epithelial cells secrete VEGF and IGF1, and reduce production of TSP1, to promote proliferation of adjacent uninfected cells and create this disease-specific appearance.

Arsenate and arsenite adsorption onto iron-coated cork granulates.

There is a growing demand for low-cost, effective adsorbents for arsenic removal from water intended for human consumption in affected rural areas. This work presents a novel adsorbent based on the coating of cork granulates with iron (oxy)hydroxides for the removal of As(III) and As(V) from aqueous matrices. A 26-3 fractional factorial design was used to determine the optimal conditions for the iron coating procedure. The optimal adsorbent was produced by coating low-density cork granulates with iron (oxy)hydroxides precipitated from a 0.05 mol L-1 FeCl3 solution at pH 7, 20 °C temperature and 20 g L-1 S/L ratio, in a single coating cycle. Arsenic adsorption was found to be dependent on pH, with inverse trends for As(III) and As(V). The iron leaching from the adsorbent was also taken into account to select the optimum pH, which was pH 9 for As(III) and pH 3 for As(V). Adsorption kinetics were better described by the pseudo-second-order model for As(III) and the Elovich model for As(V). Equilibrium was reached in 16 h for As(III) at pH 9 and 48 h for As(V) at pH 3. The isotherm models indicated different adsorption behaviours for As(III) and As(V), with better fits by Langmuir and Freundlich models, respectively. The Langmuir maximum adsorption capacity of iron-coated cork adsorbent for As(III) at pH 9 was 4.9 ±â€¯0.3 mg g-1. However, at low equilibrium concentrations, As(V) adsorption was higher than As(III) (e.g. 2.1 ±â€¯0.2 mg g-1 in equilibrium with 0.16 ±â€¯0.03 mg L-1). Speciation studies and XPS analyses indicated that no substantial oxidation of As(III) to As(V) occurred during the adsorption process. The study shows that iron coating can enhance both arsenate and arsenite adsorption capacity of cork materials, leading to an innovative natural adsorbent with high resilience and stability, with possible application in arsenic remediation.

Arsenic removal from water using iron-coated seaweeds.

Arsenic is a semi-metal element that can enter in water bodies and drinking water supplies from natural deposits and from mining, industrial and agricultural practices. The aim of the present work was to propose an alternative process for removing As from water, based on adsorption on a brown seaweed (Sargassum muticum), after a simple and inexpensive treatment: coating with iron-oxy (hydroxides). Adsorption equilibrium and kinetics were studied and modeled in terms of As oxidation state (III and V), pH and initial adsorbate concentration. Maximum adsorption capacities of 4.2 mg/g and 7.3 mg/g were obtained at pH 7 and 20 °C for arsenite and arsenate, respectively. When arsenite was used as adsorbate, experimental evidences pointed to the occurrence of redox reactions involving As(III) oxidation to As(V) and Fe(III) reduction to Fe(II), with As(V) uptake by the adsorbent. The proposed adsorption mechanism was then based on the assumption that arsenate was the adsorbed arsenic species. The most relevant drawback found in the present work was the considerable leaching of iron to the solution. Arsenite removal from a mining-influenced water by adsorption plus precipitation was studied and compared to a traditional process of coagulation/flocculation. Both kinds of treatment provided practically 100% of arsenite removal from the contaminated water, leading at best in 12.9 µg/L As after the adsorption and precipitation assays and 14.2 µg/L after the coagulation/flocculation process.