Ocular toxoplasmosis: phenotype differences between toxoplasma IgM positive and IgM negative patients in a large cohort.

PURPOSE: To investigate the differences in demographics and clinical characteristics of patients diagnosed with ocular toxoplasmosis according to their IgM status. METHODS: Retrospective case note analysis was carried out on patients who tested positive for serum Toxoplasma gondii-specific IgM antibodies (IgM+) as well as a comparator group who tested negative for serum IgM (IgM-), but positive for serum IgG. Patient demographics and clinical features were compared between the two groups to evaluate for any significant differences. RESULTS: One hundred and six patients were included in the study between March 2011 and June 2018, consisting of 37 in the IgM +group and 69 in the IgM- group. Patients in the IgM +group were significantly older (51.1 vs 34.1 years, p<0.0001), more likely to present with central macular lesions (32% vs 12%, p=0.012), and more likely to develop rhegmatogenous retinal detachment (11% vs 1%, p=0.049). In contrast, patients in the IgM- group were more likely present with pain (20% vs 3%, 0.017) and exhibit more severe inflammation of the anterior chamber and vitreous (p<0.05). Overall, retinal lesions were more likely to be superotemporal (55%) and superonasal (31%). Furthermore, age was associated with larger (p=0.003) and more peripheral lesions (p=0.007). CONCLUSIONS: This study demonstrated significant differences in clinical characteristics of ocular toxoplasmosis according to serum IgM status. IgM+ patients were older, less likely to report pain, had lower levels of intraocular inflammation, but were more likely to have macular involvement. We also found age to be correlated with larger and more peripheral lesions.

Diagnostic Value of Positive Findings of Toxoplasma gondii-Specific Immunoglobulin M Serum Antibody in Uveitis Patients to Confirm Ocular Toxoplasmosis.

Purpose: To assess the value of positive immunoglobulin (Ig) M serum antibody (Ab) findings in uveitis patients. Methods: We reviewed medical records of patients who had a positive serological test for Toxoplasma gondii-specific IgM Ab. Their clinical data, including history, demographic characteristics, laboratory findings, clinical findings, treatment outcomes, and recurrences, were reviewed retrospectively. Results: Of 2919 uveitis patients who underwent a serological test for suspected ocular toxoplasmosis (OT), 18 presented with positive Ig M results. All 18 patients (100.0% specificity) were clinically diagnosed with OT. None had any retinochoroidal scar at the initial visit, indicating the OT was a recent and primary infection. However, 15 patients (83.3%) had no history suspected to account for the Toxoplasma transmission. Conclusions: The T. gondii IgM serum Ab is a specific biomarker for diagnosis of primary OT. Epidemiological studies are warranted to investigate the non-classic transmission routes of T. gondii in OT.

New insight into the diagnostic cut-off value of serum anti-Toxocara IgG for ocular toxocariasis in uveitis patients.

Uveitis is one of the commonest causes of vision loss worldwide and its exact etiology is still not clarified in most patients. The current study is a trial to assess the efficacy of serum anti-Toxocara immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA) as a diagnostic tool for ocular toxocariasis (OT) and to detect OT prevalence and the associated ocular manifestations in sera of patients with uveitis. One hundred and twelve patients (62 females and 50 males) with uveitis were diagnosed by ophthalmologists, radiologists and rheumatologists according to ocular manifestations, laboratory and radiological investigations. Serum anti-Toxocara IgG titers were determined by ELISA in sera of all patients. Our results revealed that OT is highly associated with intermediate and posterior uveitis. Children and young adult females, especially those residing in rural areas, complained mainly of diminution of vision in the left eye, with strabismus and leukocoria. At a cut-off value of 0.258, the sensitivity and specificity of IgG ELISA were 93.3% and 100%, respectively. In conclusion, at a novel cut-off value of 0.258 the serum anti-Toxocara IgG ELISA is predicted to be a diagnostic tool for OT regarding sensitivity and specificity. Also, it has potential importance in the interpretation and differential diagnosis of OT. Thus, serum anti-Toxocara IgG ELISA should be a routine test for screening of suspected cases.

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

BACKGROUND: Ocular 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. METHODS: Retrospectively 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. RESULTS: The 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). CONCLUSION: IB 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.

A comparative histopathology, serology and molecular study, on experimental ocular toxocariasis by Toxocara cati in Mongolian gerbils and Wistar rats.

The aim of this study was to compare the performance of three in-house diagnostic tests, that is, histopathology, enzyme-linked immunosorbent assay (ELISA), and polymerase chain reaction (PCR), for the diagnosis after experimental infection with Toxocara cati. Twenty Mongolian gerbils and Wistar rats were divided into ten groups (n = 2/group). Toxocara cati infections were established in Mongolian gerbils and Wistar rats by administering doses of 240 and 2500 embryonated Toxocara cati eggs by gavage, respectively. Tissue sections were stained with Haematoxylin and Eosin and observed under the light microscope. Sera and vitreous fluid collected from separate infected groups were tested against Toxocara cati antigens, for 92 days postinfection. Genomic DNA was extracted from formalin-fixed paraffin-embedded (FFPE) blocks, and aqueous fluids belong to the animals. The histopathology test gave negative results among the groups of animals examined between 5 and 92 days postinfection. The ELISA results showed that anti-Toxocara antibodies have risen between 7 and 61 days postinfection in sera and vitreous fluid in the animals infected, respectively. Analysis of PCR products revealed positive band (660 bp) in the orbital tissue infected Mongolian gerbils at 5 days postinfection. Of the three evaluated methods, the PCR could be recommended for scientific and laboratory diagnoses of toxocariasis in experimentally infected animals.

Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with Facial rosacea.

PURPOSE: To investigate correlation between ocular Demodex infestation and serum. DESIGN: A prospective study to correlate clinical findings with laboratory data. PARTICIPANTS: We consecutively enrolled 59 patients: 34 men and 25 women with a mean age of 60.4+/-17.6 years (range, 17-93). METHODS: Demodex counting was performed based on lash sampling. Serum immunoreactivity to two 62-kDa and 83-kDa proteins derived from B oleronius was determined by Western blot analysis. Facial rosacea, lid margin, and ocular surface inflammation were documented by photography and graded in a masked fashion. MAIN OUTCOME MEASURES: Statistical significance based on correlative analyses of clinical and laboratory data. RESULTS: These 59 patients were age matched, but not gender matched, regarding serum immunoreactivity, ocular Demodex infestation, or facial rosacea. There was a significant correlation between serum immunoreactivity and facial rosacea (P = 0.009), lid margin inflammation (P = 0.040), and ocular Demodex infestation (P = 0.048), but not inferior bulbar conjunctival inflammation (P = 0.573). The Demodex count was significantly higher in patients with positive facial rosacea (6.6+/-9.0 vs. 1.9+/-2.2; P = 0.014). There was a significant correlation of facial rosacea with lid margin inflammation (P = 0.016), but not with inferior bulbar conjunctival inflammation (P = 0.728). Ocular Demodex infestation was less prevalent in patients with aqueous tear-deficiency dry eye than those without (7/38 vs. 12/21; P = 0.002). CONCLUSIONS: The strong correlation provides a better understanding of comorbidity between Demodex mites and their symbiotic B oleronius in facial rosacea and blepharitis. Treatments directed to both warrant future investigation.

Serum vitamin A levels in patients with ocular lesions attributable to non-complicated malaria in the Brazilian Amazon region.

In order to evaluate the association between serum vitamin A levels and ocular lesions attributable to non-complicated malaria, 200 patients seen consecutively at the Malaria Outpatient Clinic of FUNASA, Manaus, Amazonas, Brazil were included in this study. Ophthalmologic examination consisted of indirect binocular ophthalmoscopy under medicamentous mydriasis, biomicroscopy with a portable slit lamp and measurement of central visual acuity. Vitamin A serum concentration was determined by HPLC, and deficiency was defined as serum values equal to or lower than 0.35 micromol/l. Serum vitamin A values between 0.36 and 0.70 micromol/l were considered as marginal levels. Hypovitaminosis A (

Ultrasound biomicroscopy findings in peripheral vitreoretinal toxocariasis.

PURPOSE: To describe the morphologic alterations in ultrasound biomicroscopy (UBM) present in peripheral vitreoretinal toxocariasis. METHODS: An observational prospective study of case series. Fifteen eyes of 15 patients with clinical and laboratory diagnosis of peripheral vitreoretinal toxocariasis were enrolled. The patients were submitted to UBM examination of the region corresponding to the pars plana of the affected eye. RESULTS: The most common morphologic alterations found by UBM in patients with peripheral vitreoretinal toxocariasis were as follows: vitreal membranes (13 cases), toxocara granuloma (11 cases), and pseudocysts (8 cases). Other less frequent findings were thickening of the ciliary body (6 cases), cystic formation (2 cases), peripheral retinal detachment (2 cases), rectification of the iris root (1 case), and posterior synechiae (1 case). CONCLUSIONS: UBM allows detection of well-defined morphologic alterations associated with peripheral vitreoretinal toxocariasis, being useful to reinforce the clinical diagnosis.

[Analysis of comparative immunological profiles of intraocular fluid and serum samples in patients suspected of ocular toxoplasmosis or toxocarosis]. / Ocena porównawczego profilu immunologicznego swoistych przeciwcial w plynie sródocznym i krwi obwodowej pacjentów podejrzanych o toksoplazmoze lub toksokaroze oczna.

High seroprevalence of Toxoplasma and Toxocara spp. in populations of children and adults in Poland constitutes a significant risk of supradiagnosed parasitic eye infections. We described the clinical characteristics in relation to the analysis of comparative immunological profiles of T. gondii-specific antibodies in aqueous humour and serum samples in patients with reactivated retinochoroiditis, and of Toxocara spp. ones in cases with posterior granuloma, fibrotic and calcified tumor-like masses simulating retinoblastoma, detected by ophthalmoscopy and echography. Intraocular synthesis of specific IgG antibodies was detected in anterior eye chamber fluid in 1/2 and 2/3 of patients respectively, strongly suspected of ocular toxoplasmosis or toxocarosis. The evidence of a local production of specific antibodies in intraocular fluid shown by the Western blot seems to be a valuable immunodiagnostic method for a final confirmation of eye lesions of parasitic origin and crucial in the choice of an appropriate treatment regimen.

[Ocular toxocariasis. Diagnostic and therapeutic options]. / Okuläre Toxocariasis. Diagnostische und therapeutische Optionen.

BACKGROUND: The diagnosis of ocular toxocariasis can be difficult and the aim of this study was to evaluate the benefit of ELISA testing of vitreous body fluid. PATIENTS AND METHODS: We present five consecutively treated patients with ocular symptoms of toxocariasis, three of these patients presenting with epiretinal membranes and subretinal granulomas were vitrectomized. Vitreous and body fluid and serum were tested for toxocara antibodies by ELISA. Moreover vitreous body fluid of 10 patients with epiretinal membranes of other origins were examined by the same ELISA. RESULTS: In all three operated patients toxocara antibodies were detected in the vitreous fluid but ELISA testing of serum samples was negative in two of the three patients. Visual acuity increased or remained stable in the operated patients. The ELISA test was negative in all vitreous fluid samples of the control group. CONCLUSIONS: ELISA testing of vitreous body fluid can prove the presence of toxocara infection when no systemic signs of infection are present and no antibodies are detectable in the serum. Well-timed vitrectomy is a suitable therapy for vitreo-retinal complications in ocular toxocariasis to improve prognosis and to confirm the diagnosis.

Ocular toxocariasis in a North Indian population.

Sera form 68 patients aged 1-30 years, suffering from posterior pole granuloma, peripheral granuloma, uveitis, endophthalmitis, optic neuritis and with a clinical diagnosis of suspected ocular toxocariasis, were tested for the presence of anti-Toxocara antibodies. Antibodies to Toxocara were detected in 11 (17 per cent) subjects less than 15 years old and three (4 per cent) subjects more than 15 years of age using enzyme-linked immunosorbent assay. None of the controls sera (other helminthic diseases) were positive for anti-Toxocara antibody.

[Experimental toxocariasis in rabbits: immunological markers of ocular infections]. / Doswiadczalna toksokaroza królików: immunologiczne markery inwazji ocznej.

Rabbits were infected with an oral dose of 50 000 eggs of Toxocara canis or with an intracarotid injection of the second stage larvae of the parasite in order to develop ocular toxocariasis. Serum and ocular fluid samples were collected from the rabbits after 1, 3 and 6 months after infection and examined for specific toxocaral antibodies and circulating parasite antigen. Furthermore, an ophthalmoscopic examination was performed at the time of sampling. None of the infected animals showed the signs of ocular involvement, however, toxocaral IgG antibodies and circulating parasite antigen were present in the anterior chamber fluid samples.

Toxocara antibodies in patients with visceral or ocular disorder in Slovenia.

The incidence of Toxocara antibodies was determined in 319 sera from patients suspected of having Toxocara infection. Serological responses were compared with clinical manifestations and age of the patients. A seropositive reaction was found in 24% of the patients. Highly positive results (OD 0.510-1.000 and OD > 1.000) by ELISA were obtained significantly more frequently in younger patients than in older ones (p < 0.005). The percentage of seropositive patients with visceral disorder was found to decrease with age, whereas the proportion of seropositive patients with ocular disorder increased with age. Serologically confirmed Toxocara infection in Slovenia alerted us to the fact that this health issue should be given due attention in the future.