Toxoplasmosis ocular en Colombia: 10 años de aportes investigativos / Ocular toxoplasmosis in Colombia: 10 years of research contributions

Objetivo: Describir aportes investigativos en Toxoplasmosis ocular, realizados en Colombia. Método: Revisión narrativa de la literatura entre 2007 y 2017 en Toxoplasmosis Ocular (TO) en Colombia, sobre aspectos relacionados con el parásito y con el hospedero. Se incluyeron las revisiones publicadas, así como todos los artículos originales relacionados con diversos temas: epidemiológicos, inmunológicos, clínicos, diagnósticos y terapéuticos a través de PubMed usando los términos MeSH, con la siguiente sintaxis: "(((Colombia[Affiliation]) OR colombia[MeSHTerms]) OR south america[MeSH Terms]) AND "toxoplasmosis, ocular"[MeSH Terms] AND ("2007/01/01"[PDAT] : "2017/12/31"[PDAT]). Adicionalmente se realizaron búsquedas manuales. Resultados: En la búsqueda de la literatura con los términos MESH mencionados, se encontraron 36 artículos, distribuidos en el territorio con 10 en Colombia y 26 en el resto de Suramérica. Se encontraron diferencias importantes relacionadas con el parásito y con el hospedero, al comparar Colombia con el mundo. Las cepas en Colombia son más virulentas (Tipo I/III y atípicas). Se encontró una alta prevalencia de títulos positivos y desarrollo de TO en el país, presentándose el agua y los productos cárnicos como uno de los principales medios de contagio. Se determinó la importancia de péptidos que activan la respuesta inmune humoral en pacientes. Se encontraron diferencias significativas en la severidad clínica (tamaño de las lesiones, grado de inflamación, compromiso macular, compromiso bilateral y recurrencias, siendo mayores para los pacientes colombianos) relacionada con la respuesta inflamatoria producida en el hospedero, asociada con una disminución de los niveles intraoculares de IFN-γ /IL-17 y un aumento de IL-6/Il-13. En los pacientes colombianos el citoquinoma ocular está relacionado con las características clínicas, presentando una respuestaTh 2 relacionada con un compromiso severo ocular. Conclusión: Los aportes investigativos que Colombia ha realizado en TO, han sido de importancia mundial, permitiendo conocer más acerca del tipo de parásito, la epidemiología, la presentación clínica y la respuesta inmune.

Purpose: To describe research contributions in ocular toxoplasmosis performed in Colombia. Method: We conducted a narrative review of the literature on ocular toxoplasmosis (OT) in Colombia between 2007 and 2017 on aspects related to the parasite and to the host. Published reviews were included, as well as all the original articles related to various topics: epidemiological, immunological, clinical, diagnostic and therapeutic through PubMed using the MeSH terms, with the following syntax: "(((Colombia [Affi liation]) OR colombia [MeSH Terms]) OR south america [MeSH Terms]) AND "toxoplasmosis, ocular" [MeSH Terms] AND ("2007/01/01" [PDAT]: "2017/12/31" [PDAT]). Hand searches were also conducted. Results: In the literature search with the MESH terms, 36 articles were found, distributed in the territory with 10 in Colombia and 26 in the rest of South America. Important diff erences were found in the relationship between the parasite and the host when comparing Colombia with the rest of the world. The strains in Colombia are more virulent (Type I / III and atypical) and we found a high prevalence of positive titers and development of OT in the country, with water and meat products as one of the main means of contagion. The importance of peptides that triggered the humoral immune response in patients was determined. Significant differences were found in the clinical severity (with Colombian patients experiencing a greater size of lesions, degree of infl ammation, macular involvement, bilateral involvement, and recurrences) related to the infl ammatory response produced in the host, associated with a decrease in intraocular levels of IFN-γ / IL-17 and an increase of IL-6 / Il-13. In Colombian patients, ocular cytokinome is related to clinical features, presenting a Th 2 response related to severe ocular involvement. Conclusion: Research contributions of OT in Colombia have been of global importance, allowing to know more about the type of parasite, the epidemiology, the clinical presentation, the immune response.

Clinical spectrum, diagnostic criteria, and polymerase chain reaction of aqueous humor in viral and toxoplasma detection in Fuchs' uveitis syndrome.

AIM: The aim of this study is to describe the clinical features and diagnostic criteria of Fuchs' uveitis (FU) and to determine whether it has an association with virus and toxoplasma in the aqueous humor during cataract surgery. SETTING AND DESIGN: This is a prospective, case-control study. MATERIALS AND METHODS: Patients with FU (n = 25), anterior uveitis (n = 15), and no uveitis (normal) (n = 50) were included based on predefined inclusion and exclusion criteria for all three groups. Polymerase chain reaction (PCR) of aqueous humor and serum for rubella, herpes simplex virus (HSV), cytomegalovirus (CMV), varicella-zoster virus (VZV), and toxoplasma was done using conventional uniplex PCR. STATISTICAL ANALYSIS: It was done using SPSS software using Chi-square test for categorical variables, and P < 0.05 was considered statistically significant. RESULTS: Ninety patients were enrolled in the study in three groups, comparable for age, gender, and laterality of ocular involvement. All patients had diffuse keratic precipitates in FU group (P = 0001) with none having posterior synechiae (P = 0.046) which was statistically significant when compared to anterior uveitis patients. Iris nodules were noted in one case in both groups. Serum and aqueous PCR was negative for detection of VZV, CMV, toxoplasma, and rubella in all groups. PCR for HSV was positive in one patient in "normal" group but was not statistically significant. CONCLUSION: Our study shows that diagnosis of FU is mainly clinical. There appears to be no role of aqueous humor testing for viruses by PCR to aid in etiological diagnosis.

Non-cytomegalovirus ocular opportunistic infections in patients with acquired immunodeficiency syndrome.

PURPOSE: To report the incidence and clinical outcomes of non-cytomegalovirus (non-CMV) ocular opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS) in the era of highly active antiretroviral therapy. DESIGN: Multicenter, prospective, observational study of patients with AIDS. METHODS: Medical history, ophthalmologic examination, and laboratory tests were performed at enrollment and every 6 months subsequently. Once an ocular opportunistic infection was diagnosed, patients were seen every 3 months for outcomes. RESULTS: At enrollment, 37 non-CMV ocular opportunistic infections were diagnosed: 16 patients, herpetic retinitis; 11 patients, toxoplasmic retinitis; and 10 patients, choroiditis. During the follow-up period, the estimated incidences (and 95% confidence intervals [CI]) of these were: herpetic retinitis, 0.007/100 person-years (PY) (95% CI 0.0004, 0.039); toxoplasmic retinitis, 0.007/100 PY (95% CI 0.004, 0.039); and choroiditis, 0.014/ 100 PY (95% CI 0.0025, 0.050). The mortality rates appeared higher among those patients with newly diagnosed or incident herpetic retinitis and choroiditis (rates = 21.7 deaths/100 PY [P = .02] and 12.8 deaths/100 PY [P = .04]), respectively, than those for patients with AIDS without an ocular opportunistic infection (4.1 deaths/100 PY); toxoplasmic retinitis did not appear to be associated with greater mortality (6.4/100 PY, P = .47). Eyes with newly diagnosed herpetic retinitis appeared to have a poor visual prognosis, with high rates of visual impairment (37.9/100 PY) and blindness (17.5/100 PY), whereas those outcomes in eyes with choroiditis appeared to be lower (2.3/100 PY and 0/100 PY, respectively). CONCLUSIONS: Although uncommon, non-CMV ocular opportunistic infections may be associated with high rates of visual loss and/or mortality.

The HIV RNA Levels of Plasma and Ocular Fluids in AIDS Patients with Ophthalmic Infections.

The aim of the present study was to evaluate the impact of highly active antiretroviral therapy (HAART) on HIV viral load of plasma and intraocular fluids in AIDS patients with ophthalmic opportunistic infections. We further compared the treatment effect of HAART on these patients. From June 1997 to July 2003, we examined and followed up the ophthalmic conditions of 49 patients receiving HAART with ophthalmic diseases during this period. The method of reverse-transcriptase polymerase chain reaction was used to detect and monitor HIV load in plasma and/or aqueous humor of AIDS patients. Before HAART, the HIV levels in the plasma and aqueous humor in 8 AIDS patients with ophthalmic opportunistic infections were significantly higher than those in 6 patients with HIV-related retinopathy (p < 0.05). Compared to the eye findings and clinical improvement, HIV loads of aqueous humor in 10 of 14 AIDS patients (6 with HIV-related retinopathy, 5 with cytomegalovirus retinitis, 2 with toxoplasmic retinitis and 1 with cryptococcal chorioretinitis) declined to undetectable levels (< 400 copies/ml) after 4-8 months of HAART. HIV virus levels in the plasma of AIDS patients were significantly decreased, and the CD4 counts of these patients were significantly increased (Wilcoxon test) after initiation of HAART.

Serologic and polymerase chain reaction analysis of intraocular fluids in the diagnosis of infectious uveitis.

PURPOSE: Infectious uveitis entities are usually rapidly progressive blinding diseases that can be prevented by prompt administration of specific antimicrobial therapy. With the aim of improving early diagnosis in patients with infectious uveitis, intraocular fluid samples from patients with sight-threatening posterior uveitis were investigated to determine the causative agent. METHODS: Thirty-eight patients with acquired immunodeficiency syndrome (AIDS) and retinitis, eight immunosuppressed patients with retinitis, 16 immunocompetent patients with acute retinal necrosis, and 22 immunocompetent patients with toxoplasmic retinochoroiditis were analyzed by polymerase chain reaction for the presence of herpesviruses and Toxoplasma gondii DNA and for local antibody production against these microorganisms. RESULTS: In patients with AIDS and retinitis, polymerase chain reaction was positive for cytomegalovirus DNA in 21 (91%) of the 23 ocular fluid samples obtained during active cytomegalovirus retinitis, whereas local antibody production analysis was negative in all cases. In acute retinal necrosis, varicella-zoster virus or herpes simplex virus could be established as the inciting agent in 81% of the cases, using the combination of both techniques. Polymerase chain reaction was positive in all samples obtained within two weeks after the onset of disease. Toxoplasma gondii DNA was detected in 4 of 13 samples (31%) from immuno-competent patients with active toxoplasmic retinochoroiditis; in each case, local antibody production was also detected. In contrast, no local antibody production was observed in two of three samples from transplant recipients that were positive for T. gondii DNA. All the control samples tested were negative for the above-mentioned tests. CONCLUSIONS: In patients with AIDS, polymerase chain reaction analysis is preferable above local antibody production in detecting the inciting agent of retinitis. In other cases, the combination of both techniques can make a valuable contribution to the diagnosis.