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Akhavanrezayat A, Uludag Kirimli G, Matsumiya W, Khojasteh H, Or C, Karaca I, Pham B, Ongpalakorn P, Lajevardi S, Lam B, Hwang JJ, Than NTT, Park S, Yavari N, Bazojoo V, Mobasserian A, Khatri A, Halim MS, Thng ZX, Ghoraba H, Do DV, Tugal-Tutkun I, Gupta V, de Smet M, Nguyen QD. The Role of Corticosteroids and Immunomodulatory Therapy in the Management of Infectious Uveitis. Ocul Immunol Inflamm 2024:1-12. [PMID: 38330155 DOI: 10.1080/09273948.2023.2296032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE The index review aims to provide an update on the role of corticosteroids and steroid-sparing immunomodulatory therapy (IMT) in managing patients with infectious uveitis. METHOD Narrative literature review. RESULTS Corticosteroids and immunomodulatory therapy (IMT) focus on the host defense system instead of the pathogen, adjusting exaggerated inflammatory reactions to reduce potential harm to ocular tissues. Systemic or local corticosteroids are primarily selected as adjunctive medication for infectious uveitis. Concomitant corticosteroids have also been used in cases of paradoxical worsening in ocular tuberculosis and immune recovery uveitis in cytomegalovirus (CMV) retinitis. While there is no well-established evidence to support the use of IMT in infectious uveitis, it is occasionally used in clinical settings to treat persistent inflammation following resolution of infection such as cases of ocular tuberculosis and ocular syphilis where an insufficient response is observed with corticosteroids. CONCLUSION There is no consensus on the position of immunomodulatory therapy in the management of infectious uveitis with different etiologies. The index review provides an overview of available adjunctive corticosteroids and IMT options to assist clinicians in managing such disease entities more efficiently.
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Affiliation(s)
- Amir Akhavanrezayat
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Gunay Uludag Kirimli
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Wataru Matsumiya
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hassan Khojasteh
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Christopher Or
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Irmak Karaca
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Brandon Pham
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Sherin Lajevardi
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Brandon Lam
- Department of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Jaclyn Joyce Hwang
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ngoc Trong Tuong Than
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - SungWho Park
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Negin Yavari
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vahid Bazojoo
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Azadeh Mobasserian
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anadi Khatri
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Zheng Xian Thng
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Hashem Ghoraba
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Bayrampasa Eye Hospital, Eye Protection Foundation, Istanbul, Turkey
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Marc de Smet
- Department of Ophthalmology, MicroInvasive Ocular Surgery Clinic (MIOS), Lausanne, Switzerland
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
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Sofia O, Wahyudi INSA, Fitri LE, Prayitnaningsih S, Susianti H. Optical Coherence Tomography Angiography Findings in Ocular Toxoplasmosis with Multiple Recurrences. Int Med Case Rep J 2023; 16:35-43. [PMID: 36660225 PMCID: PMC9842519 DOI: 10.2147/imcrj.s395600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
Ocular toxoplasmosis is the most common cause of posterior uveitis that is caused by Toxoplasma gondii infection. Humans can be infected congenitally or postnatally. The typical lesion of ocular toxoplasmosis is focal necrotizing retinitis with overlying vitritis, which lead to hyperpigmented retinochoroidal scar at resolution of lesion. Macula involvement can cause substantial visual impairment. The high incidence of disease reactivation may lead to greater risk of vision loss. Optical coherence tomography angiography (OCTA) is a non-invasive imaging method to visualize the vascular and density perfusion of the retina and choroid, which cannot be obtained by conventional Optical Coherence Tomography (OCT). In this case report, we present two cases of active ocular toxoplasmosis with multiple recurrences to study pathological changes in retinal and choroidal microvasculature. The findings reveal the involvement of all of the retinal layers in the choroid, with distinct changes in the deep retinal layer.
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Affiliation(s)
- Ovi Sofia
- Doctoral Program in Medical Science, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia,Department of Ophthalmology, Faculty of Medicine, Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - I Nyoman Surya Ari Wahyudi
- Residency Training Program, Department of Ophthalmology, Faculty of Medicine, Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Loeki Enggar Fitri
- Department of Clinical Parasitology, Faculty of Medicine, Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Malang, Indonesia,Correspondence: Loeki Enggar Fitri, Department of Clinical Parasitology, Faculty of Medicine, Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Malang, Indonesia, Email
| | - Seskoati Prayitnaningsih
- Department of Ophthalmology, Faculty of Medicine, Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Hani Susianti
- Department of Clinical Pathology, Faculty of Medicine, Universitas Brawijaya, Dr. Saiful Anwar General Hospital, Malang, Indonesia
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Kohler JM, Mammo DA, Bennett SR, Davies JB. Primary ocular toxoplasmosis secondary to venison consumption. Am J Ophthalmol Case Rep 2022; 29:101776. [PMID: 36544752 PMCID: PMC9762148 DOI: 10.1016/j.ajoc.2022.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/04/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose To describe primary ocular toxoplasmosis infection related to ingestion of undercooked venison. Observations This single site, retrospective case series reviewed 4 patients with primary ocular toxoplasmosis that was acquired by ingesting undercooked venison. De-identified data was collected regarding baseline patient characteristics including age, sex, past medical and ocular history, onset of symptoms, visual acuity (VA), response to treatment, and workup. All patients with acquired toxoplasmosis had similar chronology of systemic and ocular symptoms. Exposure occurred in October or November and systemic symptoms developed within 2 weeks, followed by ocular symptoms an average of 2.6 months later. Average age at onset was 56 ± 13 (age ± SD) years old and all were male. Average initial and final VA were 20/50 and 20/50, respectively. Positive anti-toxoplasma IgM and IgG serologies were found in all cases. All patients were treated with trimethoprim/sulfamethoxazole and achieved rapid improvement. Complications occurred in 50% of cases and included epiretinal membrane, cystoid macular edema, vitreoretinal traction, and neovascularization. Conclusions and importance Consumption of undercooked venison is a source of primary ocular toxoplasmosis even in immunocompetent hosts and has a clear chronology. A presentation of retinochoroiditis during the winter months should prompt questioning for exposure to wild game.
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Affiliation(s)
- James M. Kohler
- University of Utah Department of Ophthalmology & Visual Sciences, Salt Lake City, USA
| | | | | | - John B. Davies
- Retina Consultants of Minnesota, Minneapolis, USA,Corresponding author. Retina Consultants of Minnesota, 3601 W 76th St, Suite 300, Edina, MN, 55435, USA.
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Putera I, La Distia Nora R, Utami N, Karuniawati A, Yasmon A, Wulandari D, Edwar L, Susiyanti M, Aziza Y, Jessica P, Riasanti M, Sitompul R. The impact of aqueous humor polymerase chain reaction and serological test results for establishing infectious uveitis diagnosis: An Indonesian experience. Heliyon 2022; 8:e10988. [PMID: 36262302 PMCID: PMC9573923 DOI: 10.1016/j.heliyon.2022.e10988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/20/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To assess the clinical value of aqueous humor real-time polymerase chain reaction (RT-PCR) and serological antibody tests among uveitis patients in Indonesian cohort. Methods In this prospective cohort study, single-plex RT-PCR analysis of aqueous samples from 86 new uveitis patients was performed to detect Mycobacterium tuberculosis, Toxoplasmosis gondii, cytomegalovirus, herpes simplex virus, varicella-zoster virus, Epstein-Barr virus, and rubella virus. Specific serological antibodies for suspected pathogens were also obtained. Comparison of PCR and serological antibodies with the initial and final diagnosis were presented. Results The diagnostic positivity of aqueous RT-PCR in our cohort was 20% (17/86). The rate of infection as final etiological classification was higher after RT-PCR was performed (45 patients, 52%) compared to initial diagnosis based on clinical presentation alone (38 patients, 44%). In particular, the RT-PCR positivity among patients with infection as the final etiological classification was 33.33% (15/45). A significant difference in the IgG but not IgM toxoplasma value among those with ocular toxoplasmosis as the final diagnosis compared to the other etiologies were observed (3953 (IQR 2707-19562) IU/mL vs 428 (IQR 82-1807) IU/mL; p < 0.0001). Conclusion RT-PCR analysis of aqueous fluid from uveitis patients helped confirm a third of infectious uveitis cases in Indonesia. In ocular toxoplasmosis, high IgG but not IgM antibody value might help differentiate those with other etiology.
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Affiliation(s)
- Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nunik Utami
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Anis Karuniawati
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Andi Yasmon
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Dewi Wulandari
- Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Lukman Edwar
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Made Susiyanti
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Yulia Aziza
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Priscilla Jessica
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Mei Riasanti
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Ratna Sitompul
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
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Kalogeropoulos D, Sakkas H, Mohammed B, Vartholomatos G, Malamos K, Sreekantam S, Kanavaros P, Kalogeropoulos C. Ocular toxoplasmosis: a review of the current diagnostic and therapeutic approaches. Int Ophthalmol 2022; 42:295-321. [PMID: 34370174 PMCID: PMC8351587 DOI: 10.1007/s10792-021-01994-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly on the postnatally acquired form of the disease. METHODS A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items. RESULTS Ocular toxoplasmosis is one of the most frequent infectious etiologies of posterior uveitis. It typically presents with retinochoroiditis. Setting an accurate diagnosis depends to a considerable degree on detecting characteristic clinical characteristics. In addition to the evaluation of clinical features, the diagnosis of toxoplasmosis relies at a large degree on serologic testing. The detection of the parasite DNA in the aqueous or vitreous humor can provide evidence for a definitive diagnosis. The current mainstay for the treatment, if necessary, is the use of oral antibiotic with systemic corticosteroids. Recent evidence suggests other therapeutic approaches, such as intravitreal antibiotics can be used. CONCLUSION Recent developments in the diagnostic and therapeutic approach have contributed to preventing or limiting vision loss of patients suffering from ocular toxoplasmosis. Further studies are required to provide a better understanding of epidemiology, pathogenesis, diagnosis, and treatment with a significant impact on the management of this challenging clinical entity.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece.
| | - Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Malamos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | | | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
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Ajamil-Rodanes S, Luis J, Bourkiza R, Girling B, Rees A, Cosgrove C, Pavesio C, Westcott M. Ocular toxoplasmosis: phenotype differences between toxoplasma IgM positive and IgM negative patients in a large cohort. Br J Ophthalmol 2021; 105:210-215. [PMID: 32345603 DOI: 10.1136/bjophthalmol-2019-315522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
| | - Joshua Luis
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Rabia Bourkiza
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Benedict Girling
- Ophthalmology Department, Barts Health NHS Trust, London, London, UK
| | - Angela Rees
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Catherine Cosgrove
- Infectious Department, St George's University Hospital NHS Foundation Trust, London, UK
| | - Carlos Pavesio
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Mark Westcott
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Ophthalmology Department, Barts Health NHS Trust, London, London, UK
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Seronegative ocular toxoplasma panuveitis in an immunocompetent patient. Am J Ophthalmol Case Rep 2020; 19:100745. [PMID: 32566798 PMCID: PMC7296335 DOI: 10.1016/j.ajoc.2020.100745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose Toxoplasma gondii is the most common cause of infectious posterior uveitis worldwide in immunocompetent patients. Despite its prevalence, diagnosis can still be challenging and vision-threatening in cases with atypical presentations. This case exemplifies the importance of clinical exam and additional workup when required despite negative initial serology results. Observations A 73-year-old immunocompetent woman presented with a 2-year history of recurrent panuveitis and retinal necrosis not responsive to systemic antiviral therapy. Toxoplasma serum antibodies (IgG and IgM) were not detected on systemic workup one year prior. The slit-lamp exam revealed mutton fat keratic precipitates, panuveitis, and necrotic retinal lesions adjacent to a retinal scar. Repeated Toxoplasma serum antibodies (IgG and IgM) were again negative. However, aqueous fluid testing by polymerase chain reaction (PCR) was highly positive for Toxoplasma gondii. The patient improved after starting systemic anti-toxoplasma therapy. Conclusion/Importance To our knowledge, this is the first report in the literature of an immunocompetent patient with ocular toxoplasmosis and undetectable serum IgG and IgM. Aqueous fluid PCR testing is useful in suspected ocular toxoplasmosis in patients with vision-threatening lesions despite negative serology. This is the first report in the English literature of seronegative ocular toxoplasmosis in an immunocompetent patient. Diagnosis of ocular toxoplasmosis can be challenging. Clinical exam and additional workup still have a role in excluding ocular toxoplasmosis in immunocompetent patients. Treatment is recommended in vision-threatening infections.
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Mewara A, Singh S, Khurana S, Gupta P, Sehgal R. Seroprevalence of Toxoplasmosis at a Tertiary Care Centre in North India from 2004 to 2014. Indian J Med Microbiol 2019; 37:351-357. [PMID: 32003332 DOI: 10.4103/ijmm.ijmm_19_327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose This study was carried out to determine the seroprevalence of anti-Toxoplasma gondii antibodies in different groups of patients at a tertiary care hospital in North India. Materials and Methods Clinical and demographic data such as age and gender of patients who had undergone testing for the presence of anti-T. gondii IgG and IgM antibodies between January 2004 and October 2014 were retrospectively analysed. Results Amongst the 8397 serum samples, an overall seropositivity of 21% (n = 1763) and IgG and IgM seropositivity of 5.7% (n = 481) and 15.3% (n = 1282) were respectively observed. Compared to the period of 2004-2012 (median seroprevalence: 23.6%), a decline in seropositivity to 9.7% in 2013 and 8.1% in 2014 was noted. A rising seroprevalence with age and a higher seroprevalence in females versus males (29.5%, n = 1179 vs. 13.3%, n = 584) were recorded. The highest seroprevalence was observed in suspected ocular toxoplasmosis (47.2%, n = 47), followed by neurological (26.8%, n = 77), human immunodeficiency virus/acquired immunodeficiency syndrome (18.9%, n = 267), post-transplant (17.1%, n = 12) and congenital (7.2%, n = 144) toxoplasmosis. In patients screened for Toxoplasma exposure, the seropositivity was 47.8% (n = 11) in transplant screening and 44.9% (n = 781) in antenatal screening. Conclusion Toxoplasma infection is highly prevalent in the population of North India across various clinical categories of patients. Future studies focusing on continuous monitoring of seroprevalence trends and elucidation of the risk factors associated with seropositivity in more defined groups of patients are needed.
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Affiliation(s)
- Abhishek Mewara
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shreya Singh
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumeeta Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parakriti Gupta
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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de-la-Torre A, Valdés-Camacho J, de Mesa CL, Uauy-Nazal A, Zuluaga JD, Ramírez-Páez LM, Durán F, Torres-Morales E, Triviño J, Murillo M, Peñaranda AC, Sepúlveda-Arias JC, Gómez-Marín JE. Coinfections and differential diagnosis in immunocompetent patients with uveitis of infectious origin. BMC Infect Dis 2019; 19:91. [PMID: 30683065 PMCID: PMC6347798 DOI: 10.1186/s12879-018-3613-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 12/11/2018] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Making a definite diagnosis of infectious uveitis is a challenging task because many other infectious, and non-infectious uveitis, may have similar non-specific symptoms and overlapping clinical appearances. Co-infections in immunocompetent patients are not frequently proved with traditional serologic-diagnostic tools. METHODS Descriptive transversal study, in a Uveitis Service of an Ophthalmology Reference Center, in Bogotá, Colombia, from July 2014 to February 2016. Aqueous humor (AH) and/or vitreous fluid, blood and serum samples were collected from consecutive patients suspected of having infectious uveitis. The diagnosis of ocular toxoplasmosis (OT) was confirmed by the Goldmann-Witmer coefficient (GWC) and by polymerase chain reaction (PCR). Differential diagnosis by PCR in AH was done for viral origin such as Cytomegalovirus (CMV), Herpes simplex virus type 1 (HSV1), Herpes simplex virus type 2 (HSV2), Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and Mycobacterium tuberculosis. RESULTS In 66 Colombian patients with uveitis of presumed infectious origin: 22 (33.3%) were confirmed as OT, 16 (24.2%) as undetermined OT, five (7.5%) as co-infections and 23 (34.8%) as other uveitis. Toxoplasma coinfection with M. tuberculosis was identified in one case by PCR and in four cases with HSV by GWC. The initial clinical diagnosis changed, after laboratory examination, in 21 cases (31.8%). CONCLUSIONS Clinical diagnosis can be changed by laboratory examination in a significant proportion of cases of uveitis. Diagnosis of OT should combine the use of PCR and GWC to reach the maximum of confirmation of cases. The use of multiple laboratory methods is necessary to identify co-infections and viral infections that can mimic OT in immunocompetent patients.
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Affiliation(s)
- Alejandra de-la-Torre
- Unidad de Inmunología, Grupo de Investigación en Neurociencias (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.
| | - Juanita Valdés-Camacho
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Clara López de Mesa
- Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Andrés Uauy-Nazal
- Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Juan David Zuluaga
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Lina María Ramírez-Páez
- Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Felipe Durán
- Unidad de Inmunología, Grupo de Investigación en Neurociencias (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.,Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Elizabeth Torres-Morales
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Jessica Triviño
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Mateo Murillo
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Alba Cristina Peñaranda
- Departamento de Investigación, Escuela Superior de Oftalmología-Instituto Barraquer de América, Bogotá, Colombia
| | - Juan Carlos Sepúlveda-Arias
- Grupo de Investigación Infección e Inmunidad, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Jorge Enrique Gómez-Marín
- GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
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Jeong A, Park DG, Sagong M. Fulminant Toxoplasmic Chorioretinitis Following Intravitreal Dexamethasone Implantation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.9.896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Areum Jeong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Dong-Geun Park
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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11
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Park SW, Kim SH, Kwon HJ, Lee SM, Byon IS, Lee JE. Diagnostic Value of Positive Findings of Toxoplasma gondii-Specific Immunoglobulin M Serum Antibody in Uveitis Patients to Confirm Ocular Toxoplasmosis. Ocul Immunol Inflamm 2018. [PMID: 29513626 DOI: 10.1080/09273948.2018.1433303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- Sung Who Park
- a Department of Ophthalmology , School of Medicine, Pusan National University , Busan , South Korea.,c Biomedical Research Institute , School of Medicine, Pusan National University Hospital , Busan , South Korea
| | - So Hee Kim
- a Department of Ophthalmology , School of Medicine, Pusan National University , Busan , South Korea
| | - Han Jo Kwon
- a Department of Ophthalmology , School of Medicine, Pusan National University , Busan , South Korea
| | - Seung Min Lee
- b Department of Ophthalmology , Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Ik Soo Byon
- a Department of Ophthalmology , School of Medicine, Pusan National University , Busan , South Korea.,b Department of Ophthalmology , Pusan National University Yangsan Hospital , Yangsan , South Korea
| | - Ji Eun Lee
- a Department of Ophthalmology , School of Medicine, Pusan National University , Busan , South Korea.,c Biomedical Research Institute , School of Medicine, Pusan National University Hospital , Busan , South Korea
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12
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Jasper S, Vedula SS, John SS, Horo S, Sepah YJ, Nguyen QD. Corticosteroids as adjuvant therapy for ocular toxoplasmosis. Cochrane Database Syst Rev 2017; 1:CD007417. [PMID: 28125765 PMCID: PMC5369355 DOI: 10.1002/14651858.cd007417.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Ocular infection caused by Toxoplasma gondii, a parasite, may result in inflammation in the retina, choroid, and uvea, and consequently lead to complications such as glaucoma, cataract, and posterior synechiae. OBJECTIVES The objective of this systematic review was to assess the effects of adjunctive use of corticosteroids to anti-parasitic therapy versus anti-parasitic therapy alone for ocular toxoplasmosis. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register (2016; Issue 11)), MEDLINE Ovid, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Ovid Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Literature on Health Sciences (LILACS (January 1982 to December 2016)), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/search/en). We used no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 7 December 2016. SELECTION CRITERIA We had planned to include randomized and quasi-randomized controlled trials. Eligible trials would have enrolled participants of any age who were immunocompetent and were diagnosed with acute ocular toxoplasmosis. Included trials would have compared anti-parasitic therapy plus corticosteroids versus anti-parasitic therapy alone, different doses or times of initiation of corticosteroids. DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts retrieved through the electronic searches. We retrieved full-text reports of studies categorized as 'unsure' or 'include' after we reviewed the abstracts. Two authors independently reviewed each full-text report for eligibility. Discrepancies were resolved through discussion. MAIN RESULTS We identified no completed or ongoing trial that was eligible for this Cochrane review. AUTHORS' CONCLUSIONS Although research has identified a wide variation in practice regarding the use of corticosteroids, our review did not identify any evidence from randomized controlled trials for or against the role of corticosteroids in the management of ocular toxoplasmosis. Several questions remain unanswered by well-conducted randomized trials in this context, including whether the use of corticosteroids as an adjunctive agent is more effective than the use of anti-parasitic therapy alone; if so, when corticosteroids should be initiated in the treatment regimen (early versus late course of treatment), and what would be the best dose and duration of steroid use.
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Affiliation(s)
- Smitha Jasper
- Christian Medical CollegeDepartment of OphthalmologySchell Campus, Arni RoadVelloreTamil NaduIndia632001
| | | | - Sheeja S John
- Christian Medical CollegeDepartment of OphthalmologySchell Campus, Arni RoadVelloreTamil NaduIndia632001
| | - Saban Horo
- Christian Medical CollegeDepartment of OphthalmologySchell Campus, Arni RoadVelloreTamil NaduIndia632001
| | - Yasir J Sepah
- Stanford UniversityByers Eye InstitutePalo AltoCaliforniaUSA
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13
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Roh M, Yasa C, Cho H, Nicholson L, Uchiyama E, Young LH, Lobo AM, Papaliodis GN, Durand ML, Sobrin L. The role of serological titres in the diagnosis of ocular toxoplasmosis. Acta Ophthalmol 2016; 94:521-2. [PMID: 26426456 DOI: 10.1111/aos.12851] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Miin Roh
- Uveitis Service; Department of Ophthalmology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
| | - Cagla Yasa
- Uveitis Service; Department of Ophthalmology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
- Koç University School of Medicine; Istanbul Turkey
| | - Heeyoon Cho
- Uveitis Service; Department of Ophthalmology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
- Department of Ophthalmology; Hanyang University College of Medicine; Seoul Korea
| | - Laura Nicholson
- Uveitis Service; Department of Ophthalmology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
| | - Eduardo Uchiyama
- Uveitis Service; Department of Ophthalmology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
| | - Lucy H.Y. Young
- Retina Service; Department of Ophthalmology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
| | - Ann-Marie Lobo
- Uveitis Service; Department of Ophthalmology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
| | - George N. Papaliodis
- Uveitis Service; Department of Ophthalmology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
| | - Marlene L. Durand
- Department of Medicine and Ophthalmology; Harvard Medical School; Boston MA USA
| | - Lucia Sobrin
- Uveitis Service; Department of Ophthalmology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston MA USA
- Department of Ophthalmology; Hanyang University College of Medicine; Seoul Korea
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Oray M, Ozdal PC, Cebeci Z, Kir N, Tugal-Tutkun I. Fulminant Ocular Toxoplasmosis: The Hazards of Corticosteroid Monotherapy. Ocul Immunol Inflamm 2015; 24:637-646. [DOI: 10.3109/09273948.2015.1057599] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Merih Oray
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pinar Cakar Ozdal
- Ulucanlar Eye Education and Training Hospital Ophthalmology Clinic, Ankara, Turkey
| | - Zafer Cebeci
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nur Kir
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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15
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Martins LM, Rangel ALP, Peixe RG, Silva-Dos-Santos PP, Lemos EM, Martins-Filho OA, Bahia-Oliveira LMG. Specific IgM, IgG and IgG1 directed against Toxoplasma gondii detected by flow cytometry and their potential as serologic tools to support clinical indirect fundoscopic presumed diagnosis of ocular disease. J Immunol Methods 2014; 417:97-106. [PMID: 25527345 DOI: 10.1016/j.jim.2014.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
In the present study we evaluated the anti-Toxoplasma gondii immunoglobulin profiles of a group of 118 individuals living in an endemic area. The aim of the study was to select biomarkers to support the ophthalmological diagnosis of retinal/retinochoroidal scars presumably caused by T. gondii infection. Overall anti-T. gondii reactivity of the IgM, IgG, IgA, IgE and IgG subclasses was investigated by flow cytometry-based anti-fixed tachyzoite antibodies (FC-AFTA) in four groups of subjects, referred to as: i) TOXO(L)--seropositive patients with retinal/retinochoroidal scars presumably caused by T. gondii infection; these patients were further subdivided according to morphological aspects of their ocular scar lesions as A, B or C; ii) TOXO(NL)--seropositive patients without ocular scar lesions; iii) NEG(L)--T. gondii seronegative patients presenting retinal lesions; and iv) NEG(NL)--T. gondii seronegative without retinal lesions (negative controls). Our data demonstrated that anti-T. gondii IgG profiles were able to discriminate the mean reactivity of TOXO(L) from all other clinical groups. Analysis of anti-T. gondii immunoglobulin profiles revealed that IgM and IgG were good biomarkers capable of discriminating between individual reactivity in patients with retinal/retinochoroidal scars presumably caused by T. gondii infection [TOXO(L)] from those caused by other clinical conditions. Furthermore, anti-T. gondii IgG1 reactivity was able to discriminate TOXO(L) from all other clinical groups. In conclusion, the pre-selected IgM, IgG and IgG1 anti-T. gondii antibody subclasses were able to segregate both TOXO(L) and the other subgroups, including the scar lesion group types (A, B, C), from other clinical conditions. These results suggest the applicability of this technique in the clinical laboratory to detect putative biomarker for diagnosis of ocular lesions in T. gondii-infected patients. Studies in other areas implementing the methods described in the present study would be of value and enable evaluation of a system for classification of presumed ocular toxoplasmosis scar lesions. This classification would make comparative studies on ocular toxoplasmosis conducted in different regions around the world possible.
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Affiliation(s)
- Livia Mattos Martins
- Laboratório de Biologia do Reconhecer, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | - Alba Lucinia Peixoto Rangel
- Laboratório de Biologia do Reconhecer, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | - Ricardo Guerra Peixe
- Laboratório de Biologia do Reconhecer, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil; Faculdade de Medicina de Campos, Campos dos Goytacazes, RJ, Brazil
| | | | - Elenice Moreira Lemos
- Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Olindo Assis Martins-Filho
- Laboratório de Biomarcadores de Diagnóstico e Monitoração, Centro de Pesquisas René Rachou, FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Lilian Maria Garcia Bahia-Oliveira
- Laboratório de Biologia do Reconhecer, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil; Laboratório de Imunoparasitologia Universidade Federal do Rio de Janeiro UFRJ, Macaé, RJ, Brazil.
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16
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17
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Ocular toxoplasmosis past, present and new aspects of an old disease. Prog Retin Eye Res 2014; 39:77-106. [DOI: 10.1016/j.preteyeres.2013.12.005] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 12/22/2022]
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19
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Knecht PB, Papadia M, Herbort CP. Secondary choriocapillaritis in infectious chorioretinitis. Acta Ophthalmol 2013; 91:e550-5. [PMID: 23694755 DOI: 10.1111/aos.12150] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyse the indocyanine green angiography (ICGA) patterns of hypofluorescence that are compatible with choriocapillaritis that occur secondarily to toxoplasmic retinochoroiditis (ToRC), ocular tuberculosis (including tuberculous choroiditis, TuCR and multifocal serpiginoid choroiditis, TMSC) and syphilitic chorioretinitis (SyCR). METHODS This was a single centre, retrospective case review study. Patients with a diagnosis of ToRC, TuCR, TMSC or SyCR were identified, their charts were reviewed and fundus photographs, fluorescein angiography (FA) and ICGA pictures were assessed. RESULTS Indocyanine green angiography was performed at the initial presentation in 63 of the 105 patients with ToRC, in 37 of the 38 patients with TuCR, in six of six patients with TMSC and in two of four patients with SyCR. The following four ICGA patterns indicated choriocapillaritis: extension of hypofluorescence beyond the hypofluorescence of the actual infectious focus as seen on fundus photography or FA (seen only in ToRC and TuCR); small dark dots around the infectious focus (seen only in ToRC); multiple 'confetti-like' hypofluorescent areas or hypofluorescent geographical confluent areas (seen only in TMSC); and widespread areas of nonperfusion visible only in ICGA (seen only in SyCR). CONCLUSIONS Patients with secondary choriocapillaritis have distinct typical ICGA findings. ICGA is thus an important diagnostic tool that can provide an explanation for otherwise obscure visual loss and that might have diagnostic value for specific conditions like ToRC and SyCR.
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Affiliation(s)
- Pascal B Knecht
- Retinal and Inflammatory Eye Disease, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi, Lausanne, SwitzerlandDepartment of Ophthalmology, University Hospital Zurich, Zurich, SwitzerlandDepartment of Neurosciences, Eye Clinic, Ophthalmology and Genetics, University of Genova, Genova, ItalyUniversity of Lausanne, Lausanne, Switzerland
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20
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Jasper S, Vedula SS, John SS, Horo S, Sepah YJ, Nguyen QD. Corticosteroids as adjuvant therapy for ocular toxoplasmosis. Cochrane Database Syst Rev 2013; 4:CD007417. [PMID: 23633342 PMCID: PMC4269154 DOI: 10.1002/14651858.cd007417.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ocular infestation with Toxoplasma gondii, a parasite, may result in inflammation in the retina, choroid, and uvea and consequently lead to complications such as glaucoma, cataract, and posterior synechiae. OBJECTIVES The objective of this systematic review was to assess the effects of adjunctive use of corticosteroids for ocular toxoplasmosis. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 October 2012. SELECTION CRITERIA We planned to include randomized and quasi-randomized controlled trials. Eligible trials would have enrolled participants of any age who were immunocompetent and were diagnosed with active ocular toxoplasmosis. Included trials would have compared anti-parasitic therapy plus corticosteroids versus anti-parasitic therapy alone, or different doses or times of initiation of corticosteroids. DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts retrieved from the electronic searches. We retrieved full-text articles of studies categorized as 'unsure' or 'include' after review of the abstracts. Two authors independently reviewed each full-text article. Discrepancies were resolved through discussion. MAIN RESULTS The electronic searches retrieved 368 titles and abstracts. We reviewed 20 full-text articles. We identified no trials eligible for inclusion in this systematic review. AUTHORS' CONCLUSIONS Although research has identified wide variation in practices regarding use of corticosteroids, our systematic review did not identify evidence from randomized controlled trials for the role of corticosteroids in the management of ocular toxoplasmosis. Several questions remain unanswered by well-conducted randomized trials in this context, including whether use of corticosteroids is more effective than use of anti-parasitic therapy alone, when corticosteroids should be initiated in the treatment regimen (early versus late course of treatment), and which dosage and duration of steroid use is best. These questions are easily amenable to research using a randomized controlled design and they are ethical due to the absence of evidence to support or discourage use of corticosteroids for this condition. The question of foremost importance, however, is whether they should be used as adjunct therapy (that is, additional) to anti-parasitic agents.
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Affiliation(s)
- Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, India
| | - Satyanarayana S Vedula
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheeja S John
- Department of Ophthalmology, Christian Medical College, Vellore, India
| | - Saban Horo
- Department of Ophthalmology, Christian Medical College, Vellore, India
| | - Yasir J Sepah
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Quan Dong Nguyen
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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