1
|
Inchauspe S, Palacio A, Arriazu G, Bellón M, Morales Roldan V, Torres de Leon P, Olivera Plata SL, Dodds EM. Association Between Ocular Trauma and Activation of Ocular Toxoplasmosis. Ocul Immunol Inflamm 2024; 32:1065-1069. [PMID: 37134295 DOI: 10.1080/09273948.2023.2203215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To evaluate the association between ocular trauma and activation of ocular toxoplasmosis. METHODS Retrospective review of 686 patients with ocular toxoplasmosis and its association with trauma to the eye or the head within 1 week of activation. RESULTS Ten patients with a history of trauma and activation of ocular toxoplasmosis were detected (10/686; 1.45%). Nine patients showed a primary focus of retinitis without a previous scar and one patient had a recurrent form of ocular toxoplasmosis. From these 10 patients, Toxoplasma IgG was positive in eight of them. The median age of the patients was 35.8 years-old (range 17 to 65). CONCLUSIONS These cases suggest that trauma can be associated with activation of retinal bradyzoite cysts in ocular toxoplasmosis.
Collapse
|
2
|
Lyons MR, Arantes T, Vieira BR, Furtado JM, Smith JR. Impact of gender on clinical features and outcomes of ocular toxoplasmosis. Br J Ophthalmol 2024; 108:710-714. [PMID: 37225390 DOI: 10.1136/bjo-2023-323227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
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.
Collapse
Affiliation(s)
- Matilda R Lyons
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tiago Arantes
- Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil
| | - Barbara R Vieira
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Joao M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
3
|
Hasanreisoglu M, Halim MS, Cakar Ozdal P, Ormaechea MS, Kesim C, Ozdemir HB, Uludag G, Sredar N, Cankurtaran M, Liu X, Denniston AK, Rudzinski MN, Colombero DN, Schlaen BA, Keane PA, Pavesio C, Nguyen QD. Fundus topographical distribution patterns of ocular toxoplasmosis. Br J Ophthalmol 2024; 108:530-535. [PMID: 36931697 DOI: 10.1136/bjo-2022-322747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND To establish topographic maps and determine fundus distribution patterns of ocular toxoplasmosis (OT) lesions. METHODS In this retrospective study, patients who presented with OT to ophthalmology clinics from four countries (Argentina, Turkey, UK, USA) were included. Size, shape and location of primary (1°)/recurrent (2°) and active/inactive lesions were converted into a two-dimensional retinal chart by a retinal drawing software. A final contour map of the merged image charts was then created using a custom Matlab programme. Descriptive analyses were performed. RESULTS 984 lesions in 514 eyes of 464 subjects (53% women) were included. Mean area of all 1° and 2° lesions was 5.96±12.26 and 5.21±12.77 mm2, respectively. For the subset group lesions (eyes with both 1° and 2° lesions), 1° lesions were significantly larger than 2° lesions (5.52±6.04 mm2 vs 4.09±8.90 mm2, p=0.038). Mean distances from foveola to 1° and 2° lesion centres were 6336±4267 and 5763±3491 µm, respectively. The majority of lesions were found in temporal quadrant (p<0.001). Maximum overlap of all lesions was at 278 µm inferotemporal to foveola. CONCLUSION The 1° lesions were larger than 2° lesions. The 2° lesions were not significantly closer to fovea than 1° lesions. Temporal quadrant and macular region were found to be densely affected underlining the vision threatening nature of the disease.
Collapse
Affiliation(s)
- Murat Hasanreisoglu
- Department of Ophthalmology, Koc University School of Medicine, Istanbul, Turkey
- Koc University Research Center for Translational Medicine, Koc University, Istanbul, Turkey
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
| | | | - Pinar Cakar Ozdal
- Department of Ophthalmology, University of Health Sciences Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | | | - Cem Kesim
- Department of Ophthalmology, Koc University School of Medicine, Istanbul, Turkey
| | | | - Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Nripun Sredar
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Mahmut Cankurtaran
- Department of Ophthalmology, University of Health Sciences Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Xiaoxuan Liu
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Alastair Keith Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Marcelo N Rudzinski
- Department of Ophthalmology, Universidad Católica de las Misiones, Posadas, Argentina
| | - Daniel N Colombero
- Department of Ophthalmology, Universidad Nacional de Rosario, Rosario, Argentina
| | | | - Pearse Andrew Keane
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, UCL, London, UK
| | - Carlos Pavesio
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Biomedical Research Centre, UCL, London, UK
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| |
Collapse
|
4
|
Nsiangani Lusambo N, Kaimbo Wa Kaimbo D, Mumba Ngoyi D, Kilangalanga Ngoy J, Ngoyi Bambi MT, Kadima Mutombo T, Kintoki Makela G, Ngandowe Nzamokili L, de-la-Torre A. Clinical and Serological Characteristics of Ocular Toxoplasmosis in the Democratic Republic of Congo. Ocul Immunol Inflamm 2023; 31:1522-1527. [PMID: 36328437 DOI: 10.1080/09273948.2022.2140297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To describe demographic data, clinical features, and serological profiles in a cohort of Congolese patients with ocular toxoplasmosis (OT). METHOD Cross-sectional study, carried out between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa. RESULTS The study comprised 95 participants with OT. Fifty-three patients were male (55.8%). The mean age at presentation was 35.6 ± 14.1 years (range 8-69 years); 71 had active OT (74.7%), among them, 33 had primary OT (46.5%), and 38 had recurrences (53.5%). At presentation, 51 patients (53.7%) had visual impairment (VA < 6/18). Retinochoroidal lesions were located in the central retina in 60 patients (63.1%). Patients with primary OT tend to have higher IgG levels than those with recurrent OT (P = .01). CONCLUSION We report the largest cohort of patients with OT in sub-Saharan Africa. In our setting, most patients had recurrent OT with multiple, extensive, and central retinochoroidal lesions.
Collapse
Affiliation(s)
- Nadine Nsiangani Lusambo
- The Department of Eye, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Kaimbo Wa Kaimbo
- The Department of Eye, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Mumba Ngoyi
- The Department of Parasitology, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | | | - Théodore Kadima Mutombo
- National Eye Care Program, Masina Ophthalmology Hospital, Kinshasa, Democratic Republic of Congo
| | - Guy Kintoki Makela
- National Eye Care Program, Masina Ophthalmology Hospital, Kinshasa, Democratic Republic of Congo
| | - Lady Ngandowe Nzamokili
- National Eye Care Program, Masina Ophthalmology Hospital, Kinshasa, Democratic Republic of Congo
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
5
|
Yogeswaran K, Furtado JM, Bodaghi B, Matthews JM, Smith JR. Current practice in the management of ocular toxoplasmosis. Br J Ophthalmol 2023; 107:973-979. [PMID: 35197262 DOI: 10.1136/bjophthalmol-2022-321091] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice. METHODS 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy. RESULTS For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing-usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%. CONCLUSION Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists.
Collapse
Affiliation(s)
- Kengadhevi Yogeswaran
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - João M Furtado
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Janet M Matthews
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
6
|
Araujo WMR, Ayo CM, Previato M, de Faria GM, Frederico FB, Siqueira RC, de Almeida GC, Pereira-Chioccola VL, de Mattos LC, Brandão CC. Role of interleukin 1β and interleukin 10 variants on ocular toxoplasmosis in Brazilian individuals. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1183167. [PMID: 38983057 PMCID: PMC11182258 DOI: 10.3389/fopht.2023.1183167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2024]
Abstract
Introduction Ocular toxoplasmosis (OT) is an intraocular inflammation caused by Toxoplasma gondii infection that affects the retina and choroid, giving rise to posterior uveitis. Genetic polymorphisms in cytokine genes may exert influence in the expression of these molecules and play a significant role in inflammatory responses and susceptibility to OT. The aim of this study was to evaluate the role of polymorphisms rs16944 (-511 C > T) of the interleukin (IL) 1β gene and rs1800896 (-1082 G > A) of the IL10 gene on OT in Brazilian individuals with a serologic diagnosis of T. gondii and after conducting fundoscopic exams. Methods Participants with a positive serology were classified into two distinct groups according to the presence (G1; n = 110) or absence (G2; n = 104) of OT. The control group (G3) consisted of individuals without the infection (n = 108). Results It was observed that the C/C genotype of the IL1β gene polymorphism was a protective factor for OT (p = 0.02, OR = 0.28, 95% CI 0.08-0.78 for G1 vs. G2; p = 0.03; OR = 0.29, 95% CI 0.09-0.82 for G1 vs. G3), according to the recessive inheritance model. Conclusions The -511C.T polymorphisms of the IL1β gene seems to play an important role in the pathogenesis of OT in Brazilian individuals.
Collapse
Affiliation(s)
- Warlen Miiller Rocha Araujo
- FAMERP Toxoplasma Research Group, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
| | - Christiane Maria Ayo
- FAMERP Toxoplasma Research Group, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
| | - Mariana Previato
- FAMERP Toxoplasma Research Group, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
- Ophthalmology Outpatient Clinic, Fundação Faculdade Regional de Medicina, Hospital de Base da Fundação Faculdade Regional de Medicina (HB-FUNFARME), São Paulo, Brazil
| | - Geraldo Magela de Faria
- FAMERP Toxoplasma Research Group, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
| | - Fábio Batista Frederico
- FAMERP Toxoplasma Research Group, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
- Ophthalmology Outpatient Clinic, Fundação Faculdade Regional de Medicina, Hospital de Base da Fundação Faculdade Regional de Medicina (HB-FUNFARME), São Paulo, Brazil
| | - Rubens Camargo Siqueira
- FAMERP Toxoplasma Research Group, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
| | - Gildásio Castello de Almeida
- FAMERP Toxoplasma Research Group, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
- Ophthalmology Outpatient Clinic, Fundação Faculdade Regional de Medicina, Hospital de Base da Fundação Faculdade Regional de Medicina (HB-FUNFARME), São Paulo, Brazil
| | | | - Luiz Carlos de Mattos
- FAMERP Toxoplasma Research Group, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
| | - Cinara Cássia Brandão
- FAMERP Toxoplasma Research Group, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (FAMERP), São Paulo, Brazil
| |
Collapse
|
7
|
Souza GM, de Souza CE, Passos RM, Nascimento HMD, Belfort R. Recurrence of Ocular Toxoplasmosis after Vitrectomy: Case Report and Review. Ocul Immunol Inflamm 2023; 31:416-420. [PMID: 35081011 DOI: 10.1080/09273948.2022.2026408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to report one case of ocular toxoplasmosis (OT) recurrence after vitrectomy and review the scientific basis about it. CASE REPORT A 58-year-old male patient with previous OT, properly treated, underwent vitrectomy due to macular hole. During follow-up, patient evolved with recurrence of the OT. After 1 year, patient presents visual acuity of 20/200 and extensive macular scar. CONCLUSION There is no consensus on using perioperative antiparasitic therapy aiming recurrence prophylaxis. Studies with better statistical design are necessary to evaluate the recurrence risk after ocular surgeries and the possible recommendation of prophylaxis, especially in countries where the strains are more virulent and the recurrence more common.
Collapse
Affiliation(s)
- Guilherme Macedo Souza
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos Eduardo de Souza
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Renato Magalhães Passos
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
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: 39] [Impact Index Per Article: 19.5] [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.
Collapse
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
| |
Collapse
|
9
|
Kelgaonkar A, Khalsa A, Padhy SK, Behera UC, Padhi TR, Basu S. Punctate Inner Retinal Toxoplasmosis: Case Series and Review of Literature. Ocul Immunol Inflamm 2021; 30:546-555. [PMID: 34623927 DOI: 10.1080/09273948.2021.1980815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe clinical and multimodal imaging characteristics of punctate inner retinal toxoplasmosis (PIRT) as an atypical presentation of ocular toxoplasmosis (OT). METHODS Retrospective review of OT cases with PIRT lesions and review of the literature. We describe five cases (6 eyes). RESULTS PIRT lesions were seen adjacent to active/healed toxoplasma retinochoroiditis. The appearance of PIRT was creamy yellowish-white, inner retinal, punctate, and sub-centimetric lesions. The depth of these lesions on optical coherence tomography was till the outer plexiform layer. Co-existing punctate outer retinal toxoplasmosis (PORT) was found in three eyes and recurrent retinochoroiditis in three. The fate of PIRT was resolution with minimal retinal thinning or progression to a full-thickness retinochoroiditis. CONCLUSION PIRT was noted in association with typical toxoplasma retinochoroiditis and PORT lesions, and had equal chances of resolution or progression to full-thickness lesions.
Collapse
Affiliation(s)
- Anup Kelgaonkar
- Uveitis and Retina Services, L V Prasad Eye Institute, Bhubaneswar, India
| | - Ashish Khalsa
- Uveitis and Retina Services, L V Prasad Eye Institute, Bhubaneswar, India
| | | | | | - Tapas Ranjan Padhi
- Uveitis and Retina Services, L V Prasad Eye Institute, Bhubaneswar, India
| | - Soumyava Basu
- Uveitis and Retina Services, L V Prasad Eye Institute, Bhubaneswar, India
| |
Collapse
|
10
|
Kalogeropoulos D, Kalogeropoulos C, Sakkas H, Mohammed B, Vartholomatos G, Malamos K, Sreekantam S, Kanavaros P, de-la-Torre A. Pathophysiological Aspects of Ocular Toxoplasmosis: Host-parasite Interactions. Ocul Immunol Inflamm 2021; 30:560-569. [PMID: 34242103 DOI: 10.1080/09273948.2021.1922706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: This review aims to present the state of the art to understand the pathophysiology of ocular toxoplasmosis (OT), providing further foundations that would help to improve the future treatment and prognosis of this potentially blinding disease.Methods: A thorough literature search was performed in PubMed database. An additional search was made in Google Scholar to complete the collected items.Results: Toxoplasma gondii ocular infection is one of the most frequent causes of posterior uveitis. Despite the ocular barriers, the parasite reaches the eye through different mechanisms. Once inside, it remains encysted livelong within the retina, and recurrences cannot be completely avoided. The complexity of host-parasite interactions, leading to the success of this parasite, encompasses host factors such as genetic predisposition, immune status, and age; and parasite factors such as strain diversity, virulence, phylogenetic origin, and geographical distribution. These factors influence the clinical presentation, course, and progression of the disease. Additional elements, such as pregnancy, eating behavior, and environmental, social, and cultural factors may also contribute to this complex balance.Conclusions: The host-parasite interaction in OT is a complex and multifactorial relationship, with the parasite always on the driving edge of the game. There are still multiple incompletely understood fields to be investigated. Future research would permit further insight into the immune-biology of the parasite and recognition of the host-parasite interplay to improve the diagnostic and management performance.
Collapse
Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Bashar Mohammed
- Department of Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, UK
| | - 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, Greece
| | | | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alejandra de-la-Torre
- Immunology Unit, NeURos Research Group, NeuroVitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
11
|
Abstract
The uveitides are a heterogeneous group of diseases characterized by inflammation inside the eye. The uveitides are classified as infectious or non-infectious. The non-infectious uveitides, which are presumed to be immune mediated, can be further divided into those that are associated with a known systemic disease and those that are eye limited,-ie, not associated with a systemic disease. The ophthalmologist identifies the specific uveitic entity by medical history, clinical examination, and ocular imaging, as well as supplemental laboratory testing, if indicated. Treatment of the infectious uveitides is tailored to the particular infectious organism and may include regional and/or systemic medication. First line treatment for non-infectious uveitides is corticosteroids that can be administered topically, as regional injections or surgical implants, or systemically. Systemic immunosuppressive therapy is used in patients with severe disease who cannot tolerate corticosteroids, require chronic corticosteroids at >7.5 mg/day prednisone, or in whom the disease is known to respond better to immunosuppression. Management of many of these diseases is optimized by coordination between the ophthalmologist and rheumatologist or internist.
Collapse
Affiliation(s)
- Bryn M Burkholder
- Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Yazdanpanah O, Monday LM, Surapaneni S, Singh V, Chi J. Ocular Toxoplasmosis Mimicking Lymphoma: Exploring the Correlation and Distinction. Cureus 2021; 13:e13014. [PMID: 33659144 PMCID: PMC7920518 DOI: 10.7759/cureus.13014] [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] [Indexed: 11/24/2022] Open
Abstract
We present a case of a 74-year-old woman with chronic lymphocytic leukemia (CLL) who presented with unilateral blurry vision that had progressively worsened over a few weeks. Ophthalmic examination revealed unilateral anterior chamber, vitreous body inflammation along with retinal infiltration which was initially diagnosed with posterior uveitis. Analysis of vitreous fluid aspiration was negative for bacteria, fungal and viral etiologies. Despite the broad-spectrum intraocular antibiotics, her vision continued to decline, and she later developed retinal detachment. Cytology for lymphoma was negative. However, polymerase chain reaction (PCR) with internal transcribed spacer-specific (ITS) primer set detected Toxoplasma gondii, and the patient was diagnosed with intraocular toxoplasmosis. Treatment with systemic clindamycin, pyrimethamine, leucovorin, prednisone, and topical clindamycin for four weeks successfully prevented further ocular damage.
Collapse
Affiliation(s)
- Omid Yazdanpanah
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA.,Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Lea M Monday
- Internal Medicine, John D. Dingell VA Medical Center, Detroit, USA.,Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Sarvani Surapaneni
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA.,Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Vijendra Singh
- Hematology and Oncology, Karmanos Cancer Institute, Detroit, USA
| | - Jie Chi
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| |
Collapse
|
14
|
Seers T, Myneni J, Chaudhry NL, Ugarte M. Bilateral ocular toxoplasmosis in a returning traveller: age and route of infection as potential risk factors. BMJ Case Rep 2021; 14:14/1/e237068. [PMID: 33509864 PMCID: PMC7845719 DOI: 10.1136/bcr-2020-237068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 69-year-old man, who presented in the UK with a short history of deteriorating vision and clinical features of bilateral atypical retinochoroiditis, after travelling to South America. Vitreous samples demonstrated Toxoplasma gondii DNA by PCR. Serology tests demonstrated recent acquired Toxoplasma gondii infection with IgM antibodies. He responded well to treatment with trimethoprim-sulfamethoxazole, azithromycin and oral steroids. This case is a reminder of the global importance of Toxoplasma related eye disease, and its uncommon bilateral severe presentation in a returning traveller, where the risk factors were age and the route of infection likely to be a virulent parasite oocyst from vegetables or water rather than undercooked meat or direct contact with cats.
Collapse
Affiliation(s)
- Tim Seers
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jayavani Myneni
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nadia L Chaudhry
- Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - Marta Ugarte
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK .,Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
15
|
Costa DF, Madeira RP, Torrecilhas AC, Nascimento H, Ribeiro KS, Paraboni MLR, Rizzo LV, Silveira C, Burnier MN, Lowen MS, Garcia JL, Gava R, Pereira-Chioccola VL, Commodaro AG, Belfort R. Ocular Disease in Mice Inoculated with Pork Heart Samples Infected with Toxoplasma gondii. Ocul Immunol Inflamm 2020; 30:463-469. [PMID: 32976068 DOI: 10.1080/09273948.2020.1807024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We analyzed the frequency, viability, and genetic characteristics of T. gondii in pork heart samples.Methods: Thirty-five fresh pork samples were purchased in a slaughterhouse in Erechim city. The DNA was extracted and qPCR was performed. T. gondii genotyping was performed using PCR-RFLP analysis. Positive samples were digested and inoculated in mice for viability analysis.Results: Our results showed that T. gondii DNA was detected in 25.7% of the pork heart samples and genotyping revealed one new atypical strain. The viability analyses demonstrated that 40% of mice presented clinical signs of T. gondii infection. qPCR was positive in the lung, liver, and brain of mice that presented clinical signs of T. gondii infection. Also, the histopathology analysis showed retinal disorganization, retinal detachment, inflammatory cell infiltration, and fibrosis in the eyes analyzed.Conclusion: Our findings have shown that pork eat from southern Brazil may contain live T. gondii that could be associated with toxoplasmosis.
Collapse
Affiliation(s)
- Deise F Costa
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil.,Department of Ophthalmology, McGill University Ocular Pathology Laboratory, Montreal, Canada
| | - Rafael Pedro Madeira
- Department of Pharmaceutical Sciences, Federal University of Sao Paulo, Diadema, Brazil
| | | | - Heloisa Nascimento
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | - Miguel N Burnier
- Department of Ophthalmology, McGill University Ocular Pathology Laboratory, Montreal, Canada
| | - Marcia Serva Lowen
- Department of Pathology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - João Luis Garcia
- Protozoology Laboratory, Preventive Veterinary Medicine Department, Universidade Estadual De Londrina, Londrina, PR, Brazil
| | - Ricardo Gava
- Laboratory of Molecular Biology of Parasites and Fungi, Center of Parasitology and Mycology, Adolfo Lutz Institute, Sao Paulo, Brazil
| | - Vera Lucia Pereira-Chioccola
- Laboratory of Molecular Biology of Parasites and Fungi, Center of Parasitology and Mycology, Adolfo Lutz Institute, Sao Paulo, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
16
|
de-la-Torre A, Gómez-Marín J. Disease of the Year 2019: Ocular Toxoplasmosis in HIV-infected Patients. Ocul Immunol Inflamm 2020; 28:1031-1039. [PMID: 32162993 DOI: 10.1080/09273948.2020.1735450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Ocular toxoplasmosis (OT) may be an initial manifestation of acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus (HIV)-infected patients. OT has different clinical manifestations and can mimic other intraocular infections. Clinical findings may show single or multifocal retinochoroidal lesions or panuveitis. Atypical presentations are associated with extensive uni- or bilateral areas of retinal necrosis. OT lesions not associated with preexisting retinochoroidal scars are usually due to acquired rather than congenital infection. When CD4+ T cell counts are <100 c/uL, vitritis is frequently mild. Isolated anterior uveitis has been reported in single cases. Positive immunoglobulin M (IgM) antibodies are rare but their presence can support the diagnosis. As atypical presentations of OT are common, anterior chamber puncture for multiplex polymerase chain reaction amplification of infectious DNA should be considered, as early diagnosis and treatment can prevent massive tissue destruction and preserve vision. This review provides an overview of OT in HIV-infected patients.
Collapse
Affiliation(s)
- Alejandra de-la-Torre
- Grupo de Investigación en Neurociencia (Neuros), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario , Bogotá, Colombia
| | - Jorge Gómez-Marín
- Gepamol. Centro de Investigaciones Biomédicas, Universidad del Quindío , Armenia, Q, Colombia
| |
Collapse
|
17
|
Schlaen A, Colombero D, Ormaechea S, Ladeveze E, Rudzinski C, Ingolotti M, Couto C, Rudzinski M. Regional Differences in the Clinical Manifestation of Ocular Toxoplasmosis Between the Center and Northeast of Argentina. Ocul Immunol Inflamm 2018; 27:722-730. [PMID: 29953310 DOI: 10.1080/09273948.2018.1484494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To compare the clinical characteristics of patients with active episodes of ocular toxoplasmosis from three provinces, Misiones, Santa Fe, and Buenos Aires, Argentina. Methods: Patients with a diagnosis of ocular toxoplasmosis from three databases of four tertiary referral uveitis centers were reviewed. Collected data included presentation of the retinochoroiditis, location of the active lesions, associated inflammatory ocular signs and complications. Results: Three hundred thirty-four patients were included in this study. Bilateral involvement of the ocular disease occurred in 26 patients in Misiones (35.14%), 21 patients (12.8%) in Santa Fe, and 9 patients in Buenos Aires (9.4%) (p < 0.001). Extensive retinitis was observed in 49 patients (66.2%) in Misiones, 39 patients (23.8%) in Santa Fe, and 12 patients (12.5%) in Buenos Aires (p < 0.001). Conclusion: The results indicate that there are differences in the clinical characteristics of ocular toxoplasmosis in patients from Misiones, Santa Fe, and Buenos Aires.
Collapse
Affiliation(s)
- Ariel Schlaen
- a Department of Ophthalmology, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires , Buenos Aires City , Argentina.,b Department of Ophthalmology, Hospital Universitario Austral , Buenos Aires , Derqui-Pilar , Argentina
| | - Daniel Colombero
- c Oftalmología Global , Rosario , Province of Santa Fe , Argentina.,d Department of Ophthalmology, Universidad Nacional de Rosario , Rosario , Province of Santa Fe , Argentina
| | - Soledad Ormaechea
- b Department of Ophthalmology, Hospital Universitario Austral , Buenos Aires , Derqui-Pilar , Argentina
| | - Emilio Ladeveze
- c Oftalmología Global , Rosario , Province of Santa Fe , Argentina
| | - Cesar Rudzinski
- e Rudzinski Oftalmología , Oberá , Province of Misiones , Argentina
| | - Mariana Ingolotti
- b Department of Ophthalmology, Hospital Universitario Austral , Buenos Aires , Derqui-Pilar , Argentina
| | - Cristóbal Couto
- a Department of Ophthalmology, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires , Buenos Aires City , Argentina
| | - Marcelo Rudzinski
- f Department of Ophthalmology, Universidad Católica de las Misiones (UCAMI) , Posadas , Province of Misiones , Argentina.,g Consultorio de uveítis y glaucoma , Oberá , Misiones , Argentina.,h CONICET, Consejo Nacional de Investigaciones Científicas y Técnicas, Centro de Investigación de Ciencias de la Salud - Universidad Católica de las Misiones , Posadas , Province of Misiones , Argentina
| |
Collapse
|
18
|
Synergistic Activity between Statins and Bisphosphonates against Acute Experimental Toxoplasmosis. Antimicrob Agents Chemother 2017; 61:AAC.02628-16. [PMID: 28559264 DOI: 10.1128/aac.02628-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/22/2017] [Indexed: 11/20/2022] Open
Abstract
Bisphosphonates are widely used for the treatment of bone disorders. These drugs also inhibit the growth of a variety of protozoan parasites, such as Toxoplasma gondii, the etiologic agent of toxoplasmosis. The target of the most potent bisphosphonates is the isoprenoid biosynthesis pathway enzyme farnesyl diphosphate synthase (FPPS). Based on our previous work on the inhibitory effect of sulfur-containing linear bisphosphonates against T. gondii, we investigated the potential synergistic interaction between one of these derivatives, 1-[(n-heptylthio)ethyl]-1,1-bisphosphonate (C7S), and statins, which are potent inhibitors of the host 3-hydroxy-3-methyl glutaryl-coenzyme A reductase (3-HMG-CoA reductase). C7S showed high activity against the T. gondii bifunctional farnesyl diphosphate (FPP)/geranylgeranyl diphosphate (GGPP) synthase (TgFPPS), which catalyzes the formation of FPP and GGPP (50% inhibitory concentration [IC50] = 31 ± 0.01 nM [mean ± standard deviation]), and modest effect against the human FPPS (IC50 = 1.3 ± 0.5 μM). We tested combinations of C7S with statins against the in vitro replication of T. gondii We also treated mice infected with a lethal dose of T. gondii with similar combinations. We found strong synergistic activities when using low doses of C7S, which were stronger in vivo than when tested in vitro We also investigated the synergism of several commercially available bisphosphonates with statins both in vitro and in vivo Our results provide evidence that it is possible to develop drug combinations that act synergistically by inhibiting host and parasite enzymes in vitro and in vivo.
Collapse
|
19
|
Chasen NM, Asady B, Lemgruber L, Vommaro RC, Kissinger JC, Coppens I, Moreno SNJ. A Glycosylphosphatidylinositol-Anchored Carbonic Anhydrase-Related Protein of Toxoplasma gondii Is Important for Rhoptry Biogenesis and Virulence. mSphere 2017; 2:e00027-17. [PMID: 28529974 PMCID: PMC5437132 DOI: 10.1128/msphere.00027-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/19/2017] [Indexed: 01/06/2023] Open
Abstract
Carbonic anhydrase-related proteins (CARPs) have previously been described as catalytically inactive proteins closely related to α-carbonic anhydrases (α-CAs). These CARPs are found in animals (both vertebrates and invertebrates) and viruses as either independent proteins or domains of other proteins. We report here the identification of a new CARP (TgCA_RP) in the unicellular organism Toxoplasma gondii that is related to the recently described η-class CA found in Plasmodium falciparum. TgCA_RP is posttranslationally modified at its C terminus with a glycosylphosphatidylinositol anchor that is important for its localization in intracellular tachyzoites. The protein localizes throughout the rhoptry bulbs of mature tachyzoites and to the outer membrane of nascent rhoptries in dividing tachyzoites, as demonstrated by immunofluorescence and immunoelectron microscopy using specific antibodies. T. gondii mutant tachyzoites lacking TgCA_RP display a growth and invasion phenotype in vitro and have atypical rhoptry morphology. The mutants also exhibit reduced virulence in a mouse model. Our results show that TgCA_RP plays an important role in the biogenesis of rhoptries. IMPORTANCEToxoplasma gondii is an intracellular pathogen that infects humans and animals. The pathogenesis of T. gondii is linked to its lytic cycle, which starts when tachyzoites invade host cells and secrete proteins from specialized organelles. Once inside the host cell, the parasite creates a parasitophorous vacuole (PV) where it divides. Rhoptries are specialized secretory organelles that contain proteins, many of which are secreted during invasion. These proteins have important roles not only during the initial interaction between parasite and host but also in the formation of the PV and in the modification of the host cell. We report here the identification of a new T. gondii carbonic anhydrase-related protein (TgCA_RP), which localizes to rhoptries of mature tachyzoites. TgCA_RP is important for the morphology of rhoptries and for invasion and growth of parasites. TgCA_RP is also critical for parasite virulence. We propose that TgCA_RP plays a role in the biogenesis of rhoptries.
Collapse
Affiliation(s)
- Nathan M. Chasen
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Beejan Asady
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
| | - Leandro Lemgruber
- Instituto Nacional de Metrologia, Inmetro-RJ, UFRJ, Rio de Janeiro, Brazil
| | | | - Jessica C. Kissinger
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
- Department of Genetics, University of Georgia, Athens, Georgia, USA
- Institute of Bioinformatics, University of Georgia, Athens, Georgia, USA
| | - Isabelle Coppens
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Silvia N. J. Moreno
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, USA
- Department of Cellular Biology, University of Georgia, Athens, Georgia, USA
| |
Collapse
|
20
|
Biomarker analysis revealed distinct profiles of innate and adaptive immunity in infants with ocular lesions of congenital toxoplasmosis. Mediators Inflamm 2014; 2014:910621. [PMID: 25328286 PMCID: PMC4189853 DOI: 10.1155/2014/910621] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 11/18/2022] Open
Abstract
Toxoplasma gondii is the main infectious cause of human posterior retinochoroiditis, the most frequent clinical manifestation of congenital toxoplasmosis. This investigation was performed after neonatal screening to identify biomarkers of immunity associated with immunopathological features of the disease by flow cytometry. The study included infected infants without NRL and with retinochoroidal lesions (ARL, ACRL, and CRL) as well as noninfected individuals (NI). Our data demonstrated that leukocytosis, with increased monocytes and lymphocytes, was a relevant hematological biomarker of ARL. Immunophenotypic analysis also revealed expansion of CD14+CD16+HLA-DRhigh monocytes and CD56dim cytotoxic NK-cells in ARL. Moreover, augmented TCRγδ+ and CD8+ T-cell counts were apparently good biomarkers of morbidity. Biomarker network analysis revealed that complex and intricated networks underscored the negative correlation of monocytes with NK- and B-cells in NRL. The remarkable lack of connections involving B-cells and a relevant shift of NK-cell connections from B-cells toward T-cells observed in ARL were outstanding. A tightly connected biomarker network was observed in CRL, with relevant connections of NK- and CD8+ T-cells with a broad range of cell subsets. Our findings add novel elements to the current knowledge on the innate and adaptive immune responses in congenital toxoplasmosis.
Collapse
|
21
|
Harrell M, Carvounis PE. Current treatment of toxoplasma retinochoroiditis: an evidence-based review. J Ophthalmol 2014; 2014:273506. [PMID: 25197557 PMCID: PMC4147351 DOI: 10.1155/2014/273506] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/23/2014] [Indexed: 11/29/2022] Open
Abstract
Objective. To perform an evidence-based review of treatments for Toxoplasma retinochoroiditis (TRC). Methods. A systematic literature search was performed using the PubMed database and the key phrase "ocular toxoplasmosis treatment" and the filter for "controlled clinical trial" and "randomized clinical trial" as well as OVID medline (1946 to May week 2 2014) using the keyword ''ocular toxoplasmosis". The included studies were used to evaluate the various treatment modalities of TRC. Results. The electronic search yielded a total of 974 publications of which 44 reported on the treatment of ocular toxoplasmosis. There were 9 randomized controlled studies and an additional 3 comparative studies on the treatment of acute TRC with systemic or intravitreous antibiotics or on reducing the recurrences of TRC. Endpoints of studies included visual acuity improvement, inflammatory response, lesion size changes, recurrences of lesions, and adverse effects of medications. Conclusions. There was conflicting evidence as to the effectiveness of systemic antibiotics for TRC. There is no evidence to support that one antibiotic regimen is superior to another so choice needs to be informed by the safety profile. Intravitreous clindamycin with dexamethasone seems to be as effective as systemic treatments. There is currently level I evidence that intermittent trimethoprim-sulfamethoxazole prevents recurrence of the disease.
Collapse
Affiliation(s)
- Meredith Harrell
- Texas Tech University, Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Petros E. Carvounis
- Cullen Eye Institute, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030, USA
| |
Collapse
|
22
|
Examining the choroid in ocular inflammation: a focus on enhanced depth imaging. J Ophthalmol 2014; 2014:459136. [PMID: 25024846 PMCID: PMC4082870 DOI: 10.1155/2014/459136] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/21/2014] [Indexed: 11/25/2022] Open
Abstract
The choroid is the vascular layer that supplies the outer retina and is involved in the pathogenesis of several ocular conditions including choroidal tumors, age related macular degeneration, central serous chorioretinopathy, diabetic retinopathy, and uveitis. Nevertheless, difficulties in the visualization of the choroid have limited our understanding of its exact role in ocular pathology.
Enhanced depth imaging optical coherent topography (EDI-OCT) is a novel, noninvasive technique that is used to evaluate choroidal thickness and morphology in these diseases. The technique provides detailed objective in vivo visualization of the choroid and can be used to characterize posterior segment inflammatory disorders, monitor disease activity, and evaluate efficacy of treatment. In this review we summarize the current application of this technique in ocular inflammatory disorders and highlight its utility as an additional tool in monitoring choroidal involvement in ocular inflammation.
Collapse
|
23
|
Freeman K, Salt A, Prusa A, Malm G, Ferret N, Buffolano W, Schmidt D, Tan HK, Gilbert RE. Association between congenital toxoplasmosis and parent-reported developmental outcomes, concerns, and impairments, in 3 year old children. BMC Pediatr 2005; 5:23. [PMID: 16014166 PMCID: PMC1199601 DOI: 10.1186/1471-2431-5-23] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 07/13/2005] [Indexed: 11/14/2022] Open
Abstract
Background Information is lacking on the effects of congenital toxoplasmosis on development, behavior, and impairment in later childhood, as well as on parental concerns and anxiety. This information is important for counselling parents about the prognosis for an infected child and for policy decisions on screening. Methods We prospectively studied a cohort of children identified by screening for toxoplasmosis in pregnant women or neonates between 1996 and 2000 in ten European centers. At 3 years of age, parents of children with and without congenital toxoplasmosis were surveyed about their child's development, behavior, and impairment, and about parental concerns and anxiety, using a postal questionnaire. Results Parents of 178/223 (80%) infected, and 527/821 (64%) uninfected children responded. We found no evidence that impaired development or behavior were more common in infected children, or that any potential effect of congenital toxoplasmosis was masked by prenatal treatment. Parents of infected children were significantly more anxious and reported more visual problems in their children. Conclusion On average, children aged three to four years with congenital toxoplasmosis identified by screening and treated during infancy in this European setting had risks of abnormal development and behavior similar to uninfected children. Parental anxiety about infected children needs to be addressed by clinicians. Future studies with longer follow up and clinician-administered assessments may be better able to detect any subtle differences in child outcomes.
Collapse
Affiliation(s)
- Katherine Freeman
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, New York, U.S.A
| | - Alison Salt
- The Neurodisability Service, Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | - Andrea Prusa
- Department of Pediatrics, Division of Neonatology and Intensive Care, Medical University of Vienna, Austria
| | - Gunilla Malm
- Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Nicole Ferret
- CHU de NICE, Service Parasitologie – Mycologie, Hopital L'Archet II, BP 3079, 06202 NICE Cedex 3, France
| | - Wilma Buffolano
- Perinatal Infection Unit, Dept of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Dorthe Schmidt
- Department of Parasitology, Staten Seruminstitut, Copenhagen, Denmark
| | - Hooi Kuan Tan
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Ruth E Gilbert
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | | |
Collapse
|
24
|
Abstract
Ocular toxoplasmosis is a local manifestation of systemic infection in which Toxoplasma spreads into the eye, affecting mainly the posterior segment of the eye. Reactivation of the initial retinal condition presumably results from the rupture of quiescent parasitic cysts lying adjacent to pre-existing scars and may secondarily involve the choroid (leading to retinochoroiditis). Although the molecular mechanisms underlying host-parasite interaction are largely unknown, toxoplasmic retinochoroiditis usually remains a local event, and does not necessarily evoke a detectable systemic immune response. Local immunotolerance mechanisms may likewise confound attempts to confirm the clinical diagnosis by serology. Aqueous humour may be analysed for the presence of parasite DNA or of specific antibodies, but the DNA burden therein is low, and a more definite confirmation would require risky puncturing of the vitreous. Laboratory confirmation of the diagnosis is also frustrated by marked individual differences in the time elapsing between the onset of clinical symptoms and the activation of specific antibody production, resulting in a high proportion of false negative results. Whether a delay in the onset of local specific antibody production reflects immunotolerance in cases of congenital - but not obviously in those of acquired - infection remains an open question, but it could account for a relatively low confirmation rate in laboratory tests for local antibody production. Against this background, current diagnostic strategies need to be re-evaluated with a view to future improvements.
Collapse
Affiliation(s)
- J G Garweg
- Department of Ophthalmology, University of Bern, Inselspital, 3010 Bern, Switzerland.
| |
Collapse
|