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Fabiani S, Caroselli C, Menchini M, Gabbriellini G, Falcone M, Bruschi F. Ocular toxoplasmosis, an overview focusing on clinical aspects. Acta Trop 2022; 225:106180. [PMID: 34699742 DOI: 10.1016/j.actatropica.2021.106180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022]
Abstract
Toxoplasma gondii is a widespread protozoan parasite infecting approximately one third of the world population. After proliferation of tachyzoites during the acute stage, the parasite forms tissue cysts in various anatomical sites and establishes chronic infection. Nowadays the nature of the interplay between the protozoan and its human host remains elusive. This is clearly evident in ocular toxoplasmosis, in which the parasite establishes an ambivalent relationship with the eye, manipulating the immune response and inducing variable initial lesions and further relapses. This review will focus on epidemiology and environmental, parasite and host related risk factors, clinical manifestations and laboratory findings, treatment and prophylaxis approaches in ocular toxoplasmosis. An image collection of patients referred to the Unit of Ophthalmology of Pisa's Hospital will be presented, too.
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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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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.
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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
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Khanaliha K, Hedayatfar A, Minaeian S, Bokharaei-Salim F, Alemzadeh SA, Garshasbi S, Fagheei Aghmiyuni Z, Salemi B. Detection of Toxoplasma gondii bradyzoite genes in the peripheral blood mononuclear cells among patients with toxoplasmic chorioretinitis. Trans R Soc Trop Med Hyg 2021; 115:1389-1395. [PMID: 33851204 DOI: 10.1093/trstmh/trab062] [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] [Received: 10/06/2020] [Revised: 02/07/2021] [Accepted: 03/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Toxoplasmic chorioretinitis may occur as a result of acquired toxoplasmosis or reactivated congenital toxoplasmosis. In this study, Toxoplasma gondii bradyzoite genes along with the B1 gene were evaluated to detect T. gondii DNA in serum and peripheral blood mononuclear cells (PBMCs) of patients with toxoplasmic chorioretinitis. METHODS Blood samples were collected from 10 patients (7 cases of active chorioretinal lesions and 3 cases of old chorioretinal scars). The genomic DNA was extracted from the patients' serum and PBMCs and a polymerase chain reaction (PCR) assay was performed using bradyzoite genes along with B1. The subjects were also evaluated in terms of the T. gondii antibodies. RESULTS The PCR results were positive in four of seven patients (57.1%) with active ocular toxoplasmosis lesions. In three patients (42.8%), the PCR results were positive for MAG-1 and SAG-4 and in one patient (14.3%) the PCR results were only positive for the B1 gene. The PCR results were positive only in the PBMCs, whereas they were negative in the serum samples. Two patients with positive PCR results showed high Toxoplasma immunoglobulin G (IgG) antibody titres. However, none of the patients showed positive Toxoplasma IgM antibodies. CONCLUSIONS The PBMCs are suitable for evaluating toxoplasmic chorioretinitis. The present results showed that PCR with bradyzoite genes is useful in the diagnosis of toxoplasmic chorioretinitis in PBMCs.
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Affiliation(s)
- Khadijeh Khanaliha
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Hedayatfar
- Eye Research Center, the five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.,Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Sara Minaeian
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Farah Bokharaei-Salim
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saba Garshasbi
- Vice Chancellor for Healthcare, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Fagheei Aghmiyuni
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Borna Salemi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Nsiangani-Lusambo N, Reyes-Guanes J, Uribe-Reina P, Kaimbo Wa Kaimbo D, Mumba Ngoyi D, de-la-Torre A. Ocular Toxoplasmosis in Africa: A Narrative Review of the Literature. Ocul Immunol Inflamm 2020; 30:342-347. [PMID: 32976046 DOI: 10.1080/09273948.2020.1801761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To present a narrative review about ocular toxoplasmosis epidemiology, disease burden and prevalent African parasitic strains. METHODS An initial search for MeSH terms was conducted with a posterior advanced search in two electronic databases. Full text reading was performed. RESULTS Animal African studies have identified Toxoplasma gondii type II, type III, Africa 1, and Africa 3 strains. Seroprevalence varies from 6.4% to 74.5%. Nevertheless, there is a scarcity of epidemiology and serotyping information about ocular toxoplasmosis. African studies have demonstrated that uveitis patients present high frequencies of ocular toxoplasmosis. There is a lack of studies describing specific clinical characteristics, which can be related, to environmental and socioeconomic factors, parasite serotype and genotype, and genetic susceptibility of the host. CONCLUSION As Toxoplasma gondii has more virulent strains in the Southern hemisphere, it is relevant to determine African strain types and the correlation between the infecting strains and the clinical manifestations.
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Affiliation(s)
- Nadine Nsiangani-Lusambo
- Eye Department, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Juliana Reyes-Guanes
- Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia.,Grupo de Investigación en Neurociencia (Neuros), Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Pilar Uribe-Reina
- Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia.,Grupo de Investigación en Neurociencia (Neuros), Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Dieudonné Kaimbo Wa Kaimbo
- Eye Department, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Mumba Ngoyi
- Parasitology Department, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Alejandra de-la-Torre
- Grupo de Investigación en Neurociencia (Neuros), Escuela de Medicina y Ciencias de La Salud, Universidad Del Rosario, Bogotá, Colombia
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Nsiangani Lusambo N, Kaimbo Wa Kaimbo D. [Epidemiology and clinical pattern of ocular toxoplasmosis in Kinshasa]. J Fr Ophtalmol 2019; 42:900-906. [PMID: 31248609 DOI: 10.1016/j.jfo.2019.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/17/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the epidemiology and clinical pattern of Congolese patients with ocular toxoplasmosis. PATIENTS AND METHODS A retrospective study was conducted on records of patients with ocular toxoplasmosis examined in the Teaching Hospital of Kinshasa (DR Congo) from 2010 to 2012. Each patient underwent a complete ophthalmic examination. Sociodemographic data, clinical symptoms and signs, visual outcome, modality of treatment and type of complications were studied. RESULTS Thirty-five cases of ocular toxoplasmosis were diagnosed out of 18,144 patients, giving a frequency of 0.2 %. Eighteen men (51.4 %) were affected, with a sex ratio of 1.05. The mean age of the patients was 40.9±20 years (range: 10-72 years). The mean time until consultation was 10 months (range: 2 days-84 months). Ocular involvement was unilateral for 65.7 % of patients. Decreased visual acuity (77.1 %) and pain (7.1 %) were the main ocular complains. Chorioretinal lesions involved the central retina in 26 patients (74.3 %). Five patients (14.2 %) developed recurrences during follow-up. Complications affected 17 patients (48.6 %), with macular scarring (34.3 %) and cataract (17.1 %) being the most common. At the first consultation, 61.7 % of the affected eyes had visual impairment (VA<0.3). Visual impairment was associated with macular lesions (P<0.001, OR=3 [1.4-6.1]) and age greater than 45 years (P=0.002, OR=11 [2.2-53.6]). CONCLUSION In our context, complications are common with ocular toxoplasmosis,s and they lead to visual impairment in the majority of patients.
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Affiliation(s)
- N Nsiangani Lusambo
- Service d'ophtalmologie, Cliniques universitaires, Université de Kinshasa, Kinshasa, République Démocratique du Congo.
| | - D Kaimbo Wa Kaimbo
- Service d'ophtalmologie, Cliniques universitaires, Université de Kinshasa, Kinshasa, République Démocratique du Congo
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Accorinti M, Bruscolini A, Pia Pirraglia M, Liverani M, Caggiano C. Toxoplasmic Retinochoroiditis in an Italian Referral Center. Eur J Ophthalmol 2018; 19:824-30. [PMID: 19787604 DOI: 10.1177/112067210901900522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo Accorinti
- Dipartimento di Scienze Oftalmologiche, Servizio di Immunovirologia Oculare, Università di Roma “La Sapienza”, Roma - Italy
| | - Alice Bruscolini
- Dipartimento di Scienze Oftalmologiche, Servizio di Immunovirologia Oculare, Università di Roma “La Sapienza”, Roma - Italy
| | - Maria Pia Pirraglia
- Dipartimento di Scienze Oftalmologiche, Servizio di Immunovirologia Oculare, Università di Roma “La Sapienza”, Roma - Italy
| | - Marco Liverani
- Dipartimento di Scienze Oftalmologiche, Servizio di Immunovirologia Oculare, Università di Roma “La Sapienza”, Roma - Italy
| | - Claudio Caggiano
- Dipartimento di Scienze Oftalmologiche, Servizio di Immunovirologia Oculare, Università di Roma “La Sapienza”, Roma - Italy
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Huang PK, Jianping C, Vasconcelos-Santos DV, Arruda JSD, Dutta Majumder P, Anthony E, Ganesh SK, Biswas J, Ling HS, Teoh SC, Agrawal R. Ocular Toxoplasmosis in Tropical Areas: Analysis and Outcome of 190 Patients from a Multicenter Collaborative Study. Ocul Immunol Inflamm 2017; 26:1289-1296. [PMID: 29020481 DOI: 10.1080/09273948.2017.1367407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe clinical findings and outcomes for ocular toxoplasmosis in an international multicenter collaborative study. METHODS Retrospective analysis of 190 patients diagnosed with ocular toxoplasmosis from three study sites (Brazil, India, and Singapore). RESULTS There were 93 (48.9%) females with a mean age of 32.8 years. The most common symptoms were isolated blurring of vision (36.8%), followed by blurring of vision with floaters (21.1%). Treatment regimens varied largely from monotherapy to multiple combination therapies. Final visual acuity of ≥20/40 was achieved in 106 (74.2%) patients. In a median follow-up period of 31 weeks (range 12-749 weeks), 83/190 (43.7%) patients suffered a relapse. CONCLUSIONS There appears to be geographical variation in the presentation of ocular toxoplasmosis. Compared to previous studies, we did not observe the '"dual peak" phenomenon of chronic and active disease based on age at presentation, and there was less bilateral and macular involvement (but more peripheral involvement).
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Affiliation(s)
- Philemon K Huang
- a National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
| | - Chen Jianping
- a National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
| | - Daniel Vitor Vasconcelos-Santos
- b Department of Ophthalmology , Faculdade de Medicina and Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Jacqueline Souza Dutra Arruda
- b Department of Ophthalmology , Faculdade de Medicina and Hospital São Geraldo/Hospital das Clínicas da Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | | | - Eliza Anthony
- c Medical Research Foundation , Sankara Netralaya , Chennai , Tamil Nadu , India
| | - Sudha K Ganesh
- c Medical Research Foundation , Sankara Netralaya , Chennai , Tamil Nadu , India
| | - Jyotirmay Biswas
- c Medical Research Foundation , Sankara Netralaya , Chennai , Tamil Nadu , India
| | - Ho Su Ling
- a National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
| | - Stephen C Teoh
- d Eagle Eye Centre , Mt Alvernia Hospital , Singapore , Singapore
| | - Rupesh Agrawal
- a National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore , Singapore
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Maldonado YA, Read JS. Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States. Pediatrics 2017; 139:peds.2016-3860. [PMID: 28138010 DOI: 10.1542/peds.2016-3860] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ngoungou EB, Bhalla D, Nzoghe A, Dardé ML, Preux PM. Toxoplasmosis and epilepsy--systematic review and meta analysis. PLoS Negl Trop Dis 2015; 9:e0003525. [PMID: 25695802 PMCID: PMC4335039 DOI: 10.1371/journal.pntd.0003525] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Toxoplasmosis is an important, widespread, parasitic infection caused by Toxoplasma gondii. The chronic infection in immunocompetent patients, usually considered as asymptomatic, is now suspected to be a risk factor for various neurological disorders, including epilepsy. We aimed to conduct a systematic review and meta-analysis of the available literature to estimate the risk of epilepsy due to toxoplasmosis. METHODS A systematic literature search was conducted of several databases and journals to identify studies published in English or French, without date restriction, which looked at toxoplasmosis (as exposure) and epilepsy (as disease) and met certain other inclusion criteria. The search was based on keywords and suitable combinations in English and French. Fixed and random effects models were used to determine odds ratios, and statistical significance was set at 5.0%. PRINCIPAL FINDINGS Six studies were identified, with an estimated total of 2888 subjects, of whom 1280 had epilepsy (477 positive for toxoplasmosis) and 1608 did not (503 positive for toxoplasmosis). The common odds ratio (calculated) by random effects model was 2.25 (95% CI 1.27-3.9), p = 0.005. CONCLUSIONS Despite the limited number of studies, and a lack of high-quality data, toxoplasmosis should continue to be regarded as an epilepsy risk factor. More and better studies are needed to determine the real impact of this parasite on the occurrence of epilepsy.
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Affiliation(s)
- Edgard B. Ngoungou
- INSERM, UMR1094, Neuroépidémiologie Tropicale, Limoges, France
- Université de Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- Département d’Epidémiologie-Biostatistiques et Informatique Médicale (DEBIM/EA NEMIT), Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Devender Bhalla
- INSERM, UMR1094, Neuroépidémiologie Tropicale, Limoges, France
- Université de Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
| | - Amandine Nzoghe
- Département d’Epidémiologie-Biostatistiques et Informatique Médicale (DEBIM/EA NEMIT), Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Marie-Laure Dardé
- INSERM, UMR1094, Neuroépidémiologie Tropicale, Limoges, France
- Université de Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- CHU Limoges, Laboratoire de Parasitologie-Mycologie, Limoges, France
| | - Pierre-Marie Preux
- INSERM, UMR1094, Neuroépidémiologie Tropicale, Limoges, France
- Université de Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France
- CHU Limoges, CEBIMER, Limoges, France
- * E-mail:
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Bustillo JL, Diaz JD, Pacheco IC, Gritz DC. Cuban Ocular Toxoplasmosis Epidemiology Study (COTES): incidence and prevalence of ocular toxoplasmosis in Central Cuba. Br J Ophthalmol 2014; 99:382-6. [PMID: 25253767 DOI: 10.1136/bjophthalmol-2014-305843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Serological studies indicate that rates of ocular toxoplasmosis (OT) vary geographically, with higher rates in tropical regions. Little is known about population-based rates of active OT. We aimed to describe the epidemiology of OT in Central Cuba. METHODS This large-population, cross-sectional cohort study used a prospective database at a large regional referral centre in Central Cuba. The patient database was searched for all patients who presented with OT during the 12-month study period from 1 April 2011 to 31 March 2012. Inclusion criteria were the clinical diagnosis of OT, characterised by focal retinochoroidal inflammation and a response to therapy as expected. Gender-stratified and age-stratified study population data from the 2012 Cuban Census were used to calculate incidence rates and prevalence ratios. RESULTS Among 279 identified patients with OT, 158 presented with active OT. Of these, 122 new-onset and 36 prior-onset cases were confirmed. Based on the total population in the Sancti Spiritus province (466,106 persons), the overall incidence of active OT was 26.2 per 100,000 person-years (95% CI 21.7 to 31.3) with an annual prevalence ratio of 33.9 per 100,000 persons (95% CI 28.8 to 39.6). The incidence of active OT was lowest in the oldest age group and highest in patients aged 25-44 years (4.5 and 42.1 per 100,000 person-years, respectively). CONCLUSIONS This first report describing population-based rates of OT in the Cuban population highlights the importance of patient age as a likely risk factor for OT. Disease rates were found to be highest in females and young to middle-aged adults.
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Affiliation(s)
- Jorge L Bustillo
- Instituto Superior de Ciencias Medicas de Sancti Spiritus, Sancti Spiritus, Cuba
| | - Jose D Diaz
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Idarmes C Pacheco
- Instituto Superior de Ciencias Medicas de Sancti Spiritus, Sancti Spiritus, Cuba
| | - David C Gritz
- Department of Ophthalmology, Montefiore Medical Center, Bronx, New York, USA
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Silveira C, Gargano N, Kijlstra A, Petersen E. Toxoplasmavaccines: appropriate end points and sample size in future human clinical trials. Expert Rev Anti Infect Ther 2014; 7:905-8. [DOI: 10.1586/eri.09.81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Jad A, Céline T, Bahram B, Phuc L, Nathalie C. Fuchs’ heterochromic cyclitis: a post-infectious manifestation of ocular toxoplasmosis? Int Ophthalmol 2012; 33:189-94. [DOI: 10.1007/s10792-012-9649-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 10/03/2012] [Indexed: 12/19/2022]
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14
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Kianersi F, Naderi Beni A, Naderi Beni Z. Clinical manifestation and prognosis of active ocular toxoplasmosis in Iran. Int Ophthalmol 2012; 32:539-45. [PMID: 22733253 DOI: 10.1007/s10792-012-9599-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
Toxoplasmosis is the most common cause of posterior uveitis in the world. This study described the clinical characteristics and visual outcome of 193 patients with ocular toxoplasmosis at Feiz Hospital (Isfahan, Iran) during the last six years. The setting and design used was a retrospective non-comparative observational case series. In this study, 193 patients with ocular toxoplasmosis (111 female, 82 male) were enrolled. The distribution of symptoms and fundoscopic findings were studied. The most-reported chief complaint was blurred vision in 96 % (184 patients) and floaters in 13.47 % (25 patients) of cases and most frequent clinical manifestations were chorioretinitis 98.48 % (190 patients), macular scars 50.7 % (98 patients), and atrophic optic papilla two (1.03 %) patients. Primary retinal lesions were observed in 16 (8.2 %) and combination of active lesions and old retinochoroidal scars in 177 (91.7 %) of the patients. Retinal detachment occurred in 11 (5.69 %) patients. Bilateral involvement was found in 27 % of patients. Blindness was 0.05 % after treatment. Recurrence rate was 14.5 %. In conclusion, ocular toxoplasmosis substantially varies among patients with different age, gender, site of lesion and other factors. Suddenly blurred vision, floater, and pain could be caused by Toxoplasma gondii. Flashing, may necessitate a more precise peripheral fundus examination.
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Affiliation(s)
- Farzan Kianersi
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Robert-Gangneux F, Dardé ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev 2012; 25:264-96. [PMID: 22491772 PMCID: PMC3346298 DOI: 10.1128/cmr.05013-11] [Citation(s) in RCA: 999] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The apicomplexan parasite Toxoplasma gondii was discovered a little over 100 years ago, but knowledge of its biological life cycle and its medical importance has grown in the last 40 years. This obligate intracellular parasite was identified early as a pathogen responsible for congenital infection, but its clinical expression and the importance of reactivations of infections in immunocompromised patients were recognized later, in the era of organ transplantation and HIV infection. Recent knowledge of host cell-parasite interactions and of parasite virulence has brought new insights into the comprehension of the pathophysiology of infection. In this review, we focus on epidemiological and diagnostic aspects, putting them in perspective with current knowledge of parasite genotypes. In particular, we provide critical information on diagnostic methods according to the patient's background and discuss the implementation of screening tools for congenital toxoplasmosis according to health policies.
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Affiliation(s)
- Florence Robert-Gangneux
- Service de Parasitologie, Faculté de Médecine et Centre Hospitalier Universitaire de Rennes, Rennes, France.
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Subauste CS, Ajzenberg D, Kijlstra A. Review of the series "Disease of the year 2011: toxoplasmosis" pathophysiology of toxoplasmosis. Ocul Immunol Inflamm 2012; 19:297-306. [PMID: 21970661 DOI: 10.3109/09273948.2010.605198] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Toxoplasma gondii is a major cause of chronic parasitic infection in the world. This protozoan can cause retino-choroiditis in newborns and in adults, both immunocompetent and immunodeficient. This disease tends to be recurrent and can lead to severe visual impairment. The authors review current knowledge on the role of parasite genetics in influencing susceptibility to ocular toxoplasmosis and on the immuno-pathogenesis of this disease.
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Affiliation(s)
- Carlos S Subauste
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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Alvarez G, Rey A, Adán A. [Clinical features of ocular toxoplasmosis in an inmigrant population in the Barcelona area: Study of 22 patients]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2010; 85:202-208. [PMID: 21074095 DOI: 10.1016/j.oftal.2010.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 06/18/2010] [Indexed: 05/30/2023]
Abstract
PURPOSE To report the epidemiological, clinical and prognostic features of ocular toxoplasmosis in an immigrant population in the Barcelona area. METHODS A retrospective non-comparative observational study was conducted on a case series of 22 immigrant patients diagnosed with ocular toxoplasmosis by ophthalmoscopic and serological findings. Demographic, clinical and laboratory data were analysed under baseline conditions. The minimum follow-up was 6 months. RESULTS Bilateral involvement was observed in five of the 22 patients (22.7%), a total of 27 eyes being affected by active lesions and old scars. Atypical presentations, including multiple or large necrotizing lesions, were observed in 5 eyes (25%). In 15 eyes (75%) the retinal lesions were associated with intraocular inflammation. Vitreoretinal complications were observed in eight eyes (29.6%), with 22.7% of them requiring vitreous surgery. CONCLUSIONS In immigrant patients from our area in Barcelona, ocular toxoplasmosis has specific clinical and prognostic features, including high rates of atypical presentations, frequent intraocular inflammation, and vitreoretinal complications, requiring surgery in most of the cases.
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Affiliation(s)
- G Alvarez
- Instituto de Oftalmología, Servicio de Oftalmología, Hospital Clinic de Barcelona, Barcelona, España.
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Varella IS, Canti ICT, Santos BR, Coppini AZ, Argondizzo LC, Tonin C, Wagner MB. Prevalence of acute toxoplasmosis infection among 41,112 pregnant women and the mother-to-child transmission rate in a public hospital in South Brazil. Mem Inst Oswaldo Cruz 2009; 104:383-8. [DOI: 10.1590/s0074-02762009000200037] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 03/24/2009] [Indexed: 11/21/2022] Open
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Fatoohi F, Cozon GJN, Wallon M, Kodjikian L, Peyron F. Systemic T Cell Response to Toxoplasma gondii Antigen in Patients with Ocular Toxoplasmosis. Jpn J Ophthalmol 2006; 50:103-10. [PMID: 16604384 DOI: 10.1007/s10384-005-0295-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 10/28/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Analysis of systemic cellular response to Toxoplasma antigen in patients with ocular toxoplasmosis. METHODS Activated (CD25(+)) T cells were detected by flow cytometry after a 7-day culture of whole blood from patients with ocular (n = 16) or asymptomatic (n = 14) toxoplasmosis, and controls (n = 10), in the presence of soluble Toxoplasma antigen (ST-Ag). Interferon (IFN)-gamma, interleukin (IL) 4, and IL-10 were measured in culture supernatants by enzyme-linked immunosorbent assay. RESULTS Higher percentages of CD25(+) T cells were detected in ST-Ag-activated cultures from Toxoplasma-infected patients, with or without ocular lesions (37.0 +/- 19.1% or 41.1 +/- 19.3%, respectively) than from controls (3.2 +/- 1.2%) (P < 0.0001). Differences were not statistically significant between asymptomatic and ocular toxoplasmosis (P > 0.4) or among congenital, acquired, and undetermined ocular toxoplasmosis (P > 0.2). Higher levels of IFN-gamma were detected in ST-Ag-stimulated blood cultures from infected patients than in those from controls (P < 0.0001), with no difference between patients with asymptomatic or ocular toxoplasmosis (P > 0.05). IL-10 was detected only in activated culture supernatants from three patients with ocular toxoplasmosis and two patients with asymptomatic toxoplasmosis. IL-4 was never produced in ST-Ag-activated cultures. CONCLUSIONS Systemic cellular response to ST-Ag does not differ between the patients with ocular and asymptomatic toxoplasmosis with regard to activation markers and type 1 cytokine production.
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Affiliation(s)
- Fatih Fatoohi
- E. A. 3087 Parasitologie, Faculté de Médecine, Lyon Nord, Université Cl. Bernard Lyon1, France
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Affiliation(s)
- Lily Koo
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Contini C, Seraceni S, Cultrera R, Incorvaia C, Sebastiani A, Picot S. Evaluation of a Real-time PCR-based assay using the lightcycler system for detection of Toxoplasma gondii bradyzoite genes in blood specimens from patients with toxoplasmic retinochoroiditis. Int J Parasitol 2005; 35:275-83. [PMID: 15722079 DOI: 10.1016/j.ijpara.2004.11.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Revised: 11/25/2004] [Accepted: 11/25/2004] [Indexed: 10/26/2022]
Abstract
PCR based methods have advantages over traditional methods for the diagnosis of toxoplasmosis, especially when serology fails and clinical symptoms are not evident. However, current PCR-based assays are often labour-intensive and not readily quantifiable and have the potential for contamination due to a requirement for postamplification sample handling. Real-time PCR can address these limitations. We have developed and evaluated a highly sensitive Real-time PCR (Light-cycler, LC-PCR) to detect and quantify Toxoplasma gondii B1 and bradyzoite specific genes (SAG-4, MAG-1) in serum and peripheral blood mononuclear cells (PBMC) specimens, from five immunocompetent subjects with clinically suspected toxoplasmic retinochoroiditis (TRC) or without a suspected T. gondii infection. A standard curve for quantitation of parasitic load was generated using SYBR Green I fluorescent detection. The results were compared with those obtained with a nested PCR (n-PCR). In TRC patients, both PCR methods confirmed ophtalmoscopy and fluorangiographic findings. Among the TRC patients, the use of LC-PCR was more sensitive than n-PCR for detection and quantification of either B1 gene (P<0.001) or SAG-4/MAG-1 gene (P<0.05). LC-PCR has been shown particularly useful to accurately determine the parasite DNA load in follow-up specimens in whom the performance of either B1 or SAG-4 and MAG-1 in detecting T. gondii loads, varied with respect to specific antitoxoplasmic treatment.
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Affiliation(s)
- Carlo Contini
- Section of Infectious Diseases, Department Clinical and Experimental Medicine, via Fossato di Mortara, 23, 44100 Ferrara, Italy.
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Wallon M, Kodjikian L, Binquet C, Garweg J, Fleury J, Quantin C, Peyron F. Long-term ocular prognosis in 327 children with congenital toxoplasmosis. Pediatrics 2004; 113:1567-72. [PMID: 15173475 DOI: 10.1542/peds.113.6.1567] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Retinochoroiditis is the most frequent consequence of congenital toxoplasmosis. Early diagnosis and treatment are believed to reduce the risk of visual impairment. We report on the clinical evolution of ocular lesions and final visual function in a prospective cohort of congenitally infected children who were identified during monthly maternal prenatal screening. METHODS The study included 327 congenitally infected children who were monitored for up to 14 years at the Croix Rousse Hospital in Lyon, France. Data on date of maternal infection; time and type of therapy; antenatal, neonatal, and postnatal work-ups; and ocular status were analyzed. RESULTS All mothers but 52 had been treated. Pyrimethamine and sulfadiazine was given in utero to 38% of children and after birth to 72% of newborns. Fansidar was given for an average duration of 337 days in all but 2 children. After a median follow-up of 6 years, 79 (24%) children had at least 1 retinochoroidal lesion. In 23 (29%) of them, at least 1 new event had been diagnosed up to 10 years after detection of the first lesions: reactivation of an existing lesion (1 case), new lesion in a previously healthy location (19 cases), or both (3 cases). Fifty-five children had lesions in 1 eye; of the 45 children for whom final visual acuity data were available, 31 (69%) had normal vision. Twenty-four children had lesions in both eyes; of the 21 for whom final visual acuity data were available, 11 had normal vision in both eyes. None had bilateral visual impairment. CONCLUSIONS Clinicians, parents, and elder children with congenital infection should be informed that late-onset retinal lesions and relapse can occur many years after birth but that the overall ocular prognosis of congenital toxoplasmosis is satisfactory when infection is identified early and treated accordingly.
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Affiliation(s)
- Martine Wallon
- Department of Parasitology, Hôpital de la Croix-Rousse, Lyon, France.
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Abstract
PURPOSE OF REVIEW The concepts of toxoplasmosis and its ocular manifestations in humans have thoroughly changed in the past 3 years. This review addresses new epidemiologic data, specifically the occurrence of ocular disease in postnatal infections, and puts the changed views on the frequency and pathogenesis of toxoplasmic ocular manifestations into historical perspective. RECENT FINDINGS Newly described clinical presentations are discussed together with their recent diagnostic possibilities. The new data on congenital or postnatal acquisition of infection and their importance for ocular involvement are presented as well as the high prevalence of 79% of recurrent disease in ocular toxoplasmosis, which cannot be prevented by short-term treatments. Recently published analyses of literature showed, unexpectedly, the lack of efficacy of short-term treatments for ocular disease as well as of the long-term prenatal treatments on fetal transmission rate and the severity of congenital disease. SUMMARY The recent guidelines for treatment are included together with the up-to-date recommendations for the treatment of ocular toxoplasmosis in the immunosuppressed host.
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Affiliation(s)
- Aniki Rothova
- FC Donders Institute of Ophthalmology, University Medical Centre, Utrecht, The Netherlands.
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Holland GN. Ocular toxoplasmosis: a global reassessment. Part I: epidemiology and course of disease. Am J Ophthalmol 2003; 136:973-88. [PMID: 14644206 DOI: 10.1016/j.ajo.2003.09.040] [Citation(s) in RCA: 289] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To update clinical information about ocular toxoplasmosis. Part I reviews information about prevalence of disease, sources of infection, relation of ocular disease to time of Toxoplasma gondii infection (congenital vs. postnatally acquired), and course of disease. DESIGN Literature review. METHODS Selected articles from the medical literature, information from recent scientific meetings, and the author's personal experiences were reviewed critically in preparation for the LX Edward Jackson Memorial Lecture. RESULTS The prevalence of T. gondii infection varies geographically and increases with age; in the United States, the overall proportion is 22.5%. The proportion of infected individuals in the United States who have had episodes of ocular toxoplasmosis is unknown, but may be approximately 2%. Prevalence of ocular involvement is substantially greater in other parts of the world, including southern Brazil. In addition to undercooked meat and unwashed vegetables, drinking water contaminated with oocysts may be an important source of infection in some settings. In contrast to traditional teaching, evidence suggests that most individuals with ocular toxoplasmosis were infected postnatally. Ocular lesions may first develop many years after T. gondii infection. The risk of recurrent ocular disease appears to be greater during the first year after an episode of toxoplasmic retinochoroiditis than during subsequent years. CONCLUSIONS Reassessment of older publications in the light of recent observations provides a richer understanding of ocular toxoplasmosis, although knowledge about the disease remains incomplete. A better understanding of the clinical characteristics and course of ocular toxoplasmosis will have important implications for developing more effective prevention and treatment strategies.
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Affiliation(s)
- Gary N Holland
- Jules Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California 90095-7003, USA.
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Bosch-Driessen LEH, Berendschot TTJM, Ongkosuwito JV, Rothova A. Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology 2002; 109:869-78. [PMID: 11986090 DOI: 10.1016/s0161-6420(02)00990-9] [Citation(s) in RCA: 207] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To ascertain the clinical features, visual outcome, and recurrence rates of ocular toxoplasmosis (OT) in a large series of patients. To determine the efficacy of various treatment strategies and identify the patients at risk of visual loss. DESIGN Retrospective noncomparative observational case series. PARTICIPANTS One hundred fifty-four consecutive patients with active lesions of OT (first attack and/or recurrence) were identified in a cohort of 1300 consecutive patients with uveitis. Mean follow-up was 5.8 years. INTERVENTION A review of the medical records of 154 patients with active OT. MAIN OUTCOME MEASURES Patients were subdivided according to clinical and laboratory criteria. Numerous variables were compared per patient and group, including age and gender distribution, onset and course of infection, clinical ocular features, laboratory data, therapeutic strategies and their outcomes, number of recurrences, complications, final visual acuity, and features associated with poor visual outcome. RESULTS Primary retinal lesions were observed in 28% and a combination of active lesions and old retinochoroidal scars in 72% of the patients at first presentation to the ophthalmologist. Mean age at first presentation with an active OT lesion was 29.5 years. Patients with primary OT were older than those with a combination of active lesions and old scars (P < 0.001). Serologic characteristics of the acute phase of systemic infection were found in 11% of the patients. Ocular involvement in these patients was associated with advanced age at onset (P < 0.001) and was characterized by severe intraocular inflammation. Most (82%) of the patients with serologic characteristics of the acute phase of systemic infection had primary lesions (compared with 23% of OT in the chronic phase of systemic infection; P < 0.001). Extensive retinal lesions were more frequently observed during the acute phase of systemic infection (P = 0.02) and in patients with primary OT (P < 0.04). Recurrences, which developed in 79% of all patients followed for more than 5 years, were located predominantly in previously affected eyes (with old scars) in contrast to the sporadic cases of recurrence in the healthy contralateral eye (P < 0.0001). Standard short-term therapeutic modalities had no effect on visual outcome or future recurrence rates. Legal blindness in one or both eyes was confirmed for 24% of the patients. Blindness of both eyes was more frequent in patients with congenital OT (P < 0.001). Risk factors for visual loss included congenital infection, OT manifesting during the acute phase of systemic infection, central location and/or extensive retinal lesions, and the administration of corticosteroids without a shield of antiparasitic drugs. CONCLUSIONS Legal blindness in at least one eye developed in 24% of the patients with OT. Recurrences, which developed in 79% of the patients with long-term follow-up, were located predominantly in eyes with toxoplasmic scars. Various short-term therapeutic modalities had no effect on visual outcomes or future recurrence rates, with the exception of a poor visual outcome for patients who received corticosteroids without a shield of antiparasitic drugs.
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Affiliation(s)
- Lotje E H Bosch-Driessen
- Uveitis Center, FC Donders Institute of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
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Akerele T, Lightman S. Uveitis: Diagnosis and Management. J R Coll Physicians Edinb 2000. [DOI: 10.1177/147827150003000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- T. Akerele
- Department of Clinical Ophthalmology, Institute of Ophthalmology, London and Moorfields Eye Hospital, London
| | - S. Lightman
- Department of Clinical Ophthalmology, Institute of Ophthalmology, London and Moorfields Eye Hospital, London
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Dunn D, Wallon M, Peyron F, Petersen E, Peckham C, Gilbert R. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling. Lancet 1999; 353:1829-33. [PMID: 10359407 DOI: 10.1016/s0140-6736(98)08220-8] [Citation(s) in RCA: 362] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women who acquire toxoplasmosis infection during pregnancy (in most cases detected through serological screening) require counselling about the risk of congenital infection and its clinical sequelae. Reliable estimates of risk are not currently available. We undertook an analysis of data from women referred to the toxoplasmosis reference laboratory, Lyon, France, between 1987 and 1995. METHODS Information was collected from clinical notes kept at the laboratory and, where necessary, from the relevant obstetrician or paediatrician via telephone. Methods were developed to derive estimates of the risk of congenital toxoplasmosis by exact duration of gestation at maternal seroconversion. FINDINGS We analysed obstetric and paediatric data on 603 confirmed maternal toxoplasmosis infections. At least 564 women received antiparasitic drugs according to a standard protocol. Congenital infection status was ascertained in 554 cases, and infected children were followed-up for a median of 54 months. The overall maternal-fetal transmission rate was 29% (95% CI 25-33), which masked a sharp increase in risk with duration of gestation from 6% at 13 weeks to 72% at 36 weeks. However, fetuses infected in early pregnancy were much more likely to show clinical signs of infection. These effects counterbalance, and women who seroconverted at 24-30 weeks of gestation carried the highest risk (10%) of having a congenitally infected child with early clinical signs who was thus at risk of long-term complications. INTERPRETATION This information will assist the clinical counselling of pregnant women diagnosed with acute toxoplasmosis and may guide individual decisions on investigative and therapeutic options. Further studies are required to determine the long-term risks of clinical symptoms and disability due to congenital toxoplasmosis.
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Affiliation(s)
- D Dunn
- Department of Epidemiology and Public Health, Institute of Child Health, University College London Medical School, UK
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Whittle RM, Wallace GR, Whiston RA, Dumonde DC, Stanford MR. Human antiretinal antibodies in toxoplasma retinochoroiditis. Br J Ophthalmol 1998; 82:1017-21. [PMID: 9893591 PMCID: PMC1722733 DOI: 10.1136/bjo.82.9.1017] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Toxoplasma retinochoroiditis (TR) is an important cause of blindness and visual morbidity, affecting young adults. It has been postulated that some of the retinal damage observed in TR is due to antiretinal autoimmune mechanisms. METHODS Humoral antiretinal autoimmunity in TR was investigated by indirect immunofluorescence (IIF) on normal human cadaveric retina and by a human retinal S-antigen ELISA. 36 patients with TR were separated on clinical grounds into those with first recurrence of disease (n = 18) or those with multiple recurrences (n = 18). Patients were also segregated into those with active (n = 28) or quiescent disease (n = 8). Serum from 16 normal controls (six with positive toxoplasma serology and 10 without) with no evidence of eye disease and 12 patients with idiopathic retinal vasculitis (IRV) were also tested. RESULTS Sera from 34 of the 36 patients (94%) with TR demonstrated photoreceptor layer reactivity by IIF contrasting with six of 16 normal controls (p = < 0.001) and three of 12 IRV patients (p = < 0.001). Titres of antiphotoreceptor antibody were also higher among TR patients than controls. Sera from 27 of the 36 TR patients, 10 of 16 normals, and nine of 12 retinal vasculitis patients possessed anti-human retinal S-antigen antibodies at a titre of 1:400 or more as assessed by ELISA (p = > 0.05). Antiretinal autoantibody as detected by IIF did not run in parallel with S-antigen reactivity. CONCLUSIONS The data indicate that the extent of antiretinal reactivity within TR is not accounted for by anti-S-antigen antibodies alone. This remarkably high prevalence of antiphotoreceptor antibody in TR as opposed to that found in either healthy or disease controls suggest that these antibodies may be co-pathogenic in toxoplasma retinochoroiditis.
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Affiliation(s)
- R M Whittle
- Department of Immunology, Rayne Institute, St Thomas's Hospital, London
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Rahi JS, Edelsten C. The British Ophthalmological Surveillance Unit: the study of uncommon ophthalmic disorders made easier. Eye (Lond) 1998; 11 ( Pt 6):766-7. [PMID: 9537127 DOI: 10.1038/eye.1997.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Abstract
In the study of uveitis, epidemiology is frequently neglected. Our uveitis register consisted of data collected on all uveitis patients except minor, easily resolved, anterior uveitis cases at the Leicester Royal Infirmary. The diagnoses of these patients were classified by the aetiological method. A total of 712 patients was entered into the register over a period of 10 years starting from January 1985. In the study, 73.0% of the cases fit into named clinical syndromes while 27.0% of the cases were diagnosed as idiopathic but uncategorised. The commonest definable cause of anterior uveitis was HLA-B27-related acute anterior uveitis, comprising 15.2% of all uveitis cases. Intermediate uveitis accounted for 7.9% of all cases while the commonest definable cause of posterior uveitis was toxoplasmosis, forming 4.6% of all uveitis cases. The aim of the study was to present data relating to diagnostic categories from a primary and secondary uveitis clinic, and to explore the usefulness of such a uveitis register within an ophthalmic department.
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Affiliation(s)
- L H Thean
- Department of Ophthalmology, Leicester Royal Infirmary, U.K
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Ho-Yen DO, Joss AW, Dargie L. Incidence of toxoplasma retinochoroiditis. BMJ (CLINICAL RESEARCH ED.) 1995; 311:691-2. [PMID: 7549669 PMCID: PMC2551472 DOI: 10.1136/bmj.311.7006.691c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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