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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.
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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
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Cifuentes-González C, Rojas-Carabali W, Pérez ÁO, Carvalho É, Valenzuela F, Miguel-Escuder L, Ormaechea MS, Heredia M, Baquero-Ospina P, Adan A, Curi A, Schlaen A, Urzua CA, Couto C, Arellanes L, de-la-Torre A. Risk factors for recurrences and visual impairment in patients with ocular toxoplasmosis: A systematic review and meta-analysis. PLoS One 2023; 18:e0283845. [PMID: 37011101 PMCID: PMC10069780 DOI: 10.1371/journal.pone.0283845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/19/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Ocular toxoplasmosis (OT) is caused by the parasite Toxoplasma gondii. OT is the leading cause of posterior uveitis globally; it is a recurrent disease that may result in visual impairment and blindness. This systematic review and meta-analysis aim to summarize and evaluate the risk factors for recurrences, visual impairment, and blindness described in the literature worldwide. METHODS AND FINDINGS We performed a systematic literature search in PubMed, Embase, VHL, Cochrane Library, Scopus, and DANS EASY Archive. All studies reporting patients with clinically and serologically confirmed OT presenting any clinical or paraclinical factor influencing recurrences, visual impairment, and blindness were included. Studies presenting secondary data, case reports, and case series were excluded. An initial selection was made by title and abstract, and then the studies were reviewed by full text where the eligible studies were selected. Then, the risk of bias was assessed through validated tools. Data were extracted using a validated extraction format. Qualitative synthesis and quantitative analysis were done. This study was registered on PROSPERO (CRD42022327836). RESULTS Seventy two studies met the inclusion criteria. Fifty-three were summarized in the qualitative synthesis in three sections: clinical and environmental factors, parasite and host factors, and treatment-related factors. Of the 72 articles, 39 were included in the meta-analysis, of which 14 were conducted in South America, 13 in Europe, four in Asia, three multinational, two in North America and Central America, respectively, and only one in Africa. A total of 4,200 patients with OT were analyzed, mean age ranged from 7.3 to 65.1 year of age, with similar distribution by sex. The frequency of recurrences in patients with OT was 49% (95% CI 40%-58%), being more frequent in the South American population than in Europeans. Additionally, visual impairment was presented in 35% (95% CI 25%-48%) and blindness in 20% (95% CI 13%-30%) of eyes, with a similar predominance in South Americans than in Europeans. On the other hand, having lesions near the macula or adjacent to the optic nerve had an OR of 4.83 (95% CI; 2.72-8.59) for blindness, similar to having more than one recurrence that had an OR of 3.18 (95% CI; 1.59-6.38). Finally, the prophylactic therapy with Trimethoprim/Sulfamethoxazole versus the placebo showed a protective factor of 83% during the first year and 87% in the second year after treatment. CONCLUSION Our Systematic Review showed that clinical factors such as being older than 40 years, patients with de novo OT lesions or with less than one year after the first episode, macular area involvement, lesions greater than 1 disc diameter, congenital toxoplasmosis, and bilateral compromise had more risk of recurrences. Also, environmental and parasite factors such as precipitations, geographical region where the infection is acquired, and more virulent strains confer greater risk of recurrences. Therefore, patients with the above mentioned clinical, environmental, and parasite factors could benefit from using prophylactic therapy.
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Affiliation(s)
- Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Álvaro Olate Pérez
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Érika Carvalho
- Clinical Research Laboratory of Infectious Diseases in Ophthalmogy, National Institute of Infectious Disease, INI-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Felipe Valenzuela
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lucía Miguel-Escuder
- Hospital Clinic of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - María Soledad Ormaechea
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Milagros Heredia
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Pablo Baquero-Ospina
- Inflammatory Eye Disease Clinic, Dr. Luis Sanchez Bulnes" Hospital, Asociación para Evitar la Ceguera en México (APEC), Mexico City, CDMX, Mexico
| | - Alfredo Adan
- Hospital Clinic of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Andre Curi
- Clinical Research Laboratory of Infectious Diseases in Ophthalmogy, National Institute of Infectious Disease, INI-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Cristhian Alejandro Urzua
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
- Faculty of Medicine, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Cristóbal Couto
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Lourdes Arellanes
- Inflammatory Eye Disease Clinic, Dr. Luis Sanchez Bulnes" Hospital, Asociación para Evitar la Ceguera en México (APEC), Mexico City, CDMX, Mexico
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
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Aloise DDA, Coura-Vital W, Carneiro M, Rodrigues MV, Toscano GADS, da Silva RB, Silva-Portela RDCB, Fontes-Dantas FL, Agnez-Lima LF, Vitor RWA, Andrade-Neto VFD. Association between ocular toxoplasmosis and APEX1 and MYD88 polymorphism. Acta Trop 2021; 221:106006. [PMID: 34118207 DOI: 10.1016/j.actatropica.2021.106006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
Ocular toxoplasmosis (OT) is the most common form of posterior uveitis, and in some countries, it is the most frequent cause of visual impairment. Studies demonstrate that the polymorphism in genes involved with the immune response can be related both to the occurrence and to the recurrence of OT. Thus, the present study aimed to analyze the association between OT and the polymorphism of the APEX1 (rs1130409) and MyD88 (rs7744) genes. The studied sample consisted of 48 volunteers with OT and 96 asymptomatic volunteers, but positive for anti - T. gondii IgG (control group). Blood collection was performed for serological analysis (ELISA) and DNA extraction. Genotyping of the polymorphism was performed using real-time PCR. To analyze the association between gene polymorphism and OT, logistic regression was performed. The results showed no association between the MYD88 gene polymorphism and the development of OT. However, a significant association was found between OT and APEX1 gene polymorphism, indicating that individuals expressing polymorphic (GG) or heterozygous (GT) alleles are more likely to develop the disease (P-value = 0.02 and 0.03 respectively). These results suggest that APEX1 (rs1130409) polymorphism is a risk factor for the occurrence of ocular toxoplasmosis in the studied population.
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Toxoplasma gondii in South America: a differentiated pattern of spread, population structure and clinical manifestations. Parasitol Res 2021; 120:3065-3076. [PMID: 34390383 DOI: 10.1007/s00436-021-07282-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/05/2021] [Indexed: 02/04/2023]
Abstract
Toxoplasma gondii is an obligate intracellular parasite belonging to the phylum Apicomplexa. It has a worldwide distribution and can infect a wide variety of intermediate hosts, including humans. In South America, toxoplasmosis shows high health impacts, and the incidence of the disease is frequently reported and more severe than in other regions, such as Europe. Although most T. gondii infections are asymptomatic, severe manifestations can occur in cases of congenital toxoplasmosis and immunocompromised individuals. In South America, the ocular disease in immunocompetent individuals is also frequently reported. Treatment for any clinical manifestation of toxoplasmosis consists of the combination of sulfadiazine (SDZ) and pyrimethamine (PYR). However, failures in the treatment of toxoplasmosis have been reported, especially in South America, suggesting the acquisition of resistance against SDZ and PYR. Another paradigm present in the literature is that once infected with T. gondii, the host is immunologically protected from further reinfections. However, some studies indicate cases of congenital transmission of T. gondii from immunocompetent pregnant women with chronic infection, suggesting the possibility of reinfection in humans. Thus, in this review, we will cover several aspects of South American T. gondii isolates, such as genetic characterization, disease manifestation, host reinfection and drug resistance.
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Classification Criteria for Toxoplasmic Retinitis. Am J Ophthalmol 2021; 228:134-141. [PMID: 33845002 PMCID: PMC8594742 DOI: 10.1016/j.ajo.2021.03.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine classification criteria for toxoplasmic retinitis. DESIGN Machine learning of cases with toxoplasmic retinitis and 4 other infectious posterior uveitides / panuveitides. METHODS Cases of infectious posterior uveitides / panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior uveitides / panuveitides. The resulting criteria were evaluated on the validation set. RESULTS Eight hundred three cases of infectious posterior uveitides / panuveitides, including 174 cases of toxoplasmic retinitis, were evaluated by machine learning. Key criteria for toxoplasmic retinitis included focal or paucifocal necrotizing retinitis and either positive polymerase chain reaction assay for Toxoplasma gondii from an intraocular specimen or the characteristic clinical picture of a round or oval retinitis lesion proximal to a hyperpigmented and/or atrophic chorioretinal scar. Overall accuracy for infectious posterior uveitides / panuveitides was 92.1% in the training set and 93.3% (95% confidence interval 88.2, 96.3) in the validation set. The misclassification rates for toxoplasmic retinitis were 8.2% in the training set and 10% in the validation set. CONCLUSIONS The criteria for toxoplasmic retinitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
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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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Lago EG, Endres MM, Scheeren MFDC, Fiori HH. Ocular Outcome of Brazilian Patients With Congenital Toxoplasmosis. Pediatr Infect Dis J 2021; 40:e21-e27. [PMID: 33060522 DOI: 10.1097/inf.0000000000002931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Retinochoroiditis is the most frequent manifestation of congenital toxoplasmosis. We aimed to describe the ocular outcome and factors that may influence the visual prognosis of these patients. METHODS Cohort of patients with confirmed congenital toxoplasmosis seen between 1996 and 2017 in Porto Alegre, southern Brazil. RESULTS Seventy-seven patients were included, of which 65 (85.5%) were identified by routine screening. Median age at the end of the follow-up was 10 years (minimum 2, maximum 25). Retinochoroiditis was present in 55 patients (71.4%). New retinochoroidal lesions developed after the first year of life in 77.8% of the patients who began treatment after the fourth month of life, compared with 35.2% among those treated before 4 months of life (relative risk = 0.45, 95% confidence intervals: 0.27-0.75, P = 0.02) and 33.3% among those treated before 2 months of life (relative risk = 0.42, 95% confidence intervals: 0.25-0.72, P = 0.01). There was a peak incidence of new retinochoroidal lesions between 4 and 5 years and another peak between 9 and 14 years, the latter only among girls. Thirty-four patients with retinochoroiditis were followed up for 10 years or more, and the school performance was appropriate in 28 (82.4%). CONCLUSIONS The high incidence of new retinochoroidal lesions during the follow-up period indicates the importance of long-term follow-up of patients with congenital toxoplasmosis. Initiating treatment within the first 4 months of life, especially within the first 2 months, was a protective factor against the later development of retinochoroiditis. Despite the usual favorable prognosis, the high morbidity of congenital toxoplasmosis in Brazil was confirmed.
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Affiliation(s)
- Eleonor Gastal Lago
- From the Neonatology Division, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre/RS, Brazil
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Brandão-de-Resende C, Santos HH, Rojas Lagos AA, Lara CM, Arruda JSD, Marino APMP, do Valle Antonelli LR, Gazzinelli RT, de Almeida Vitor RW, Vasconcelos-Santos DV. Clinical and Multimodal Imaging Findings and Risk Factors for Ocular Involvement in a Presumed Waterborne Toxoplasmosis Outbreak, Brazil 1. Emerg Infect Dis 2020; 26. [PMID: 33219657 PMCID: PMC7706934 DOI: 10.3201/eid2612.200227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
After a 2015 outbreak, 23% of patients had retinochoroiditis, indicating that patients with acquired toxoplasmosis should have long-term follow-up, regardless of initial ocular involvement. In 2015, an outbreak of presumed waterborne toxoplasmosis occurred in Gouveia, Brazil. We conducted a 3-year prospective study on a cohort of 52 patients from this outbreak, collected clinical and multimodal imaging findings, and determined risk factors for ocular involvement. At baseline examination, 12 (23%) patients had retinochoroiditis; 4 patients had bilateral and 2 had macular lesions. Multimodal imaging revealed 2 distinct retinochoroiditis patterns: necrotizing focal retinochoroiditis and punctate retinochoroiditis. Older age, worse visual acuity, self-reported recent reduction of visual acuity, and presence of floaters were associated with retinochoroiditis. Among patients, persons >40 years of age had 5 times the risk for ocular involvement. Five patients had recurrences during follow-up, a rate of 22% per person-year. Recurrences were associated with binocular involvement. Two patients had late ocular involvement that occurred >34 months after initial diagnosis. Patients with acquired toxoplasmosis should have long-term ophthalmic follow-up, regardless of initial ocular involvement.
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Pereira AV, Gois MB, Silva MS, Miranda Junior NRD, Campos CBHF, Schneider LCL, Barbosa CP, Nogueira-Melo GDA, Sant'Ana DDMG. Toxoplasma gondii causes lipofuscinosis, collagenopathy and spleen and white pulp atrophy during the acute phase of infection. Pathog Dis 2020; 77:5739919. [PMID: 32068829 DOI: 10.1093/femspd/ftaa008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022] Open
Abstract
In this study, we evaluated homeostatic and functional disorders of the spleen in mice inoculated with Toxoplasma gondii. The kinetics of megakaryocyte and leukocyte production, body and spleen mass and certain histopathological aspects were analyzed. There was increased (P < 0.05) the accumulation of lipofuscin in the red pulp of the spleen, in the periods of 30 and 60 dpi of the infection, that is, in the chronification stage of the disease and decrease of the white pulp area. In addition, we observed (from 7dpi) a quantitative and qualitative increase (P < 0.05) in the deposition of collagen fibers in the spleen of all infected mice. Since resolution of the inflammatory process resulted in pathophysiological changes, we can suggest that the T. gondii invaded and multiplied in the cells of the white and red pulps of the spleen. Although we did not find the parasite in the spleen, this hypothesis is supported by the presence of diffuse inflammatory infiltrate, which extended through the spleen parenchyma of all inoculated mice. Taken together, our results suggest that T. gondii causes severe homeostatic disorders that have altered spleen physiology, including diffuse parenchymal inflammation, lipofuscinosis in histiocytes, early aging, collagenopathy, systemic sclerosis and spleen and white pulp atrophy.
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Affiliation(s)
- Andréia Vieira Pereira
- State University of Maringá, Department of Clinical Analysis and Biomedicine, Avenue Colombo, 5790, CEP: 87020-900, Maringá, Brazil
| | - Marcelo Biondaro Gois
- Federal University of "Recôncavo'' of Bahia, Avenue Carlos Amaral, Santo Antônio de Jesus, CEP 44.430-622, Brazil; Institute of Health Sciences, Federal University of Bahia; and Postgraduate Program in Regional Development and Environment, Maria Milza College
| | - Mariana Sacchi Silva
- State University of Maringá, Department of Clinical Analysis and Biomedicine, Avenue Colombo, 5790, CEP: 87020-900, Maringá, Brazil
| | | | - Carla Betânia Huf Ferraz Campos
- State University of Maringá, Department of Clinical Analysis and Biomedicine, Avenue Colombo, 5790, CEP: 87020-900, Maringá, Brazil
| | - Larissa Carla Lauer Schneider
- State University of Maringá, Department of Morphological Sciences, Avenue Colombo, 5790, CEP: 87020-900, Maringá, Brazil
| | - Carmem Patrícia Barbosa
- State University of Maringá, Department of Morphological Sciences, Avenue Colombo, 5790, CEP: 87020-900, Maringá, Brazil
| | | | - Débora de Mello Gonçales Sant'Ana
- State University of Maringá, Department of Clinical Analysis and Biomedicine, Avenue Colombo, 5790, CEP: 87020-900, Maringá, Brazil.,State University of Maringá, Department of Morphological Sciences, Avenue Colombo, 5790, CEP: 87020-900, Maringá, Brazil
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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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Matet A, Paris L, Fardeau C, Terrada C, Champion E, Fekkar A, Cassoux N, Touitou V, LeHoang P, Bodaghi B. Clinical and Biological Factors Associated With Recurrences of Severe Toxoplasmic Retinochoroiditis Confirmed by Aqueous Humor Analysis. Am J Ophthalmol 2019; 199:82-93. [PMID: 30502335 DOI: 10.1016/j.ajo.2018.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate clinical and biological factors influencing recurrences of severe toxoplasmic retinochoroiditis (TRC) confirmed by aqueous humor analysis. DESIGN Retrospective case series. METHODS Retrospective analysis of 87 subjects with severe TRC, proven by positive Goldmann-Witmer coefficient (GWC), Toxoplasma gondii (T. gondii) immunoblot, or T. gondii-specific polymerase chain reaction (PCR) in aqueous humor. Cases with immunosuppression or retinal scars without previous recorded episode were excluded. Time-dependent, clinical, treatment-related, and biological factors were explored by univariate and multivariate shared frailty survival analyses. RESULTS Among 44 included subjects (age, 40.4 ± 17.6 years; follow-up, 8.3 ± 2.7 years), 22 presented recurrences. There was 0.11 recurrence/patient/year and mean disease-free interval was 5.0 ± 2.9 years. The risk of recurrence was higher immediately after an episode (P < .0001). Among recurrent cases, the risk of multiple recurrences was higher when the first recurrence occurred after longer disease-free intervals (P = .046). In univariate analysis, the recurrence risk declined with higher number of intense bands on aqueous T. gondii immunoblot (P = .006), and increased when venous vasculitis was present initially (P = .019). Multivariate analysis confirmed that eyes with more intense bands on immunoblot had fewer recurrences (P = .041). There was a near-significant risk elevation after pyrimethamine/azithromycin treatment (P = .078 and P = .054, univariate and multivariate). Intravenous corticosteroid administration, oral corticosteroid administration, aqueous GWC, and T. gondii PCR did not influence recurrences (P = .12, P = .10, P = .39, and P = .96, respectively). CONCLUSIONS Recurrences of severe TRC are not random and may be influenced by clinical and biological factors possibly related to blood-retinal barrier alterations. These results may contribute to identifying biomarkers for TRC reactivation.
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MESH Headings
- Administration, Oral
- Adolescent
- Adult
- Aged
- Antibodies, Protozoan/immunology
- Aqueous Humor/parasitology
- Biological Factors
- Chorioretinitis/diagnosis
- Chorioretinitis/genetics
- Chorioretinitis/immunology
- Chorioretinitis/parasitology
- DNA, Protozoan/genetics
- Eye Infections, Parasitic/diagnosis
- Eye Infections, Parasitic/genetics
- Eye Infections, Parasitic/immunology
- Eye Infections, Parasitic/parasitology
- Female
- Follow-Up Studies
- Glucocorticoids/administration & dosage
- Humans
- Immunoblotting
- Infusions, Intravenous
- Male
- Middle Aged
- Polymerase Chain Reaction
- Recurrence
- Retrospective Studies
- Toxoplasma/genetics
- Toxoplasma/immunology
- Toxoplasmosis, Ocular/diagnosis
- Toxoplasmosis, Ocular/genetics
- Toxoplasmosis, Ocular/immunology
- Toxoplasmosis, Ocular/parasitology
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Affiliation(s)
- Alexandre Matet
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France.
| | - Luc Paris
- Parasitology Department, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Christine Fardeau
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Céline Terrada
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Emmanuelle Champion
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Arnaud Fekkar
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Nathalie Cassoux
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Valérie Touitou
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Phuc LeHoang
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
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Immune Mediator Profile in Aqueous Humor Differs in Patients with Primary Acquired Ocular Toxoplasmosis and Recurrent Acute Ocular Toxoplasmosis. Mediators Inflamm 2019; 2019:9356728. [PMID: 30906227 PMCID: PMC6398019 DOI: 10.1155/2019/9356728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/12/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare the intraocular cytokine and chemokine profiles in patients with acute primary acquired ocular toxoplasmosis (pOT) or recurrent ocular toxoplasmosis (rOT) and to correlate them with their clinical characteristics. Methods Aqueous humor samples were collected from 62 consecutive patients (21 pOT, 30 rOT, and 11 noninfected controls) and analyzed by multiplex assay. Correlations were assessed between cytokine/chemokine levels, type of inflammatory response (Th1, Th2, and Th17), and clinical characteristics. In all OT patients, the clinical diagnosis of either pOT or rOT was confirmed by positive intraocular Goldmann/Witmer-Desmonts coefficient. Correlations were assessed between a preselected panel of immune mediators and the clinical characteristics of OT. Results In pOT patients, increased levels of IL-2, IFN-γ, TNF-α, IL-15, IL-4, IL-5, IL-9, IL-13, IL-17, IL-1Rα, IL-6, IL-1β, and chemokines MIP-1α, MIP-1β, IP-10, Eotaxin, IL-8, RANTES, PDGF-bb, GM-CSF, G-CSF, and MCP-1 were found in comparison to those in controls (p < 0.05). Patients with rOT showed elevated levels of IL-2, IFN-γ, TNF-α, IL-15, IL-4, IL-5, IL-9, IL-17, IL-1Rα, IL-6, IL-1β, and chemokines MIP-1α, IP-10, Eotaxin, IL-8, RANTES, PDGF-bb, G-CSF, and MCP-1 compared to controls (p < 0.05). In addition, IL-7 (p = 0.028) differed between pOT and rOT; IL-9 (p = 0.054) and IL-13 (p = 0.051) showed a tendency of higher concentration in pOT than in rOT. A negative correlation was found between IL-7 (p = 0.017) as well as IL-9 (p = 0.008) and the number of recurrences. Cytokine ratios showed no difference between pOT and rOT, indicating a dominant Th1-type response in both infectious groups. Moreover, a positive correlation was detected between IL-7, VEGF, IL-13 and age at aqueous humor sampling (p < 0.05). Conclusions This study for the first time shows subtle differences between the intraocular cytokine profiles in patients with either acute pOT or rOT.
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13
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Aleixo ALQDC, Vasconcelos C. de Oliveira R, Cavalcanti Albuquerque M, Biancardi AL, Land Curi AL, Israel Benchimol E, Reis Amendoeira MR. Toxoplasmic retinochoroiditis: The influence of age, number of retinochoroidal lesions and genetic polymorphism for IFN-γ +874 T/A as risk factors for recurrence in a survival analysis. PLoS One 2019; 14:e0211627. [PMID: 30753197 PMCID: PMC6372150 DOI: 10.1371/journal.pone.0211627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose To analyze risk factors for recurrent toxoplasmic retinochoroiditis. Design Single center prospective case series. Population and Methods A total of 230 patients with toxoplasmic retinochoroiditis were prospectively followed to assess recurrences. All patients were treated with a specific drug regime for toxoplasmosis in each episode of active retinochoroiditis. Individuals with chronic diseases and pregnant women were excluded. Survival analysis by extended Cox regression model (Prentice-Williams-Peterson counting process model) was performed to evaluate the time between recurrences according to some potential risk factors: age, number of retinochoroidal lesions at initial evaluation, sex and interferon gamma +874 T/A gene polymorphism. Hazard Ratios (HR) and 95% confidence intervals (CI) were provided to interpret the risk effects. Results One hundred sixty-two recurrence episodes were observed in 104 (45.2%) patients during follow-up that lasted from 269 to 1976 days. Mean age at presentation was 32.8 years (Standard deviation = 11.38). The risk of recurrence during follow up was influenced by age (HR = 1.02, 95% CI = 1.01–1.04) and number of retinochoroidal lesions at the beginning of the study (HR = 1.60, 95% CI = 1.07–2.40). Heterozygosis for IFN-γ gene polymorphism at position +874 T/A was also associated with recurrence (HR = 1.49, 95% CI = 1.04–2.14). Conclusion The risk of ocular toxoplasmosis recurrence after an active episode increased with age and was significantly higher in individuals with primary lesions, which suggests that individuals with this characteristic and the elderly could benefit from recurrence prophylactic strategies with antimicrobials. Results suggest an association between IFN-γ gene polymorphism at position +874T/A and recurrence.
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Affiliation(s)
| | | | | | | | - André Luiz Land Curi
- Infectious Ophthalmology Laboratory, Evandro Chagas National Institute of Infectious Diseases—FIOCRUZ, Rio de Janeiro, Brazil
| | - Eliezer Israel Benchimol
- Infectious Ophthalmology Laboratory, Evandro Chagas National Institute of Infectious Diseases—FIOCRUZ, Rio de Janeiro, Brazil
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14
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Kharel Sitaula R, Joshi SN, Sah R, Khadka S, Khatri Kc A, Pokharel BM. Toxoplasma gondii bradyzoites and tachyzoites isolation from vitreous of atypical necrotizing retinitis. J Ophthalmic Inflamm Infect 2018; 8:8. [PMID: 29904801 PMCID: PMC6002333 DOI: 10.1186/s12348-018-0151-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 05/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detection of Toxoplasma gondii cysts in vitreous of immunocompetent patient with necrotizing retinitis is extremely rare. We herein report the isolation of Toxoplasma bradyzoites and tachyzoites from the vitreous of healthy person. RESULTS A 19-year-old immunocompetent female presented with sudden loss of vision in left eye since 1 week. The BCVA was 6/6 and HM in right and left eye. The left eye finding was suggestive of diffuse necrotizing retinitis with retinal detachment. The IgM and IgG for TORCH infection were negative and HIV, HCV and HBsAg tests were also non reactive. The patient underwent diagnostic and therapeutic vitrectomy with silicon oil installation. The vitreous toxoplasma IgG titre was found to be significantly raised to 1:16. Bradyzoites of toxoplasma were identified in H&E staining and tachyzoites of Toxoplasma were identified in Giemsa staining of vitreous sample. She received oral clindamycin and oral corticosteroid but the vision could not be restored in left eye. CONCLUSION Hence, atypical toxoplasmosis with necrotizing retinitis is a fulminant condition with the diagnostic and therapeutic challenge.
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Affiliation(s)
- Ranju Kharel Sitaula
- B.P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj Medical Campus, Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
| | - Sagun Narayan Joshi
- B.P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj Medical Campus, Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Ranjit Sah
- B.P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj Medical Campus, Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.,Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sushila Khadka
- B.P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj Medical Campus, Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.,Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Anadi Khatri Kc
- Vitreo-Retinal Pathology and Surgery, Lumbini Eye Institute, Lumbini, Nepal
| | - Bharat Mani Pokharel
- Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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15
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Hosseini SM, Moghaddas E, Sharifi K, Dadgar Moghaddam M, Shamsian SA. Assessment of ocular toxoplasmosis patients reported at a tertiary center in the northeast of Iran. Int Ophthalmol 2018; 38:2527-2533. [PMID: 29335806 DOI: 10.1007/s10792-017-0764-3] [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] [Received: 09/07/2016] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Ocular toxoplasmosis, which is caused by the single-cell parasite Toxoplasma gondii, is currently the most significant cause of posterior uveitis in the world. No previous studies have described the prevalence and clinical features of ocular toxoplasmosis in the northeast of Iran. The purpose of the current study was to address this gap. METHODS In this retrospective study, the medical records of 488 uveitis patients who presented to the Khatam-al-Anbia Eye Hospital of Mashhad University of Medical Sciences, a tertiary ophthalmology center in the northeast of Iran, between January 2013 and December 2015 were evaluated. The clinical features and risk factors of 99 (20%) consecutive patients with ocular toxoplasmosis were extracted. RESULTS Ninety-nine including 53 (53.5%) female and 46 (46.5%) male patients with ocular toxoplasmosis were included in the analysis. Reduced vision (77%) and floaters (15.2%) were the most common presenting symptoms. The age category that was most affected by ocular toxoplasmosis was 20-40 years (range: 11-65 years) with a mean age of 27.2. All patients had retinochoroiditis, but just two had anterior uveitis. All of the extracted patients, with the exception of three patients, had unilateral involvement. None of the patients had any other medical disorders with the exception of one woman, who had diabetes. Only four recurring ocular toxoplasmosis patients were referred to the education hospital during the study. Serology data were available for just 32 patients, of which 31 (96.8%) were IgG positive, and 1 (3.2%) was IgM positive. CONCLUSION Toxoplasma gondii was responsible for 20% of the patients of uveitis that presented to the largest ophthalmology center in the northeast of Iran. There is a high incidence of patients of ocular toxoplasmosis in the northeast of Iran, and it is a significant cause of uveitis and visual impairment in this area.
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Affiliation(s)
| | - Elham Moghaddas
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Karim Sharifi
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihe Dadgar Moghaddam
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Aliakbar Shamsian
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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16
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Morais FB, Arantes TEFE, Muccioli C. Seroprevalence and Manifestations of Ocular Toxoplasmosis in Patients with Schizophrenia. Ocul Immunol Inflamm 2017; 27:134-137. [PMID: 29283732 DOI: 10.1080/09273948.2017.1408843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Recent studies have linked infectious agents such as Toxoplasma gondii to schizophrenia. We investigated the seroprevalence of T. gondii and conducted ophthalmologic examinations in schizophrenia patients and controls to identify lesions suggestive of ocular toxoplasmosis. METHODS During 2015 and 2016, 34 schizophrenia patients and 85 healthy controls underwent ophthalmologic examination and anti-T. gondii IgG and IgM antibody measurements by chemiluminescence. RESULTS Schizophrenia patients had a higher prevalence of anti-T. gondii IgG positivity than controls (91.18% [95% confidence interval (CI), 77.04%-96.95%] vs. 70.59% [95% CI, 60.18%-79.21%]; p = 0.017). Anti-T. gondii IgM antibodies (acute form) were not detected in any patient. One (3%) schizophrenic patient and two (2.4%) control patients presented fundoscopic scarring. CONCLUSION The seropositivity rate was significantly higher among schizophrenia patients than among controls (p = 0.017). There was no association between the presence of fundoscopic scarring and schizophrenia (p = 1.000).
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Affiliation(s)
- Fábio Barreto Morais
- a Department of Ophthalmology , Universidade Federal de São Paulo - UNIFESP , São Paulo , SP , Brazil and
| | | | - Cristina Muccioli
- a Department of Ophthalmology , Universidade Federal de São Paulo - UNIFESP , São Paulo , SP , Brazil and
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17
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Chronopoulos A, Roquelaure D, Souteyrand G, Seebach JD, Schutz JS, Thumann G. Aqueous humor polymerase chain reaction in uveitis - utility and safety. BMC Ophthalmol 2016; 16:189. [PMID: 27793120 PMCID: PMC5084402 DOI: 10.1186/s12886-016-0369-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/20/2016] [Indexed: 11/23/2022] Open
Abstract
Background To study the value and safety of aqueous humor polymerase chain reaction (PCR) analysis for Herpes simplex, varicella zoster, cytomegalovirus, Epstein-Barr virus and Toxoplasma gondii in patients with uveitis. Methods Records of 45 consecutive patients with anterior and posterior uveitis who underwent AC paracentesis with PCR were reviewed. The main outcome measure was frequency of PCR positivity. Secondary outcomes were alteration of treatment, safety of paracentesis, and correlation of keratitic precipitates with PCR positivity, Results The overall PCR positivity was 48.9 % (22/45). Therapy was changed because of the PCR results in 14/45 patients (37.7 %). One patient experienced a paracentesis related complication (1/45, 2.2 %) without long-term sequelae. Conclusion Aqueous PCR altered the diagnosis and treatment in over a third of our patients and was relatively safe. Aqueous PCR should be considered for uveitis of atypical clinical appearance, recurrent severe uveitis of uncertain etiology, and therapy refractory cases.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland.
| | - Daniel Roquelaure
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Georges Souteyrand
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Jörg Dieter Seebach
- Division of Immunology and Allergy, University Hospitals and School of Medicine, Geneva, Switzerland
| | - James Scott Schutz
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Gabriele Thumann
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
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18
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Ozgonul C, Besirli CG. Recent Developments in the Diagnosis and Treatment of Ocular Toxoplasmosis. Ophthalmic Res 2016; 57:1-12. [PMID: 27723657 DOI: 10.1159/000449169] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/16/2016] [Indexed: 11/19/2022]
Abstract
Ocular toxoplasmosis, a chorioretinal infection with Toxoplasma gondii, is the most common etiology of posterior uveitis in many countries. Accurate diagnosis depends heavily on the characteristic clinical features of this disease, but atypical presentations, especially in immunocompromised patients, may create diagnostic challenges and lead to misdiagnosis and inappropriate treatment. Molecular biology techniques to diagnose ocular toxoplasmosis have been available for many years and are now accessible as standard laboratory tests in many countries. Aqueous humor or vitreous evaluation to detect parasite DNA by polymerase chain reaction or specific antibody may provide definitive evidence for rapid diagnosis. Oral pyrimethamine and sulfadiazine plus systemic corticosteroids are an effective therapy for ocular toxoplasmosis. Recent data supports the use of other treatment approaches, including intravitreal antibiotics. The aim of the present review is to discuss briefly the new diagnostic tools and treatment options for ocular toxoplasmosis.
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Affiliation(s)
- Cem Ozgonul
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Mich., USA
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19
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Fernández C, Jaimes J, Ortiz MC, Ramírez JD. Host and Toxoplasma gondii genetic and non-genetic factors influencing the development of ocular toxoplasmosis: A systematic review. INFECTION GENETICS AND EVOLUTION 2016; 44:199-209. [PMID: 27389360 DOI: 10.1016/j.meegid.2016.06.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/13/2022]
Abstract
Toxoplasmosis is a cosmopolitan infection caused by the apicomplexan parasite Toxoplasma gondii. This infectious disease is widely distributed across the world where cats play an important role in its spread. The symptomatology caused by this parasite is diverse but the ocular affectation emerges as the most important clinical phenotype. Therefore, we conducted a systematic review of the current knowledge of ocular toxoplasmosis from the genetic diversity of the pathogen towards the treatment available for this infection. This review represents an update to the scientific community regarding the genetic diversity of the parasite, the genetic factors of the host, the molecular pathogenesis and its association with disease, the available diagnostic tools and the available treatment of patients undergoing ocular toxoplamosis. This review will be an update for the scientific community in order to encourage researchers to deploy cutting-edge investigation across this field.
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Affiliation(s)
- Carolina Fernández
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia; Grupo de Investigaciones Microbiológicas - UR (GIMUR), Programa de Biología, Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Jesús Jaimes
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia; Grupo de Investigaciones Microbiológicas - UR (GIMUR), Programa de Biología, Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - María Camila Ortiz
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia; Grupo de Investigaciones Microbiológicas - UR (GIMUR), Programa de Biología, Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Juan David Ramírez
- Grupo de Investigaciones Microbiológicas - UR (GIMUR), Programa de Biología, Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia.
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Fuh UC, Omoti AE, Enock ME. Clinical Features and Risk Factors of Patients with Presumed Ocular Toxoplasmosis. J Ophthalmic Vis Res 2016; 11:48-53. [PMID: 27195085 PMCID: PMC4860987 DOI: 10.4103/2008-322x.180694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: To determine the clinical features and risk factors of presumed ocular toxoplasmosis (POT) in patients affected with the condition at Irrua, Nigeria. Methods: The study included 69 patients with POT, and 69 age and sex matched subjects who served as the control group. Data was obtained using interviewer administered questionnaires. Examination included measurement of visual acuity (VA), intraocular pressure (IOP), slit lamp examination, gonioscopy and dilated fundus examination. Results: Mean age of cases and control subjects was 57.16 ± 18.69 and 56.09 ± 16.01 years respectively. The peak age group in patients with POT was 60 years and above. The most common presenting complaint was blurred vision occurring in 100% of cases. Drinking unfiltered water in 58 (84.1%) patients was the most common risk factor. Other risk factors included post cataract surgery status in 32 (46.4%) subjects, ingestion of poorly cooked meat in 30 (43.5%) cases and exposure to cats in 9 (13.0%) patients. All risk factors were more common in POT patients (P < 0.05). Out of 69 patients, 62 (89.9%) had unilateral while 7 (10.1%) had bilateral involvement. Out of 76 eyes with uveitis, 53 (69.7%) were blind. Active disease was significantly more common with increasing age (P < 0.05). Conclusion: Patients with POT were rather old and some risk factors were modifiable, therefore health education for preventing the transmission of toxoplasmosis and provision of sanitary water may help reduce the incidence of ocular toxoplasmosis.
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Affiliation(s)
- Ukamaka Celestina Fuh
- Department of Ophthalmology, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
| | - Afekhide E Omoti
- Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Malachi E Enock
- Department of Ophthalmology, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
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Toxoplasmic Retinochoroiditis: Clinical Characteristics and Visual Outcome in a Prospective Study. PLoS Negl Trop Dis 2016; 10:e0004685. [PMID: 27136081 PMCID: PMC4852945 DOI: 10.1371/journal.pntd.0004685] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 04/13/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To ascertain the clinical features and visual outcome of toxoplasma retinochoroiditis in a large series of cases. Subjects and Methods Two hundred and thirty subjects diagnosed with active toxoplasma retinochoroiditis were prospectively followed for periods ranging from 269 to 1976 days. All patients presented with active retinochoroiditis and positive IgG T. gondii serology at the beginning of the study and received a standardized drug treatment for toxoplasmosis, both in the first episode and in the subsequent recurrences. Results The group involved 118 (51.3%) men and 112 (48.7%) women, with ages ranging from 14 to 77 years, mean of 32.4 years (SD = 11.38). Primary retinochoroidal lesions were observed in 52 (22.6%) cases and active retinochoroiditis combined with old scars in 178 (77.4%) subjects at the beginning of the study. A hundred sixty-two recurrent episodes in 104 (45.2%) patients were observed during follow-up. New subclinical retinochoroidal lesions were detected in 23 of 162 (14.2%) recurrences episodes during the follow-up. Posterior segment complications were observed in 73 (31.7%) subjects. Retinochoroidal lesions adjacent to the optic nerve and in the macular area were observed in 27 of 40 (67.5%) cases of severe visual impairment (VA = 20/200 or worse). Conclusion Toxoplasma retinochoroiditis in this population had a high recurrence rate after an active episode. Severe visual impairment was associated with location of the retinochoroidal scar, recurrences and posterior segment complications. It is crucial to consider the location of the lesion in studies analyzing visual prognosis as a measure for treatment effectiveness and prevention strategies. Ocular toxoplasmosis affects millions of people worldwide and is a cause of severe vision loss. Prospective studies on the disease are rare and require long and expensive follow-ups. A network of intricate host and parasite factors can influence its evolution and its treatment is still subject of discussion and controversy. This article describes clinical features in a series of cases prospectively followed, confirming findings of previous studies conducted in other continents, despite the probable genetic variability of the evaluated populations and parasite. In addition, brings insights into the course of the disease and causes of visual impairment that may help future studies on strategies for treatment and prevention.
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Cunningham ET, Belfort R, Muccioli C, Arevalo JF, Zierhut M. Ocular Toxoplasmosis. Ocul Immunol Inflamm 2016; 23:191-3. [PMID: 26066570 DOI: 10.3109/09273948.2015.1051360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center , San Francisco, California , USA
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Abu EK, Boampong JN, Kyei S, Afoakwah R, Ayi I. Associations between Polymorphisms within Interferon Gamma and Tumor Necrosis Factor Genes and Toxoplasma Retinochoroiditis in Ghanaian Patients. Ocul Immunol Inflamm 2016; 25:678-684. [DOI: 10.3109/09273948.2016.1159315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Emmanuel Kwasi Abu
- Department of Optometry, School of Allied Health Sciences, University of Cape Coast, Ghana
- Department of Biomedical and Forensic Sciences, School of Allied Health Sciences, University of Cape Coast, Ghana
| | - Johnson N. Boampong
- Department of Biomedical and Forensic Sciences, School of Allied Health Sciences, University of Cape Coast, Ghana
| | - Samuel Kyei
- Department of Optometry, School of Allied Health Sciences, University of Cape Coast, Ghana
| | - Richmond Afoakwah
- Department of Biomedical and Forensic Sciences, School of Allied Health Sciences, University of Cape Coast, Ghana
| | - Irene Ayi
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Ghana
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Abstract
PURPOSE OF REVIEW The purpose of this review was to provide an overview of current data on antibiotic prophylaxis in ocular toxoplasmosis. RECENT FINDINGS Studies showing the prophylactic effect of long-term antibiotics are discussed. Prophylaxis seems to be justified in patients with a high risk of recurrence because of antibiotic's potential side-effects. Therefore, predisposing factors leading to a higher risk of recurrence and the time period during which an antibiotic prophylaxis is most appropriate are reviewed. Finally, a patient-individualized treatment recommendation is summarized. SUMMARY In the current literature, two prospective, randomized case-control studies exist, which show the protective effect of an antibiotic prophylaxis. Hematologic, gastrointestinal and dermatologic complications are potential side-effects. Especially during the first year after suffering a recurrence, an antibiotic prophylaxis seems to be justified. The risk of a recurrence is inter alia influenced by the duration of the disease, the immune status of the host and the patient's age. Therefore, an antibiotic prophylaxis should be considered for patients who have recently been infected with ocular toxoplasmosis, for middle-aged and elderly patients and patients with a compromised immune system. This should be discussed with each patient individually, especially if the lesion is close to the macula.
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Abu EK, Boampong JN, Amoabeng JK, Ilechie AA, Kyei S, Owusu-Ansah A, Boadi-Kusi SB, Amoani B, Ayi I. Epidemiology of Ocular Toxoplasmosis in Three Community Surveys in the Central Region of Ghana, West Africa. Ophthalmic Epidemiol 2016; 23:14-9. [PMID: 26786055 DOI: 10.3109/09286586.2015.1089579] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To conduct the first ever population-based survey on ocular toxoplasmosis in the Central Region of Ghana. METHODS A cross-sectional population-based study was conducted in three randomly selected communities in the Central Region, Ghana. Visual acuity (VA) measurement, dilated fundus examination by indirect ophthalmoscopy and serology testing were performed on all participants. Ocular toxoplasmosis was diagnosed based on characteristic retinal lesions and supported by positive serologic testing using commercial enzyme-linked immunosorbent assay (ELISA) kits. RESULTS A total of 390 subjects aged 10-100 years (mean age 47 years) were examined; 118 (30.3%) were male and 272 (69.7%) female. Ten subjects (6 females and 4 males) had toxoplasmic ocular lesions (prevalence 2.6%). Of these, two had bilateral lesions and eight had unilateral lesions. Subjects with toxoplasmic ocular lesions were older than those without lesions (p = 0.028). The development of ocular toxoplasmosis was not associated with rural dwelling, sex, keeping cats, or consumption of meat. CONCLUSION The prevalence of ocular toxoplasmosis in our Ghanaian study population was lower than findings from Southern Brazil, where there is a similar prevalence of infection in the general population.
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Affiliation(s)
- Emmanuel Kwasi Abu
- a Department of Optometry , School of Physical Sciences, University of Cape Coast , Ghana.,b Department of Biomedical and Forensic Sciences , School of Biological Sciences, University of Cape Coast , Ghana
| | - Johnson Nyarko Boampong
- b Department of Biomedical and Forensic Sciences , School of Biological Sciences, University of Cape Coast , Ghana
| | - Joseph Kwame Amoabeng
- a Department of Optometry , School of Physical Sciences, University of Cape Coast , Ghana.,c Department of Ophthalmology , Effia Nkwanta Regional Hospital , Sekondi , Ghana
| | - Alex A Ilechie
- a Department of Optometry , School of Physical Sciences, University of Cape Coast , Ghana
| | - Samuel Kyei
- a Department of Optometry , School of Physical Sciences, University of Cape Coast , Ghana.,d Discipline of Optometry , School of Health Sciences, University of KwaZulu-Natal, Westville Campus , Durban , South Africa
| | - Andrew Owusu-Ansah
- a Department of Optometry , School of Physical Sciences, University of Cape Coast , Ghana.,e Department of Ophthalmology , the Second Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - Samuel Bert Boadi-Kusi
- a Department of Optometry , School of Physical Sciences, University of Cape Coast , Ghana.,d Discipline of Optometry , School of Health Sciences, University of KwaZulu-Natal, Westville Campus , Durban , South Africa
| | - Benjamin Amoani
- b Department of Biomedical and Forensic Sciences , School of Biological Sciences, University of Cape Coast , Ghana
| | - Irene Ayi
- f Department of Parasitology , Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana , Accra , Ghana
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Dukaczewska A, Tedesco R, Liesenfeld O. Experimental Models of Ocular Infection with Toxoplasma Gondii. Eur J Microbiol Immunol (Bp) 2015; 5:293-305. [PMID: 26716018 PMCID: PMC4681357 DOI: 10.1556/1886.2015.00045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/11/2015] [Indexed: 01/12/2023] Open
Abstract
Ocular toxoplasmosis is a vision-threatening disease and the major cause of posterior uveitis worldwide. In spite of the continuing global burden of ocular toxoplasmosis, many critical aspects of disease including the therapeutic approach to ocular toxoplasmosis are still under debate. To assist in addressing many aspects of the disease, numerous experimental models of ocular toxoplasmosis have been established. In this article, we present an overview on in vitro, ex vivo, and in vivo models of ocular toxoplasmosis available to date. Experimental studies on ocular toxoplasmosis have recently focused on mice. However, the majority of murine models established so far are based on intraperitoneal and intraocular infection with Toxoplasma gondii. We therefore also present results obtained in an in vivo model using peroral infection of C57BL/6 and NMRI mice that reflects the natural route of infection and mimics the disease course in humans. While advances have been made in ex vivo model systems or larger animals to investigate specific aspects of ocular toxoplasmosis, laboratory mice continue to be the experimental model of choice for the investigation of ocular toxoplasmosis.
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Affiliation(s)
- Agata Dukaczewska
- Institut für Mikrobiologie und Hygiene, Charité UniversitätsmedizinBerlin, Germany
| | - Roberto Tedesco
- Disciplina de Anatomia Descritiva e Topográfica, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil, Germany
| | - Oliver Liesenfeld
- Institut für Mikrobiologie und Hygiene, Charité UniversitätsmedizinBerlin, Germany
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Time patterns of recurrences and factors predisposing for a higher risk of recurrence of ocular toxoplasmosis. Retina 2015; 35:809-19. [PMID: 25299969 DOI: 10.1097/iae.0000000000000361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To ascertain time patterns of recurrences and factors predisposing for a higher risk of recurrence of ocular toxoplasmosis. METHODS Retrospective observational case series with follow-up examination. Database of 4,381 patients with uveitis was used. Data of 84 patients with ocular toxoplasmosis (sample group) could be included. RESULTS Two hundred and eighty active lesions in the first affected eye were detected. The mean number of recurrences per year was 0.29 (standard deviation, 0.24). Median recurrence-free survival time was 2.52 years (95% confidence interval, 2.03-3.02 years). Risk of recurrence was highest in the first year after the most recent episode (26%) implying a decrease with increasing recurrence-free interval. The risk of recurrence decreased with the duration of disease (P < 0.001). Treatment of the first active lesion influenced the risk of recurrence (P = 0.048). Furthermore, the risk of recurrence was influenced by patient age at the time of the first active lesion (P = 0.021) and the most recent episode (P = 0.002). CONCLUSION A secondary antibiotic prophylaxis could be discussed 1) during the first year after an active lesion has occurred, especially in case of the first active lesion of ocular toxoplasmosis, and 2) in older patients, especially if primarily infected with Toxoplasma gondii at an older age.
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Ocular Involvement Following Postnatally Acquired Toxoplasma gondii Infection in Southern Brazil: A 28-Year Experience. Am J Ophthalmol 2015; 159:1002-1012.e2. [PMID: 25743338 DOI: 10.1016/j.ajo.2015.02.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the incidence of, and risk factors for, ocular involvement among people known to have postnatally acquired Toxoplasma gondii infection in a region of southern Brazil where there is a high prevalence of endemic disease. DESIGN Retrospective longitudinal cohort study. METHODS Records of 302 patients with serologic evidence of recent T gondii infection (a positive anti-T gondii IgM antibody test) from Erechim, Rio Grande do Sul state, Brazil (1974-2002) were analyzed. The incidence of ocular involvement was calculated in terms of person-years (PY) of follow-up. Risk factors for ocular involvement were analyzed using log-rank and Fisher exact tests. RESULTS At initial ocular examination (baseline), 30 patients (9.9%) had intraocular inflammation only (anterior chamber cells and flare, vitreous inflammatory reactions, retinal whitening), without clinically apparent necrotizing retinochoroiditis. At baseline, men were more likely to have ocular involvement (P = .043) and antiparasitic treatment was associated with less ocular involvement (P = .015). Follow-up examinations were performed on 255 patients (median follow-up, 13.7 months [range 0.4-261.9 months]). Among those without ocular involvement at baseline, the incidence of necrotizing retinochoroiditis was 6.4/100 PY. Patients >40 years of age at first IgM test had a greater risk of incident necrotizing retinochoroiditis (hazard ratio = 4.47, 95% CI = 1.67-11.93, P = .003) than younger patients. The incidence of recurrent necrotizing retinochoroiditis was 10.5/100 PY. CONCLUSION Isolated intraocular inflammatory reactions can be an initial manifestation of T gondii infection, with necrotizing retinochoroiditis occurring months or years later. Male sex and older age are risk factors for toxoplasmic retinochoroiditis. Antitoxoplasmic treatment may protect against early ocular involvement.
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Norouzpour Deilami K, Daryani A, Ahmadpour E, Sharif M, Dadimoghaddam Y, Sarvi S, Alizadeh A. Excretory–secretory antigens: A suitable candidate for immunization against ocular toxoplasmosis in a murine model. Comp Immunol Microbiol Infect Dis 2014; 37:369-74. [DOI: 10.1016/j.cimid.2014.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/19/2014] [Accepted: 10/20/2014] [Indexed: 01/05/2023]
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Mallewa M, Wilmshurst JM. Overview of the effect and epidemiology of parasitic central nervous system infections in African children. Semin Pediatr Neurol 2014; 21:19-25. [PMID: 24655400 PMCID: PMC3989118 DOI: 10.1016/j.spen.2014.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Infections of the central nervous system are a significant cause of neurologic dysfunction in resource-limited countries, especially in Africa. The prevalence is not known and is most likely underestimated because of the lack of access to accurate diagnostic screens. For children, the legacy of subsequent neurodisability, which affects those who survive, is a major cause of the burden of disease in Africa. Of the parasitic infections with unique effect in Africa, cerebral malaria, neurocysticercosis, human African trypanosomiasis, toxoplasmosis, and schistosomiasis are largely preventable conditions, which are rarely seen in resource-equipped settings. This article reviews the current understandings of these parasitic and other rarer infections, highlighting the specific challenges in relation to prevention, diagnosis, treatment, and the complications of coinfection.
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Affiliation(s)
- Macpherson Mallewa
- Department of Paediatrics and Child Health, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
| | - Jo M Wilmshurst
- Department of Pediatric Neurology, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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New clinical and experimental insights into Old World and neotropical ocular toxoplasmosis. Int J Parasitol 2014; 44:99-107. [DOI: 10.1016/j.ijpara.2013.09.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/20/2013] [Accepted: 09/22/2013] [Indexed: 01/12/2023]
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Abstract
Toxoplasma gondii, an Apicomplexan, is a pathogic protozoan that can infect the central nervous system. Infection during pregnancy can result in a congenial infection with severe neurological sequelae. In immunocompromised individuals reactivation of latent neurological foci can result in encephalitis. Immunocompetent individuals infected with T. gondii are typically asymptomatic and maintain this infection for life. However, recent studies suggest that these asymptomatic infections may have effects on behavior and other physiological processes. Toxoplasma gondii infects approximately one-third of the world population, making it one of the most successful parasitic organisms. Cats and other felidae serve as the definite host producing oocysts, an environmentally resistant life cycle stage found in cat feces, which can transmit the infection when ingested orally. A wide variety of warm-blooded animals, including humans, can serve as the intermediate host in which tissue cysts (containing bradyzoites) develop. Transmission also occurs due to ingestion of the tissue cysts. There are three predominant clonal lineages, termed Types I, II and III, and an association with higher pathogenicity with the Type I strains in humans has emerged. This chapter presents a review of the biology of this infection including the life cycle, transmission, epidemiology, parasite strains, and the host immune response. The major clinical outcomes of congenital infection, chorioretinitis and encephalitis, and the possible association of infection of toxoplasmosis with neuropsychiatric disorders such as schizophrenia, are reviewed.
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Affiliation(s)
- Sandra K Halonen
- Department of Microbiology, Montana State University, Bozeman, MT, USA
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Balaskas K, Vaudaux J, Boillat-Blanco N, Guex-Crosier Y. Azithromycin versus Sulfadiazine and Pyrimethamine for non-vision-threatening toxoplasmic retinochoroiditis: a pilot study. Med Sci Monit 2012; 18:CR296-302. [PMID: 22534709 PMCID: PMC3560626 DOI: 10.12659/msm.882735] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The purpose of this pilot study is to compare the efficacy and tolerance of azithromycin alone as opposed to standard treatment with sulfadiazine and pyrimethamine for active, non-vision-threatening toxoplasmic retinochoroiditis. Material/Methods We conducted a prospective, randomized, institutional clinical study comparing azithromycin to sulfadiazine and pyrimethamine for active, non-vision-threatening toxoplasmic retinochoroiditis. Nineteen out of 75 patients fulfilled inclusion criteria and were randomized into 2 treatment regimens. Nine patients were treated with sulfadiazine and pyrimethamine and 10 patients with azithromycin at a dose of 500 mg qd. Main outcome measures assessed were time to sharpening of lesion borders, time to lesion scarring, time to disease inactivity, and treatment tolerance. Results Azithromycin monotherapy achieved lesion scarring and disease inactivity in all but 1 patient. Although no statistically significant difference was found between the 2 patient groups as regards main outcome measures for treatment efficacy, all median times to endpoints (days) were longer for the azithromycin group – time to sharpening of lesion borders on clinical evaluation (25.5 vs. 24) and masked evaluation of photographs (30.5 vs. 24), time to lesion scarring on clinical evaluation (73 vs. 47) and masked evaluation of photographs (71.5 vs. 36) and time to disease inactivity (73 vs. 49). Treatment tolerance was significantly better for the azithromycin group (p=0.0005). Conclusions Azithromycin monotherapy at a dose of 500 mg per day was shown to be effective and well-tolerated for the treatment of active, non-vision-threatening toxoplasmic retinochoroiditis. Duration of treatment was clinically longer for the azithromycin group.
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Ouologuem DT, Djimdé AA, Diallo N, Doumbo OK, Roos DS. Toxoplasma gondii seroprevalence in Mali. J Parasitol 2012; 99:371-4. [PMID: 22924926 DOI: 10.1645/ge-3239.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The protozoan parasite Toxoplasma gondii is globally distributed, with considerable local variation in prevalence based on behavioral and environmental factors. To assess prevalence and estimate risk in Mali, we conducted a survey of 760 serum samples previously collected for malaria studies. A modified agglutination test detected antibodies in ∼27% of the adult population, with no significant differences between men and women, or between urban and rural study sites. In the village of Kolle, seroprevalence rose from 0% in infants (<1 yr, but after weaning of maternal immunoglobulin G) to 0.8% (1-5 yr), 2.7% (6-10), 11.3% (11-15), and 26.8% (>15); differences between the <10-, 11-15-, and >15-yr age groups were highly significant (P ≤ 0.01). We also observed an increase in anti- T. gondii antibody titers with age. Modeling the observed age distribution suggests a seroconversion rate of ∼1%/yr, indicating that congenital toxoplasmosis may be an under-appreciated public health concern in Mali.
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Affiliation(s)
- Dinkorma T Ouologuem
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali
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Garza-Leon M, Garcia LA. Ocular toxoplasmosis: clinical characteristics in pediatric patients. Ocul Immunol Inflamm 2012; 20:130-8. [PMID: 22409567 DOI: 10.3109/09273948.2012.656878] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the clinical features of Ocular Toxoplasmosis in pediatric patients. METHODS A retrospective, non-comparative series of cases was studied. We reviewed the clinical records of patients 16 year old or younger diagnosed with Ocular Toxoplasmosis. RESULTS Forty patients (56 eyes) were included. The mean age was 9.5 yrs old. Twenty were female. Unilateral involvement was noticed in 60% of patients. The most common symptoms were strabismus (32.1%) and reduced VA in (23.2%). An inactive retinal scar was observed in most cases (71.4%). Panuveitis was found in 8 eyes (14.2%), and posterior uveitis in 7 eyes of 7 patients (12.5%); one eye presented neuroretinitis. The most frequent location of retinochoroidal lesions was the posterior pole (72.7%). CONCLUSIONS In children, ocular toxoplasmosis is most commonly diagnosed during the inactive stage. When inflammation is present, it can be severe and frequently associated with other complications such vasculitis and papillitis.
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Affiliation(s)
- Manuel Garza-Leon
- Asociación para Evitar la Ceguera en Mexico, Inflammatory eye disease clinic, Coyoacan, Mexico, Mexico.
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Toxoplasmosis in humans and animals in Brazil: high prevalence, high burden of disease, and epidemiology. Parasitology 2012; 139:1375-424. [PMID: 22776427 DOI: 10.1017/s0031182012000765] [Citation(s) in RCA: 336] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infections by the protozoan parasite Toxoplasma gondii are widely prevalent in humans and animals in Brazil. The burden of clinical toxoplasmosis in humans is considered to be very high. The high prevalence and encouragement of the Brazilian Government provides a unique opportunity for international groups to study the epidemiology and control of toxoplasmosis in Brazil. Many early papers on toxoplasmosis in Brazil were published in Portuguese and often not available to scientists in English-speaking countries. In the present paper we review prevalence, clinical spectrum, molecular epidemiology, and control of T. gondii in humans and animals in Brazil. This knowledge should be useful to biologists, public health workers, veterinarians, and physicians. Brazil has a very high rate of T. gondii infection in humans. Up to 50% of elementary school children and 50-80% of women of child-bearing age have antibodies to T. gondii. The risks for uninfected women to acquire toxoplasmosis during pregnancy and fetal transmission are high because the environment is highly contaminated with oocysts. The burden of toxoplasmosis in congenitally infected children is also very high. From limited data on screening of infants for T. gondii IgM at birth, 5-23 children are born infected per 10 000 live births in Brazil. Based on an estimate of 1 infected child per 1000 births, 2649 children with congenital toxoplasmosis are likely to be born annually in Brazil. Most of these infected children are likely to develop symptoms or signs of clinical toxoplasmosis. Among the congenitally infected children whose clinical data are described in this review, several died soon after birth, 35% had neurological disease including hydrocephalus, microcephaly and mental retardation, 80% had ocular lesions, and in one report 40% of children had hearing loss. The severity of clinical toxoplasmosis in Brazilian children may be associated with the genetic characteristics of T. gondii isolates prevailing in animals and humans in Brazil.
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Kovačević-Pavićević D, Radosavljević A, Ilić A, Kovačević I, Djurković-Djaković O. Clinical pattern of ocular toxoplasmosis treated in a referral centre in Serbia. Eye (Lond) 2012; 26:723-8. [PMID: 22361847 DOI: 10.1038/eye.2012.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To analyze the clinical pattern of ocular toxoplasmosis (OT) in a referral centre in Serbia. PATIENTS AND METHODS The medical records of consecutive patients admitted for OT to the single referral centre for uveitis in Serbia between 2006 and 2010 were retrospectively analyzed. OT was diagnosed on the basis of typical fundus lesions and positive serology for Toxoplasma. RESULTS In a total of 457 uveitis patients, OT was the third leading cause, with 59 patients (12.9%). Most OT cases (73%) were monocular. An active primary retinal lesion was observed in 36% and recurrent OT in 64% patients. Localization of lesions was central/paracentral (44%), juxtapapillar (27%), peripheral (19%), and multifocal (10%). Other ocular manifestations of inflammation included vitritis (44%), anterior uveitis (19%), and retinal vasculitis (10%). Complications included choroidal neovascularization in two and exudative retinal detachment with cataract, glaucoma, and cystoid macular oedema in one patient each. The detection of Toxoplasma-specific IgM antibodies in a single patient indicates a low rate of OT concomitant with acute infection. After treatment, the mean best-corrected visual acuity (BCVA) increased significantly. However, 14 (24%) patients ended up legally blind in the affected eye, of which 2 (3%) with bilateral blindness, all with a very poor BCVA (0.047 ± 0.055) at presentation. Visual impairment and treatment outcome were both associated with central localization of lesions (P<0.0001 and P=0.006, respectively). CONCLUSION OT is a significant cause of posterior uveitis in Serbia. Patients should be aware of the recurring nature of OT and react immediately if symptoms occur.
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Affiliation(s)
- D Kovačević-Pavićević
- Uveitis Department, Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia
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Bodaghi B, Touitou V, Fardeau C, Paris L, LeHoang P. Toxoplasmosis: new challenges for an old disease. Eye (Lond) 2012; 26:241-4. [PMID: 22222265 DOI: 10.1038/eye.2011.331] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
More than a century after the identification of Toxoplasma gondii, major issues need to be addressed for the optimal management of ocular disease. Toxoplasmic retinochoroiditis is the main cause of posterior uveitis in several geographical areas. The parasite establishes a love-hate relationship with the eye, manipulating the immune response and inducing variable initial lesions and further relapses. It is now well established that most cases are acquired after birth and not congenital. The severity of the disease is mainly due to the parasite genotype and the host immune status. Diagnosis is based on clinical features, but may be confirmed by biological tools applied to ocular fluids. Combining several techniques improves the diagnostic yield in equivocal cases. Therapeutic management is the most important challenge. Even though evidence-based data on the efficacy of anti-parasitic drugs are still missing, new strategies with a good safety profile are available and may be proposed earlier during the course of the disease, but also in selected cases, to reduce sight-threatening relapses. Revisiting the therapeutic options and indications may be an important step towards long-term maintenance of the visual function and avoidance of major complications.
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Affiliation(s)
- B Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France.
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Bergerson JRE, Chod R, Steele RW. A child with sudden vision loss in one eye. Clin Pediatr (Phila) 2011; 50:1071-5. [PMID: 21669901 DOI: 10.1177/0009922811410231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jenna R E Bergerson
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA.
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López-Castillo CA, de-la-Torre A. [Definition of acquired toxoplasmosis infection: when is it congenital or acquired?]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2011; 86:224-225. [PMID: 21798410 DOI: 10.1016/j.oftal.2011.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 12/23/2010] [Accepted: 02/22/2011] [Indexed: 05/31/2023]
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Alvarez G, Rey A, Adán A. [Author's reply]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2011; 86:225-226. [PMID: 21798411 DOI: 10.1016/j.oftal.2011.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/22/2011] [Indexed: 05/31/2023]
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CD8 T Cells and Toxoplasma gondii: A New Paradigm. J Parasitol Res 2011; 2011:243796. [PMID: 21687650 PMCID: PMC3112509 DOI: 10.1155/2011/243796] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 03/10/2011] [Indexed: 01/09/2023] Open
Abstract
CD8 T cells are essential for control of Toxoplasma gondii infection. Once activated they undergo differentiation into short-lived effector and memory precursor effector cells. As effector cells, CD8 T cells exert immune pressure on the parasite via production of inflammatory cytokines and through their cytolytic activity. Once immune control has been established, the parasite encysts and develops into chronic infection regulated by the memory CD8 T-cell population. Several signals are needed for this process to be initiated and for development of fully differentiated memory CD8 T cells. With newly developed tools including CD8 T-cell tetramers and TCR transgenic mice, dissecting the biology behind T. gondii-specific CD8 T-cell responses can now be more effectively addressed. In this paper, we discuss what is known about the signals required for effective T. gondii-specific CD8 T-cell development, their differentiation, and effector function.
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Norose K, Kikumura A, Luster AD, Hunter CA, Harris TH. CXCL10 is required to maintain T-cell populations and to control parasite replication during chronic ocular toxoplasmosis. Invest Ophthalmol Vis Sci 2011; 52:389-98. [PMID: 20811054 DOI: 10.1167/iovs.10-5819] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Toxoplasma gondii is a major cause of ocular disease, which can lead to permanent vision loss in humans. T cells are critically involved in parasite control, but little is known about the molecules that promote T-cell trafficking and migration in the retina. Thus, the aim of this study was to image and dissect the T-cell response during chronic toxoplasmic retinochoroiditis. METHODS C57BL/6 mice were infected with the Me49 strain of T. gondii, and T cells that infiltrated the eye were analyzed by flow cytometry and imaged using multiphoton microscopy. IFN-γ, CXCL9, CXCL10, and CXCR3 mRNA levels were measured by real-time PCR. To investigate the role of CXCL10, mice were treated with anti-CXCL10 antibodies, and histopathology and immunohistochemistry were performed to monitor changes in pathology, cellular infiltration, and parasite burden in the eye. RESULTS Infection with T. gondii leads to the infiltration of highly activated motile T cells into the eye. These cells express CXCR3 and are capable of producing IFN-γ and TNF-α, and CD8+ T cells express granzyme B. The expression of CXCL9 and CXCL10 in the retina was significantly upregulated during chronic infection. Treatment of chronically infected mice with anti-CXCL10 antibodies led to decreases in the numbers of CD3+, CD4+, and CD8+ T cells and the amount of IFN-γ mRNA expression in the retina and an increase in replicating parasites and ocular pathology. CONCLUSIONS The maintenance of the T-cell response and the control of T. gondii in the eye during chronic infection is dependent on CXCL10.
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Affiliation(s)
- Kazumi Norose
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chiba, Japan
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Tabatabaei S, Soleimani M, Foroutan A, Ahmadabadi M, Zarei R, Piri N, Gordiz A. Ocular toxoplasmosis in Iran: 40 cases analysis. Int J Ophthalmol 2011; 4:199-201. [PMID: 22553642 DOI: 10.3980/j.issn.2222-3959.2011.02.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 01/24/2011] [Indexed: 11/02/2022] Open
Abstract
AIM To report ocular symptoms, funduscopic findings and demographic distribution of ocular toxoplasmosis in Iran METHODS In this cross-sectional study, a total of 40 patients with ocular toxoplasmosis (24 female, 16 male) were enrolled. The distribution of symptoms and funduscopic findings were studied. RESULTS The patients' age was in the range of 13-52 with the most common age of 19 years old. Twenty-four patients were female (60.0%). The most common presenting sign was visual loss. There was anterior chamber (AC) inflammation in 23 patients (57.5%). Vitritis was presented in 36 patients (90.0%). In 35 patients (87.5%), the retinal lesion was central. In patients with peripheral lesion, 3 patients (60.0%) had flashing vs 12.5% chance of flashing in all patients. Older patients had larger lesion (P=0.04). CONCLUSION Ocular toxoplasmosis substantially varies among patients with different age, gender, status of immunity, site of lesion and other undetermined factors. One of ocular symptoms, flashing, may necessitate a more precise peripheral fundus examination.
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Affiliation(s)
- Seidali Tabatabaei
- Farabi Eye Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
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Barratt JLN, Harkness J, Marriott D, Ellis JT, Stark D. Importance of nonenteric protozoan infections in immunocompromised people. Clin Microbiol Rev 2010; 23:795-836. [PMID: 20930074 PMCID: PMC2952979 DOI: 10.1128/cmr.00001-10] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.
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Affiliation(s)
- J L N Barratt
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia.
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Albuquerque MCD, Aleixo ALQDC, Benchimol EI, Leandro ACCS, das Neves LB, Vicente RT, Bonecini-Almeida MDG, Amendoeira MRR. The IFN-gamma +874T/A gene polymorphism is associated with retinochoroiditis toxoplasmosis susceptibility. Mem Inst Oswaldo Cruz 2009; 104:451-5. [PMID: 19547871 DOI: 10.1590/s0074-02762009000300009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 03/03/2009] [Indexed: 11/21/2022] Open
Abstract
Toxoplasmosis is a worldwide zoonosis that generally produces an asymptomatic infection. In some cases, however, toxoplasmosis infection can lead to ocular damage. The immune system has a crucial role in both the course of the infection and in the evolution of toxoplasmosis disease. In particular, IFN-gamma plays an important role in resistance to toxoplasmosis. Polymorphisms in genes encoding cytokines have been shown to have an association with susceptibility to parasitic diseases. The aim of this work was to analyse the occurrence of polymorphisms in the gene encoding IFN-gamma (+874T/A) among Toxoplasma gondii seropositive individuals, including those with ocular lesions caused by the parasite, from a rural population of Santa Rita de Cássia, Barra Mansa, state of Rio de Janeiro, Brazil. Further, we verified which of these polymorphisms could be related to susceptibility to the development of ocular toxoplasmosis. This study included 34 individuals with ocular toxoplasmosis (ocular group) and 134 without ocular lesions (control group). The differences between A and T allele distributions were not statistically significant between the two groups. However, we observed that a higher frequency of individuals from the ocular group possessed the A/A genotype, when compared with the control group, suggesting that homozygocity for the A allele could enhance susceptibility to ocular toxoplasmosis in T. gondii infection.
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