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Santos Oliveira J, Catarino S, Magalhães A, Rocha G, Santos Silva R. The Red Reflex Test and Leukocoria in Childhood. ACTA MEDICA PORT 2024; 37:638-646. [PMID: 39074051 DOI: 10.20344/amp.21367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/20/2024] [Indexed: 07/31/2024]
Abstract
The red reflex test, performed using a direct ophthalmoscope, serves as a critical diagnostic tool in identifying various ocular conditions. These conditions encompass retinal anomalies (such as retinoblastoma, Coats disease, retinopathy of prematurity, familial exudative vitreoretinopathy, myelinated nerve fibers, ocular toxocariasis, ocular toxoplasmosis, retinochoroidal coloboma, astrocytic, and combined hamartoma), vitreous abnormalities (including persistent fetal vasculature), lens issues (like cataract), anterior chamber and corneal conditions (comprising dysgenesis of the anterior segment, congenital glaucoma, birth trauma), and tear film disturbances. During this examination, the presence of leukocoria, characterized by a white pupillary reflex, can suggest the presence of underlying conditions. Any suspicion of an abnormal red reflex test warrants immediate evaluation by a qualified ophthalmologist. This article primarily underscores the paramount importance of the red reflex examination, not only to identify potential sight-threateningbut also life-threatening conditions. It delves into the most common causes of leukocoria in childhood and offers insights into a comprehensive diagnostic approach. The target audience for this article includes pediatricians, primary care clinicians, and ophthalmologists, all of whom play a pivotal role in the early detection and intervention of these critical eye disorders.
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Affiliation(s)
| | - Sara Catarino
- Pediatrics Department. Unidade Local de Saúde de São João. Porto. Portugal
| | - Augusto Magalhães
- Department of Ophthalmology & Reference Centre of Inherited Metabolic Diseases at the Pediatrics Department. Unidade Local de Saúde de São João. Porto. Portugal
| | - Gustavo Rocha
- Department of Neonatology. Unidade Local de Saúde de São João. Porto. Portugal
| | - Renato Santos Silva
- Department of Ophthalmology. Unidade Local de Saúde de São João. Porto.; Department of Surgery and Physiology. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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Zhou Y, Zhen F, Wu J, Wang S, Lu X, Yang G, Hu Z, Chen F, Li Q, Dong S. Intravitreal Dexamethasone Implant (Ozurdex) for Ocular Toxocariasis. J Ophthalmol 2024; 2024:6685092. [PMID: 39041005 PMCID: PMC11262872 DOI: 10.1155/2024/6685092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/13/2023] [Accepted: 02/02/2024] [Indexed: 07/24/2024] Open
Abstract
This study aimed to evaluate the efficacy and safety of intravitreal dexamethasone implants in the treatment of ocular toxocariasis (OT). A retrospective analysis was performed on 6 cases in which laboratory tests diagnosed OT. All patients were administered with intravitreal dexamethasone implants with or without vitrectomy. The average follow-up time was 19.7 months. All operated eyes achieved anatomic success, and all patients' visual acuity was improved. Five of these six had a visual acuity of 20/100, and three had final acuity of 20/40 or even better. Intravitreal dexamethasone implants can be used to treat different types of OT, which not only effectively control inflammation and improve the patient's vision but also reduce the use of systemic glucocorticoids.
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Affiliation(s)
- Yongwei Zhou
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Fangyuan Zhen
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Jiahui Wu
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Shasha Wang
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Xiaoyan Lu
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Ge Yang
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Zhirou Hu
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Fei Chen
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Qiuming Li
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
| | - Shuqian Dong
- Department of OphthalmologyThe First Affiliated Hospital of Zhengzhou UniversityHenan Provincial Ophthalmic Hospital, Zhengzhou, China
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Xu Q, Gong C, Yang X, Li J, Zhang Z, Sheng A, Zhang Y, Feng R, Liu Y, Qiao L, Li Y, Li S. The Consistency of Anti-Toxocara IgG Between the Aqueous Humor and Vitreous of Patients With Clinically Suspected Ocular Toxocariasis. Am J Ophthalmol 2024; 267:90-99. [PMID: 38871266 DOI: 10.1016/j.ajo.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To assess the consistencies of anti-Toxocara IgG (T-IgG) and Goldmann-Witmer coefficient (GWC) between paired aqueous humor (AH) and vitreous samples from patients with clinically suspected ocular toxocariasis (OT). DESIGN Inter-test reliability assessment. METHODS A total of 47 patients with clinically suspected OT who underwent vitrectomy were included. AH, vitreous, and serum samples from each patient were collected, and levels of specific T-IgG in them were detected. The association and agreement of T-IgG and GWC between AH and vitreous were evaluated. The area under the receiver operating characteristic curve was generated to assess the diagnostic performance of AH. RESULTS The T-IgG levels and GWC values in vitreous were higher than those in AH (P = .023 and P = .029, respectively), but similar positivity rates in the T-IgG (P = 1.000) and GWC >3 (P = 1.000) were apparent between vitreous and AH. In addition, there was a positive correlation between the AH and vitreous T-IgG levels (rs = 0.944, P < .001) and the GWC values (rs = 0.455, P = .022). Moreover, the consistencies between AH and vitreous samples in their T-IgG and GWC positivity rates were almost perfect (both, κ = 0.915, 95% CI = 0.799-1.000) in both. The area under the receiver operating characteristic curve reached 0.991, with a 95% confidence interval of 0.971 to 1.000. The best cut-off value for accurate OT diagnosis was found at 1.434, yielding 96% sensitivity and 100% specificity. CONCLUSIONS Our findings demonstrate that AH and vitreous samples had significant correlations and perfect agreements for both T-IgG and GWC, suggesting that the AH may serve as a proxy for vitreous to provide a safer, earlier, and more convenient screening of OT.
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Affiliation(s)
- Qing Xu
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Chaoju Gong
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Xiao Yang
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Jie Li
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Zhengpei Zhang
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Aiqin Sheng
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Yipeng Zhang
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Ruifang Feng
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Yalu Liu
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Lei Qiao
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China
| | - Yanlian Li
- Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China
| | - Suyan Li
- From the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University (Q.X., C.G., Y.Z., R.F., L.Q., S.L.), Xuzhou First People's Hospital, Xuzhou Key Laboratory of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou, China; Department of Ophthalmology (X.Y., J.L., Z.Z., A.S., Y.L., Y.L.,S.L.), The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou First People's Hospital, Eye Institute of Xuzhou, Xuzhou, China.
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Zheng S, Sun L, Huang L, Xie Y, Ding X. Toxocara canis infection in multiple types of animals: ophthalmological and pathological observations. Parasit Vectors 2024; 17:85. [PMID: 38395932 PMCID: PMC10885396 DOI: 10.1186/s13071-023-06070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/27/2023] [Indexed: 02/25/2024] Open
Abstract
Human ocular toxocariasis (OT), caused by pet roundworm Toxocara canis (Nematoda Ascaridoidea), is a worldwide ocular parasitic infection that poses a severe threat to eyesight, especially in school-aged children. However, the infection process and pathological mechanism of Toxocara are difficult to study in the human body. This study was designed to explore long-term ocular manifestations in different rodents infected with Toxocara canis, uncovering the specific pathological mechanism and migration pathway of larvae after infection. The three types of experimental animals we selected were C57BL/6 mice, Mongolian gerbils and Brown Norway rats. Mice were randomly divided into five groups and infected orally with 1000, 2000, 4000, 8000 and 10,000 T. canis eggs; gerbils were randomly divided into four groups and infected orally with 1000, 2000, 4000 and 10,000 T. canis eggs; rats were randomly divided into three groups and infected orally with 2000, 6000 and 10,000 T. canis eggs. Their ocular changes were closely observed and recorded for at least 2 months. We also enucleated the eyeballs of some animals to perform pathological sectioning and hematoxylin-eosin staining. After 3 dpi (days post-infection), hemorrhagic lesions, mechanical injury of the retina and larval migration could be observed in some infected animals. The ocular infection and mortality rates tended to be stable at 7 dpi. Larval tissue, structure disorder and inflammation could be observed in the pathological sections. In conclusion, the mice infected with 2000 T. canis eggs and gerbils infected with 1000, 2000 and 4000 T. canis eggs showing obvious ocular lesions and lower mortality rates could provide a basis for long-term observation.
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Affiliation(s)
- Shuxin Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, 7 Jinsui Road, Guangzhou, 510060, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, 7 Jinsui Road, Guangzhou, 510060, China
| | - Li Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, 7 Jinsui Road, Guangzhou, 510060, China
| | - Yue Xie
- Department of Parasitology, College of Veterinary Medicine, Sichuan Agricultural University, 211 Huimin Road, Chengdu, 611130, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China.
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, 7 Jinsui Road, Guangzhou, 510060, China.
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Curi ALL, de-la-Torre A, Schlaen A, Mahendradas P, Biswas J. Pediatric Posterior Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1944-1954. [PMID: 38096404 DOI: 10.1080/09273948.2023.2284990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE To describe the most important cause of infectious posterior uveitis in pediatric patients. METHODS Review of the literature. RESULTS The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas. CONCLUSION Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.
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Affiliation(s)
- André Luiz Land Curi
- Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Disease - INI/Fiocruz, Rio de Janeiro, Brazil
| | - 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
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Derqui-Pilar, Argentina
| | | | - Jyortimay Biswas
- Uveitis and Ocular Pathology Department, Sankara Nethralaya, Chennai, India
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Lin S, Han X, Dai R. Recurrent vitreous opacity caused by intraocular Toxocara larva: a case report and literature review. BMC Ophthalmol 2022; 22:505. [PMID: 36550446 PMCID: PMC9773548 DOI: 10.1186/s12886-022-02687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Toxocara larva entity has seldom been reported on the surface of the retina. We report on an unusual case of recurrent vitreous opacity caused by intraocular Toxocara larva after vitrectomy. CASE PRESENTATION A 34-year-old male was referred to our clinic with a 6-month history of decreased visual acuity in the right eye characterized as red, painless, and progressive. Optos fundus photograph showed optic disc elevation with granuloma, and proliferative membrane starting from the optic disc and running towards the superior temporal retina due to the movement of a Toxocara larva, which was covered by the proliferative membrane in the superior temporal retina. Since it adhered closely to the retina, the lesion in the superior temporal retina was not removed to avoid induction of an iatrogenic retinal break and the larva was not found during the first diagnostic pars plana vitrectomy. Intraocular Anti-Toxocara IgG was 45.53U (< 3, enzyme-linked immunosorbent assay (ELISA)), and the Goldmann-Witmer coefficient was 8.55, confirming the diagnosis of ocular toxocariasis. After this operation, visual acuity improved to 20/200. However, vitreous opacity worsened again, and the proliferative membrane expanded around the Toxocara larva three weeks after the operation. Toxocara larva was found and removed in the superior temporal region during the second operation. His visual acuity improved to 20/100, vitreous opacity disappeared, and the retina was stable two months after the second operation. CONCLUSION It is advisable to remove suspected Toxocara larva to prevent the reoccurrence of ocular toxocariasis.
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Affiliation(s)
- Shiqun Lin
- grid.413106.10000 0000 9889 6335Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Xiaoxu Han
- grid.413106.10000 0000 9889 6335Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730 China
| | - Rongping Dai
- grid.413106.10000 0000 9889 6335Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730 China
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Zhang X, Yang Y, Zheng Y, Hu Y, Rao Y, Li J, Zhao P, Li J. The Value of the Antibody Detection in the Diagnosis of Ocular Toxocariasis and the Aqueous Cytokine Profile Associated With the Condition. Front Med (Lausanne) 2022; 9:838800. [PMID: 35419376 PMCID: PMC9000971 DOI: 10.3389/fmed.2022.838800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction To evaluate and compare the specificity of Toxocara canis-specific antibody detection in the serum and aqueous samples for the diagnosis of ocular toxocariasis (OT) and explore the cytokine profiles associated with the condition in children. Materials and Methods This is a prospective cohort study. The inclusion criteria were the clinical presentations of OT, which included unilateral vision reduction, typical peripheral or posterior pole granuloma with variable degrees of vitritis, and exclusion of other diagnoses. The titer of antibody against the excretory-secretory antigen of Toxocara canis [T-immunoglobulin G (IgG)] was measured in serum and aqueous samples that were taken from the affected eyes. The diagnosis of OT was made upon positive detection of T-IgG either in the serum or aqueous. The rest with typical clinical presentations as described above but a positive serum or aqueous T-IgG could not be confirmed were diagnosed as suspected OT. Cytokines were measured using multiplexed cytometric bead array system. Results Two hundred and eleven eyes of 211 patients had participated in the study. One hundred and twenty-eight eyes were diagnosed as OT. The median age of the cohort was 7.7 years with a male to female ratio of 2.5:1. Major initial symptoms were decreased vision (74%) and strabismus (22%). The percentages of eyes with peripheral granuloma, posterior granuloma, and endophthalmitis were 40, 18, and 41%, respectively. Vitritis (100%), vitreous strands (64%), retinal fibrotic bands (57%), and retinal detachment (42%) were the most common signs. T-IgG was positive in 66.7% of the aqueous and 57.2% of the serum samples. Forty-four patients were diagnosed T-IgG negative in both serum and aqueous of the affected eyes. Interleukin (IL)-6, monocyte chemoattractant protein (MCP)-1, IL-8, eosinophil chemotactic protein (Eotaxin), MCP-1β, and vascular endothelial growth factor (VEGF) were higher in T-IgG negative eyes when compared to controls and further increased in T-IgG positive eyes. However, only T-IgG positive eyes showed increased IL-5, IL-13, and IL-10. IL-1β, tumor necrosis factor-alpha (TNF-α), IL-12, IL-2, interferon-gamma (IFN-γ), and IL-4 were undetectable in all eyes. Conclusions Pediatric OT is often present with severe retinal complications. Polarized intraocular Th2 response was only found in aqueous T-IgG positive eyes. Our results supported an aqueous sample-based antibody test for the more specific diagnosis of OT.
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Affiliation(s)
- Xiang Zhang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Yang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zheng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqian Hu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqing Rao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiakai Li
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Li
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Fata A, Hosseini SM, Woo SJ, Zibaei M, Berenji F, Farash BRH, Moghaddas E. Frequency of Toxocara Antibodies in Patients Clinically Suspected to Ocular Toxocariasis, Northeast of Iran. IRANIAN JOURNAL OF PARASITOLOGY 2021; 16:305-311. [PMID: 34557246 PMCID: PMC8418656 DOI: 10.18502/ijpa.v16i2.6312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/20/2020] [Indexed: 11/24/2022]
Abstract
Background: Human toxocariasis is a neglected parasitic disease in most countries including Iran. Among different clinical forms of toxocariasis, ocular toxocariasis (OT) is an important disease resulting in severe vision loss. However, the prevalence and incidence of OT are currently unclear in Iran. This study aimed to determine the prevalence of ocular toxocariasis among patients with uveitis in the Northeast of Iran. Methods: From 2015 to 2017, 510 patients with uveitis referred to Khatam-al-Anbia, a tertiary eye hospital at Mashhad, Iran were examined for OT. Serum samples of the suspected patients were obtained and evaluated for IgG against Toxocara canis using ELISA test. Anti-Toxocara IgG positive serums were further investigated using confirmatory Western blotting (WB) analysis. Results: Twenty patients had pathologic changes and clinical presentations in the anterior and posterior segments of their eyes and they were clinically diagnosed ocular toxocariasis. Among the 20 patients, 2 (10%) patients showed IgG antibody against Toxocara canis on ELISA as well as on WB test. The calculated prevalence of ocular toxocariasis was about 0.4%. Conclusion: Ocular toxocariasis can be diagnosed both clinically and serologically in Mashhad, northeastern Iran. Although OT is a rare pathologic eye disease, it should be considered as one of the important cause of infectious posterior uveitis.
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Affiliation(s)
- Abdolmajid Fata
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mohammad Zibaei
- Department of Parasitology and Mycology, Faculty of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Fariba Berenji
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bibi Razieh Hosseini Farash
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Moghaddas
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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9
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Diagnostic and Therapeutic Challenges. Retina 2021; 41:224-227. [PMID: 31599793 DOI: 10.1097/iae.0000000000002658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Hennein L, de Alba Campomanes AG, Afshar AR, Robbins SL. As the worm turns: An infant with exotropia. Surv Ophthalmol 2020; 67:288-292. [PMID: 33309950 DOI: 10.1016/j.survophthal.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
A two-year-old full-term boy with a history of an intermittent exotropia presented to the pediatric ophthalmology clinic for routine follow-up. He was found to have a stable sensorimotor examination however dilated funduscopic examination of the right eye was significant for a dim foveal reflex with a new discrete, white, elevated retinal lesion superotemporal to the fovea with surrounding subretinal exudates. An examination under anesthesia (EUA) was performed two days later that revealed a subretinal posterior pole granuloma with hyperfluorescence and late leakage from the lesion without telangiectatic vessels on fluorescein angiography. A repeat EUA one month later demonstrated an increase in surrounding subretinal and overlying intraretinal fluid. The patient was started on topical 1% prednisolone with a presumed diagnosis of Toxocara granuloma. At EUA, three months later, the subretinal and intraretinal fluid had resolved. The topical steroids were tapered, and the patient continues to be followed closely.
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Affiliation(s)
- Lauren Hennein
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | | | - Armin R Afshar
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Shira L Robbins
- Ratner Children's Eye Center, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
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Li S, Sun L, Liu C, Wang W, Huang S, Zhang T, Chen C, Wang Z, Cao L, Luo X, Yu B, Ding X. Clinical features of ocular toxocariasis: a comparison between ultra-wide-field and conventional camera imaging. Eye (Lond) 2020; 35:2855-2863. [PMID: 33273717 DOI: 10.1038/s41433-020-01332-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/20/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of this study is to compare the lesion detection rates of ocular toxocariasis (OT) between ultra-wide-field scanning laser ophthalmoscopy (UWF-SLO) and conventional fundus photography (CFP), and to evaluate the potential diagnostic ability of UWF-SLO in OT. METHODS A total of 56 patients with serological/immunological confirmed unilateral OT were enrolled. The presence of OT characteristic features included the posterior granuloma (postG), peripheral granuloma (periG), tractional retinal detachment (TRD), retinal folds (RF), and vitreous strands (VS) and was analyzed in 36 patients with UWF-SLO and 56 patients with CFP. Diagnostic tests were employed using the clinical examination as gold standard. RESULTS In total of the 56 OT eyes, granulomas were identified in 91.1% (51/56) of eyes, including postG in 46.4% (26/56) of eyes, periG in 41.1% (23/56) of eyes, and combined granulomas in 3.6% (2/56) of eyes. TRD, RF, and VS were found in 28.6% (16/56), 51.8% (29/56), and 83.9% (47/56) of patients, respectively. Although the specificities of the diagnosis in clinical features were similar by the diagnostic tests, the sensitivities of postG, periG, TRD, RF, and VS using UWF-SLO were 100%, 100%, 66.7%, 95%, and 81.8%, respectively, which were significantly higher those of CFP (72.2%, 31.3%, 11.1%, 55%, and 48.5%). Additionally, the extent of vitreous haze was milder graded by UWF-SLO compared to CFP (p = 0.0099). CONCLUSIONS The diagnostic ability of UWF-SLO was superior to CFP using clinical examination as gold standard for the ascertainment of the characteristic manifestations of OT, especially for granulomas and RF.
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Affiliation(s)
- Songshan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chengxi Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, China
| | - Weiqing Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Sijian Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ting Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chonglin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Liming Cao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoling Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Bilin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Hernanz I, Moll-Udina A, Llorenç BV, Adan CA. Ocular Toxocariasis: Beyond Typical Patterns through the New Imaging Technologies. Ocul Immunol Inflamm 2020; 29:1252-1258. [PMID: 32835578 DOI: 10.1080/09273948.2020.1793370] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE To report five cases of ocular Toxocariasis (OT) in which ultrawide-field (UWF) imaging was helpful in diagnosis and assessment. OT is an underdiagnosed condition triggered by the ocular invasion of Toxocara larvae. Typical features are peripheral granuloma or endophthalmitis.Methods: A retrospective case series of 10 outpatients were studied by complete ophthalmologic examination and complementary tests. UWF retinal imaging, fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SDOCT) were retrospectively analyzed. Five patients with suspected OT were included.Results: UWF imaging and FAF was able to detect all retinal lesions in a single rapid capture. Two patients showed positive serology for Toxocara. An image suggesting the larva in the vitreous cavity was shown in one patient. Antihelmintic 15 treatment along with steroids was prescribed in two patients.Conclusion: UWF imaging and SDOCT provide a more efficient approach and follow-up in OT, raising final standards of care.
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Affiliation(s)
- I Hernanz
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - A Moll-Udina
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Belles V Llorenç
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Civera A Adan
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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13
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Martinez J, Ivankovich-Escoto G, Wu L. Pediatric Ocular Toxocariasis in Costa Rica: 1998-2018 Experience. Ocul Immunol Inflamm 2020; 29:1246-1251. [DOI: 10.1080/09273948.2020.1792513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Joaquin Martinez
- Caja Costarricense De Seguro Social, Servicio De Oftalmología, Hospital Nacional De Niños, San José, Costa Rica
- Caja Costarricense De Seguro Social, Clínica de Uveítis, Servicio De Oftalmología, Hospital Nacional De Niños, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Caja Costarricense De Seguro Social, Clínica de Uveítis, Servicio De Oftalmología, Hospital Nacional De Niños, San José, Costa Rica
- Caja Costarricense De Seguro Social, Servicio De Inmunología Y Reumatología Pediátrica, Hospital Nacional De Niños, Paseo Colón, San José, Costa Rica
- Escuela De Medicina, Universidad De Costa Rica, San José, Costa Rica
| | - Lihteh Wu
- Asociados De Macula, Vítreo Y Retina De Costa Rica, San José, Costa Rica
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, Chicago, IL, United States
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Abstract
Several imaging modalities have now been employed to visualize the manifestations of larval Toxocara infection in hepatic, neurologic, ocular, renal, and other anatomical sites. This report reviews the usefulness and value of these individual imaging methods in diagnosis and follow-up of the different cases causing eosinophilic (granulomatous) infiltrations the liver, lungs, brain, heart, and eyes. Imaging provides a means of assisting in diagnosis and management in this infection where diagnosis by biopsy is often unlikely to capture an actual larva for the purpose of making a definitive diagnosis on the basis of larval morphology or DNA detection.
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Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
| | - Carmen Cretu
- Department of Parasitology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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15
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Karska-Basta I, Kubicka-Trząska A, Chrząszcz M, Pociej-Marciak W, Romanowska-Dixon B. Toxocara Optic Disc Granuloma: Deep Range Imaging Optical Coherence Tomography Findings. Case Rep Ophthalmol 2019; 10:339-343. [PMID: 31762765 PMCID: PMC6873007 DOI: 10.1159/000503139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022] Open
Abstract
We aimed to present a unique case of a child with an optic disc granuloma with exudative retinal detachment as a manifestation of ocular toxocariasis. The response to systemic therapy was assessed using deep range imaging optical coherence tomography. This imaging technique was the most accurate for identification of retinal, macular and vitreous changes associated with this intraocular pathology.
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Affiliation(s)
- Izabella Karska-Basta
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Jagiellonian University Medical College, Krakow, Poland.,Department of Ophthalmology and Ocular Oncology, Krakow University Hospital, Krakow, Poland
| | - Agnieszka Kubicka-Trząska
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Jagiellonian University Medical College, Krakow, Poland.,Department of Ophthalmology and Ocular Oncology, Krakow University Hospital, Krakow, Poland
| | - Michał Chrząszcz
- Department of Ophthalmology and Ocular Oncology, Krakow University Hospital, Krakow, Poland
| | - Weronika Pociej-Marciak
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Jagiellonian University Medical College, Krakow, Poland.,Department of Ophthalmology and Ocular Oncology, Krakow University Hospital, Krakow, Poland
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Jagiellonian University Medical College, Krakow, Poland.,Department of Ophthalmology and Ocular Oncology, Krakow University Hospital, Krakow, Poland
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16
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Zhang T, Guo D, Xu G, Jiang R. Ocular Toxocariasis: Long-Term Follow-Up and Prognosis of Patients following Vitrectomy. Ocul Immunol Inflamm 2019; 28:517-523. [PMID: 31305199 DOI: 10.1080/09273948.2019.1597897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose: To investigate the outcomes of surgical treatment in patients with ocular toxocariasis and identify prognostic factors.Methods: We retrospectively reviewed the medical records of 56 consecutive patients who underwent vitrectomy.Results: The mean follow-up was 20.7 months. Visual acuity (VA) improved in 70.4% of patients by the final visit, but VA was better than Snellen 20/70 in only 31.5% of patients. Preoperative VA was closely correlated with final VA (P = 0.001). Macular involvement was associated with final VA worse than 20/70 (P = 0.03). The most common postoperative complications were ocular hypertension (19.6%) and retinal detachment (12.5%). Seven patients (12.5%) experienced recurrent inflammation postoperatively, but no preoperative factors were associated with recurrent inflammation.Conclusion: Surgical treatment could rescue visual function in patients with ocular toxocariasis but their prognosis was unfavorable. Preoperative VA was associated with final VA, whereas macular involvement was associated with poor visual outcomes.
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Affiliation(s)
- Ting Zhang
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Diwen Guo
- Department of Ophthalmology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical School, Fudan University, Shanghai, China
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17
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Agarwal A, Das P, Kumar A, Sharma S, Aggarwal K, Sehgal S, Gupta V. Multiple Granulomas of Ocular Toxocariasis in an Immunocompetent Male. Ocul Immunol Inflamm 2019; 28:111-115. [PMID: 31157988 DOI: 10.1080/09273948.2019.1597895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 25-year-old male presented with unilateral panuveitis with multiple voluminous elevated retinal lesions along with subretinal fluid and exudation. An extensive laboratory work-up was done, and a clinical suspicion of viral retinitis was considered. The patient was initiated on antiviral therapy and, subsequently, oral corticosteroids. As the corticosteroids were tapered, the patient developed worsening lesions and vitreous inflammation. Pars plana vitrectomy (diagnostic and therapeutic) was performed and cytology sample revealed a highly eosinophilic infiltrate suggestive of parasitic infection. The real-time polymerase chain reaction was positive for Toxocara cati. The diagnosis of ocular toxocariasis was made. This case highlights a highly unusual presentation where multiple retinal granulomas of ocular toxocariasis were observed in an immunocompetent male.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pranab Das
- Department of Ophthalmology, Calcutta Medical Research Institute, Kolkata, India
| | - Aman Kumar
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suryaprakash Sharma
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shobha Sehgal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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18
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Toxocariasis: a silent threat with a progressive public health impact. Infect Dis Poverty 2018; 7:59. [PMID: 29895324 PMCID: PMC5998503 DOI: 10.1186/s40249-018-0437-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Toxocariasis is a neglected parasitic zoonosis that afflicts millions of the pediatric and adolescent populations worldwide, especially in impoverished communities. This disease is caused by infection with the larvae of Toxocara canis and T. cati, the most ubiquitous intestinal nematode parasite in dogs and cats, respectively. In this article, recent advances in the epidemiology, clinical presentation, diagnosis and pharmacotherapies that have been used in the treatment of toxocariasis are reviewed. Main text Over the past two decades, we have come far in our understanding of the biology and epidemiology of toxocariasis. However, lack of laboratory infrastructure in some countries, lack of uniform case definitions and limited surveillance infrastructure are some of the challenges that hindered the estimation of global disease burden. Toxocariasis encompasses four clinical forms: visceral, ocular, covert and neural. Incorrect or misdiagnosis of any of these disabling conditions can result in severe health consequences and considerable medical care spending. Fortunately, multiple diagnostic modalities are available, which if effectively used together with the administration of appropriate pharmacologic therapies, can minimize any unnecessary patient morbidity. Conclusions Although progress has been made in the management of toxocariasis patients, there remains much work to be done. Implementation of new technologies and better understanding of the pathogenesis of toxocariasis can identify new diagnostic biomarkers, which may help in increasing diagnostic accuracy. Also, further clinical research breakthroughs are needed to develop better ways to effectively control and prevent this serious disease. Electronic supplementary material The online version of this article (10.1186/s40249-018-0437-0) contains supplementary material, which is available to authorized users.
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19
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Gordon CA, Kurscheid J, Jones MK, Gray DJ, McManus DP. Soil-Transmitted Helminths in Tropical Australia and Asia. Trop Med Infect Dis 2017; 2:E56. [PMID: 30270913 PMCID: PMC6082059 DOI: 10.3390/tropicalmed2040056] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022] Open
Abstract
Soil-transmitted helminths (STH) infect 2 billion people worldwide including significant numbers in South-East Asia (SEA). In Australia, STH are of less concern; however, indigenous communities are endemic for STH, including Strongyloides stercoralis, as well as for serious clinical infections due to other helminths such as Toxocara spp. The zoonotic hookworm Ancylostoma ceylanicum is also present in Australia and SEA, and may contribute to human infections particularly among pet owners. High human immigration rates to Australia from SEA, which is highly endemic for STH Strongyloides and Toxocara, has resulted in a high prevalence of these helminthic infections in immigrant communities, particularly since such individuals are not screened for worm infections upon entry. In this review, we consider the current state of STH infections in Australia and SEA.
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Affiliation(s)
- Catherine A Gordon
- QIMR Berghofer Medical Research Institute, Molecular Parasitology Laboratory, Queensland 4006, Australia.
| | - Johanna Kurscheid
- Australian National University, Department of Global Health, Research School of Population Health, Australian Capital Territory 2601, Australia.
| | - Malcolm K Jones
- School of Veterinary Science, University of Queensland, Brisbane, QLD 4067, Australia.
| | - Darren J Gray
- Australian National University, Department of Global Health, Research School of Population Health, Australian Capital Territory 2601, Australia.
| | - Donald P McManus
- QIMR Berghofer Medical Research Institute, Molecular Parasitology Laboratory, Queensland 4006, Australia.
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20
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Chen Q, Gu J, Jiang R, Zhou M, Chang Q. Role of ultrasound biomicroscopy in diagnosis of ocular toxocariasis. Br J Ophthalmol 2017; 102:642-646. [DOI: 10.1136/bjophthalmol-2017-310583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/27/2017] [Accepted: 08/13/2017] [Indexed: 11/03/2022]
Abstract
PurposeTo investigate ultrasound biomicroscopy (UBM) characteristics of patients with ocular toxocariasis (OT) and to explore the role of UBM in the diagnosis and differential diagnosis of OT.DesignCross-sectional study.Methods78 eyes of 77 patients clinically consistent with OT and confirmed by serum and/or intraocular antibodies in a single tertiary centre (Fudan University Eye and ENT Hospital, Shanghai) between July 2009 and July 2016 were included in the study. UBM was performed, and the outcomes were analysed.ResultsMean age of the patients included was 12.8±10.3 years. Positive UBM findings were observed in 72 of 78 eyes (92.3%). The primary imaging feature was peripheral granulomas (66 eyes; 84.6%), of which 78.5% were adjacent to the nasal or temporal side of horizontal meridian and 79.7% located on the surface of the ciliary body, presenting as olivary foci on radical section and botuliform foci on coronal section. Moreover, 12 of the peripherally involved eyes were accompanied with posterior pole granulomas, which could be termed ‘combined type’. Other UBM findings included vitreous strands (53 eyes; 67.9%), peripheral tractional retinal detachment (41 eyes; 52.6%) and tractional cyclodialysis (32 eyes; 41.0%).ConclusionsThe utilisation of UBM verifies the existence of the combined subtype (with both peripheral and posterior pole granulomas) and improves the detection rate of peripheral granulomas, which is of great importance to the diagnosis and differential diagnosis of OT.
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21
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Abstract
Infectious uveitis accounts for majority of the cases of uveitis in developing countries. It also encompasses an array of various microorganisms and their clinical presentations. Some of these infectious uveitic entities are familiar, while others are newly emerging in the global ophthalmic world. Many of these entities are also a major cause of morbidity and mortality, and appropriate, timely management is required to save not the eye, but life of the patient. This review highlights the ocular manifestations of various infectious uveitic entities, relevant to the ophthalmologist.
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Affiliation(s)
| | - Avirupa Ghosh
- Department of Uvea, Aditya Birla Sankara Nethralaya, Kolkata, India
| | - Jyotirmay Biswas
- Department of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
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22
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Liu J, Li S, Deng G, Yang W, Chen W, Lu H. Ultrasound biomicroscopic imaging in paediatric ocular toxocariasis. Br J Ophthalmol 2017; 101:1514-1517. [DOI: 10.1136/bjophthalmol-2016-309850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/07/2017] [Accepted: 02/23/2017] [Indexed: 11/03/2022]
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23
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Wang ZJ, Zhou M, Cao WJ, Ji J, Bi YW, Huang X, Xu GZ. Evaluation of the Goldmann-Witmer coefficient in the immunological diagnosis of ocular toxocariasis. Acta Trop 2016; 158:20-23. [PMID: 26899678 DOI: 10.1016/j.actatropica.2016.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/10/2016] [Accepted: 02/14/2016] [Indexed: 10/22/2022]
Abstract
Ocular toxocariasis (OT) is a zoonotic parasitic infection mainly caused by the intraocular tissue invasion of second-stage Toxocara canis or Toxocara cati larva. Measuring specific anti-T. canis antibodies in the intraocular fluid (IF) can increase OT diagnosis accuracy using Goldmann-Witmer coefficient (GWC). However, there is no systemic evaluation of GWC application in the immunological diagnosis of OT. To assess GWC for the immunodiagnosis of ocular toxocariasis, paired IF and serum samples from 72 patients diagnosed with OT were retrospectively analyzed for specific anti-T. canis IgG by enzyme linked immunosorbent assay (ELISA). GWC values were calculated to determine intraocular specific IgG production. Clinical features and other laboratory data were recorded, and their correlations with GWC evaluated. Of the 72 OT patients, 60 (83.33%) showed intraocular specific IgG production confirmed by GWC, while intraocular nonspecific IgE production was found in 64/69 (92.75%) cases. No significant correlation was found among clinical features and IF specific IgG production. Values for peripheral blood samples were lower than those of intraocular fluid regarding OT screening, and vitreous humor samples showed increased local specific IgG and nonspecific IgE production compared with aqueous humor samples. Overall, our results indicate that GWC and intraocular IgE production have referential values in diagnosing ocular toxocariasis.
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Ocular Toxocariasis: Clinical Features and Long-term Visual Outcomes in Adult Patients. Am J Ophthalmol 2016; 166:162-168. [PMID: 27066722 DOI: 10.1016/j.ajo.2016.03.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate clinical characteristics and treatment outcomes of proven ocular toxocariasis (OT) in adult patients. DESIGN Retrospective, consecutive, interventional case series. METHODS setting: Institutional. STUDY POPULATION Consecutive OT patients with positive serum serology and positive western blot (WB) on ocular sample. OBSERVATION PROCEDURES Clinical features, optical coherence tomography (OCT), and treatment outcomes. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) and OCT central foveal thickness (CFT). RESULTS Fourteen patients were included between 2011 and 2013. Mean age at diagnosis was 45.6 years. Mean duration between the first symptoms and diagnosis was 15.1 months. Uveitis was unilateral in all cases and all patients displayed vitreous inflammation. The main baseline findings were presence of ≥1 peripheral granulomas (57.1%), vasculitis (57.1%), vitreoretinal traction (57.1%), and chronic macular edema (ME) (71.4%). Delayed diagnosis (>8 months) seemed to be associated with higher rate of ME. All patients received albendazole. Systemic (n = 5) and/or local corticosteroids (CS) (n = 7) were administered in case of ME and/or posterior segment inflammation. Vitrectomy was performed when vitreous inflammation was severe and persistent despite CS or in case of threatening traction or visually significant epimacular membrane (28.6%). Overall, this regimen allowed significant decrease of CFT (P = .01). In the vitrectomy subgroup, mean BCVA increased (P = .01) and CFT decreased (P = .017). CONCLUSION While some features such as granuloma are typical signs of OT, atypical features can delay the diagnosis. In doubtful situations, WB on ocular samples seems to be more specific than serum antibodies alone. ME seems to be a common complication of longstanding OT in the adult.
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Liu Y, Zhang Q, Li J, Ji X, Xu Y, Zhao P. Clinical Characteristics of Pediatric Patients with Ocular Toxocariasis in China. Ophthalmologica 2016; 235:97-105. [DOI: 10.1159/000443215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 11/26/2015] [Indexed: 11/19/2022]
Abstract
Objective: The aim of the study was to analyze the clinical characteristics of pediatric patients with ocular toxocariasis. Methods: Ocular toxocariasis was diagnosed and treated in 46 children from Shanghai and surrounding provinces. The diagnosis of ocular toxocariasis was confirmed immunologically by performing an enzyme-linked immunosorbent assay on serum and/or intraocular fluid. All pediatric patients and their guardians completed a questionnaire concerning their cases and living habits. Results: The mean age of onset was 6 ± 3 years. Most children (85%) resided in rural areas, and 91% of the children had contact with adult dogs or puppies. At the first visit, visual acuity (VA) was <20/200 in 36 cases, and we detected peripheral granuloma in 36 patients. In our study, the most common signs were vitritis, vitreous strands, and tractional retinal detachment. The Optomap 200Tx device detected granuloma with an 85% sensitivity, which is much higher than that of other techniques. We treated 40 cases (87%) with topical corticosteroids, while 28 patients (61%) were treated with systemic corticosteroids. Only 18 children (39%) required surgical intervention. All patients were examined and treated by the same ophthalmologists. Conclusions: Preschool children in China are more often affected by toxocariasis compared with other age groups. The most common signs included unilateral granuloma and ocular inflammation. In our study, clinical manifestations were severe and complicated. At the first visit, VA was <20/200 in most patients. Ocular toxocariasis was diagnosed on the basis of clinical signs and symptoms; the diagnosis was confirmed by immunological testing. Techniques using the Optomap 200Tx device can facilitate the early detection and lead to better visual prognosis.
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Abstract
Toxocara canis and T. cati are highly prevalent nematode infections of the intestines of dogs and cats. In paratenic hosts, larvae do not mature in the intestine but instead migrate through the somatic tissues and organs of the body. The presence of these migrating larvae can contribute to pathology. Toxocara larvae can invade the brains of humans, and while case descriptions of cerebral toxocariasis are historically rare, improved diagnosis and greater awareness have contributed to increased detection. Despite this, cerebral or neurological toxocariasis (NT) remains a poorly understood phenomenon. Furthermore, our understanding of cognitive deficits due to toxocariasis in human populations remains particularly deficient. Recent data describe an enhanced expression of biomarkers associated with brain injury, such as GFAP, AβPP, transforming growth factor β1 (TGF-β1), NF-L, S100B, tTG, and p-tau, in mice receiving even low doses of Toxocara ova. Finally, this review outlines a hypothesis to explore the relationship between the presence of T. canis larvae in the brain and the progression of Alzheimer's disease (AD) due to enhanced AD-associated neurodegenerative biomarker expression.
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Lack of Association between Toxocara Exposure and Suicide Attempts in Psychiatric Patients. J Parasitol Res 2015; 2015:608604. [PMID: 26483971 PMCID: PMC4592907 DOI: 10.1155/2015/608604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 11/30/2022] Open
Abstract
Infection with Toxocara may affect the central nervous system. A high seroprevalence of Toxocara infection has been reported in psychiatric patients. To the best of our knowledge, there is no previous report about an association of Toxocara infection with suicide attempts. Therefore, we sought to determine whether Toxocara exposure is associated with suicide attempts in psychiatric patients. We studied 282 psychiatric outpatients (156 with suicide attempts and 126 without suicide attempts). Sera of patients were analyzed for the presence of anti-Toxocara IgG antibodies by using a commercially available enzyme immunoassay. One of the 156 (0.6%) suicide attempters and 1 (0.8%) of the 126 controls were positive for anti-Toxocara IgG antibodies (OR = 0.80; 95% CI: 0.04–13.02; P = 1.00). Toxocara seropositivity was significantly higher (P = 0.01) in male patients with consumption of raw dried goat meat than male patients without this consumption. Results suggest that Toxocara exposure is not associated with suicide attempts in psychiatric outpatients in Durango City, Mexico. However, further studies with larger samples sizes to confirm our results should be conducted. Too few patients were seropositive to assess further associations of Toxocara exposure with sociodemographic, clinical, and behavioral characteristics of the psychiatric patients.
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Alvarado-Esquivel C, Hernandez-Tinoco J, Sanchez-Anguiano LF. Seroepidemiology of Toxocara infection in patients with vision impairment and blindness in durango, Mexico. J Clin Med Res 2014; 7:176-81. [PMID: 25584103 PMCID: PMC4285064 DOI: 10.14740/jocmr2032w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 11/18/2022] Open
Abstract
Background Toxocara infection is a cause of vision impairment and blindness. We aimed to determine the seroprevalence and correlates of Toxocara infection in patients suffering from vision impairment and blindness in Durango City, Mexico. Methods Through a cross-sectional seroprevalence study, 204 patients with vision impairment and 19 blind patients were studied for the presence of anti-Toxocara IgG antibodies in Durango City, Mexico. Seroprevalence association with socio-demographic, housing, clinical, and behavioral characteristics of participants was also investigated. Results Five (2.5%) of the 204 patients with vision impairment, and none of the 19 patients with blindness were positive for anti-Toxocara IgG antibodies. In total, five of the 223 (2.2%) patients were positive for anti-Toxocara IgG antibodies. Seropositivity to Toxocara was not associated with age, sex, educational level, socio-economic status, presence of underlying diseases or behavioral characteristics of the patients. In contrast, multivariate analysis showed that Toxocara seropositivity was associated with living in a house with soil floor (odds ratio (OR) = 11.14; 95% confidence interval (CI): 1.57 - 78.74; P = 0.01). Conclusions This is the first report of Toxocara exposure in patients with vision impairment and blindness in Mexico, and of an association of Toxocara exposure with living in a house with soil floors. Results suggest a low Toxocara exposure in these patients in Durango, Mexico. The risk factor associated with Toxocara exposure identified in this study warrants for further investigation.
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Affiliation(s)
- Cosme Alvarado-Esquivel
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Jesus Hernandez-Tinoco
- Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Luis Francisco Sanchez-Anguiano
- Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
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Adult ocular toxocariasis mimicking ciliary body malignancy. Case Rep Med 2014; 2014:368907. [PMID: 25371681 PMCID: PMC4209779 DOI: 10.1155/2014/368907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 07/05/2014] [Accepted: 07/12/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. To discuss an unusual presentation of ocular toxocariasis. Methods. Case report. Results. A 40-year-old woman presented with decreased vision in the left eye with a long history of recurrent red eye from uveitis. Eosinophilia and positive ELISA titers for Toxocara canis favored the diagnosis of ocular toxocariasis. Over 3 months, an anterior scleral mass had a rapid growth raising the possibility of medulloepithelioma, which rarely can mimic uveitic syndromes. Surgical plan changed from local excision to enucleation. Histopathology demonstrated a large homogeneous mass of chronic inflammatory cells with inflammation of the overlying thinned out sclera, medial rectus insertion, and limbal cornea. The triad of peripheral granuloma, eosinophilia, and positive blood serology established the diagnosis of ocular toxocariasis. Conclusions. Ocular toxocariasis can mimic ocular malignancy such as medulloepithelioma in adults and rarely presents as an anterior scleral mass.
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Zibaei M, Sadjjadi SM, Jahadi-Hosseini SH. Toxocara cati larvae in the eye of a child: a case report. Asian Pac J Trop Biomed 2014; 4:S53-5. [PMID: 25183145 DOI: 10.12980/apjtb.4.2014c1281] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022] Open
Abstract
Toxocariasis is a consequence of human infection by Toxocara larvae. There are symptomatic (visceral, ocular) and asymptomatic course of toxocariasis. The ocular form is very rare. We present a 6-year-old patient who developed an ocular form of toxocariasis caused by Toxocara cati. He demonstrated lesions in the peripheral retina of the right eye. White granuloma was present in the superior peripheral retina. A positive immunological assay for toxocariasis essentially completed the outcomes. On the basis of clinical manifestations and conducted examinations, a diagnosis of ocular form of toxocariasis was established. Albendazole and corticosteroids were applied in treatment. Current results clearly highlight the usefulness of excretory-secretory antigens derived from larvae of Toxocara cati for the fine diagnosis ocular larva migrans caused by Toxocara larvae.
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Affiliation(s)
- Mohammad Zibaei
- Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyed Mahmoud Sadjjadi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Toxocara infection in gardeners: a case control seroprevalence study. ASIAN PAC J TROP MED 2014; 7S1:S79-81. [DOI: 10.1016/s1995-7645(14)60207-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 06/13/2014] [Accepted: 06/20/2014] [Indexed: 11/23/2022] Open
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McGuinness SL, Leder K. Global Burden of Toxocariasis: A Common Neglected Infection of Poverty. CURRENT TROPICAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40475-013-0012-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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The epidemiology and public health importance of toxocariasis: A zoonosis of global importance. Int J Parasitol 2013; 43:999-1008. [DOI: 10.1016/j.ijpara.2013.07.004] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 07/16/2013] [Accepted: 07/18/2013] [Indexed: 11/21/2022]
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Van De N, Trung NV, Duyet LV, Chai JY. Molecular diagnosis of an ocular toxocariasis patient in Vietnam. THE KOREAN JOURNAL OF PARASITOLOGY 2013; 51:563-7. [PMID: 24327783 PMCID: PMC3857505 DOI: 10.3347/kjp.2013.51.5.563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 08/21/2013] [Accepted: 09/04/2013] [Indexed: 11/23/2022]
Abstract
An ocular Toxocara canis infection is reported for the first time in Vietnam. A 34-year-old man residing in a village of Son La Province, North Vietnam, visited the National Eye Hospital (NEH) in August 2011. He felt a bulge-sticking pain in his left eye and loss of vision occurred over 3 months before visiting the hospital. The eye examination in the hospital showed damage of the left eye, red eye, retinal fibrosis, retinal detachment, inflammation of the eye tissues, retinal granulomas, and a parasitic cyst inside. A larva of Toxocara was collected with the cyst by a medical doctor by surgery. Comparison of 264 nucleotides of internal transcribed spacer 2 (ITS2) of ribosomal DNA was done between our Vietnamese Toxocara canis and other Toxocara geographical isolates, including Chinese T. canis, Japanese T. canis, Sri Lankan T. canis, and Iranian T. canis. The nucleotide homology was 97-99%, when our T. canis was compared with geographical isolates. Identification of a T. canis infection in the eye by a molecular method was performed for the first time in Vietnam.
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Affiliation(s)
- Nguyen Van De
- Department of Parasitology, Hanoi Medical University, Hanoi, Vietnam
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