Therapy of ocular toxoplasmosis.
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Neuroretinitis is a clinical condition usually seen in young healthy adults that is characterized by rapid profound unilateral loss of vision. Funduscopic findings include swollen disc, splinter hemorrhages, and macular star. Catscratch fever and leptospirosis have been suggested as possible etiologies in this condition. We report a case of a patient with neuroretinitis whose only laboratory abnormality was an elevated enzyme-linked immunosorbent assay immunoglobulin G Toxoplasma titer. The patient responded favorably to treatment with clindamycin, triple sulfa, and systemic corticosteroids. We recommended toxoplasmic serology be added to the workup of patients with neuroretinitis.
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A single subretinal injection of RH toxoplasma initiated an experimental toxoplasmosis of the eyes in big chinchilla rabbits. This animal model was used to study the development of the serum IgG level against toxoplasma. As a rule, the specific antibody level rose between the 9th and the 20th day following injection. At that time, the peak of inflammation had already been exceeded. An influence of cyclophosphamide0 or complete Freund's adjuvant on the humoral immune response of the animals to toxoplasma could not be detected. An attempt is made to interpret the findings deviating from the toxoplasmosis of the human eye.
The results of clinical observations on 34 patients with toxoplasmosis affecting mainly eyes over the period of 2-6 years are presented. The presence of antibodies to Toxoplasma, the content of IgA, IgM and IgG, as well as a number of characteristics of the T and B immunity systems in these patients were determined in their dynamics. For control, similar characteristics were determined in 28 practically healthy persons. During the period of observation the patients showed multiple fluctuations in the level of titers of serological reactions with toxoplasmic antigens and changes in the severity of the clinical picture. In contrast to healthy persons, toxoplasmosis patients were found to have statistically significant changes in a number of characteristics of the T immunity system. The content of B lymphocytes remained within normal limits. Complex treatment with the use of immunostimulating agents proved to be effective only in some of the patients.
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The toxoplasmosic origin of focal chorioretinitis can be detected on the basis of certain clinical signs in the fundus. However, this must be biologically confirmed by studying the local production of specific antibodies. For that purpose, the rate of intraocular specific Immunoglobulins is compared to the serum rate. The ELISA method is well adapted to quantitative determination of microamounts in aqueous humors. The authors report a study of 103 patients of whom, 28 were suffering from uveitis, and have studied the correlation between clinical lesions and results of the ELISA test. There was no false positive in the first group reference series, and in the positive cases there was a very high correlation with the clinical indicators.
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