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Identification of Toxoplasma gondii in paraffin-embedded sections by the polymerase chain reaction.

We used the polymerase chain reaction to amplify DNA fragments specific to Toxoplasma gondii. The sensitivity of the technique allowed for the detection of as few as ten cultured T. gondii tachyzoites. We applied the same amplification technique to deparaffinized ocular sections from two cases of ocular toxoplasmosis. Although toxoplasmic cysts could only be seen in one eye by optical microscopy, polymerase chain reaction allowed the identification of the parasite in both cases. Our study indicates the feasibility of a sensitive DNA-based assay to complement pathologic studies of an ocular parasitic disease.

Adult↗

The prevalence of Toxoplasma antibody in patients with various ocular diseases in central Japan.

BACKGROUND: Ocular toxoplasmosis has been considered to be a largely asymptomatic infection because of the high seroprevalence of Toxoplasma antibodies and the low rate of clinical diagnosis. On the other hand, Toxoplasma infection has been reported to be associated with the other ocular disease. To investigate the association of Toxoplasma infection with the development of various ocular diseases, we studied Toxoplasma seroprevalence in patients with various ocular diseases. METHODS: We investigated Toxoplasma seroprevalence in 982 patients with various ocular diseases in central Japan. Then we compared the seroprevalence of anti-Toxoplasma antibodies. RESULTS: Of 982 patients with various ocular diseases, 122 (12.4%) had serological evidence of previous exposure to Toxoplasma gondii. There were no statistically significant differences among the patients with various ocular diseases. However, the seroprevalence in patients aged 40 to 99 years with macular degenerative lesions was significantly higher than that in patients without these lesions (P < 0.05, Yates' correction). CONCLUSION: This result suggests that Toxoplasma infection could play some role in the development of a type of macular degenerative lesion.

Adolescent↗

[Presumed toxoplasmic chorioretinitis: comparative study of treatment with pyrimethamine and sulfadiazine or clindamycin].

A prospective, randomized study was conducted in 29 patients with presumed toxoplasmic retinochoroiditis to compare the efficacy of oral pyrimethamine and sulfadiazine (P + S) with subconjunctival injections of clindamycin. There was no difference in the mean visual acuity in both groups after treatment; the mean healing time was similar in the two treatment groups, 1.80 months with clindamycin and 1.88 month with P + S. However subjective improvement was obtained earlier with clindamycin. After 14 months' follow up, recurrences of ocular toxoplasmosis developed in both groups, 21% with clindamycin and 36% with P + S, respectively (NS). Other than the discomfort due to topical treatment, clindamycin did not produce any side-effects, which did happened after oral P + S. Subconjunctival injections of clindamycin provide an interesting alternative in the choice of an antitoxoplasmic ocular therapy.

Acute Disease↗

[Experimental models of toxoplasmosis. Pharmacological applications].

Toxoplasma gondii is an ubiquitous protozoan parasite causing severe or life-threatening infections in immunocompromised patients and in congenitally infected infants. Animal models have been extensively used to describe the pathology of infection and to identify new effective drugs for the treatment of congenital infections, chrorioretinitis and toxoplasmic encephalitis. Although inherent differences between man and animal can reduce the relevance of data obtained experimentally, animal models have greatly improved our knowledge on the various aspects of toxoplasmosis. Toxoplasma infection can be easily obtained in most laboratory animals, with exception of rats which are partially resistant. According to the strain used, the resulting infection may be acute, subacute or chronic, and can be monitored either by the survival of animals, the histopathological examination of lesions or, preferably, by titration of parasites in infected tissues using subinoculation to mice or tissue culture. This latter method has proved particularly useful to describe the kinetics of infection in host tissues and to assess the efficacy of drugs, according to their pharmacokinetics and tissue distribution. The relevance of results obtained in animal models of congenital toxoplasmosis and of chrorioretinitis is more questionable, due to the marked differences between the mode of infection in humans and in animals. Experiments performed in primates provided valuable informations for the management of therapy of congenital toxoplasmosis but were of limited interest for ocular toxoplasmosis. The pathogeny of toxoplasmic encephalitis is still poorly understood, and no experimental model is fully satisfactory to produce focal encephalitic lesions as observed in immunocompromised humans. Acute infections with highly virulent strains induce disseminated infection with major pulmonary and brain involvement, and thus can be used to assess the efficacity of drugs in these tissues. Direct inoculation of tachyzoites into brain tissue can induce focal encephalitis but this model is of difficult use for large scale studies. Although cellular immunity is mainly responsible for the control of toxoplasmosis at the chronic stage, administration of immunosuppressive drugs does not usually result in focal brain reactivation; such reactivation can only be obtained using antibodies against CD8 and CD4 T lymphocytes or interferon gamma. Another experimental approach is the use of genetically immunodeficient animals: these models are of limited interest for pharmacological research since infection of nude or T depleted mice usually results in a dissemination of infection; however, using these models it could be clearly demonstrated that immunity plays a major adjunctive role in the control of acute infection. Concurrent infections between viruses and parasites is a common feature in immunocompromised patients and especially during AIDS.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

[A case of primary toxoplasmosis in an immunocompetent patient].

CASE REPORT: A case of an immunocompetent patient presenting primary systemic toxoplasma infection involving the eye (condition seen in less than 3% of primary infections). The patient showed reactivation of this primary focus two years later. DISCUSSION: Diagnosis of toxoplasm retinitis is based on a typical lesion consisting in an area of active retinitis adjacent to an inactive corioretinal scar. Differential diagnosis must consider other causes of retinal coroiditis in primary infection cases: sarcoidosis, tuberculosis, syphilis as well as viral and fungal infections. Ocular toxoplasmosis was confirmed by serum tests.

Adult↗

[Enzyme-linked-immunosorbent assay (ELISA) for demonstrating antibodies against toxoplasmosis].

Serologic tests for specific antibodies are the primary method of diagnosis in suspected cases of toxoplasmosis. Available tests differ widely with regard to specificity and sensitivity. The enzyme-linked immunosorbent assay (ELISA) is specific for toxoplasmosis and has a sensitivity comparable to radio-immuno assays. The reproducibility of the CORDIA-T assay, tested by the authors in their laboratory, was excellent; the test itself was very easy to perform. When testing sera of 590 apparently normal subjects the authors found specific antibodies in 17.9% to 48.1% of all cases, depending on age. The ELISA-test seems to be useful in the diagnosis of ocular toxoplasmosis.

Adolescent↗

Circulating ICAM-1 levels in serum of uveitis patients.

Intercellular Adhesion Molecule-1 (ICAM-1) is a cytokine-inducible adhesion molecule expressed on cells of multiple lineages at sites of inflammation. Recently a truncated form of ICAM-1 has been discovered to be circulating in serum. This study reports on circulating serum (cICAM-1) levels in 132 uveitis patients (HLA-B 27 pos. acute anterior uveitis (AAU); HLA-B27 neg. anterior uveitis (AU); intermediate uveitis (IU); heterochromic cyclitis Fuchs (HCF); sarcoidosis; Toxoplasmosis). Measurement of circulating ICAM-1 serum levels was performed using a monoclonal antibody based ELISA, with healthy blood donors serving as the control group. Applying multiple variance analysis and the Student Newmann-Keuls test we found a statistically significant elevation of serum cICAM-1 level in the HLA-B 27 neg. AU group (n:31), in the IU group (n:25) and in patients with sarcoidosis (n:18). Serum levels of HLA-B27 pos. AAU patients, patients with HCF and patients suffering from ocular toxoplasmosis did not differ significantly from levels of the control group.

Acute Disease↗

Presumed toxoplasmosic anterior optic neuropathy.

PURPOSE: To describe the clinical findings and course of toxoplasmic anterior optic neuropathy and to differentiate primary and secondary involvement. METHODS: Retrospective observational case series from a tertiary referral institution. Clinical and photographic charts of 13 patients with toxoplasmosis with direct optic nerve head involvement were reviewed and data were collected throughout the length of follow-up. RESULTS: Toxoplasmic anterior optic neuropathy was divided into two types. Type I was defined as secondary infectious involvement of the optic nerve head from an adjacent focus of chorioretinitis that resolved with chorioretinal scarring. Type II was defined as primary involvement of the optic nerve head that resolved without chorioretinal scarring. Visual acuity improved after treatment in both Type I and Type II patients; however, the visual prognosis was worse in Type I patients due to macular involvement. Eighty-three percent of Type II patients had a final visual acuity equal to or better than 20/25 compared to 50% of Type I patients. Visual field defects were present in all patients, most frequently arcuate or altitudinal (62%). Delay in diagnosis was common (54%), especially in Type II patients (71%). Vitreous inflammation was absent on the initial examination in 31% of the patients. CONCLUSION: Toxoplasmic anterior optic neuropathy is an uncommon manifestation of ocular toxoplasmosis. Delays in diagnosis are common because of the frequent lack of typical chorioretinitis or vitreous inflammation. Adjacent macular involvement strongly influences visual outcome.

Adolescent↗

[Fansidar in the treatment of toxoplasmosis].

Toxoplasmosis chorioretinitis is the most frequent posterior uveitis. Different treatment modes are used for its therapy. Classical is the combination of 50 mg of pyrimethamine with 4 g of sulphadiazine and corticosteroids. In this study the results of treatment with lower doses of pyrimethamine together with long-acting sulphonamide are reported. Twelve patients were treated with Fansidar, combination of 25 mg of pyrimethamine and 500 mg sulphadoxine. The treatment consisted of a loading dose of two tablets of Fansidar, followed by one tablet a day. Prednisone 0.5 mg/kg/day was added and gradually tapered off. Patients were treated for 28 days on average (range 21-50 days). In 83% of patients the scar was considerably smaller than original lesion (on average the scar represented 25% of original lesion). Three months after the treatment the visual acuity was 6/9 or better in 83% of patients. No side-effects of the treatment were observed. Lower doses of pyrimethamine with suphadoxine in an easy once a day treatment regime could be an alternative and cost-effective therapy for ocular toxoplasmosis.

Adolescent↗

Onset of ocular complications in congenital toxoplasmosis associated with immunoglobulin M antibodies to Toxoplasma gondii.

Four patients with congenital toxoplasmosis serologically diagnosed by the Sabin-Feldman test (SFT) and the IgM-indirect fluorescent antibody test (IgM-IFAT) in the first year of life presented with eye disease between the age of 21 months and ten years. Repeated serological testing revealed increasing levels of specific antibodies as measured by the SFT. IgM antibodies to Toxoplasma gondii were detected in all four patients by the immunosorbent agglutination assay, in two by the IgM-IFAT and in three by the IgM-indirect haemagglutination test. Findings suggest that specific IgM antibodies reappear at the time of reactivation of congenital toxoplasmosis later in life, or possibly persist for an extraordinary long period (up to ten years).

Age Factors↗

Toxoplasmosis.

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Head↗

Congenital toxoplasmosis: prevention, screening and treatment.

Congenital toxoplasmosis is an established cause of abortion, neonatal disease and ocular defects presenting in later life. Preventative options include health education, immunization and screening of pregnant women and infants with appropriate management of cases found to be at risk. Screening requires a knowledge of the disease, the test, the treatment and the administration of the proposed programme. Treatment can be directed towards the acutely infected mother, the infected fetus or infant and the patient with an acute exacerbation of ocular toxoplasmosis following congenital infection. Harm-benefit assessment of screening programmes designed to prevent congenital toxoplasmosis has produced conflicting results. Further research is required into the incidence of acute toxoplasmosis in pregnancy and subsequent congenital infection, the frequency of neonatal handicap, precise tests for the diagnosis of recent maternal infection and the presence of congenital toxoplasmosis and improved treatment of the infection.

Female↗

Paradoxical effect of clindamycin in experimental, acute toxoplasmosis in cats.

Cats were experimentally inoculated parenterally with the ME49 strain of Toxoplasma gondii to characterize the efficacies of two different dosages of orally administered clindamycin hydrochloride in the treatment of ocular toxoplasmosis. Concentrations of clindamycin hydrochloride at levels previously suggested to be inhibitory to T. gondii replication in vitro were achieved in the serum and aqueous humor but not in the cerebrospinal fluid. Antibiotic therapy, initiated 7 days after inoculation, resulted in no significant difference in the morphometric severity of ocular posterior segment lesions compared with that in the control groups. Treatment appeared to blunt T. gondii-specific immunoglobulin M production but had no significant effect on immunoglobulin G titers. Paradoxically, clindamycin administration was associated with increased morbidity and mortality from hepatitis and interstitial pneumonia, which are characteristic of generalized toxoplasmosis. Serum tumor necrosis factor alpha activity was detected at moderate levels in all groups of cats and correlated with the severity of clinical disease. The results of the study suggest that clindamycin, when administered at this specific time interval following inoculation, does not ameliorate ocular lesions and has a detrimental effect on the clinical course of acute, experimental toxoplasmosis in cats. The factors responsible for and the relevance of this detrimental effect to naturally occurring toxoplasmosis in humans and pet cats were not clear from the study but may relate to an antibiotic-associated decrease in the antitoxoplasmic activity of phagocytic cells responsible for the control of T. gondii.

Acute Disease↗