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Ophthalmoscopic appearances of congenital and acquired presumed ocular toxoplasmosis are described. Four illustrative cases of presumed ocular toxoplasmosis are discussed, with some emphasis on related general health history. Some speculations are offered to account for the varied ophthalmoscopic appearances of these lesions.
PURPOSE: To determine if quantitative competitive polymerase chain reaction can be used to diagnose ocular toxoplasmosis with certainty. METHODS: We examined the vitreous humor of a patient with recurrent ocular toxoplasmosis by using quantitative competitive polymerase chain reaction. RESULTS: The number of Toxoplasma gondii in the vitreous humor was quantified by quantitative competitive polymerase chain reaction. CONCLUSION: Quantitative competitive polymerase chain reaction was useful for diagnosing ocular toxoplasmosis.
Ocular toxoplasmosis is an uncommon complication of acquired immunodeficiency syndrome (AIDS), and it is generally described associated with central nervous system (CNS) lesions. We describe two cases of ocular toxoplasmosis in human immunodeficiency virus (HIV) infected patients, without concurrent CNS infection. Both developed bilateral or unilateral choriorretinitis with favorable response to antitoxoplasma therapy. None of them presented toxoplasmosis of the CNS coexisting with ocular lesions. Ocular toxoplasmosis should be considered in HIV infected patients although no involvement of the CNS is found.
PURPOSE: To evaluate the diagnostic value of polymerase chain reaction (PCR) in blood and aqueous humor samples from immunocompetent patients with reactivated ocular toxoplasmosis. METHODS: Group 1 was composed of seven patients with a clinical diagnosis of reactivated ocular toxoplasmosis. Group 2 consisted of 33 controls. In each subject, blood and aqueous humor samples were obtained for detection of Toxoplasma gondii DNA by means of simple PCR, seminested PCR, and Southern blot hybridization. RESULTS: Group 1: Simple PCR was positive in 3 of 7 blood samples (42%) and in 2 of 7 (28%) aqueous humor samples. Seminested PCR was positive in 4 of 7 (57%) blood samples and in 3 of 7 (42%) aqueous humor samples. Group 2: Simple and seminested PCR were positive in both samples in 2 of 33 (6%) and 4 of 33 (12%), respectively. Sensitivity 57% (18.41-90.10), specificity 87% (71.80-96.60); positive and negative likelihood ratio 4.38 and 0.49, respectively. CONCLUSIONS: Polymerase chain reaction can be useful for confirming the diagnosis of ocular toxoplasmosis, especially in those eyes where fundus examination does not yield conclusive results. The detection of T. gondii DNA in blood suggests that reactivation of ocular toxoplasmosis cannot be considered a local event.
Serological studies are one of the important diagnostic tools used in the investigation of uveitis. This study was based on anti-toxoplasma serotitres obtained from 80 normal healthy adults and 122 patients investigated for ocular toxoplasmosis over a 42 month period. Fifteen per cent of normal healthy sera were found to have low titres (1:64 to 1:256), while 3.8% had high titres (1:1024 or higher). Thirty five eyes of 29 patients had presumed ocular toxoplasmosis based on clinical features and a typical fundal appearance. 89.6% of clinically positive ocular toxoplasmosis were found to have titres ranging from 1:64 to 1:4096. Among the suspected ocular toxoplasmosis cases with a serotitre more than or equal to 1:256, at least 77% had clinical ocular toxoplasmosis.
PURPOSE: Analysis of systemic cellular response to Toxoplasma antigen in patients with ocular toxoplasmosis. METHODS: Activated (CD25(+)) T cells were detected by flow cytometry after a 7-day culture of whole blood from patients with ocular (n = 16) or asymptomatic (n = 14) toxoplasmosis, and controls (n = 10), in the presence of soluble Toxoplasma antigen (ST-Ag). Interferon (IFN)-gamma, interleukin (IL) 4, and IL-10 were measured in culture supernatants by enzyme-linked immunosorbent assay. RESULTS: Higher percentages of CD25(+) T cells were detected in ST-Ag-activated cultures from Toxoplasma-infected patients, with or without ocular lesions (37.0 +/- 19.1% or 41.1 +/- 19.3%, respectively) than from controls (3.2 +/- 1.2%) (P < 0.0001). Differences were not statistically significant between asymptomatic and ocular toxoplasmosis (P > 0.4) or among congenital, acquired, and undetermined ocular toxoplasmosis (P > 0.2). Higher levels of IFN-gamma were detected in ST-Ag-stimulated blood cultures from infected patients than in those from controls (P < 0.0001), with no difference between patients with asymptomatic or ocular toxoplasmosis (P > 0.05). IL-10 was detected only in activated culture supernatants from three patients with ocular toxoplasmosis and two patients with asymptomatic toxoplasmosis. IL-4 was never produced in ST-Ag-activated cultures. CONCLUSIONS: Systemic cellular response to ST-Ag does not differ between the patients with ocular and asymptomatic toxoplasmosis with regard to activation markers and type 1 cytokine production.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.