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PubMed2001

[Diagnosis of the early phase of larval toxocariasis using IgG avidity].

The term avidity used to express the strength of the bond between a serum specimen and a multivalent antigen. It is known that the avidity increases with time after antibody challenge and measurement of the avidity has been used diagnostically. Recently an assay measuring the IgG avidity of various virus infections and of toxoplasmosis was used to distinguish between acute and chronic infection. Our study was focused on the method to distinguish acute and chronic Toxocara infection, zoonosis caused by the larvae of dog and cat ascarids Toxocara canis and Toxocara cati known all over the world for the possibility of provoking the infestation of man, accompanied by visceral or ocular clinical manifestations. The infection is generally diagnosed by demonstration of specific immunoglobulins to Toxocara excretory-secretory antigens (TES) in sera of infected patients. Highly sensitive assays with specific antigens are necessary for detection of antibodies. The test that has been proved clinically useful is the ELISA reaction with TES antigens. This method detects the antibodies for months or even years after infection and this is the reason why the discrimination between chronic and recent infection is very difficult. For disrupting the hydrogen bond urea has been used. The index of avidity was calculated as the ratio of IgG values in sera treated with urea and the value of IgG in non-treated sera, multiplied by 100. An index up to 40 is considered as low avidity, that means freshly acquired infection (36 to 40 borderline) and more than 40 is high avidity. In the group of 1,376 patients only 5.09% low avidities were found. It means that predominantly patients in the chronic stage of infection attend examination.

Animals↗

PubMed1983

Autoimmunity and the outer retina.

Structurally and therefore antigenically the retina is a complex tissue. Since it develops as an extension from the neural tube it shares with the brain several cell membranes and cytoplasm associated antigens including those present in neurofilaments of the various neurones and the glial filaments of the astrocytes. The advent of monoclonal antibodies has helped to dissect, in detail, the antigenic makeup of the retina. Nervous system antigens (NS-3, 4 and 7) are generously represented in the retina. At least in the chick eye there seems to be a concentration gradient of retinal antigens along a dorsoventral axis which is believed to provide means by which neurones of developing retinal signal and receive the positional information necessary for the formation of specific synapses. It now seems certain that organ-specific antigens are presented not only in the photoreceptors and the retinal pigment epithelium but also in the retinal ganglion cells and the astrocytes. Photoreceptor outer-segment contains soluble antigens which when injected in rats, rabbits, guinea-pigs or monkeys produce varying degrees of intraocular inflammation leading to uveitis, retinal detachment, photoreceptor degeneration and occasionally retinal vasculitis. Both cell-mediated and humoral immunity to photoreceptor antigen has been demonstrated in various types of uveitis (including toxoplasmosis and sarcoidosis), pars planitis, vitriitis, Behçets disease, sympathetic ophthalmitis, Vogt-Koyanagi-Harada syndrome, birdshot retinopathy, retinitis pigmentosa and retinal vasculitis. Retinal autoimmunity is also found in retinal detachment and diabetic retinopathy, particularly after Argon laser photocoagulation. Antibodies to retinal antigens are also found in patients with systemic lupus erythematosus and other systemic immune disorders without ocular involvement. The precise pathogenetic role of retinal autoimmunity in eye disease is therefore uncertain. It may simply represent an epiphenomenon which develops afer retinal damage due to physical, micro-organismal or immunological insult. Alternatively it is possible that although autoimmunity does not initiate ocular inflammation it perpetuates and maintains the inflammatory state and produces further damage to ocular tissues.

Animals↗

PubMed1994

Toxoplasma gondii-specific antibodies in the aqueous humor of cats with toxoplasmosis.

We decided to determine whether Toxoplasma gondii-specific IgM or IgG is produced locally or is deposited in the aqueous humor of T gondii-naive cats after primary or secondary inoculation with T gondii. Cats were orally inoculated with T gondii tissue cysts during weeks 0 and 36. Aqueous humor and serum T gondii-specific IgM and IgG were measured, using ELISA, during weeks 0, 2, 4, 6, 8, 12, 16, 20, 26, 34, 38, 40, 42, 44, 48, 56, 62, 66, and 72 after primary oral inoculation. Total immunoglobulin-based Goldmann-Witmer coefficients were calculated to verify intraocular antibody production. Toxoplasma gondii-specific IgM was not detected in the aqueous humor of any cat. Data indicate that cats have transient local production of T gondii-specific IgG in the aqueous humor after primary and secondary oral inoculations with T gondii tissue cysts. The intraocular immune response to systemic T gondii infection may signal ocular recruitment of antigen-specific lymphocytes that function independently from the general humoral response to T gondii infection. Cautious interpretation of results that suggest intraocular production of T gondii-specific IgG in cats with uveitis is warranted.

Animals↗

PubMed1997

Congenital lymphocytic choriomeningitis virus syndrome: a disease that mimics congenital toxoplasmosis or Cytomegalovirus infection.

OBJECTIVE: To describe the clinical characteristics of intrauterine infection with lymphocytic choriomeningitis (LCM) virus, an uncommonly recognized cause of congenital viral infection. PATIENTS: Three infants born in the midwestern United States in 1994 and 1995 with clinical features and serologic studies consistent with congenital LCM virus infection and cases of congenital infection identified by review of the medical literature between 1955 and 1996. RESULTS: Twenty-six infants with serologically confirmed congenital LCM virus infection were identified. Twenty-two infants were products of term gestations, and birth weights ranged from 2384 to 4400 g (median, 3520 g). Ocular abnormalities, macrocephaly, or microcephaly were the most commonly identified neonatal features. Twenty-one infants (88%) had chorioretinopathy, 10 (43%) had macrocephaly (head circumference >90th percentile) at birth, and 3 (13%) were microcephalic (head circumference <10th percentile). Macrocephaly and hydrocephalus developed postnatally in one of the latter infants. Hydrocephalus or intracranial calcifications were documented in five infants by computed tomography or magnetic resonance imaging. Nine infants (35%) died, and 10 (63%) of the 16 reported survivors had severe neurologic sequelae, consisting of spastic quadriparesis, seizures, visual loss, or mental retardation. One-half of the mothers reported illnesses compatible with LCM virus infection, and 25% reported exposures to rodents during their pregnancies. CONCLUSIONS: These cases suggest that congenital LCM virus infection could be an underrecognized cause of congenital infection among infants born in the United States. Because of the clinical similarities of these congenital infections, cases of congenital LCM virus infection can be confused with infections with cytomegalovirus or Toxoplasma gondii.

Apgar Score↗

PubMedDate not supplied

Nested polymerase chain reaction for Mycobacterium tuberculosis DNA detection in aqueous and vitreous of patients with uveitis.

BACKGROUND: Tuberculosis may be a lethal disease. Its ocular manifestations are commonly associated with severe difficulties in diagnosis and therapy; furthermore, it may cause blindness. DNA amplification methods may allow early detection of small amounts of Mycobacterium tuberculosis DNA to afford the possibility of prompt diagnosis. We evaluated a nested polymerase chain reaction (nPCR) assay for detection of Mycobacterium tuberculosis DNA in aqueous and vitreous. METHODS: In a case-control study, 22 cases of diagnosed TB uveitis (three HIV-infected patients) and 38 controls (18 HIV-infected patients) with other types of uveitis (syphilis, nine; cytomegalovirus, seven; toxoplasmosis, five; herpes simplex, one; autoimmune vasculitis, eight; Vogt-Koyanagi-Harada, four; pars planitis, one; serpinginous choroiditis, one; Wegener granulomatosis, one; and Fuchs iridocyclitis, one studied). Samples from aqueous or vitreous were cultured and analyzed by nPCR for presence of M. tuberculosis nucleic acids. We used two sets of primers corresponding to IS6110 region coding for 219 bp and 123 bp DNA sequences. RESULTS: Results were confirmed by Southern blot. All samples were tested by PCR simultaneously for Herpes simplex I, Herpes zoster, cytomegalovirus (CMV) and Toxoplasma gondii. nPCR was positive in 17 cases (77.2%) and only in three controls (8.8%) p = 0.022. All cultures were negative. Southern blot confirmed all positive nPCR tests. According to our definition of cases, there were five false negative results: two in patients with pulmonary tuberculosis; two in patients with tuberculous lymphadenitis, and one with positive skin test and hematuria. There were three cases considered false positives for nPCR: one with autoimmune vasculitis, and two with toxoplasmic uveitis. CONCLUSIONS: nPCR for TB in ocular fluids was positive in the majority of cases of ocular TB. This method is useful in early confirmation of ocular tuberculosis.

Adolescent↗

PubMed2006

Pediatric and adolescent population with visual impairment: study of 385 cases.

OBJECTIVE: To analyze data on the pediatric population attending the Ophthalmologic Clinic's Low Vision Service at the São Paulo University Medical School. METHODS: Low vision ophthalmologic assessment, from April 1998 to December 2003, of 385 children and adolescents with mean age of 7 years; 51.7% males and 48.3% females. The main data analyzed were age, diagnosis, anatomic site of the ocular injury, visual acuity, and prescription of optical aids. RESULTS: 45.4% were below 6 years, and 54.6% were between 6 and 16 years. 35.5% experienced moderate visual impairment, 26% had severe visual impairment, 8.6% had profound visual impairment, 10.6% were near blind, and 1.6% were blind. The main causes of visual impairment included congenital glaucoma (30.6%), macular retinochoroiditis due to congenital toxoplasmosis (16.7%), congenital cataract (12.8%), retinal and macular inherited disorders (11.7%), and optic atrophy (9.8%). Among school-age children, 52.9% received a prescription of optical aids. The most widely used optical aids for distance were 2.8 X 26 (34.4%); 4.2 X 12 (30.3%); and 6 X 17 (26.8%) telescopic systems. The most frequently prescribed optical aid for near vision was the 2x magnifying bar (33.3%). CONCLUSIONS: There is a need for prevention of primary (congenital infections), secondary (congenital glaucoma and retinopathy of prematurity), and tertiary (congenital cataract) visual impairment. The prescription of optical aids for school-age children will help them perform better at school and contribute to their social inclusion.

Adolescent↗

PubMedDate not supplied

Intraretinal hemorrhage associated with leishmaniasis.

A 39-year-old man presented with sudden loss of visual acuity caused by two retinal hemorrhages with no choroidal neovascularization (confirmed by fluorescein angiography). The patient was hospitalized for malaise, progressive pancytopenia, hepatosplenomegaly, progressive anemia, and perianal inflammation. Positive serologies were obtained for toxoplasmosis (IgG) and Leishmania (1/160). A diagnosis of visceral leishmaniasis was made, and the patient was treated with pentavalent antimonials. Two months later, best-corrected visual acuity was 20/25, with no residual scotoma. Indirect ophthalmoscopy showed complete resolution of the hemorrhages. This patient was an otherwise healthy immunocompetent adult who presented frank visceral leishmaniasis and retinal hemorrhages as the only ocular or systemic hemorrhagic findings, with spontaneous resolution after improvement of platelet levels. This rare cause of macular hemorrhage should be considered in areas where Leishmania is endemic.

Adult↗

PubMed1977

Anophthalmos. Report of two cases.

Two infants were found to have bilateral anophthalmos and other congenital anomalies. Secondary anophthalmia was diagnosed in one patient who showed malformations of the brain and an absence of ocular tissues including the optic nerves. The other patient had degenerative (consecutive) anophthalmos; fragments of ocular tissues including the optic nerves were found in the orbits.

Abnormalities, Multiple↗

PubMed2005

Use of PCR to diagnose Toxoplasma gondii chorioretinitis in eyes with severe vitritis.

Two cases are reported of intraocular inflammation in which severe vitritis hampered the fundal view, making an accurate clinical diagnosis impossible, and vitreous analysis using conventional techniques was unhelpful. PCR for Toxoplasma gondii was positive in both cases and provided the only way of confirming the diagnosis. Other ocular samples also underwent PCR for Toxoplasma DNA and the specificity of this approach is demonstrated.

Animals↗

PubMed1994

[Ophthalmologic manifestations in early and late stages of AIDS].

In a prospective study of 101 patients with HIV infection and a medium CD4 lymphocyte cell count of 350 x 10(6)/l and a retrospective study of the records of 79 AIDS patients, we compared the first ocular symptoms in HIV-infected patients to the CD4 count. In Walter-Reed stages 2-4 (n = 101) we found sicca syndrome in 9.2%, in 52% lens opacities in the cortex and only in less than 1% HIV-related angiopathy of the retina. In Walter Reed stages 5-6 (n = 79), 26% of the AIDS patients developed CMV retinitis, 33% HIV angiopathy of the retina and only 1% retinal toxoplasmosis. The average CD4 lymphocyte cell count was never better than 100 x 10(6). Lens opacities in HIV-infected patients could be an early ophthalmological symptom of HIV infection.

AIDS-Related Opportunistic Infections↗

PubMed1995

Comparison of methods for estimation of Toxoplasma gondii-specific antibody production in the aqueous humor of cats.

Intraocular production of Toxoplasma gondii-specific antibody in cats has been estimated by comparing the ratio of T gondii-specific antibody in aqueous humor and serum with the ratio of total immunoglobulins in serum and aqueous humor (Goldmann-Witmer coefficient; aqueous antibody coefficient; C value). It has been proposed that in human beings, comparison of the ratio of T gondii-specific antibody in aqueous humor and serum with the ratio of antibodies against a nonocular pathogen in serum and aqueous humor is more accurate than methods using total immunoglobulin quantification. We developed an ELISA for detection of calicivirus-specific antibodies in the serum and aqueous humor of cats. By evaluating calicivirus-specific antibody concentrations in the aqueous humor of healthy and diseased cats, calicivirus was assessed as a nonintraocular pathogen. The ratio of T gondii-specific antibodies in the aqueous humor and serum and the ratio of calicivirus-specific antibodies in serum and aqueous humor were evaluated as a means of estimating intraocular T gondii-specific antibody production. A field strain of feline calicivirus was isolated, cultured, and purified. A calicivirus-specific IgG ELISA was developed for detection of feline calicivirus-specific IgG in serum and aqueous humor. Calicivirus-specific IgG was measured in the serum and aqueous humor from 3 groups of control cats. Results suggested that calicivirus is a nonintraocular pathogen in cats and that calicivirus IgG detected in aqueous humor is attributable to leakage across a damaged blood-ocular barrier.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Uveitis in childhood.

PURPOSE: To review the etiologic factors and complications of uveitis in patients younger than 16 years. PATIENTS AND METHODS: Between January 1989 and December 1999 in the Department of Ophthalmology of Hacettepe University School of Medicine, 219 patients were diagnosed or observed as having pediatric uveitis. After complete ocular and physical examinations, routine and specific laboratory and radiologic investigations were performed. Medical or surgical treatment was employed when necessary. RESULTS: Of the 219 patients, 112 were girls, with a mean age of 7.4 +/- 4.2 years, and 107 were boys, with a mean age of 8.3 +/- 3.4 years. In 24.2% of the cases, no etiologic factor could be ascertained; these cases comprised the idiopathic group. Among the remaining cases, the most common etiologies were toxoplasmosis, juvenile rheumatoid arthritis (JRA), pars planitis, Behçet's disease, and Fuchs' heterochromic iridocyclitis. Anatomically, anterior uveitis was the most common form. The mean follow-up time was 37 +/- 6.2 months. Complications for which surgical treatment was employed were identified in 71 eyes (20.9%), most of which were due to JRA, pars planitis, or Behçet's disease. CONCLUSION: Uveitis in childhood may be idiopathic or most commonly due to toxoplasmosis, JRA, and pars planitis. Due to inflammation itself or to prolonged therapy especially with corticosteroids, pediatric uveitis entities (mostly JRA, pars planitis, or Behçet's disease) may result in complications necessitating a surgical approach.

Adrenal Cortex Hormones↗

PubMed1994

Ocular and disseminated candidiasis in an immunosuppressed cat.

Ocular and systemic candidiasis was diagnosed in an immunosuppressed and diabetic 12-year-old cat that initially was examined because of polyuria, polydipsia, and urinary tract disease. Bilateral recurrent corneal erosions and chorioretinitis, urinary tract infections attributable to bacteria or Candida sp, and renal dysfunction developed during the next 2 months. Examination of corneal scrapings revealed spherical to oval, budding, yeast-like cells. The cat's condition progressively deteriorated, and it was euthanatized. Toxoplasmosis was diagnosed by fecal flotation and from serum titers, and pituitary-dependent hyperadrenocorticism was detected at postmortem histologic evaluation. Candida budding yeasts and pseudohyphae with blastospores were detected in the corneas, vitreous bodies, retinas, CNS, pharynx, trachea, esophagus, kidneys, and urinary bladder at postmortem examination.

Animals↗

PubMed1996

Uveitis in dogs and cats: guidelines for the practitioner.

Uveitis is a commonly misdiagnosed ophthalmic condition with a wide aetiological base and often the cause cannot be established. Uveitis can be associated with systemic diseases like feline infectious peritonitis, feline immunodeficiency virus, feline leukaemia virus, lymphoma, toxoplasmosis and canine ehrlichiosis. The classification and general clinical signs of uveitis are discussed. Applicable clinical cases, manifestations and diagnostic methods of the selected diseases are mentioned, and a general approach to the treatment of uveitis is given.

Animals↗

PubMed1991

[Uveitis: an etiological study of 200 cases following a protocol].

BACKGROUND: To evaluate the usefulness of a systematic study of patients with uveitis and to assess the associated systemic diseases. METHODS: 200 patients seen in an outpatient clinic for the evaluation of uveitis between 1981 and 1988 were included in the study. Patients with eye disease associated with drug abuse or human immunodeficiency virus were excluded. The study protocol included an initial clinical and ophthalmological evaluation followed by selected specific investigations. RESULTS: Anatomical localization: anterior uveitis 122 (61%), posterior 41 (20.5%), panuveitis 30 (15%) and intermediate 7 (3.5%). ETIOLOGY: 74 cases (37%) were secondary, 101 (50.5%) were idiopathic, and 25 (12.5%) were specific syndromes of uveitis of unknown cause. Toxoplasmosis was the most common cause of infective uveitis, and ankylosing spondylitis was the most common noninfective cause. Diagnostic process: group 1, diagnosed by the ophthalmological investigation (25 cases); group 2, diagnosed on the basis of the accompanying clinical features and/or specific investigations (66 cases); and group 3, diagnosed by wider detection methods (8 cases). CONCLUSIONS: There was a remarkably high rate uveitis without etiological diagnosis. The evaluation of patients with uveitis requires a careful evaluation of ocular and systemic features, followed by selected specific investigation. The indiscriminate use of diagnostic tests is not warranted.

Adolescent↗

PubMed1990

Repeated transplacental transmission of Neospora caninum in dogs.

Four litters of German Shorthaired Pointers from one owner developed a toxoplasmosis-like illness. According to the records, 29 of 39 dogs had hind limb paralysis. Six dogs from 2 litters were necropsied and had generalized encephalomyelitis. Tachyzoites and tissue cysts of Neospora caninum were found in the brain and spinal cord of each dog. Lesions were found in the eyes, extraocular muscles, or both in all of the dogs, and N caninum was detected microscopically in the eyes (retina and choroid in 1 dog), extraocular muscles, or both in 5 of the 6 dogs. Ocular lesions consisted of focal retinitis, choroiditis, mild nonspecific iridocyclitis, and myositis of extraocular muscles. Organisms stained with anti-N caninum serum, but not with anti-Toxoplasma gondii serum in an immunohistochemical test, except in 1 dog. In one dog, aged thick-walled N caninum tissue cysts reacted mildly with anti-T gondii serum.

Animals↗

PubMed1999

[Epidemiology of uveitis].

Uveitis are a large group of inflammatory diseases involving the iris, the ciliary body and the uvea. Multiple causes can be responsible for ocular inflammation that can result either from infectious or autoimmune disease. The incidence varies from 14 to 28/100,000 habitants. According to the anatomical classification, about 30-60% (average 47%) are related to anterior uveitis. 6-30% average 21%) are posterior uveitis, 7-15% (average 12%) are intermediate uveitis and 7-69% (average 20%) are panuveitis. A specific diagnostic can be established in more than 70% in most series. The most frequently diagnosed entities are HLA-B27 related uveitis, acute anterior uveitis in herpes zoster disease, toxoplasmosis, sarcoidosis and pars planitis.

Adolescent↗

PubMed1999

[Diagnostic problems in intraocular melanoma].

PURPOSE: To evaluate accuracy of the diagnosis, rate of advancement and therapeutic possibilities of intraocular malignant melanomas, basing on our one-year clinical material. MATERIAL AND METHODS: The total of 288 consecutive patients with suspicion or diagnosis of intraocular malignant melanoma, referred in the year 1997 to the Department of Ophthalmology CM UJ, were analysed. There were 121 males and 167 females, aged 22-76, mean 50. The period of time between the patient's first ocular symptoms and his visit to the ophthalmologist ranged between 7 days and several years. Besides routine ophthalmological examination each patient underwent USG and, if necessary AF, ICG, CT and IMR. RESULTS: Diagnosis of malignant melanoma was confirmed in 141 cases. Among these patients in 69 brachytherapy was applied, in 20 surgical resection of the tumor and in 52 enucleation. In 111 cases other following diseases were diagnosed: iris cysts, deficient iridectomy, iris nevus, choroidal nevus, metastatic tumors, age-related macular degeneration, myelinated nerve fibres, Leber-Coats syndrome, toxoplasmosis and granulomatous uveitis. In 36 cases the diagnosis was not exact and those patients remained under periodic clinical observation. CONCLUSIONS: Our study shows that in many patients intraocular malignant melanoma is diagnosed too late and in these cases enucleation is the only method of treatment. The most diagnostic challenges are connected with differentiation of choroidal melanoma from choroidal nevus and exudative form of age-related macular degeneration.

Adult↗