RESUMEN
BACKGROUND: Retinochoroiditis is the most frequent manifestation of congenital toxoplasmosis. We aimed to describe the ocular outcome and factors that may influence the visual prognosis of these patients. METHODS: Cohort of patients with confirmed congenital toxoplasmosis seen between 1996 and 2017 in Porto Alegre, southern Brazil. RESULTS: Seventy-seven patients were included, of which 65 (85.5%) were identified by routine screening. Median age at the end of the follow-up was 10 years (minimum 2, maximum 25). Retinochoroiditis was present in 55 patients (71.4%). New retinochoroidal lesions developed after the first year of life in 77.8% of the patients who began treatment after the fourth month of life, compared with 35.2% among those treated before 4 months of life (relative risk = 0.45, 95% confidence intervals: 0.27-0.75, P = 0.02) and 33.3% among those treated before 2 months of life (relative risk = 0.42, 95% confidence intervals: 0.25-0.72, P = 0.01). There was a peak incidence of new retinochoroidal lesions between 4 and 5 years and another peak between 9 and 14 years, the latter only among girls. Thirty-four patients with retinochoroiditis were followed up for 10 years or more, and the school performance was appropriate in 28 (82.4%). CONCLUSIONS: The high incidence of new retinochoroidal lesions during the follow-up period indicates the importance of long-term follow-up of patients with congenital toxoplasmosis. Initiating treatment within the first 4 months of life, especially within the first 2 months, was a protective factor against the later development of retinochoroiditis. Despite the usual favorable prognosis, the high morbidity of congenital toxoplasmosis in Brazil was confirmed.
Asunto(s)
Coriorretinitis , Toxoplasmosis Congénita , Adolescente , Adulto , Anticuerpos Antiprotozoarios/sangre , Brasil , Niño , Preescolar , Coriorretinitis/diagnóstico , Coriorretinitis/epidemiología , Coriorretinitis/parasitología , Coriorretinitis/fisiopatología , Femenino , Humanos , Incidencia , Masculino , Pronóstico , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Toxoplasmosis Congénita/complicaciones , Toxoplasmosis Congénita/diagnóstico , Toxoplasmosis Congénita/epidemiología , Toxoplasmosis Congénita/fisiopatología , Agudeza Visual , Adulto JovenRESUMEN
Purpose: The purpose of this article is to analyze possible associations between systemic and ocular cytokine levels and specific clinical ophthalmologic signs from patients with a reactivation of toxoplasmic retinochoroiditis (RTR). Methods: A total of 18 patients with an active RTR episode, 8 patients with inactive scars, and 14 control patients were included in the study. Serum samples and aqueous humor (AH) samples were analyzed for IFN (interferon)-γ, interleukin (IL)-10, and IL-6 levels by ELISA. Inflammation grade, location, and size of the retinochoroidal active lesion, sampling time, and time to resolution were recorded. Results: A significantly negative correlation between AH and serum levels of IFN-γ was detected (p < 0.05). Patients with an AH IFN-γ/IL-10 ratio lower than 1 were associated with the longest time to resolution and/or severe complications. Conclusion: Serum IFN-γ levels may be used as a prognostic marker for both time to resolution and the development of possible severe complications during a given RTR episode.
Asunto(s)
Biomarcadores/sangre , Coriorretinitis/parasitología , Interferón gamma/sangre , Interleucina-10/sangre , Interleucina-6/sangre , Toxoplasma/fisiología , Toxoplasmosis Ocular/parasitología , Adulto , Antiprotozoarios/uso terapéutico , Humor Acuoso/metabolismo , Coriorretinitis/tratamiento farmacológico , Coriorretinitis/inmunología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Factores Inmunológicos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Toxoplasmosis Ocular/tratamiento farmacológico , Toxoplasmosis Ocular/inmunología , Adulto JovenRESUMEN
Abstract Toxoplasmic retinochoroiditis (TR) is the most common identifiable cause of posterior uveitis in Brazil. Response to treatment and clinical presentation may vary significantly. We assessed serum levels of brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), nerve growth factor (NGF), neurotrophin (NT)-3, and NT-4/5 in patients with active TR, before and after TR treatment. Methods: Twenty patients with active lesion and 15 healthy controls were enrolled in the study. Serum concentration of neurotrophic factors was determined by enzyme-linked immunosorbent assay. Results: BDNF levels were significantly higher in patients before treatment when compared with controls (p = 0.0015). There was no significant difference in pro-BDNF, NGF, GDNF, NT-3, and NT-4/5 levels between TR patients and controls. Treatment did not affect the levels of these factors. Conclusion: BDNF may be released in the context of the active TR inflammatory response.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Biomarcadores/sangre , Toxoplasmosis Ocular/sangre , Coriorretinitis/sangre , Ensayo de Inmunoadsorción Enzimática , Estudios de Casos y Controles , Coriorretinitis/parasitología , Factor Neurotrófico Derivado del Encéfalo/sangre , Factor de Crecimiento Nervioso/sangre , Neurotrofina 3/sangre , Factor Neurotrófico Derivado de la Línea Celular Glial/sangre , Factores de Crecimiento Nervioso/sangreRESUMEN
Toxoplasmic retinochoroiditis (TR) is the most common identifiable cause of posterior uveitis in Brazil. Response to treatment and clinical presentation may vary significantly. We assessed serum levels of brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), nerve growth factor (NGF), neurotrophin (NT)-3, and NT-4/5 in patients with active TR, before and after TR treatment. METHODS: Twenty patients with active lesion and 15 healthy controls were enrolled in the study. Serum concentration of neurotrophic factors was determined by enzyme-linked immunosorbent assay. RESULTS: BDNF levels were significantly higher in patients before treatment when compared with controls (p=0.0015). There was no significant difference in pro-BDNF, NGF, GDNF, NT-3, and NT-4/5 levels between TR patients and controls. Treatment did not affect the levels of these factors. CONCLUSION: BDNF may be released in the context of the active TR inflammatory response.
Asunto(s)
Biomarcadores/sangre , Coriorretinitis/sangre , Toxoplasmosis Ocular/sangre , Adulto , Factor Neurotrófico Derivado del Encéfalo/sangre , Estudios de Casos y Controles , Coriorretinitis/parasitología , Ensayo de Inmunoadsorción Enzimática , Femenino , Factor Neurotrófico Derivado de la Línea Celular Glial/sangre , Humanos , Masculino , Factor de Crecimiento Nervioso/sangre , Factores de Crecimiento Nervioso/sangre , Neurotrofina 3/sangreRESUMEN
PURPOSE: To ascertain the clinical features and visual outcome of toxoplasma retinochoroiditis in a large series of cases. SUBJECTS AND METHODS: Two hundred and thirty subjects diagnosed with active toxoplasma retinochoroiditis were prospectively followed for periods ranging from 269 to 1976 days. All patients presented with active retinochoroiditis and positive IgG T. gondii serology at the beginning of the study and received a standardized drug treatment for toxoplasmosis, both in the first episode and in the subsequent recurrences. RESULTS: The group involved 118 (51.3%) men and 112 (48.7%) women, with ages ranging from 14 to 77 years, mean of 32.4 years (SD = 11.38). Primary retinochoroidal lesions were observed in 52 (22.6%) cases and active retinochoroiditis combined with old scars in 178 (77.4%) subjects at the beginning of the study. A hundred sixty-two recurrent episodes in 104 (45.2%) patients were observed during follow-up. New subclinical retinochoroidal lesions were detected in 23 of 162 (14.2%) recurrences episodes during the follow-up. Posterior segment complications were observed in 73 (31.7%) subjects. Retinochoroidal lesions adjacent to the optic nerve and in the macular area were observed in 27 of 40 (67.5%) cases of severe visual impairment (VA = 20/200 or worse). CONCLUSION: Toxoplasma retinochoroiditis in this population had a high recurrence rate after an active episode. Severe visual impairment was associated with location of the retinochoroidal scar, recurrences and posterior segment complications. It is crucial to consider the location of the lesion in studies analyzing visual prognosis as a measure for treatment effectiveness and prevention strategies.
Asunto(s)
Coriorretinitis/fisiopatología , Coriorretinitis/parasitología , Ojo/patología , Toxoplasmosis Ocular/fisiopatología , Agudeza Visual , Adolescente , Adulto , Anciano , Anticuerpos Antiprotozoarios/sangre , Coriorretinitis/tratamiento farmacológico , Ojo/parasitología , Femenino , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Recurrencia , Retina/diagnóstico por imagen , Retina/parasitología , Retina/patología , Toxoplasma/efectos de los fármacos , Toxoplasma/inmunología , Toxoplasma/aislamiento & purificación , Toxoplasmosis Ocular/complicaciones , Toxoplasmosis Ocular/tratamiento farmacológico , Toxoplasmosis Ocular/parasitología , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Ocular toxoplasmosis is a prominent and severe condition of high incidence in Brazil. The current study provides new insights into the immunological events that can be associated with retinochoroiditis in the setting of congenital toxoplasmosis in human infants. METHODS: Flow cytometry of intracytoplasmic cytokines in leukocyte subsets following in vitro short-term antigenic recall in infants with congenital T. gondii infection. RESULTS: Our data demonstrates that whereas neutrophils and monocytes from T. gondii-infected infants display a combination of proinflammatory and regulatory cytokine profiles, natural killer cells showed a predominantly proinflammatory profile upon in vitro T. gondii stimulation. The proinflammatory response of CD4(+) and CD8(+) T cells, characterized by the production of interferon γ (IFN-γ) and interleukin 17 in patients with an active retinochoroidal lesion, revealed the presence of IFN-γ and tumor necrosis factor α during early and late immunological events. This specific proinflammatory pattern is associated with early events and active retinochoroidal lesion, whereas a robust monocyte-derived interleukin 10-mediated profile is observed in children with cicatricial ocular lesions. CONCLUSIONS: These findings support the existence of a progressive immunological environment concomitant with the initial, apical, and cicatricial phases in the process of retinochoroidal lesion formation in infants with congenital toxoplasmosis that may be relevant in the establishment of stage-specific clinical management.
Asunto(s)
Coriorretinitis/inmunología , Citocinas/inmunología , Toxoplasma/inmunología , Toxoplasmosis Ocular/inmunología , Brasil , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Coriorretinitis/congénito , Coriorretinitis/parasitología , Humanos , Lactante , Células Asesinas Naturales/inmunología , Masculino , Monocitos/inmunología , Neutrófilos/inmunología , Toxoplasmosis Ocular/congénito , Toxoplasmosis Ocular/parasitologíaRESUMEN
PURPOSE: To evaluate outcomes and complications of pars plana vitrectomy in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis. METHODS: Retrospective evaluation of the records of 14 patients who underwent pars plana vitrectomy for epiretinal membrane secondary to toxoplasmic retinochoroiditis. The best-corrected visual acuity, intraoperative and postoperative complications, and macular optical coherence tomography were analysed. All patients received postoperative prophylactic treatment with trimethoprim/sulfamethoxazole. RESULTS: Fourteen patients, 5 men and 9 women, were included. Mean follow-up period after surgery was 6.07 ± 2.64 months. Preoperative mean best-corrected visual acuity was 20/200, and postoperative mean best-corrected visual acuity was 20/60. There were no intraoperative complications. Three patients developed posterior capsule opacification, and one patient developed cataract. CONCLUSION: Pars plana vitrectomy is a safe and effective procedure in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis, improving both visual acuity and anatomical result on macular optical coherence tomography. The most frequent postoperative complications were posterior capsule opacification and cataract. No recurrences of the disease were recorded.
Asunto(s)
Coriorretinitis/cirugía , Membrana Epirretinal/cirugía , Infecciones Parasitarias del Ojo/cirugía , Toxoplasmosis Ocular/cirugía , Vitrectomía , Adulto , Antibacterianos/administración & dosificación , Coriorretinitis/diagnóstico por imagen , Coriorretinitis/parasitología , Membrana Epirretinal/diagnóstico por imagen , Membrana Epirretinal/parasitología , Infecciones Parasitarias del Ojo/diagnóstico por imagen , Infecciones Parasitarias del Ojo/parasitología , Femenino , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Recurrencia , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Toxoplasmosis Ocular/diagnóstico por imagen , Toxoplasmosis Ocular/parasitología , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Agudeza Visual/fisiología , Adulto JovenRESUMEN
PURPOSE: To report a case with unilateral preexisting ocular toxoplasmosis (OT) and newly occurred active retinochoroidal inflammation associated with white-centered retinal hemorrhages (Roth spots) in the healthy eye. DESIGN: Case report. METHODS: A 20 year-old man presented with a decrease of visual acuity in his right eye associated with 2+ cells in the anterior chamber. Ophthalmoscopy revealed an active retinochoroidal lesion on the upper nasal border of the optic disc associated with local hemorrhage and vitritis. The posterior pole presented white-centered flame-shaped retinal hemorrhages. RESULTS: Toxoplasmosis serology showed an IgG titer >300IU/ml and a negative IgM titer. A complete blood count revealed no abnormalities; other serologies were negative. After 2 weeks of treatment with sulfadiazine, pyrimethamine, folinic acid and prednisone, although the peripapillary lesion was still active, the Roth spots disappeared. CONCLUSION: OT may be one differential diagnosis of patients suffering Roth spots in association with retinochoroidal inflammation.
Asunto(s)
Coriorretinitis/diagnóstico , Hemorragia Retiniana/diagnóstico , Toxoplasmosis Ocular/diagnóstico , Antiprotozoarios/uso terapéutico , Coriorretinitis/tratamiento farmacológico , Coriorretinitis/parasitología , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Inmunoglobulina G/sangre , Masculino , Oftalmoscopía , Pirimetamina/uso terapéutico , Hemorragia Retiniana/tratamiento farmacológico , Hemorragia Retiniana/parasitología , Sulfadiazina/uso terapéutico , Tomografía de Coherencia Óptica , Toxoplasmosis Ocular/tratamiento farmacológico , Toxoplasmosis Ocular/parasitología , Trastornos de la Visión/diagnóstico , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: To evaluate the ability of real-time quantitative PCR (qPCR) for detectingToxoplasma gondii DNA in the peripheral blood and aqueous humor of patients with toxoplasmic active focal necrotizing retinochoroiditis. METHODS: Fifty-five patients with infectious uveitis seen from 2009 to 2013 at the Department of Ophthalmology and Visual Sciences of the Federal University of São Paulo were enrolled in this study. Forty-three patients had toxoplasmic active focal necrotizing retinochoroiditis, and the remaining 12 had non-toxoplasmic infectious uveitis and served as controls. qPCR analysis forT. gondii DNA was performed on the patients' peripheral blood and aqueous humor samples. RESULTS: The qPCR was positive for T. gondii DNA in 37.21% (16/43) of the aqueous humor samples and 2.33% (1/43) of the peripheral blood samples; further, 16.27% (7/43) of the patients had positive results in both their blood and aqueous humor samples. CONCLUSION: qPCR was able to detect T. gondii DNA in patients with toxoplasmic active focal necrotizing retinochoroiditis in the blood as well as the aqueous humor and can help with the diagnosis of the disease.
Asunto(s)
Humor Acuoso/parasitología , Coriorretinitis/parasitología , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Toxoplasma/genética , Toxoplasmosis Ocular/parasitología , Uveítis/parasitología , Coriorretinitis/sangre , Coriorretinitis/diagnóstico , ADN Protozoario/análisis , ADN Protozoario/sangre , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Toxoplasmosis Ocular/sangre , Toxoplasmosis Ocular/diagnóstico , Uveítis/sangreRESUMEN
ABSTRACT Purpose: To evaluate the ability of real-time quantitative PCR (qPCR) for detectingToxoplasma gondii DNA in the peripheral blood and aqueous humor of patients with toxoplasmic active focal necrotizing retinochoroiditis. Methods: Fifty-five patients with infectious uveitis seen from 2009 to 2013 at the Department of Ophthalmology and Visual Sciences of the Federal University of São Paulo were enrolled in this study. Forty-three patients had toxoplasmic active focal necrotizing retinochoroiditis, and the remaining 12 had non-toxoplasmic infectious uveitis and served as controls. qPCR analysis forT. gondii DNA was performed on the patients' peripheral blood and aqueous humor samples. Results: The qPCR was positive for T. gondii DNA in 37.21% (16/43) of the aqueous humor samples and 2.33% (1/43) of the peripheral blood samples; further, 16.27% (7/43) of the patients had positive results in both their blood and aqueous humor samples. Conclusion: qPCR was able to detect T. gondii DNA in patients with toxoplasmic active focal necrotizing retinochoroiditis in the blood as well as the aqueous humor and can help with the diagnosis of the disease.
RESUMO Objetivo: Analisar o uso do PCR em tempo real (qPCR) na detecção do DNA do T. gondii no sangue periférico e no humor aquoso de pacientes com lesões de retinocoroidite focal, ativa por toxoplasmose. Métodos: Cinquenta e cinco pacientes com uveite infecciosa foram incluídos neste estudo. Os pacientes foram atendidos entre 2009 a 2013, no Departamento de Oftalmologia e Ciências Visuais da Universidade Federal de São Paulo. Quarenta e três pacientes tiveram o diagnóstico de lesões de retinocoroidite focal, ativa por toxoplasmose e, os outros 12 tiveram o diagnóstico de uveíte infecciosa não toxoplásmica e, por isso foram usados como grupo controle. A técnica de qPCR foi utilizada na detecção de DNA do T. gondii em amostras de sangue periférico e humor aquoso. Resultados: O qPCR foi positivo para o DNA do T. gondii em 37,21% (16/43) das amostras de humor aquoso, 2,33% (1/43) nas amostras de sangue periférico e, 16,27% (7/43) em ambas amostras simultaneamente. Conclusão: O qPCR foi capaz de detectar o DNA do T. gondii em pacientes com lesões de retinocoroidite focal, ativa por Toxoplasmose, no sangue bem como, no humor aquoso, podendo ajudar no diagnostico.
Asunto(s)
Femenino , Humanos , Masculino , Humor Acuoso/parasitología , Coriorretinitis/parasitología , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Toxoplasma/genética , Toxoplasmosis Ocular/parasitología , Uveítis/parasitología , Coriorretinitis/sangre , Coriorretinitis/diagnóstico , ADN Protozoario/análisis , ADN Protozoario/sangre , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Toxoplasmosis Ocular/sangre , Toxoplasmosis Ocular/diagnóstico , Uveítis/sangreRESUMEN
PURPOSE: To determine the incidence of, and risk factors for, ocular involvement among people known to have postnatally acquired Toxoplasma gondii infection in a region of southern Brazil where there is a high prevalence of endemic disease. DESIGN: Retrospective longitudinal cohort study. METHODS: Records of 302 patients with serologic evidence of recent T gondii infection (a positive anti-T gondii IgM antibody test) from Erechim, Rio Grande do Sul state, Brazil (1974-2002) were analyzed. The incidence of ocular involvement was calculated in terms of person-years (PY) of follow-up. Risk factors for ocular involvement were analyzed using log-rank and Fisher exact tests. RESULTS: At initial ocular examination (baseline), 30 patients (9.9%) had intraocular inflammation only (anterior chamber cells and flare, vitreous inflammatory reactions, retinal whitening), without clinically apparent necrotizing retinochoroiditis. At baseline, men were more likely to have ocular involvement (P = .043) and antiparasitic treatment was associated with less ocular involvement (P = .015). Follow-up examinations were performed on 255 patients (median follow-up, 13.7 months [range 0.4-261.9 months]). Among those without ocular involvement at baseline, the incidence of necrotizing retinochoroiditis was 6.4/100 PY. Patients >40 years of age at first IgM test had a greater risk of incident necrotizing retinochoroiditis (hazard ratio = 4.47, 95% CI = 1.67-11.93, P = .003) than younger patients. The incidence of recurrent necrotizing retinochoroiditis was 10.5/100 PY. CONCLUSION: Isolated intraocular inflammatory reactions can be an initial manifestation of T gondii infection, with necrotizing retinochoroiditis occurring months or years later. Male sex and older age are risk factors for toxoplasmic retinochoroiditis. Antitoxoplasmic treatment may protect against early ocular involvement.
Asunto(s)
Coriorretinitis/epidemiología , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Toxoplasma/aislamiento & purificación , Toxoplasmosis Ocular/transmisión , Adolescente , Adulto , Anticuerpos Antiprotozoarios/sangre , Brasil/epidemiología , Niño , Preescolar , Coriorretinitis/diagnóstico , Coriorretinitis/parasitología , Estudios de Cohortes , Enfermedades Endémicas , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Estudios de Seguimiento , Humanos , Inmunoglobulina M/sangre , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Estudios Seroepidemiológicos , Toxoplasma/inmunología , Toxoplasmosis Ocular/diagnóstico , Toxoplasmosis Ocular/epidemiología , Toxoplasmosis Ocular/parasitologíaRESUMEN
PURPOSE: To investigate ocular involvement (prevalence, incidence, lesion characteristics) following postnatally acquired infection with an "atypical" genotype of Toxoplasma gondii during a well-characterized 2001 outbreak in Santa Isabel do Ivaí, Brazil, attributed to a contaminated municipal reservoir. DESIGN: Prospective longitudinal cohort study. METHODS: We performed ophthalmic examinations on 290 of 454 individuals with serologic evidence of T gondii infection during the epidemic (positive IgM antibody tests). Prevalence of ophthalmic findings (intraocular inflammatory reactions [including transient, isolated retinal whitening without clinically apparent retinal necrosis] and necrotizing retinochoroiditis) at initial examination (baseline) and incidence of new findings during 10.5 months of follow-up were calculated. Cumulative risks of ophthalmic events were determined (Kaplan-Meier technique). RESULTS: Ocular involvement was present in 33 of 288 IgM+ individuals (11.5%) at baseline, including 17 with focal retinal whitening only and 13 with necrotizing retinochoroiditis. Incidence of new ocular involvement was estimated to be 1.73 events per 100 person-months (PM); cumulative risk at 10.5 months was 30.1%. Incident necrotizing retinochoroiditis was more common among those with focal retinal whitening at baseline (6.7/100 PM) than among those with no ocular involvement at baseline (1.11/100 PM; hazard ratio 6.07 [1.94-19.01]; P < .0001). CONCLUSIONS: Waterborne infection with an atypical genotype of T gondii is associated with substantial risk of ocular involvement. Lesions may continue to develop during the first year after infection. The increased risk of late necrotizing retinochoroiditis associated with isolated focal retinal whitening at presentation suggests the early presence of parasites in the retina, despite initial lack of observable retinal necrosis.
Asunto(s)
Coriorretinitis/epidemiología , Brotes de Enfermedades , Toxoplasma/aislamiento & purificación , Toxoplasmosis Ocular/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antiprotozoarios/sangre , Antiprotozoarios/uso terapéutico , Brasil/epidemiología , Niño , Preescolar , Coriorretinitis/diagnóstico , Coriorretinitis/tratamiento farmacológico , Coriorretinitis/parasitología , Estudios de Cohortes , Enfermedades Endémicas , Ensayo de Inmunoadsorción Enzimática , Femenino , Antagonistas del Ácido Fólico/uso terapéutico , Humanos , Inmunoglobulina M/sangre , Incidencia , Lactante , Recién Nacido , Leucovorina/uso terapéutico , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Pirimetamina/uso terapéutico , Estudios Seroepidemiológicos , Sulfadiazina/uso terapéutico , Toxoplasma/inmunología , Toxoplasmosis Ocular/diagnóstico , Toxoplasmosis Ocular/tratamiento farmacológico , Toxoplasmosis Ocular/parasitología , Agua/parasitología , Abastecimiento de AguaRESUMEN
TNF-α blockers are associated with reactivation of latent granulomatous infections and almost 6% of the world population has some chorioretinitis (CR) caused by Toxoplasma gondii. Thus, the blockade of TNF-α could reactivate a latent toxoplasmosis infection (LTxI). This study was conducted to evaluate the prevalence and incidence of chronic and active CR related to T. gondii in patients with ankylosing spondylitis (AS). A total of 74 eyes from 37 active AS outpatients starting TNFα blockers were compared with 35 AS patients, matched to age and sex, under conventional therapy in a prospective and controlled trial. All patients underwent serological tests for T. gondii, as well as periodic ophthalmologic examination during 12months. Active CR was defined if a white, focal retinochoroidal lesion with overlying vitreous inflammation had been found. Retinochoroidal lesions with sharp edges, hyperpigmented borders and atrophic center were defined as CR scars. At baseline, no patient had active CR. From the 144 eyes examined, almost 6% had CR scars and only 2.1% had a typical toxoplasmic CR scar and all of them were negative for HLA-B27. During 12months of follow-up, no recurrence or new CR were observed. AS patients using TNF-α blockers do not have a higher risk of acute or chronic CR caused by T. gondii.
Asunto(s)
Coriorretinitis/parasitología , Espondilitis Anquilosante/complicaciones , Toxoplasma/fisiología , Toxoplasmosis Ocular/complicaciones , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab , Adulto , Animales , Antiinflamatorios no Esteroideos/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Coriorretinitis/tratamiento farmacológico , Coriorretinitis/inmunología , Etanercept , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulina G/uso terapéutico , Incidencia , Infliximab , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Espondilitis Anquilosante/tratamiento farmacológico , Espondilitis Anquilosante/inmunología , Toxoplasmosis Ocular/tratamiento farmacológico , Toxoplasmosis Ocular/inmunologíaRESUMEN
PURPOSE: Experimental data have demonstrated a relevant role for IL-6 in the modulation of acute ocular toxoplasmosis. Therefore, we aim to investigate the possible association between the IL-6 gene polymorphism at position -174 and toxoplasmic retinochoroiditis (TR) in humans. METHODS: Ninety-seven patients with diagnosed TR were recruited from the Uveitis Section, Federal University of Minas Gerais. For comparison, 83 healthy blood donors with positive serology for toxoplasmosis and without retinal signs of previous TR were included in the study. Genomic DNA was obtained from oral swabs of individuals and amplified using polymerase chain reaction (PCR) with specific primers flanking the locus -174 of IL-6 (-174G/C). PCR products were submitted to restriction endonuclease digestion and analysed by polyacrylamide gel electrophoresis to distinguish allele G and C of the IL-6 gene, allowing the detection of the polymorphism and determination of genotypes. RESULTS: There was a significant difference in the genotype (χ(2) = 12.9, p = 0.001) and allele (χ(2) = 6.62, p = 0.01) distribution between TR patients and control subjects. In a subgroup analysis, there was no significant difference in genotypes and allele frequencies regarding TR recurrence. CONCLUSIONS: This study suggests that the genotypes related with a lower production of IL-6 may be associated with the occurrence of TR.
Asunto(s)
Coriorretinitis/genética , ADN/genética , Interleucina-6/genética , Polimorfismo Genético , Toxoplasmosis Ocular/genética , Adulto , Alelos , Animales , Coriorretinitis/metabolismo , Coriorretinitis/parasitología , Electroforesis en Gel de Poliacrilamida , Femenino , Estudios de Seguimiento , Frecuencia de los Genes , Genotipo , Humanos , Interleucina-6/metabolismo , Masculino , Reacción en Cadena de la Polimerasa , Toxoplasmosis Ocular/metabolismo , Toxoplasmosis Ocular/parasitologíaRESUMEN
PURPOSE: To characterize the active retinochoroiditis lesion observed in patients with the classic clinical presentation of ocular toxoplasmosis (OT) utilizing spectral optical coherence tomography (SOCT). METHODS: Twenty-four patients with OT and satellite lesions underwent standardized ophthalmologic examination and multimodal fundus imaging. The SOCT findings observed at presentation were described. RESULTS: The mean age of the fourteen (58.3%) women and ten (41.7%) men was 27.6 years. The mean LogMAR ETDRS best-corrected visual acuity was 0.58 (Snellen equivalent, 20/80(+1) ). On SOCT evaluation, the posterior hyaloid was diffusely thickened in 23 (95.8%) of 24 eyes, increased hyper-reflective signals in the vitreous were observed in 18 (75.0%), and vitreal spherical hyper-reflective depositions were observed in 12 (50.0%) eyes. In all patients, at the active OT lesion site, the inner retinal layers were abnormally hyper-reflective with full-thickness disorganization of the retinal reflective layers (smudge effect); associated choriocapillaris/choroidal optical shadowing was observed in 22 (91.7%) eyes. The retina was thickened in 22 (91.7%) eyes, the retinal pigment epithelium-Bruch membrane reflective complex was focally increased or contained focal splits in 16 (66.7%) eyes and the choroid appeared thickened in 17 (70.8%) eyes. Disorganization of the outer retinal highly reflective layers adjacent to the active OT lesion was observed in all eyes. CONCLUSION: Full-thickness disorganization of the retinal reflective layers, generally associated with some degree of posterior optical shadowing, was observed in the active OT lesion in all patients. The posterior hyaloid was often thickened and, adjacent to the OT lesion, the outer retina was consistently altered.
Asunto(s)
Coriorretinitis/diagnóstico , Tomografía de Coherencia Óptica , Toxoplasmosis Ocular/diagnóstico , Adolescente , Adulto , Anticuerpos Antiprotozoarios/sangre , Antígenos de Protozoos/inmunología , Niño , Coriorretinitis/inmunología , Coriorretinitis/parasitología , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Persona de Mediana Edad , Toxoplasma/inmunología , Toxoplasmosis Ocular/inmunología , Toxoplasmosis Ocular/parasitología , Agudeza Visual/fisiología , Adulto JovenRESUMEN
This study aimed to investigate the serum levels of the cytokine TNF-α and its soluble receptors (sTNFR1 and sTNFR2) in patients with toxoplasmosis retinochoroidits (TR) and controls. 37 patients with TR and 30 subjects with positive serology for toxoplasmosis but without history and signs of uveitis were included in this study. Serum concentrations of TNF-α, sTNFR1, and sTNFR2 were determined by ELISA. Serum concentrations of TNF-α and sTNFR1 were similar in controls (mean ± SD median values; 56.57 ± 141.96 and 504.37 ± 163.87, respectively) and TR patients (mean ± SD values, 121.62 ± 217.56 and 511.15 ± 189.30, respectively). Serum concentrations of sTNFR2 were higher in the uveitis group when compared to the control group (respectively, mean ± SD values, 1734.84 ± 379.32 and 1442.75 ± 309.47; p=0.002). There was no association between the serum levels of the molecules and the time of first symptoms, severity of vitreous haze, size or localization of active lesions, levels of visual acuity, and presence of vasculitis. These results suggest that TR is associated with changes in the circulating levels of inflammatory biomarkers, but they are not correlated with local/ocular signs.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Coriorretinitis/sangre , Receptores Tipo I de Factores de Necrosis Tumoral/sangre , Receptores Tipo II del Factor de Necrosis Tumoral/sangre , Toxoplasmosis Ocular/sangre , Factor de Necrosis Tumoral alfa/sangre , Biomarcadores/sangre , Estudios de Casos y Controles , Coriorretinitis/parasitologíaRESUMEN
INTRODUCTION: A single nucleotide polymorphism (SNP) in the gene encoding gamma interferon influences its production and is associated with severity of infectious diseases. This study aimed to evaluate the association of IFNγ+874T/A SNP with duration of disease, morbidity, and development of retinochoroiditis in acute toxoplasmosis. METHODS: A case-control study was conducted among 30 patients and 90 controls. RESULTS: Although statistical associations were not confirmed, A-allele was more common among retinochoroiditis cases and prolonged illness, while T-allele was more frequent in severe disease. CONCLUSIONS: Despite few cases, the results could indicate a relation between IFNγ+874T/A single nucleotide polymorphism and clinical manifestations of toxoplasmosis.
INTRODUÇÃO: Um polimorfismo de nucleotideo único (SNP) no gene codificante para interferon gama influencia a sua produção e pode estar associado à gravidade de diversas doenças infecciosas. O objetivo deste estudo foi avaliar a associação entre SNP para IFNγ+874T/A com a duração da doença, a morbidade e o desenvolvimento de retinocoroidite na toxoplasmose aguda. MÉTODOS: Estudo de caso-controle incluindo 30 pacientes e 90 controles. RESULTADOS: Apesar da ausência de associação estatística, o alelo A foi mais comum entre os casos com retinocoroidite e doença prolongada e o alelo T nas formas mais severas. CONCLUSÕES: Os dados encontrados sugerem uma relação entre o polimorfismo de base única em IFNγ+874T/A com a morbidade e com o desenvolvimento de retinocoroidite por toxoplasmose.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Coriorretinitis/parasitología , Frecuencia de los Genes , Interferón gamma/genética , Polimorfismo de Nucleótido Simple/genética , Toxoplasmosis/genética , Enfermedad Aguda , Estudios de Casos y Controles , Coriorretinitis/genética , Predisposición Genética a la Enfermedad , Genotipo , Índice de Severidad de la Enfermedad , Toxoplasmosis Ocular/genéticaRESUMEN
This study aimed to investigate the serum levels of the cytokine TNF-α and its soluble receptors (sTNFR1 and sTNFR2) in patients with toxoplasmosis retinochoroiditis (TR) and controls. 37 patients with TR and 30 subjects with positive serology for toxoplasmosis but without history and signs of uveitis were included in this study. Serum concentrations of TNF-α, sTNFR1, and sTNFR2 were determined by ELISA. Serum concentrations of TNF-α and sTNFR1 were similar in controls (mean ± SD median values; 56.57±141.96 and 504.37±163.87, respectively) and TR patients (mean ± SD values, 121.62±217.56 and 511.15±189.30, respectively). Serum concentrations of sTNFR2 were higher in the uveitis group when compared to the control group (respectively, mean ± SD values, 1734.84±379.32 and 1442.75±309.47; p=0.002). There was no association between the serum levels of the molecules and the time of first symptoms, severity of vitreous haze, size or localization of active lesions, levels of visual acuity, and presence of vasculitis. These results suggest that TR is associated with changes in the circulating levels of inflammatory biomarkers, but they are not correlated with local/ocular signs.
Asunto(s)
Coriorretinitis/sangre , Receptores Tipo II del Factor de Necrosis Tumoral/sangre , Receptores Tipo I de Factores de Necrosis Tumoral/sangre , Toxoplasmosis Ocular/sangre , Factor de Necrosis Tumoral alfa/sangre , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Coriorretinitis/parasitología , Femenino , Humanos , MasculinoRESUMEN
INTRODUCTION: A single nucleotide polymorphism (SNP) in the gene encoding gamma interferon influences its production and is associated with severity of infectious diseases. This study aimed to evaluate the association of IFNγ+874T/A SNP with duration of disease, morbidity, and development of retinochoroiditis in acute toxoplasmosis. METHODS: A case-control study was conducted among 30 patients and 90 controls. RESULTS: Although statistical associations were not confirmed, A-allele was more common among retinochoroiditis cases and prolonged illness, while T-allele was more frequent in severe disease. CONCLUSIONS: Despite few cases, the results could indicate a relation between IFNγ+874T/A single nucleotide polymorphism and clinical manifestations of toxoplasmosis.
Asunto(s)
Coriorretinitis/parasitología , Frecuencia de los Genes , Interferón gamma/genética , Polimorfismo de Nucleótido Simple/genética , Toxoplasmosis/genética , Enfermedad Aguda , Adulto , Estudios de Casos y Controles , Coriorretinitis/genética , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Masculino , Índice de Severidad de la Enfermedad , Toxoplasmosis Ocular/genéticaRESUMEN
The diagnosis of ocular toxoplasmosis is mainly clinical, based in the presence of focal necrotizing retinochoroiditis often associated with a preexistent chorioretinal scar, and variable involvement of the vitreous, retinal blood vessels, optic nerve, and anterior segment of the eye. Recognition of this clinical spectrum of toxoplasmic retinochoroiditis is crucial, but other infectious, noninfectious, and neoplastic entities should also be considered in the differential diagnosis. Investigations such as serological tests, polymerase chain reaction of ocular fluids, and assessment of intraocular antibody synthesis are helpful in uncertain cases. This article provides an overview of the differential diagnosis of ocular toxoplasmosis, focusing on the most important entities to be considered and emphasizing distinctive features of each one of them in the clinical setting. Ocular toxoplasmosis has multiple clinical manifestations, which partially overlap with those of other entities and these should be carefully considered when making the differential diagnosis, particularly in less typical cases.