Regalado AB, Rodríguez PMS, Fraga NJ, Rojas RL, Núñez FFÁ, Jerez PLE

Language: Spanish
References: 32
Page: 13-25
PDF size: 126.22 Kb.

ABSTRACT

Introduction: Toxoplasma gondii, the causative agent of toxoplasmosis, is an intracellular protozoan that can affect the eye, and be the most common cause of posterior uveitis.
Objective: to determine the usefulness of serological and molecular techniques for the diagnosis of ocular toxoplasmosis in patients with uveitis.
Methods: a cross-sectional study was designed in order to compare a group of patients with toxoplasmic retinochoroiditis and another affected by non-toxoplasmic retinochoroiditis. In both groups serological methods such as indirect immunofluorescence assay, immunoassay (ELISA), and the polymerase chain reaction were used for the diagnosis of ocular toxoplasmosis.
Results: serological techniques allowed detecting anti-Toxoplasma IgG antibodies in 100 % of patients with toxoplasmic retinochoroiditis, and only 3 patients were positive to IgM antibodies. Finally, only one had a weak result for IgG avidity. The polymerase chain reaction detected DNA from Toxoplasma gondii in 15 out of 47 patients for a sensitivity of 31.9 %.
Conclusions: this paper reports the detection of anti-Toxoplasma antibodies in all toxoplasmic retinochoroiditis cases by serological methods; but the most sensible method was immunofluorescence assay. The molecular detection of Toxoplasma gondii's DNA in patients with ocular toxoplasmosis was employed for the first time in Cuba. The results suggest that serological and molecular techniques can be applied to confirm the diagnosis of Toxoplasma infection in patients with toxoplasmic retinochoroiditis.

REFERENCES

1. Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol. 2004; 42:941-5.

2. Holland GN, O'Connor GR, Belfort Jr R, Remington JS. Toxoplasmosis. En: Pepose JS, Holland GN, Wilhelmus KR, editors. Ocular infection and immunity. St Louis: Mosby Year-Book; 2006. p. 1183-223.

3. Pardo A, Callizo J, Valldeperas X. Revisión de la prevención y tratamiento de la toxoplasmosis ocular. Tarragona. Rev An Oftalmol. 2004;12:11-20.

4. Sudharshan S, Ganesh SK, Biswas J. Current approach in the diagnosis and management of posterior uveitis. Indian J Ophthalmol. 2010;58:29-43.

5. Mattos CC, Meira LS, Ferreira AI, Frederico FB, Hiramoto RM, Almeida GC, et al. Contribution of laboratory methods in diagnosing clinically suspected ocular toxoplasmosis in Brazilian patients. Diagn Microbiol Infect Dis. 2011;70:362-6.

6. Bastien P. Molecular diagnosis of toxoplasmosis. Trans R Soc Trop Med Hyg. 2002;96(S1):205-15.

7. Montoya TG. Laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis. J Infect Dis 2002;185(Suppl 1):73-82.

8. Figueroa MS, Bou G, Marti-Belda P, Lopez-Velez R, Guerrero A. Diagnostic value of polymerase chain reaction in blood and aqueous humor in immunocompetent patients with ocular toxoplasmosis. Retina. 2000; 20:614-9.

9. Talabani H, Asseraf M, Yera H, Delair E, Ancelle T, Thulliez P, et al. Contributions of immunoblotting, real-time PCR, and the Goldmann-Witmer coefficient to diagnosis of atypical toxoplasmic retinochoroiditis. J Clin Microbiol 2009;47:2131-5.

10. Sugita S, Ogawa M, Inoue S, Shimizu N, Mochizuki M. Diagnosis of ocular toxoplasmosis by two polymerase chain reaction (PCR) examinations: qualitative multiplex and quantitative real-time. Jpn J Ophthalmol. 2011;55(5):495-501.

11. Montoya JG, Remington JS. Toxoplasmic chorioretinitis in the setting of acute acquired toxoplasmosis. Clin Infect Dis. 1996;23:277-82.

12. Silveira C, Vallochi AL, Rodrigues da Silva U, Muccioli C, Holland GN, Nussenblatt RB, et al. Toxoplasma gondii in the peripheral blood of patients with acute and chronic toxoplasmosis. Br J Ophthalmol. 2011;95(3):396-400.

13. De Boer JH, Verhagen C, Bruinenberg M, Rothova A, de Jong PT, Baarsma GS, et al. Serologic and polymerase chain reaction analysis of intraocular fluids in the diagnosis of infectious uveitis. Am J Ophthalmol. 1996;121:650-8.

14. Danise A, Cinque P, Vergani S, Candino M, Racca S, De Bona A, et al. Use of polymerase chain reaction assays of aqueous humor in the differential diagnosis of retinitis in patients infected with human immunodeficiency virus. Clin Infect Dis. 1997;24:1100-6.

15. Montoya J, Parmley S, Liesenfeld O, Jaffe G, Remington J. Use of the polymerase chain reaction for diagnosis of ocular toxoplasmosis. Ophthalmology. 1999;106:1554-63.

16. Gegundez JA. Exploraciones complementarias en las uveítis. Arch Soc Esp Oftalmol. 2003;78:1-5.

17. Bou G, Figueroa MS, Martí-Belda P, Navas E, Guerrero A. Value of PCR for detection of Toxoplasma gondii in aqueous humor and blood samples from immunocompetent patients with ocular toxoplasmosis. J Clin Microbiol. 1999;37:3465-8.

18. Delgado G, González C. Coriorretinitis por toxoplasmosis: estudio de 65 casos. Rev Cubana Med Trop. 1978;30:69-78.

19. González I, Díaz M, Pérez J. Coriorretinitis por Toxoplasma en niños. Rev Cubana Med Trop. 1999;51:138-42.

20. Álvarez G, Rey A, Adán A. Características clínicas de toxoplasmosis ocular en población inmigrante del área de Barcelona: estudio de 22 pacientes. Arch Soc Esp Oftalmol. 2010;85:202-8.

21. Campos A M, Mariastrid C, Carreño M. Breve descripción de la toxoplasmosis [citada 13 Feb 2012]. Disponible en: http://www.slideshare.net/macr091/toxoplasmosis-11555328

22. Goldman M, Cover RK. Fluorescence inhibition test for toxoplasmosis. Public Health Lab. 1962;20:80-7.

23. Lappalainen M, Koskela P, Koskiniem M, Ammala P, Hilesnaa V, Terano K, et al. Toxoplasmosis acquired during pregnancy. Improved serodiagnosis based on avidity of IgG. J Infect Dis. 1993;167:691-7.

24. Maniatis T, Fritsch EF, Sambrook J. Molecular cloning: a laboratory manual. Cold Spring Harber Laboratory Press. Cold Spring Harber. New York; 1992.

25. Burg JL, Grove CM, Pouletty P, Boothroyd JC. Directed and sensitive detection of a pathogenic protozoan, Toxoplasma gondii, by polymerase chain reaction. J Clin Microbiol 1989; 27:1787-92.

26. Jaeschke R, Guyatt G, Sackett DL, the Evidence-Based Medicine Working Group. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? JAMA. 1994;271:703-7.

27. Commodaro AG, Belfort RN, Rizzo LV, Muccioli C, Silveira C, Burnier Jr MN, et al. Ocular toxoplasmosis: an update and review of the literature. Mem Inst Oswaldo Cruz . 2009;104:345-50.

28. Fekkar A, Bodaghi B, Touafek F, Le Hoang P, Mazier D, Paris L. Comparison of immunoblotting, calculation of the Goldmann-Witmer coefficient, and real-time PCR using aqueous humor samples for diagnosis of ocular toxoplasmosis. J Clin Microbiol. 2008;46:1965-7.

29. Kaplan JE, Benson C, Holmes KH, Brooks JT, Pau A, Masur H, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1-207.

30. Garweg JG, Scherrer J, Wallon M, Kodjikian L, Peyron F. Reactivation of ocular toxoplasmosis during pregnancy. BJOG. 2005;112:241-2.

31. Spalding SM, Amendoeira MR, Klein CH, Ribeiro LC. Serological screening and toxoplasmosis exposure factors among pregnant women in South of Brazil. Rev Soc Bras Med Trop. 2005;38:173-7.

32. Heukelbach J, Meyer-Cirkel V, Sabóia R, Gomide M, Nogueira JA, Saweljew P, et al. Waterborne Toxoplasmosis, Northeastern Brazil. Emerg Infect Dis. 2007;13:287-9.