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Ramos RCF, Barbosa ADS, Aleixo ALQDC, Arruda IF, Amendoeira MRR. Comparison of immunological and molecular methods for laboratory diagnosis of ocular toxoplasmosis in blood, serum and tears in Brazil. PLoS One 2024; 19:e0298393. [PMID: 38319921 PMCID: PMC10846737 DOI: 10.1371/journal.pone.0298393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
Ocular toxoplasmosis (OT) is caused by protozoan T. gondii. Ophthalmological examination is considered the gold standard for OT diagnosis, and laboratory tests are used for diagnostic confirmation. However, these tests can present different results, which change depending on their basis, on sample type and on patients' clinical alteration. Thus, the aim of the present study is to assess immunodiagnostic and molecular techniques applied in blood, serum and tear fluid to diagnose T. gondii infection in patients seen at an Ophthalmology Clinic. In total, 160 patients were included in the study, 40 of them had OT with active lesions (G1); 40 had OT with healed lesions (G2), 40 had non-toxoplasmic uveitis (G3) and 40 had no ocular alterations (G4). Serum samples were subjected to Immunoenzymatic Assay (ELISA) and to Indirect Immunofluorescence Reaction (IFAT) to search for anti-T. gondii IgM and IgG. Tear fluid samples were analyzed through ELISA for IgA research. All blood and tear fluid samples were subjected to conventional polymerase chain reaction (cPCR) and in a Nested PCR model for T. gondii DNA amplification with targets B1, GRA7 and REP 529. IgG and IgM anti-T. gondii was detected in serum samples from 106 and 15 patients, respectively, when combining ELISA and IFAT results. Anti-T.gondii IgA antibodies were detected in 9.2% of the tear material. Nested PCR with GRA7 target showed higher positivity in blood samples (24.4%); Nested PCR with B1 target showed a higher frequency of positivity in tears (15%). Biological samples of patients with active lesions showed the highest positivity frequencies in all immunodiagnostic assays, as well as in most PCR models. The present results highlighted the need of associating techniques with different fundamentals to confirm OT diagnosis. Furthermore, further tear fluid analyses should be performed to validate this biological material as lesser invasive alternative for the more accurate OT diagnosis.
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Affiliation(s)
| | - Alynne da Silva Barbosa
- Laboratory of Toxoplasmosis and Other Protozooses, Oswaldo Cruz/Fiocruz Institute, Rio de Janeiro, Brazil
- Department of Microbiology and Parasitology, Biomedical Institute / Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Ana Luisa Quintella do Couto Aleixo
- Laboratory of Clinical Research in Infectious Ophthalmology–Evandro Chagas National Institute of Infectology/Fiocruz, Rio de Janeiro, Brazil
| | - Igor Falco Arruda
- Laboratory of Toxoplasmosis and Other Protozooses, Oswaldo Cruz/Fiocruz Institute, Rio de Janeiro, Brazil
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2
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Yamada K, Tazaki A, Ushio-Watanabe N, Usui Y, Takeda A, Matsunaga M, Suzumura A, Shimizu H, Zheng H, Ariefta NR, Yamamoto M, Hara H, Goto H, Sonoda KH, Nishiguchi KM, Kato M, Nishikawa Y, Toyokuni S, Kaneko H. Retinal ferroptosis as a critical mechanism for the induction of retinochoroiditis during ocular toxoplasmosis. Redox Biol 2023; 67:102890. [PMID: 37738924 PMCID: PMC10519826 DOI: 10.1016/j.redox.2023.102890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Abstract
Toxoplasmosis is a major infectious disease, affecting approximately one-third of the world's population; its main clinical manifestation, ocular toxoplasmosis (OT), is a severe sight-threatening disease. Nevertheless, the diagnosis of OT is based on clinical findings, which needs improvement, even with biochemical tests, such as polymerase chain reaction and antibody detections. Furthermore, the efficacy of OT-targeted treatment is limited; thus, additional measures for diagnosis and treatments are needed. Here, we for the first time report a significantly reduced iron concentration in the vitreous humor (VH) of human patients infected with OT. To obtain further insights into molecular mechanisms, we established a mouse model of T. gondii infection, in which intravitreally injected tracer 57Fe, was accumulated in the neurosensory retina. T. gondii-infected eyes showed increased lipid peroxidation, reduction of glutathione peroxidase-4 expression and mitochondrial deformity in the photoreceptor as cristae loss. These findings strongly suggest the involvement of ferroptotic process in the photoreceptor of OT. In addition, deferiprone, an FDA-approved iron chelator, reduced the iron uptake but also ameliorated toxoplasma-induced retinochoroiditis by reducing retinal inflammation. In conclusion, the iron levels in the VH could serve as diagnostic markers and iron chelators as potential treatments for OT.
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Affiliation(s)
- Kazuhisa Yamada
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Akira Tazaki
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Nanako Ushio-Watanabe
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, 080-8555, Japan.
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, 160-8402, Japan.
| | - Atsunobu Takeda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Masaaki Matsunaga
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan.
| | - Ayana Suzumura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Hideyuki Shimizu
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Hao Zheng
- Department of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Nanang R Ariefta
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, 080-8555, Japan.
| | - Masahiro Yamamoto
- Department of Immunoparasitology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan.
| | - Hideaki Hara
- Department of Biofunctional Evaluation, Molecular Pharmacology, Gifu Pharmaceutical University, Gifu, 501-1196, Japan.
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, 160-8402, Japan.
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Koji M Nishiguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Masashi Kato
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Yoshifumi Nishikawa
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, 080-8555, Japan.
| | - Shinya Toyokuni
- Department of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan; Center for Low-Temperature Plasma Sciences, Nagoya University, Furo-Cho, Chikusa-ku, Nagoya, 464-8603, Japan.
| | - Hiroki Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
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Nsiangani Lusambo N, Kaimbo Wa Kaimbo D, Mumba Ngoyi D, Kilangalanga Ngoy J, Ngoyi Bambi MT, Kadima Mutombo T, Kintoki Makela G, Ngandowe Nzamokili L, de-la-Torre A. Clinical and Serological Characteristics of Ocular Toxoplasmosis in the Democratic Republic of Congo. Ocul Immunol Inflamm 2023; 31:1522-1527. [PMID: 36328437 DOI: 10.1080/09273948.2022.2140297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To describe demographic data, clinical features, and serological profiles in a cohort of Congolese patients with ocular toxoplasmosis (OT). METHOD Cross-sectional study, carried out between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa. RESULTS The study comprised 95 participants with OT. Fifty-three patients were male (55.8%). The mean age at presentation was 35.6 ± 14.1 years (range 8-69 years); 71 had active OT (74.7%), among them, 33 had primary OT (46.5%), and 38 had recurrences (53.5%). At presentation, 51 patients (53.7%) had visual impairment (VA < 6/18). Retinochoroidal lesions were located in the central retina in 60 patients (63.1%). Patients with primary OT tend to have higher IgG levels than those with recurrent OT (P = .01). CONCLUSION We report the largest cohort of patients with OT in sub-Saharan Africa. In our setting, most patients had recurrent OT with multiple, extensive, and central retinochoroidal lesions.
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Affiliation(s)
- Nadine Nsiangani Lusambo
- The Department of Eye, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Kaimbo Wa Kaimbo
- The Department of Eye, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Mumba Ngoyi
- The Department of Parasitology, University Clinic, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | | | - Théodore Kadima Mutombo
- National Eye Care Program, Masina Ophthalmology Hospital, Kinshasa, Democratic Republic of Congo
| | - Guy Kintoki Makela
- National Eye Care Program, Masina Ophthalmology Hospital, Kinshasa, Democratic Republic of Congo
| | - Lady Ngandowe Nzamokili
- National Eye Care Program, Masina Ophthalmology Hospital, Kinshasa, Democratic Republic of Congo
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Goh EJH, Putera I, La Distia Nora R, Mahendradas P, Biswas J, Chee SP, Testi I, Pavesio CE, Curi ALL, Vasconcelos-Santos DV, Arora A, Gupta V, de-la-Torre A, Agrawal R. Ocular Toxoplasmosis. Ocul Immunol Inflamm 2023; 31:1342-1361. [PMID: 36095008 DOI: 10.1080/09273948.2022.2117705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide, affecting individuals acrossdifferent age groups. The key to reducing vision loss includes prompt diagnosis and treatment. However, despite the prevalence of ocular toxoplasmosis, there has been little consensus regarding its pathophysiology,clinical features, diagnosis, and especially management. METHODS The data sources were literature reviews, including Pub Med and Medline databases. Search terms included toxoplasmosis, retinitis, vasculitis, vitritis, uveitis alone or in combination with, serum, aqueous, vitreous eye, ocular and review. RESULTS In this review paper, we have sought to provide an overview of the pathophysiology, epidemiology, and clinical features of the disease, both based on current literature and our own clinical experience. We have also discussed the use of serology, ocular fluid, and ophthalmic investigations that could further facilitate the diagnosis of ocular toxoplasmosis.Different management strategies have been reported worldwide, including newer approaches such as local therapy. CONCLUSION A better understanding of critical aspects of ocular toxoplasmosis will hopefully lead to reduced morbidity, including blindness associated with this condition.
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Affiliation(s)
- Eunice Jin Hui Goh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Soon-Phaik Chee
- Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | | | - Andre Luiz Land Curi
- Infectious Ophthalmology Laboratory, Evandro Chagas National Institute of Infectious Diseases-FIOCRUZ, Rio de Janeiro, Brazil
| | - Daniel Vitor Vasconcelos-Santos
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Hospital São Geraldo, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, The Academia, Singapore
- Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Lee Kong Chian School of Medicine, Singapore
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Souza IMFNBD, Siqueira VDS, Ribeiro IDC, Moraes LSP, Prado DPGD, Rezende SR, Costa WLGD, Rezende HHA. Molecular and serological diagnosis of toxoplasmosis: a systematic review and meta-analysis. Rev Inst Med Trop Sao Paulo 2023; 65:e19. [PMID: 36921207 PMCID: PMC10013468 DOI: 10.1590/s1678-9946202365019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/06/2023] [Indexed: 03/17/2023] Open
Abstract
Toxoplasmosis is an infection of vast worldwide distribution whose etiologic agent is Toxoplasma gondii. This disease can cause problems ranging from mild symptoms to serious conditions, such as encephalitis, miscarriage and blindness. Therefore, it is of utmost importance to perform a diagnosis with reproducible techniques in order to obtain a good prognosis. The aim of this review was to analyze the efficiency of toxoplasmosis diagnostic techniques based on sensitivity and specificity results. Five research platforms in English language were used (Eric, Elsevier, Google Scholar, PubMed and SciELO), which contained data on the diagnosis of toxoplasmosis. The search and selection were performed for studies published prior to June 2021. The search resulted in the inclusion of 13 articles published from 2005 to 2020. The data revealed the use of different samples in the standardization of techniques such as serum, total blood, colostrum and amniotic fluid. The flow cytometry, lateral flow immunoassay and qPCR techniques showed 100% sensitivity, whereas the ELISA, western blotting, qPCR and RE-LAMP techniques achieved 100% specificity. Significantly, the qPCR and LAMP techniques were more accurate when the likelihood ratio was assessed. The meta-analysis identified that ISAGA and western blotting have low sensitivity values and LIASON, ELFA and ELISA, using a silica bioconjugate, also have low specificity values. It was noted that a wide range of methods have high values of sensitivity and specificity. Therefore, the choice of the method will be based on the conditions and its financial viability.
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Affiliation(s)
| | - Victor da Silva Siqueira
- Universidade Federal de Jatai, Programa de Pós-Graduação em Ciências Aplicadas à Saúde, Jataí, Goiás, Brazil
| | | | | | | | | | - Webster Leonardo Guimarães da Costa
- Universidade Federal de Jatai, Programa de Pós-Graduação em Ciências Aplicadas à Saúde, Jataí, Goiás, Brazil.,Universidade Estadual de Campinas, Instituto de Biologia, Programa de Pós-Graduação em Genética e Biologia Molecular (Imunologia), Campinas, São Paulo, Brazil
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Kohler JM, Mammo DA, Bennett SR, Davies JB. Primary ocular toxoplasmosis secondary to venison consumption. Am J Ophthalmol Case Rep 2022; 29:101776. [PMID: 36544752 PMCID: PMC9762148 DOI: 10.1016/j.ajoc.2022.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/04/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose To describe primary ocular toxoplasmosis infection related to ingestion of undercooked venison. Observations This single site, retrospective case series reviewed 4 patients with primary ocular toxoplasmosis that was acquired by ingesting undercooked venison. De-identified data was collected regarding baseline patient characteristics including age, sex, past medical and ocular history, onset of symptoms, visual acuity (VA), response to treatment, and workup. All patients with acquired toxoplasmosis had similar chronology of systemic and ocular symptoms. Exposure occurred in October or November and systemic symptoms developed within 2 weeks, followed by ocular symptoms an average of 2.6 months later. Average age at onset was 56 ± 13 (age ± SD) years old and all were male. Average initial and final VA were 20/50 and 20/50, respectively. Positive anti-toxoplasma IgM and IgG serologies were found in all cases. All patients were treated with trimethoprim/sulfamethoxazole and achieved rapid improvement. Complications occurred in 50% of cases and included epiretinal membrane, cystoid macular edema, vitreoretinal traction, and neovascularization. Conclusions and importance Consumption of undercooked venison is a source of primary ocular toxoplasmosis even in immunocompetent hosts and has a clear chronology. A presentation of retinochoroiditis during the winter months should prompt questioning for exposure to wild game.
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Affiliation(s)
- James M. Kohler
- University of Utah Department of Ophthalmology & Visual Sciences, Salt Lake City, USA
| | | | | | - John B. Davies
- Retina Consultants of Minnesota, Minneapolis, USA,Corresponding author. Retina Consultants of Minnesota, 3601 W 76th St, Suite 300, Edina, MN, 55435, USA.
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7
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Dillon AB, Budoff G, McCannel CA, Tsui E, Pullarkat ST, Schwartz SD. Ocular Toxoplasmosis: No Stranger to the Masquerade Ball. Journal of VitreoRetinal Diseases 2022; 6:391-398. [PMID: 37006900 PMCID: PMC9954925 DOI: 10.1177/24741264211056769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This article illustrates multiple atypical manifestations of ocular toxoplasmosis masquerading as acute retinal necrosis and vitreoretinal lymphoma. Methods: Two case presentations are discussed, and the body of pertinent literature is reviewed and discussed. Results: In these cases, an extensive workup and attention to history lead to the correct diagnosis and management. Conclusions: Aggressive cases of ocular toxoplasmosis may present in a variety of phenotypes that may mimic other vision- and potentially life-threatening conditions, particularly in a milieu of inadequate endogenous and exogenous antimicrobial defenses.
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Affiliation(s)
- Alexander B. Dillon
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Greg Budoff
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Colin A. McCannel
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Edmund Tsui
- Uveitis Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | | | - Steven D. Schwartz
- Vitreoretinal Surgery Service, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
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8
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Wollanke B, Gerhards H, Ackermann K. Infectious Uveitis in Horses and New Insights in Its Leptospiral Biofilm-Related Pathogenesis. Microorganisms 2022; 10:387. [PMID: 35208842 PMCID: PMC8875353 DOI: 10.3390/microorganisms10020387] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/17/2022] Open
Abstract
Uveitis is a sight-threatening eye disease in equids known worldwide that leads to considerable pain and suffering. By far the most common type of uveitis in Germany and neighboring countries is classical equine recurrent uveitis (ERU), which is caused by chronic intraocular leptospiral infection and is the main cause of infectious uveitis in horses. Other infectious causes are extremely rare and are usually clinically distinguishable from ERU. ERU can be treated very effectively by vitreous cavity lavage (vitrectomy). For proper indications of this demanding surgery, it is necessary to differentiate ERU from other types of uveitis in which vitrectomy is not helpful. This can be conducted on the basis of anamnesis in combination with ophthalmologic findings and by aqueous humor examination. During vitrectomy, vitreous material is obtained. These vitreous samples have historically been used for numerous etiologic studies. In this way, a chronic intraocular leptospiral infection has been shown to be the cause of typical ERU and, among other findings, ERU has also been recognized as a biofilm infection, providing new insights into the pathogenesis of ERU and explaining some thus far unexplainable phenomena of ERU. ERU may not only have transmissible aspects to some types of uveitis in humans but may also serve as a model for a spontaneously occurring biofilm infection. Vitreous material obtained during therapeutically indicated vitrectomy can be used for further studies on in vivo biofilm formation, biofilm composition and possible therapeutic approaches.
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Affiliation(s)
- Bettina Wollanke
- Equine Clinic, Ludwig-Maximilians-University, 80539 Munich, Germany; (H.G.); (K.A.)
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9
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Rahimi Esboei B, Fallahi S, Zarei M, Kazemi B, Mohebali M, Shojaee S, Mousavi P, Teimouri A, Mahmoudzadeh R, Salabati M, Keshavarz Valian H. Utility of blood as the clinical specimen for the diagnosis of ocular toxoplasmosis using uracil DNA glycosylase-supplemented loop-mediated isothermal amplification and real-time polymerase chain reaction assays based on REP-529 sequence and B1 gene. BMC Infect Dis 2022; 22:89. [PMID: 35078413 PMCID: PMC8787932 DOI: 10.1186/s12879-022-07073-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ocular infection with Toxoplasma gondii is a major preventable cause of blindness, especially in young people. The aim of the present study was to assess detection rate of T. gondii DNA in blood samples of clinically diagnosed of ocular toxoplasmosis using uracil DNA glycosylase-supplemented loop-mediated isothermal amplification (UDG-LAMP) and real-time quantitative PCR (qPCR) based on REP-529 and B1. METHODS One hundred and seventeen patients with clinically diagnosed ocular toxoplasmosis (OT) were participated in the study as well as 200 control patients. Peripheral blood samples were assessed using UDG-LAMP and qPCR techniques targeting REP-529 and B1. RESULTS Detection limits of qPCR using REP-529 and B1 were estimated as 0.1 and 1 fg of T. gondii genomic DNA, respectively. The limits of detection for UDG-LAMP using REP-529 and B1 were 1 and 100 fg, respectively. In this study, 18 and 16 patients were positive in qPCR using REP-529 and B1, respectively. Based on the results of UDG-LAMP, 15 and 14 patients were positive using REP-529 and B1, respectively. Results of the study on patients with active ocular lesion showed that sensitivity of REP-529 and BI targets included 64 and 63%, respectively using qPCR. Sensitivity of 62 and 61%, were concluded from UDG-LAMP using REP-529 and B1 in the blood cases of active ocular lesion. qPCR was more sensitive than UDG-LAMP for the detection of Toxoplasma gondii DNA in peripheral blood samples of patients with clinically diagnosed toxoplasmic chorioretinitis. Furthermore, the REP-529 included a better detection rate for the diagnosis of ocular toxoplasmosis in blood samples, compared to that the B1 gene did. Moreover, the qPCR and UDG-LAMP specificity assessments have demonstrated no amplifications of DNAs extracted from other microorganisms based on REP-529 and B1. CONCLUSIONS Data from the current study suggest that qPCR and UDG-LAMP based on the REP-529 are promising diagnostic methods for the diagnosis of ocular toxoplasmosis in blood samples of patients with active chorioretinal lesions.
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Affiliation(s)
- Bahman Rahimi Esboei
- Department of Parasitology and Mycology, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Shirzad Fallahi
- Department of Medical Parasitology and Mycology, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Zarei
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Kazemi
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Shojaee
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Mousavi
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aref Teimouri
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Raziyeh Mahmoudzadeh
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mirataollah Salabati
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Hossein Keshavarz Valian
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .,Center for Research of Endemic Parasites of Iran, Tehran University of Medical Sciences, Tehran, Iran.
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10
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Fabiani S, Caroselli C, Menchini M, Gabbriellini G, Falcone M, Bruschi F. Ocular toxoplasmosis, an overview focusing on clinical aspects. Acta Trop 2022; 225:106180. [PMID: 34699742 DOI: 10.1016/j.actatropica.2021.106180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022]
Abstract
Toxoplasma gondii is a widespread protozoan parasite infecting approximately one third of the world population. After proliferation of tachyzoites during the acute stage, the parasite forms tissue cysts in various anatomical sites and establishes chronic infection. Nowadays the nature of the interplay between the protozoan and its human host remains elusive. This is clearly evident in ocular toxoplasmosis, in which the parasite establishes an ambivalent relationship with the eye, manipulating the immune response and inducing variable initial lesions and further relapses. This review will focus on epidemiology and environmental, parasite and host related risk factors, clinical manifestations and laboratory findings, treatment and prophylaxis approaches in ocular toxoplasmosis. An image collection of patients referred to the Unit of Ophthalmology of Pisa's Hospital will be presented, too.
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Schaeffer M, Ballonzoli L, Gaucher D, Arndt C, Angioi-Duprez K, Baudonnet R, Bodaghi B, Bron A, Chiambaretta F, Cimon B, Chiquet C, Creuzot-Garcher C, Daien V, Deleplanque AS, Fricker-Hidalgo H, Hadjadj E, Houze S, Ifrah T, Korobelnik JF, Labalette P, Le Lez ML, L’Ollivier C, Mercie M, Mouriaux F, Paris L, Pelloux H, Pomares C, Quintyn JC, Rougier MB, Rousseau A, Soler V, Talmud M, Villena I, Villard O, Speeg-Schatz C, Bourcier T, Sauer A. Prise en charge de la toxoplasmose oculaire en France : résultats d’une étude Delphi modifiée. J Fr Ophtalmol 2022; 45:413-422. [DOI: 10.1016/j.jfo.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
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Sanfelice RADS, Bortoleti BTDS, Tomiotto-Pellissier F, Silva TF, Bosqui LR, Nakazato G, Castilho PM, de Barros LD, Garcia JL, Lazarin-Bidóia D, Conchon-Costa I, Pavanelli WR, Costa IN. Biogenic silver nanoparticles (AgNp-Bio) reduce Toxoplasma gondii infection and proliferation in HeLa cells, and induce autophagy and death of tachyzoites by apoptosis-like mechanism. Acta Trop 2021; 222:106070. [PMID: 34331897 DOI: 10.1016/j.actatropica.2021.106070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/27/2022]
Abstract
Toxoplasma gondii is a protozoan parasite that can cause severe and debilitating diseases, especially in immunocompromised individuals. The available treatment is based on drugs that have low efficacy, high toxicity, several adverse effects, and need long periods of treatment. Thus, the search for therapeutic alternatives is urgently needed. Biogenic silver nanoparticles (AgNp-Bio) have been associated with several biological effects, as antiproliferative, pro-apoptotic, antioxidant, antiviral, antifungal, and antiprotozoal activity. Thus, the objective was evaluating AgNp-Bio effect on HeLa cells infected with T. gondii (RH strain). First, nontoxic AgNp-Bio concentrations for HeLa cells (1.5 - 6 µM) were determined, which were tested on cells infected with T. gondii. A significant reduction in infection, proliferation, and intracellular parasitic load was observed, also an increase in ROS and IL-6. Additionally, the evaluation of the action mechanisms of the parasite showed that AgNp-Bio acts directly on tachyzoites, inducing depolarization of the mitochondrial membrane, ROS increase, and lipid bodies accumulation, as well as triggering an autophagic process, causing damage to the parasite membrane, and phosphatidylserine exposure. Based on this, it was inferred that AgNp-Bio affects T. gondii by inducing immunomodulation and microbicidal molecules produced by infected cells, and acts on parasites, by inducing autophagy and apoptosis.
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Affiliation(s)
| | | | | | - Taylon Felipe Silva
- Laboratory of Immunoparasitology of Neglected Diseases and Cancer - LIDNC, State University of Londrina, PR, Brazil
| | - Larissa Rodrigues Bosqui
- Laboratory of Immunoparasitology of Neglected Diseases and Cancer - LIDNC, State University of Londrina, PR, Brazil
| | - Gerson Nakazato
- Laboratory of Basic and Applied Bacteriology, State University of Londrina, PR, Brazil
| | - Pablo Menegon Castilho
- Department of Preventive Veterinary Medicine, Laboratory of Animal Protozoology, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid, Pr 445 km 380, 86057-970, Londrina, PR, Brazil
| | - Luiz Daniel de Barros
- Department of Preventive Veterinary Medicine, Laboratory of Animal Protozoology, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid, Pr 445 km 380, 86057-970, Londrina, PR, Brazil
| | - João Luis Garcia
- Department of Preventive Veterinary Medicine, Laboratory of Animal Protozoology, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid, Pr 445 km 380, 86057-970, Londrina, PR, Brazil
| | - Danielle Lazarin-Bidóia
- Laboratory of Immunoparasitology of Neglected Diseases and Cancer - LIDNC, State University of Londrina, PR, Brazil
| | - Ivete Conchon-Costa
- Laboratory of Immunoparasitology of Neglected Diseases and Cancer - LIDNC, State University of Londrina, PR, Brazil
| | - Wander Rogério Pavanelli
- Laboratory of Immunoparasitology of Neglected Diseases and Cancer - LIDNC, State University of Londrina, PR, Brazil
| | - Idessania Nazareth Costa
- Laboratory of Immunoparasitology of Neglected Diseases and Cancer - LIDNC, State University of Londrina, PR, Brazil.
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Robert MG, Brenier-Pinchart MP, Garnaud C, Fricker-Hidalgo H, Pelloux H. Molecular diagnosis of toxoplasmosis: recent advances and a look to the future. Expert Rev Anti Infect Ther 2021; 19:1529-1542. [PMID: 34112045 DOI: 10.1080/14787210.2021.1941867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Toxoplasmosis is a globally distributed parasitic infection that can be particularly severe when opportunistic or congenital. Its diagnosis requires accurate and rapid techniques that rely mainly on serology and molecular methods. AREAS COVERED The aim of this review was to discuss the positioning of the molecular diagnosis of toxoplasmosis according to the different clinical situations possibly resulting from infection with T. gondii, and to detail recent developments in this technique. The English and French literature were searched with the following keywords: 'Toxoplasmosis', "Molecular diagnosis" and 'PCR'. EXPERT OPINION Molecular techniques have revolutionized the diagnosis of toxoplasmosis, and practices have considerably evolved over the past decades. However, there is still a high degree of inter-laboratory heterogeneity which impairs comparisons between results and studies. Efforts to standardize practices are underway.
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Affiliation(s)
- Marie Gladys Robert
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France
| | - Marie-Pierre Brenier-Pinchart
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France.,Centre National de Référence Toxoplasmose - Pôle Biologie Moléculaire, France
| | - Cécile Garnaud
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Hervé Pelloux
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France.,Centre National de Référence Toxoplasmose - Pôle Biologie Moléculaire, France
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Leal SM Jr, Rodino KG, Fowler WC, Gilligan PH. Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Ocular Infections. Clin Microbiol Rev 2021; 34:e0007019. [PMID: 34076493 DOI: 10.1128/CMR.00070-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The variety and complexity of ocular infections have increased significantly in the last decade since the publication of Cumitech 13B, Laboratory Diagnosis of Ocular Infections (L. D. Gray, P. H. Gilligan, and W. C. Fowler, Cumitech 13B, Laboratory Diagnosis of Ocular Infections, 2010). The purpose of this practical guidance document is to review, for individuals working in clinical microbiology laboratories, current tools used in the laboratory diagnosis of ocular infections. This document begins by describing the complex, delicate anatomy of the eye, which often leads to limitations in specimen quantity, requiring a close working bond between laboratorians and ophthalmologists to ensure high-quality diagnostic care. Descriptions are provided of common ocular infections in developed nations and neglected ocular infections seen in developing nations. Subsequently, preanalytic, analytic, and postanalytic aspects of laboratory diagnosis and antimicrobial susceptibility testing are explored in depth.
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Mirahmadi H, Nozari B, Raissi V, Alijani E, Etemadi S. Frequency and parasite load of Toxoplasma gondii in hemodialysis patients based on RE gene by real-time PCR. Gene Reports 2021. [DOI: 10.1016/j.genrep.2021.101145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brenier-Pinchart MP, Robert-Gangneux F, Accoceberry I, Pichard S, Garnaud C, Fricker-Hidalgo H, Lévêque MF, Hoarau G, Pelloux H, Bastien P, Sterkers Y, Varlet-Marie E. Multicenter Comparative Assessment of the TIB MolBiol Toxoplasma gondii Detection Kit and Four Laboratory-Developed PCR Assays for Molecular Diagnosis of Toxoplasmosis. J Mol Diagn 2021; 23:1000-6. [PMID: 34082073 DOI: 10.1016/j.jmoldx.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
Toxoplasmosis can be a life-threatening infection, particularly during pregnancy and in immunocompromised patients. The biological diagnosis of toxoplasmosis is challenging and has been revolutionized by molecular detection methods. This article summarizes the data of a multicenter study involving four centers to assess the performances of a commercial PCR assay as compared with four in-house PCR assays using Toxoplasma gondii standards, 20 external quality control specimens, and 133 clinical samples. This clinical cohort includes well-characterized clinical samples corresponding to different clinical situations: confirmed congenital toxoplasmosis (44 samples), toxoplasmosis in immunocompromised patients (25 samples), and chorioretinitis (5 samples). Furthermore, 59 samples from patients without toxoplasmosis were included as negative controls. The analytical sensitivities of the five methods tested were very similar; and the limit of Toxoplasma DNA detection was around 0.01 T. gondii genome per reaction for all the methods. The overall concordance between the commercial PCR and the four in-house PCR assays was 97.7% (130/133). The clinical sensitivity and specificity were >98% and could be increased for the commercial kit when PCR was performed in multiplicate to detect low parasitic loads. In conclusion, the commercial PCR assay shows suitable performances to diagnose the different clinical forms of toxoplasmosis.
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de Faria Junior GM, Murata FHA, Lorenzi HA, Castro BBP, Assoni LCP, Ayo CM, Brandão CC, de Mattos LC. The Role of microRNAs in the Infection by T. gondii in Humans. Front Cell Infect Microbiol 2021; 11:670548. [PMID: 34055667 PMCID: PMC8160463 DOI: 10.3389/fcimb.2021.670548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
MicroRNAs are molecules belonging to an evolutionarily conserved family of small non-coding RNAs, which act on post-transcriptional gene regulation, causing messenger RNA (mRNA) degradation or inhibiting mRNA translation into proteins. These molecules represent potential biomarkers for diagnosis, non-invasive prognosis, and monitoring the development of the disease. Moreover, they may provide additional information on the pathophysiology of parasitic infections and guide strategies for treatment. The Apicomplexan parasite Toxoplasma gondii modifies the levels of microRNAs and mRNAs in infected host cells by modulating the innate and adaptive immune responses, facilitating its survival within the host. Some studies have shown that microRNAs are promising molecular markers for developing diagnostic tools for human toxoplasmosis. MicroRNAs can be detected in human specimens collected using non-invasive procedures. changes in the circulating host microRNAs have been associated with T. gondii infection in mice and ocular toxoplasmosis in humans. Besides, microRNAs can be amplified from samples using sensitive and molecular-specific approaches such as real-time PCR. This review presents recent findings of the role that microRNAs play during T. gondii infection and discuss their potential use of these small nuclei acid molecules to different approaches such as laboratory diagnosis, modulation of cell and tissue infected as other potential applications in human toxoplasmosis.
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Affiliation(s)
- Geraldo Magela de Faria Junior
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
| | - Fernando Henrique Antunes Murata
- Beltsville Agricultural Research Center, Animal Parasitic Diseases Laboratory, United States Department of Agriculture, Agricultural Research Service, Beltsville, MD, United States
| | | | - Bruno Bello Pede Castro
- Department of Preventive Veterinary Medicine and Animal Health, Faculty of Veterinary Medicine, University of São Paulo, São Paulo, Brazil
| | - Letícia Carolina Paraboli Assoni
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
| | - Christiane Maria Ayo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
| | - Cinara Cássia Brandão
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
| | - Luiz Carlos de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
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Abstract
Infections with the protozoan parasite Toxoplasma gondii are frequent, but one of its main consequences, ocular toxoplasmosis (OT), remains poorly understood. While its clinical description has recently attracted more attention and publications, the underlying pathophysiological mechanisms are only sparsely elucidated, which is partly due to the inherent difficulties to establish relevant animal models. Furthermore, the particularities of the ocular environment explain why the abundant knowledge on systemic toxoplasmosis cannot be just transferred to the ocular situation. However, studies undertaken in mouse models have revealed a central role of interferon gamma (IFNγ) and, more surprisingly, interleukin 17 (IL17), in ocular pathology and parasite control. These studies also show the importance of the genetic background of the infective Toxoplasma strain. Indeed, infections due to exotic strains show a completely different pathophysiology, which translates in a different clinical outcome. These elements should lead to more individualized therapy. Furthermore, the recent advance in understanding the immune response during OT paved the way to new research leads, involving immune pathways poorly studied in this particular setting, such as type I and type III interferons. In any case, deeper knowledge of the mechanisms of this pathology is needed to establish new, more targeted treatment schemes.
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Affiliation(s)
- Valentin Greigert
- Institut de Parasitologie et Pathologie Tropicale, UR 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Faiza Bittich-Fahmi
- Institut de Parasitologie et Pathologie Tropicale, UR 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Alexander W. Pfaff
- Institut de Parasitologie et Pathologie Tropicale, UR 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
- Service de Parasitologie et Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- * E-mail:
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Almeria S, Dubey JP. Foodborne transmission of Toxoplasma gondii infection in the last decade. An overview. Res Vet Sci 2020; 135:371-385. [PMID: 33148402 DOI: 10.1016/j.rvsc.2020.10.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 01/07/2023]
Abstract
Toxoplasmosis is a zoonotic disease of global distribution and importance. It is caused by the protozoan parasite Toxoplasma gondii, the only species in the Toxoplasma genus. This parasite can infect most warm-blooded animals, including humans and livestock. Main routes of transmission are by ingestion of tissue cysts in raw or undercooked meat of infected animals, ingestion of raw vegetables or water contaminated with T. gondii oocysts from cat feces, and transplacental. Around one-third of human beings are chronically infected with T. gondii. Most infections appear to be asymptomatic in immunocompetent persons, but toxoplasmosis can be fatal to the fetus and immunocompromised adults. Water and foodborne outbreaks have been caused by this parasite worldwide, but few are well documented. Importantly, T. gondii is a parasite of high importance in animal health, causing reproductive failure, particularly in small ruminants, and clinical toxoplasmosis in many species. This overview discusses the knowledge of T. gondii infections in the last decade focusing on the foodborne transmission of this parasite.
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Affiliation(s)
- S Almeria
- Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Nutrition, Office of Applied Research and Safety Assessment, Division of Virulence Assessment, Laurel, MD 20708, USA.
| | - J P Dubey
- USA Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Service, Animal Parasitic Disease Laboratory, Building 1001, BARC-East, Beltsville, MD 20705-2350, USA
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Dupont D, Fricker-Hidalgo H, Brenier-Pinchart MP, Garnaud C, Wallon M, Pelloux H. Serology for Toxoplasma in Immunocompromised Patients: Still Useful? Trends Parasitol 2020; 37:205-213. [PMID: 33046380 DOI: 10.1016/j.pt.2020.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022]
Abstract
Toxoplasmosis represents one of the most common comorbidity factors in solid organ or hematopoietic stem cell transplant recipients as well as in other immunocompromised patients. In the past decades, availability and performance of molecular tools for the diagnosis or the exclusion of toxoplasmosis in these patients have greatly improved. However, if accurately used, serology remains a complementary and essential diagnostic tool for physicians and medical parasitologists for the prevention and management of toxoplasmosis in immunocompromised patients as well. It is required for determination of the immunological status of patients against Toxoplasma. It also helps diagnose and monitor complex cases of opportunistic Toxoplasma infection in immunocompromised patients. New perspectives are available to further enhance their yield and ease of use.
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Affiliation(s)
- Damien Dupont
- Institut des Agents Infectieux, Service de Parasitologie Mycologie Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, 69004, France; Physiologie intégrée du système d'éveil, Centre de Recherche en Neurosciences de Lyon, INSERM U1028-CNRS UMR 5292, Faculté de Médecine, Université Claude Bernard Lyon 1, Bron, 69500, France.
| | - Hélène Fricker-Hidalgo
- Laboratoire de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France; Institut pour l'Avancée des Biosciences (IAB), INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, 38000, France
| | - Marie-Pierre Brenier-Pinchart
- Laboratoire de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France; Institut pour l'Avancée des Biosciences (IAB), INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, 38000, France
| | - Cécile Garnaud
- Laboratoire de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France; Université Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, 38000, France
| | - Martine Wallon
- Institut des Agents Infectieux, Service de Parasitologie Mycologie Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, 69004, France; Physiologie intégrée du système d'éveil, Centre de Recherche en Neurosciences de Lyon, INSERM U1028-CNRS UMR 5292, Faculté de Médecine, Université Claude Bernard Lyon 1, Bron, 69500, France
| | - Hervé Pelloux
- Laboratoire de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, 38000, France; Institut pour l'Avancée des Biosciences (IAB), INSERM U1209-CNRS UMR 5309, Université Grenoble Alpes, Grenoble, 38000, France
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Park SM, Lee HA, Chu KB, Quan FS, Kim SJ, Moon EK. Production of a polyclonal antibody against inosine-uridine preferring nucleoside hydrolase of Acanthamoeba castellanii and its access to diagnosis of Acanthamoeba keratitis. PLoS One 2020; 15:e0239867. [PMID: 32997695 DOI: 10.1371/journal.pone.0239867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/14/2020] [Indexed: 11/21/2022] Open
Abstract
Acanthamoeba keratitis (AK) is a rare disease but its prevalence throughout the globe continues to grow, primarily due to increased contact lens usage. Since early-stage symptoms associated with AK closely resemble those from other corneal infections, accurate diagnosis is difficult and this often results in delayed treatment and exacerbation of the disease, which can lead to permanent visual impairment. Accordingly, developing a rapid Acanthamoeba–specific diagnostic method is highly desired. In the present study, a rapid and differential method for AK diagnosis was developed using the secretory proteins derived from the pathogenic Acanthamoeba. Among the vast quantities of proteins secreted by the pathogenic Acanthamoeba, an open reading frame of the inosine-uridine preferring nucleoside hydrolase (IPNH) gene was obtained. After expressing and purifying the IPNH protein using the pGEX 4T-3 vector system, mice were immunized with the purified proteins for polyclonal antibody generation. Western blot was performed using protein lysates of the human corneal cell, non-pathogenic amoeba, pathogenic amoeba, and clinical amoeba isolate along with lysates from other causes of keratitis such as Staphylococcus aureus, Pseudomonas aeruginosa, and Fusarium solani to confirm Acanthamoeba-specificity. Western blot using the polyclonal IPNH antibody revealed that IPNH was Acanthamoeba-specific since these proteins were only observed in lysates of Acanthamoeba origin or its culture media. Our findings indicate that the IPNH antibody of Acanthamoeba may serve as a potential agent for rapid and differential AK diagnosis.
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Sandri V, Gonçalves IL, Machado das Neves G, Romani Paraboni ML. Diagnostic significance of C-reactive protein and hematological parameters in acute toxoplasmosis. J Parasit Dis 2020;:1-9. [PMID: 32904402 DOI: 10.1007/s12639-020-01262-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/17/2020] [Indexed: 01/08/2023] Open
Abstract
Abstract Toxoplasmosis is a zoonosis caused by Toxoplasma gondii, which can be acquired by oral contact and may cause severe health problems especially for pregnant (congenital toxoplasmosis) and immunocompromised patients. This study aimed to verify the diagnostic significance of hematological parameters and C-reactive protein (CRP) for toxoplasmosis acute detection. A case-control study was carried out between December 2017 and May 2018, in samples of convenience independent of age and sex. The case group was formed by 25 patients with positive anti-Toxoplasma gondii IgG/IgM antibody and the control group was formed by 21 patients with non-positive anti-Toxoplasma gondii IgG/IgM antibody. The results of the hematological parameters and CRP were analyzed in these patients. The patients with Toxoplasma gondii IgM antibody reagent showed higher lymphocytes counting and lower neutrophils counting than the control group. C-reactive protein levels were not different between the groups case and control. ROC curve analysis highlighted that the cut-off value of > 32.00% for lymphocytes and < 57.50% for neutrophils were able to produce specificity higher than 90% for IgM antibody detection. The Naïve Bayes classifier was considered suitable (AUC ≈ 0.700) to separate both groups according to their white cell counting. Changes in lymphocytes and neutrophils may be useful parameters for toxoplasmosis identification and may be used as a tool in the complementary diagnosis of toxoplasmosis. Graphic abstract ![]()
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Ferreira AIC, Brandão de Mattos CC, Frederico FB, Bernardo CR, de Almeida Junior GC, Siqueira RC, Meira-Strejevitch CS, Pereira-Chioccola VL, de Mattos LC. Duffy blood group system and ocular toxoplasmosis. Infect Genet Evol 2020; 85:104430. [PMID: 32565360 DOI: 10.1016/j.meegid.2020.104430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Duffy blood group phenotypes [Fy(a + b-), Fy(a-b+), Fy(a + b+), Fy(a-b-)], characterized by the expression of Fya, and Fyb antigens, are present in red blood cells. Therefore, we hypothesize that the non-hematopoietic expression of these antigens might influence cell invasion by T. gondii. 576 consecutive patients from both genders were enrolled. The presumed OT clinical diagnosis was performed. Duffy phenotyping was performed by hemagglutination in gel columns and for the correct molecular characterization Fy(a-b-) phenotype, using PCR-RFLP. Anti-T. gondii IgG antibodies were detected by ELISA. Chi-square, Fisher's exact tests were used to compare the proportions. OT was present in 22.9% (n = 132) and absent in 77.1% (n = 444) of patients. The frequencies of anti-T. gondii IgG antibodies were higher in OT (127/132, 96.2%) than those without this disease (321/444, 72.3%) (p < .0001). None of the Duffy antigens or phenotypes were associated with T. gondii infection (χ2: 2.222, GL: 3, p = .5276) as well as the risk of OT (χ2: 0.771, GL: 3, p = .8566). Duffy blood group system phenotypes and their antigens do not constitute risk factors for infection by T. gondii infection and the development of OT.
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Affiliation(s)
- Ana Iara Costa Ferreira
- Universidade Federal de Roraima. Brazil; Faculdade de Medicina de São Jose do Rio Preto, SP, Brazil
| | | | - Fábio Batista Frederico
- Ophthalmology Outpatient Clinic of Fundação Faculdade Regional de Medicina de São José do Rio Preto, SP, Brazil
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Sigle M, El Atrouni W, Ajlan RS. Seronegative ocular toxoplasma panuveitis in an immunocompetent patient. Am J Ophthalmol Case Rep 2020; 19:100745. [PMID: 32566798 DOI: 10.1016/j.ajoc.2020.100745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose Toxoplasma gondii is the most common cause of infectious posterior uveitis worldwide in immunocompetent patients. Despite its prevalence, diagnosis can still be challenging and vision-threatening in cases with atypical presentations. This case exemplifies the importance of clinical exam and additional workup when required despite negative initial serology results. Observations A 73-year-old immunocompetent woman presented with a 2-year history of recurrent panuveitis and retinal necrosis not responsive to systemic antiviral therapy. Toxoplasma serum antibodies (IgG and IgM) were not detected on systemic workup one year prior. The slit-lamp exam revealed mutton fat keratic precipitates, panuveitis, and necrotic retinal lesions adjacent to a retinal scar. Repeated Toxoplasma serum antibodies (IgG and IgM) were again negative. However, aqueous fluid testing by polymerase chain reaction (PCR) was highly positive for Toxoplasma gondii. The patient improved after starting systemic anti-toxoplasma therapy. Conclusion/Importance To our knowledge, this is the first report in the literature of an immunocompetent patient with ocular toxoplasmosis and undetectable serum IgG and IgM. Aqueous fluid PCR testing is useful in suspected ocular toxoplasmosis in patients with vision-threatening lesions despite negative serology. This is the first report in the English literature of seronegative ocular toxoplasmosis in an immunocompetent patient. Diagnosis of ocular toxoplasmosis can be challenging. Clinical exam and additional workup still have a role in excluding ocular toxoplasmosis in immunocompetent patients. Treatment is recommended in vision-threatening infections.
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Murata FHA, Previato M, Frederico FB, Barbosa AP, Nakashima F, de Faria GM, Silveira Carvalho AP, Meira Strejevitch CDS, Pereira-Chioccola VL, Castiglioni L, de Mattos LC, Siqueira RC, Brandão de Mattos CC. Evaluation of Serological and Molecular Tests Used for the Identification of Toxoplasma gondii Infection in Patients Treated in an Ophthalmology Clinic of a Public Health Service in São Paulo State, Brazil. Front Cell Infect Microbiol 2020; 9:472. [PMID: 32117820 PMCID: PMC7019025 DOI: 10.3389/fcimb.2019.00472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/23/2019] [Indexed: 11/13/2022] Open
Abstract
Ocular toxoplasmosis is one of the most common complications caused by the infection with the parasite Toxoplasma gondii. The risk of developing eye lesions and impaired vision is considered higher in Brazil than other countries. The clinical diagnosis is difficult and the use of sensitive and specific laboratorial methods can aid to the correct diagnosis of this infection. We compared serological methods ELISA and ELFA, and molecular cPCR, Nested PCR and qPCR for the diagnosis of T. gondii infection in groups of patients clinically evaluated with ocular diseases non-toxoplasma related (G1 = 185) and with lesions caused by toxoplasmosis (G2 = 164) in an Ophthalmology clinic in Brazil. Results were compared by the Kappa index, and sensitivity (S), specificity (E), positive predictive value (PPV), and negative (NPV) were calculated. Serologic methods were in agreement with ELISA more sensitive and ELFA more specific to characterize the acute and chronic infections while molecular methods were discrepant where qPCR presented higher sensitivity, however, lower specificity when compared to cPCR and Nested PCR.
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Affiliation(s)
- Fernando Henrique Antunes Murata
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | - Mariana Previato
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | - Fábio Batista Frederico
- FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil.,Ambulatório de Oftalmologia Do Hospital de Base, Fundação Faculdade Regional de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil
| | - Amanda Pires Barbosa
- Ambulatório de Oftalmologia Do Hospital de Base, Fundação Faculdade Regional de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil
| | - Fabiana Nakashima
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil
| | - Geraldo Magela de Faria
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | | | | | - Vera Lucia Pereira-Chioccola
- Laboratório de Biologia Molecular de Parasitas e Fungos Do Centro de Parasitologia e Micologia, Instituto Adolfo Lutz, São Paulo, Brazil
| | - Lilian Castiglioni
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil
| | - Luiz Carlos de Mattos
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | - Rubens Camargo Siqueira
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
| | - Cinara Cássia Brandão de Mattos
- Faculdade de Medicina de São José Do Rio Preto, São José Do Rio Preto, Brazil.,FAMERP Toxoplasma Research Group, São José Do Rio Preto, Brazil
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Nakashima F, Pardo VS, Miola MP, Murata FHA, Paduan N, Longo SM, Brandão de Mattos CC, Pereira-Chioccola VL, Ricci O, de Mattos LC. Serum IgG Anti- Toxoplasma gondii Antibody Concentrations Do Not Correlate Nested PCR Results in Blood Donors. Front Cell Infect Microbiol 2020; 9:461. [PMID: 31993377 PMCID: PMC6970978 DOI: 10.3389/fcimb.2019.00461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background:Toxoplasma gondii infects millions of individuals worldwide. This protozoan is food and water-borne transmitted but blood transfusion and organ transplantation constitute alternative forms for transmission. However, the influence of IgG anti-T. gondii antibodies in molecular analysis carried out in peripheral blood still remain unclear. This study aimed to investigate the serum IgG anti-T. gondii antibody concentrations correlate Nested PCR results in blood donors. Methods: 750 blood donors were enrolled. IgM and IgG anti-T. gondii antibodies were assessed by ELISA (DiaSorin, Italy). Nested PCR was performed with primers JW62/JW63 (288 bp) and B22/B23 (115 bp) of the T. gondii B1 gene. The mean values of IgG concentration were compared for PCR positive and PCR Negative blood donors using the t-test or Mann-Whitney according to the normal distribution (p-value ≤ 0.05). Results: 361 (48.1%) blood donors presented positive serology as follow: IgM+/IgG−: 5 (0.6%); IgM+/IgG+: 21 (2.8%); IgM−/IgG+: 335 (44.7%) and 389 (51.9%), negative serology. From 353 blood donors with positive serology tested, the Nested PCR was positive in 38 (10.8%) and negative in 315 (89.2%). There were no differences statistically significant between the mean values of serum IgG anti-T. gondii antibody concentrations and the Nested PCR results. Conclusions: In conclusion, our data show that variations in the serum IgG anti-T. gondii antibody concentrations do not correlate T. gondii parasitemia detected by Nested PCR in chronically infected healthy blood donors.
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Affiliation(s)
- Fabiana Nakashima
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Valquíria Sousa Pardo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Marcos Paulo Miola
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil.,Blood Bank São José do Rio Preto, Fundação Faculdade Regional de Medicina, São Paulo, Brazil
| | | | - Natalia Paduan
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Stefani Miqueline Longo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Cinara Cássia Brandão de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil.,FAMERP Toxoplasma Research Group, São Paulo, Brazil
| | | | - Octávio Ricci
- Blood Bank São José do Rio Preto, Fundação Faculdade Regional de Medicina, São Paulo, Brazil
| | - Luiz Carlos de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil.,FAMERP Toxoplasma Research Group, São Paulo, Brazil
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Greigert V, Pfaff AW, Sauer A, Filisetti D, Candolfi E, Villard O. Biological Diagnosis of Ocular Toxoplasmosis: a Nine-Year Retrospective Observational Study. mSphere 2019; 4:e00636-19. [PMID: 31554726 DOI: 10.1128/mSphere.00636-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Ocular toxoplasmosis (OT), a parasitic infection of the eye, is considered to be the most important infectious cause of posterior uveitis worldwide. Its prevalence is particularly high in South America, where aggressive Toxoplasma gondii strains are responsible for more-severe presentations. The particular pathophysiology of this infection leads, from recurrence to recurrence, to potentially severe vision impairment. The diagnosis of this infection is usually exclusively based on the clinical examination. However, the symptoms may be misleading and are not always sufficient to confirm a diagnosis of OT. In such cases, biological tests performed by means of several techniques on blood and ocular samples may facilitate the diagnosis. In this study, we analyzed the tests that were performed in our laboratory over a 9-year period every time OT was suspected. Our report highlights that the quality of ocular sampling by ophthalmologists and combinations of several techniques are critical for a reliable biological OT diagnosis. Ocular toxoplasmosis (OT), i.e., the ocular manifestation of Toxoplasma gondii infection, is one of the leading causes of posterior uveitis. While ocular lesions are often typical, atypical forms often require biological confirmation of the diagnosis. Our study sought to review the biological OT diagnoses made in our laboratory to further assess the role of each test in the diagnostic procedure. All ocular samples sent to our laboratory over the last 9 years for OT diagnosis were included. These samples were analyzed using T. gondii PCR and antibody detection by means of immunoblotting and Candolfi coefficient (CC) determinations, either alone or in combination. Since serum analysis is required to interpret both the CC and immunoblotting, blood serology for T. gondii was also performed in most cases. Of the 249 samples analyzed, 80 (32.1%; 95% confidence interval [95%CI], 26.3 to 37.9) were positive for OT. Of these 80 cases, 52/80 (65.0%; 54.6 to 74.5) displayed a positive PCR, 15/80 (18.8%; 10.2 to 27.3) a positive CC, and 33/80 (41.3%; 95%CI, 30.5 to 52.0) a positive immunoblot result. Overall, 63 of the 80 OT diagnoses (78.8%; 95%CI, 69.8 to 87.7) were made on the basis of a single positive test result. Our study results remind us that current biological diagnostic tools for OT must be employed in combination to obtain an optimal diagnosis based on the precious ocular fluids sampled by ophthalmologists. Clinicobiological studies that are focused on correlating the performances of the different tests with clinical features are critically needed to improve our understanding of the pathophysiology and diagnosis of OT. IMPORTANCE Ocular toxoplasmosis (OT), a parasitic infection of the eye, is considered to be the most important infectious cause of posterior uveitis worldwide. Its prevalence is particularly high in South America, where aggressive Toxoplasma gondii strains are responsible for more-severe presentations. The particular pathophysiology of this infection leads, from recurrence to recurrence, to potentially severe vision impairment. The diagnosis of this infection is usually exclusively based on the clinical examination. However, the symptoms may be misleading and are not always sufficient to confirm a diagnosis of OT. In such cases, biological tests performed by means of several techniques on blood and ocular samples may facilitate the diagnosis. In this study, we analyzed the tests that were performed in our laboratory over a 9-year period every time OT was suspected. Our report highlights that the quality of ocular sampling by ophthalmologists and combinations of several techniques are critical for a reliable biological OT diagnosis.
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