Toxoplasma gondii infection can trigger autoreactivity by different mechanisms. In the case of ocular toxoplasmosis, disruption of the blood-retinal barrier may cause exposure of confined retinal antigens such as recoverin. Besides, cross-reactivity can be induced by molecular mimicry of parasite antigens like HSP70, which shares 76% identity with the human ortholog. Autoreactivity can be a determining factor of clinical manifestations in the eye and in the central nervous system. We performed a prospective observational study to determine the presence of autoantibodies against recoverin and HSP70 by indirect ELISA in the serum of 65 patients with ocular, neuro-ophthalmic and congenital cerebral toxoplasmosis. We found systemic autoantibodies against recoverin and HSP70 in 33.8% and 15.6% of individuals, respectively. The presence of autoantibodies in cases of OT may be related to the severity of clinical manifestations, while in cases with CNS involvement they may have a protective role. Unexpectedly, anti-recoverin antibodies were found in patients with cerebral involvement, without ocular toxoplasmosis; therefore, we analyzed and proved cross-reactivity between recoverin and a brain antigen, hippocalcin, so the immunological phenomenon occurring in one immune-privileged organ (e.g. the central nervous system) could affect the environment of another (egg. the eye).
COMUNICACIONES BrEVES resumen Las vasculitis retinianas secundarias son manifestaciones oculares poco frecuentes de diversas enfermedades con compo-nente autoinmune, como granulomatosis con poliangitis, enfermedad de Behcet, sarcoidosis, lupus eritematoso sistémico y esclerosis múltiple, entre otras. Debido a las repercusiones sistémicas el diagnóstico correcto es de mayor importancia. Los síntomas oftalmológicos más frecuentes son visión borrosa y miodesopsias. En algunos casos se observan signos oftalmo-lógicos altamente sugestivos de ciertas enfermedades como la imagen de periflebitis retiniana en «gota de cera» de la sarcoidosis y el hipopion en la enfermedad de Behcet. Las manifestaciones sistémicas son esenciales para el diagnóstico por lo cual se deben reconocer las principales características de las enfermedades frecuentemente involucradas. Palabras clave: Vasculitis retinianas secundarias. Sarcoidosis. Enfermedad de Behcet. Lupus eritematoso sistémico. Esclerosis múltiple. Abstract Secondary retinal vasculitis are unusual ocular manifestations of several autoimmune diseases, such as granulomatosis with polyangiitis, Behcet disease, sarcoidosis, systemic lupus erythematosus and multiple sclerosis, among others. As a consequence of systemic repercussions the correct diagnosis is of greater importance. The most frequent ophthalmological symptoms are blurry vision and floaters. In some cases highly suggestive ophthalmological signs of certain diseases might be presented, such as retinal periphlebitis also known as "candle wax drippings'' image of sarcoidosis and the hypophion in Behcet disease. Systemic manifestations are essential for a correct diagnosis, therefore main features of the frequently involved diseases shall be identified.
para evitar la ceguera en México -México; 2 Servicio de enfermedades inflamatorias oculares, Asociación para evitar la ceguera en México -México. The authors declare no conflicts of interestRecebido para publicação em 14/2/2014 -Aceito para publicação em 16/9/2014 ABSTRACT Purpose: To correlate clinical findings of Vogt-Koyanagi-Harada disease with standardized echography findings in a cross-sectional, descriptive and observational study. Methods: Patients with Vogt-Koyanagi-Harada disease in the convalescent and recurrence phases were evaluated with standardized ocular echography. Eyes with opaque media were excluded. Clinical findings were correlated with echographic data. Results: Thirty-seven eyes of 25 patients were included. Best corrected visual acuity was in average 20/100 (0.70 logMAR). Clinical findings included: sunset glow fundus (92%), pigment migration (92%), nummular chorioretinal depigmented scars (68%) and subretinal fibrosis (64.8%). Standardized echography was able to recognize all the cases with subretinal fibrosis (n=24) described clinically. Standardized echography showed a 100% sensitivity and specificity of finding subretinal fibrosis. Subretinal fibrosis in patients with Vogt-Koyanagi-Harada represents a risk factor for low vision. In our patients' eyes, presence of subretinal fibrosis had a 2.5 time relative risk of having a visual acuity equal or worst to 20/70. Conclusion: Standardized echography represents a useful tool in patients with VKH in the chronic (convalescence and recurrence) phase of the disease. Subretinal fibrosis, a sight threatening complication in the convalescence and recurrent phases of Vogt-Koyanagi-Harada, can be diagnosed with ocular echography, with characteristic images. Knowledge of these images can be useful in cases with opaque media and bilateral anterior segment granulomatous inflammatory disease.Keywords: Uveomeningoencephalitic syndrome/diagnosis; Ultrasonography; Retinal diseases/diagnosis; Fibrosis/diagnosis RESUMO Objetivo: Correlacionar achados clínicos da síndrome de Vogt-Koyanagi-Harada com resultados ecográficos padronizado da doença em um estudo transversal, descritivo e observacional. Métodos: Pacientes com a doença de Vogt-Koyanagi-Harada, o convalescente e recorrência em fases padronizadas foram avaliados com ecografia ocular. Olhos com material opaco foram excluídos. Achados clínicos foram correlacionados com dados ecográficos. Resultados: Um total de 25 pacientes e trinta e sete olhos foram incluídos no estudo. A acuidade visual (AV) 20/100 foi em média 0.70 logMAR. Os achados clínicos incluídos: sunset glow fundus (92%), pigmento migração (92%), numular despigmentado cicatrizes coriorretinianas (68%) e fibrose sub-retiniana (64,8%). A ecografia padronizada foi capaz de reconhecer todos os casos de fibrose sub-retiniana (n= 24) descrito clinicamente. A ecografia revelou um padrão 100% de sensibilidade e especificidade do diagnóstico fibrose sub-retiniana. Sub-retiniana em pacientes com fibrose Vogt-Koyanagi-Harada representa um fator de risc...
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