Diagnosis of toxoplasmic retinochoroiditis with atypical clinical features

Fardeau, Christine; Romand, S.; Rao, Narsing A.; Cassoux, Nathalie; Bettembourg, O.; Thulliez, P.; LeHoang, Phuc

doi:10.1016/s0002-9394(02)01500-3

Cited by 141 publications

(114 citation statements)

References 19 publications

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“…Additional molecular analyses of ocular fluids are often required for confirmation in this condition. 39 A predominance of macrophages in the vitreous sample may occur in Whipple's disease, ocular toxoplasmosis, and endophthalmitis due to Mycobacterium avium, Histoplasmosis capsulatum, Pneumocystis carinii, Cryptococcus and Blastomyces. In these conditions, fungal stains such as PAS and mucicarmine may reveal cytoplasmic inclusions or cysts of particular sizes and shape.…”

Section: Inflammatory Non-infectious Vitritismentioning

confidence: 99%

The pathologist's perspective on vitreous opacities

Coupland

2008

Eye

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Section: Inflammatory Non-infectious Vitritismentioning

confidence: 99%

The pathologist's perspective on vitreous opacities

Coupland

2008

Eye

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“…Viral retinitis and ocular tuberculosis, both of which can cause focal chorio-retinal lesions, were reported the most likely differential diagnoses for atypical OT. To accurately diagnose OT in such a situation, additional investigations would be needed (Fardeau et al 2002;Mahalakshmi et al 2006;Talabani et al 2009). These include detection of toxoplasma DNA in ocular fluids with polymerase chain reaction and intra-ocular antibody testing for the Goldman-Witmer co-efficient.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, we suspect that a large pool of OT lesions would belong to the 'atypical' category. Such lesions may be confused with other infectious and non-infectious conditions and need additional tests for accurate diagnosis, unlike the typical lesions (Fardeau et al 2002;Mahalakshmi et al 2006;Talabani et al 2009). …”

Section: Introductionmentioning

confidence: 99%

An ophthalmologist survey-based study of the atypical presentations and current treatment practices of ocular toxoplasmosis in India

et al. 2011

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The last two decades have seen a paradigm shift in the understanding of ocular toxoplasmosis. Postnatally acquired infection with its atypical presentations, has emerged as a common form of the disease. We conducted a questionnaire-based survey to investigate the characteristics of atypical presentations and current treatment practices of ocular toxoplasmosis, in India. A written questionnaire was distributed to ophthalmologists at two major uveitis meetings, held in Hyderabad, India in January, 2009. It evaluated characteristics of atypical presentations of ocular toxoplasmosis and specific treatmentrelated issues in India. Of 37 respondents who completed the questionnaire, 28 (75.6%) found atypical presentations in less than one-fourth of ocular toxoplasmosis patients. Atypical presentations were mostly seen as primary retinitis lesion, and in healthy immuno-competent individuals. Most ophthalmologists (n = 28, 75.6%) thought viral retinitis to be the most common differential diagnosis for atypical ocular toxoplasmosis and relied on serological tests (n = 19, 51.3%) for the diagnosis. Twenty-three (62.1%) respondents treated all patients with active lesions. A diverse range of treatment regimens were used, trimethoprim-sulphamethoxazole combination being most common (n = 12, 32.4%). Corticosteroids were included in all regimens. Atypical presentations of ocular toxoplasmosis were identified by all ophthalmologists, participating in the survey, though not commonly by most. Treatment practices were diverse, reflecting the lack of consensus on this issue.

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“…In the eye, the local production of antibodies in the aqueous humour, compared to the serum antibody levels (Goldmann-Wittmer coefficient), can be determined within a sensitivity range of 41-80% (Desmont 1966, Bornard & de Gottrau 1997, Garweg et al 2000, Fardeau et al 2002 and with a specificity of ~90%, depending on the technique used for measuring the antibodies. Thus, using immunoblotting, the sensitivity for IgG detection was 50% with a specificity of 93%; for IgA detection, however, 35% of the patients tested positive and 20% of normal controls had IgA that was reactive to T. gondii (Garweg et al 2004).…”

Section: Discussionmentioning

confidence: 99%