Immunological tests and their interpretation in uveitis

Abstract

Uveitis is a complex disorder including both infectious and non-infectious etiologies. Clinical diagnosis is a challenge because many diseases share common clinical signs. Laboratory support is crucial for confirming the clinical diagnosis. Laboratory diagnosis includes direct tests and indirect tests. For example smear, culture, and molecular diagnostics demonstrate the pathogens, hence they are direct tests. Immunologic tests employ an antigen to detect presence of antibodies to a pathogen, or an antibody to detect the presence of an antigen, of the pathogen in the specimens. The immunological tests used in laboratories are made by producing artificial antibodies that exactly “match” the pathogen in question. When these antibodies come into contact with a sample they bind to the matching pathogen if found in the sample. Hence they are grouped under indirect evidence. There are several investigations in uveitis to reach the confirmed diagnosis including microbiological, immunological, imaging and molecular diagnostic testing. In this section we will discuss immunological investigations of infectious and non-infectious uveitis.

Clinical spectrum, disease course and management outcome of post-fever retinitis cases: experience from a tertiary eye institute in central India

“…Viral infections occur in close synchrony with environmental factors; the vector responsible for transmission of virus, is directly influenced by conducive environmental conditions for its own breeding and dissemination [ 8 , 9 ]. Serological assays tend to remain positive, in a population, long after the epidemic or illness has subsided [ 5 , 10 ]. Serologies may not provide a definitive evidence of an ongoing ocular infection in this subset of retinitis and guiding treatment based on the same is unlikely to yield better results and could sometimes delay institution of anti-inflammatory therapy.…”

The impact of aqueous humor polymerase chain reaction and serological test results for establishing infectious uveitis diagnosis: An Indonesian experience

“…On the other hand, the performance of the immunological tests for detecting indirect evidence of infections, i.e., IgG and IgM, has gained less attention even though they may still be employed in clinical settings. Seropositivity across populations could be varied, and the interpretation of such positive results could be misleading, especially in only positive IgG [ 16 ].…”

Commentary: Understanding immunological tests for uveitis – ten essentials

“…In this issue of the IJO, Rathinam et al ., have provided a comprehensive overview of the range of different immunological tests currently available in our armamentarium. [ 1 ] However, to use these tests meaningfully, it is important to remember certain fundamental principles about the application of these tests. These are listed below.…”