Serologic evaluation of patients with primary and recurrent ocular toxoplasmosis for evidence of recent infection.

PURPOSE: To identify the frequency of recently acquired vs chronic systemic Toxoplasma gondii infections in patients with ocular toxoplasmosis. METHODS: Serum samples from 22 patients with primary ocular toxoplasmosis (not from scars) and 42 patients with recurrent ocular toxoplasmosis were tested for the presence of anti-T. gondii IgM, IgG, and IgA antibodies and compared with samples from 24 patients with other causes of uveitis. Intraocular production of anti-T. gondii IgG and IgA, and the presence of T. gondii DNA was determined in patient s and control subjects from whom ocular fluid was available. RESULTS: Serologic evidence of recently acquired infection was found for 11 (50%) of 22 patients with primary ocular toxoplasmosis and for one (2%) of 42 with recurrent ocular toxoplasmosis. In the uveitis control group, anti-T. gondii IgM antibodies could be detected in two (8%) of 24 patients, but anti-T. gondii IgA antibodies were not detectable. Patients with primary ocular toxoplasmosis and serologic markers of recently acquired systemic infection were significantly older than those with chronic infection (P = .008). Intraocular production of anti-T. gondii IgG was more frequently noted in patients with recurrent than primary ocular toxoplasmosis (81% vs 41%; P < .001), but intraocular T. gondii DNA was more frequently found in patients with primary ocular toxoplasmosis than in those with recurrent ocular toxoplasmosis (37% vs 4%; P < .01). CONCLUSIONS: Primary ocular toxoplasmosis can be seen in either recently acquired or chronic T. gondii infection. Patients with ocular disease and recently acquired infection were older and more likely to have T. gondii DNA in intraocular fluids.

Recurrent ocular disease in postnatally acquired toxoplasmosis.

PURPOSE: Although recurrences are typical of congenital toxoplasmosis, the long-term ocular manifestations in postnatally acquired toxoplasmosis have never been systematically studied. We report on the ocular manifestations complicating the chronic phase of postnatally acquired toxoplasmosis. METHODS: Review of the clinical data of 14 patients who presented with active ocular toxoplasmosis not associated with scars and who had serologic characteristics of recently acquired systemic toxoplasmosis. RESULTS: Mean follow-up was 4.6 years. Recurrent ocular disease developed in eight (57%) of 14 cases. The number of patients with recurrences increased with the follow-up time: four (29%) of 14 during the first year of follow-up; eight (57%) of 14 during the second year; and eight of nine during the third follow-up year. No risk factors for the development of recurrences were identified. Satellite lesions developed in five of eight patients with recurrences, whereas lesions not adjacent to old scars, located in areas of previously unaffected retina, developed in three patients. CONCLUSIONS: In postnatally acquired toxoplasmosis, frequent recurrences of ocular disease can be seen during the chronic phase of infection.

Antinuclear antibody and HLA-B27 positive uveitis: combination of two diseases?

AIMS/BACKGROUND: Anterior uveitis associated with juvenile chronic arthritis concerns two different clinical entities: firstly, antinuclear antibody (ANA) positive patients who have a chronic anterior uveitis with severe complications and often a poor visual prognosis; secondly, usually HLA-B27 positive children, predominantly boys, with unilateral recurrent anterior uveitis. Three patients are described who had a combination of clinical and laboratory features of both diseases. METHODS: Retrospective clinical and laboratory analysis of three patients. RESULTS: Ocular features in the three patients combined the clinical picture of ANA positive chronic anterior uveitis during early childhood with the clinical features of HLA-B27 unilateral acute anterior uveitis during adolescence. The patients fulfilled the diagnostic criteria of juvenile chronic arthritis, and they had no ankylosing spondylitis. All three patients had the HLA-B*2705 subtype. CONCLUSIONS: Whether the association of ANA positive chronic anterior uveitis and HLA-B27 unilateral acute anterior uveitis is a coincidence or represents a distinct clinical entity is not yet clear.