Abstract
BackgroundMaking a definite diagnosis of infectious uveitis is a challenging task because many other infectious, and non-infectious uveitis, may have similar non-specific symptoms and overlapping clinical appearances. Co-infections in immunocompetent patients are not frequently proved with traditional serologic-diagnostic tools.MethodsDescriptive transversal study, in a Uveitis Service of an Ophthalmology Reference Center, in Bogotá, Colombia, from July 2014 to February 2016. Aqueous humor (AH) and/or vitreous fluid, blood and serum samples were collected from consecutive patients suspected of having infectious uveitis. The diagnosis of ocular toxoplasmosis (OT) was confirmed by the Goldmann–Witmer coefficient (GWC) and by polymerase chain reaction (PCR). Differential diagnosis by PCR in AH was done for viral origin such as Cytomegalovirus (CMV), Herpes simplex virus type 1 (HSV1), Herpes simplex virus type 2 (HSV2), Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and Mycobacterium tuberculosis.ResultsIn 66 Colombian patients with uveitis of presumed infectious origin: 22 (33.3%) were confirmed as OT, 16 (24.2%) as undetermined OT, five (7.5%) as co-infections and 23 (34.8%) as other uveitis. Toxoplasma coinfection with M. tuberculosis was identified in one case by PCR and in four cases with HSV by GWC. The initial clinical diagnosis changed, after laboratory examination, in 21 cases (31.8%).ConclusionsClinical diagnosis can be changed by laboratory examination in a significant proportion of cases of uveitis. Diagnosis of OT should combine the use of PCR and GWC to reach the maximum of confirmation of cases. The use of multiple laboratory methods is necessary to identify co-infections and viral infections that can mimic OT in immunocompetent patients.
Highlights
Making a definite diagnosis of infectious uveitis is a challenging task because many other infectious, and non-infectious uveitis, may have similar non-specific symptoms and overlapping clinical appearances
As the relative importance of different etiologies changes from one geographical site to another, we aim to evaluate the differential diagnosis of this parasitic infection in immunocompetent patients seen in an Ocular Immunology and Uveitis Service, in Bogotá, Colombia
Sixty-six consecutive patients – 32 females (47.8%), and 34 males (51.5%), aged between 13 and 79, with a median age of 37 years – who presented with uveitis that was clinically consistent with ocular toxoplasmosis (OT) were first studied by Toxoplasma serological tests
Summary
Making a definite diagnosis of infectious uveitis is a challenging task because many other infectious, and non-infectious uveitis, may have similar non-specific symptoms and overlapping clinical appearances. Around 10% of people that acquire this infection postnatally [2, 3], and up to 80% of children congenitally infected [4, 5], develop ocular toxoplasmosis (OT) This clinical form of toxoplasmosis is the most common etiology of posterior uveitis worldwide [1, 6]. A definitive diagnosis is only obtained after direct evidence of the presence of the parasite in aqueous humor (AH) by polymerase chain reaction (PCR) that amplifies specific Toxoplasma DNA or by determining the eye’s own antibody production through Goldmann-Witmer coefficient (GWC) [15, 16]. These methods cannot only de-la-Torre et al BMC Infectious Diseases (2019) 19:91 confirm the OT diagnosis but can rule out other similar infectious diseases [17]
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