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Ocular toxoplasmosis: phenotype differences between toxoplasma IgM positive and IgM negative patients in a large cohort
  1. Sofia Ajamil-Rodanes1,
  2. Joshua Luis1,
  3. Rabia Bourkiza1,
  4. Benedict Girling2,
  5. Angela Rees1,
  6. Catherine Cosgrove3,
  7. Carlos Pavesio1,
  8. Mark Westcott1,2
  1. 1 Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
  2. 2 Ophthalmology Department, Barts Health NHS Trust, London, London, UK
  3. 3 Infectious Department, St George's University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Sofia Ajamil-Rodanes, Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK; sofia.ajamil{at}gmail.com

Abstract

Purpose To investigate the differences in demographics and clinical characteristics of patients diagnosed with ocular toxoplasmosis according to their IgM status.

Methods Retrospective case note analysis was carried out on patients who tested positive for serum Toxoplasma gondii-specific IgM antibodies (IgM+) as well as a comparator group who tested negative for serum IgM (IgM-), but positive for serum IgG. Patient demographics and clinical features were compared between the two groups to evaluate for any significant differences.

Results One hundred and six patients were included in the study between March 2011 and June 2018, consisting of 37 in the IgM +group and 69 in the IgM- group. Patients in the IgM +group were significantly older (51.1 vs 34.1 years, p<0.0001), more likely to present with central macular lesions (32% vs 12%, p=0.012), and more likely to develop rhegmatogenous retinal detachment (11% vs 1%, p=0.049). In contrast, patients in the IgM- group were more likely present with pain (20% vs 3%, 0.017) and exhibit more severe inflammation of the anterior chamber and vitreous (p<0.05). Overall, retinal lesions were more likely to be superotemporal (55%) and superonasal (31%). Furthermore, age was associated with larger (p=0.003) and more peripheral lesions (p=0.007).

Conclusions This study demonstrated significant differences in clinical characteristics of ocular toxoplasmosis according to serum IgM status. IgM+ patients were older, less likely to report pain, had lower levels of intraocular inflammation, but were more likely to have macular involvement. We also found age to be correlated with larger and more peripheral lesions.

  • ocular toxoplasmosis
  • serology IgG IgM
  • acute chronic infection

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Footnotes

  • Contributors SA-R collected data and wrote the manuscript with input from all authors. RB and BG collaborated in the data collection. AR and CC gave an input in the manuscript. JL performed the analysis and help in the designing of the the figures, aided in interpreting the results and worked on the manuscript. MW and CP were involved in planning and supervised the work along with writing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was conducted in accordance with the tenets of the Declaration of Helsinki and was approved by the Moorfields Eye Hospital ethics committee (reference number CA18/UV/213).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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