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Journal of Clinical Microbiology, March 2000, p. 996-1001, Vol. 38, No. 3
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Early Aqueous Humor Analysis in Patients with Human Ocular Toxoplasmosis

Justus G. Garweg,1,* Patrick Jacquier,2 and Matthias Boehnke1

Department of Ophthalmology, University of Bern, Inselspital, CH-3010 Bern,1 and ParaDiag, Laboratory for Clinical Parasitology, CH-3000 Bern 13,2 Switzerland

Received 26 April 1999/Returned for modification 7 June 1999/Accepted 24 November 1999

To evaluate the diagnostic sensitivity of a panel of laboratory tests for ocular toxoplasmosis performed at the time of presentation, paired samples of aqueous humor and serum were collected from 49 consecutive episodes of ocular toxoplasmosis with a clinical course of less than 3 weeks. Total immunoglobulin G (IgG) and Toxoplasma gondii-specific IgG, IgM, and IgA were quantified by enzyme-linked immunosorbent assay. The avidity of T. gondii-specific IgG was determined, and DNA extracted from aqueous humor was amplified for detection of a glycoprotein B gene sequence of T. gondii. The diagnosis was confirmed for 73% (36 of 49) of the patients; this rate rose to 79.5% if data from a later analysis of aqueous humor derived from five of the negative patients were included. The analysis of serum (detection of T. gondii-specific IgM and analysis of consecutive serum samples) alone did not contribute to the diagnosis. Calculation of local antibody production lacked diagnostic sensitivity when it was determined less than 3 weeks after the manifestation of clinical symptoms (28 of 49 patients [57%]), but this rose to 70% after an analysis of a second aqueous humor sample. The antibody avidity index attained diagnostic significance in only 8 of 43 instances (19%), and T. gondii DNA was amplified from no more than 6 of 39 (16%) aqueous humor samples. However, T. gondii-specific IgA was found within the aqueous humors of 11 of 43 patients (26%); measurement of the T. gondii-specific IgA level thus contributed substantially to the diagnostic sensitivity of the laboratory tests.

* Corresponding author. Mailing address: Department of Ophthalmology, University of Bern, Inselspital, CH-3010 Bern, Switzerland. Phone: 41 31 632 8503. Fax: 41 31 632 8539. E-mail: justus.garweg{at}insel.ch.

Journal of Clinical Microbiology, March 2000, p. 996-1001, Vol. 38, No. 3
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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