Diagnoi of toxoplamic retinochoroiditi with atypical clinical feature

PURPOE: To determine the value of aqueou humor analyi for confirming the diagnoi of ocular toxoplamoi in patient who preent with atypical clinical feature and to relate the reult of local antibody production and polymerae chain reaction (PCR) with the extent of active retiniti and the immune tatu of the patient. DEIGN: Retropective cae erie. METHOD: ixty-even conecutive patient with retiniti or retinochoroiditi that wa clinically conitent with atypical ocular toxoplamoi underwent diagnotic anterior chamber paracentei and erological tudie. The aqueou humor wa analyzed both by PCR to detect Toxoplama gondii B1 gene and by the Goldman-Witmer coefficient to determine level of local anti-T. gondii antibody production. REULT: In nine of the 67 cae, PCR wa poitive for T. gondii; even of thee were negative for local antibody production. All nine patient had illnee aociated with immunouppreion or advanced old age and all had active retiniti with a mean area of 11.5 dik area (DA). Twenty-five of the remaining 58 cae were poitive for local antibody production. Thee 25 had a mean area of active retiniti meauring 2.6 DA, and 24 of thee patient were immunocompetent. All 34 cae with laboratory evidence of ocular toxoplamoi diagnoed by either method reponded to anti-T. gondii agent. The remaining 33 were negative for T. gondii infection by thee two method; ome had laboratory evidence of other infection. CONCLUION: Although in the preent tudy, the enitivity and pecificity of the aqueou humor PCR and Goldman-Witmer coefficient could not be acertained in the laboratory diagnoi of toxoplamic retinochoroiditi, the PCR method appear to confirm the diagnoi in immunocompromied individual with large atypical foci of retiniti. Converely, determination of local antibody production may be appropriate for proper diagnoi in immunocompetent individual preenting with mall foci of retiniti.