Unidad de Inmunología, Grupo de Investigación en Neurociencias (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.
GEPAMOL, Centro de Investigaciones Biomédicas, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia.
BMC Infect Dis. 2019 Jan 25;19(1):91. doi: 10.1186/s12879-018-3613-8.
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. Co-infections in immunocompetent patients are not frequently proved with traditional serologic-diagnostic tools.
Descriptive 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.
In 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%).
Clinical 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.
明确诊断感染性葡萄膜炎是一项具有挑战性的任务，因为许多其他感染性和非感染性葡萄膜炎可能具有类似的非特异性症状和重叠的临床表现。免疫功能正常患者的合并感染通常无法通过传统的血清学诊断工具得到证实。
这是一项 2014 年 7 月至 2016 年 2 月在哥伦比亚波哥大一家眼科参考中心葡萄膜炎科进行的描述性横断面研究。连续收集疑似患有感染性葡萄膜炎的患者的房水（AH）和/或玻璃体液、血液和血清样本。眼弓形体病（OT）的诊断通过 Goldmann-Witmer 系数（GWC）和聚合酶链反应（PCR）得到确认。通过 PCR 对 AH 进行病毒来源的鉴别诊断，用于检测巨细胞病毒（CMV）、单纯疱疹病毒 1 型（HSV1）、单纯疱疹病毒 2 型（HSV2）、水痘-带状疱疹病毒（VZV）、EB 病毒（EBV）和结核分枝杆菌。
在 66 例疑似感染性葡萄膜炎的哥伦比亚患者中：22 例（33.3%）被确诊为 OT，16 例（24.2%）为未确定的 OT，5 例（7.5%）为合并感染，23 例（34.8%）为其他葡萄膜炎。通过 PCR 发现一例患者弓形虫合并结核分枝杆菌感染，通过 GWC 发现四例患者单纯疱疹病毒感染。在 21 例（31.8%）患者中，实验室检查改变了初始临床诊断。
在相当一部分葡萄膜炎患者中，实验室检查可以改变临床诊断。OT 的诊断应结合使用 PCR 和 GWC，以最大限度地确认病例。需要使用多种实验室方法来识别合并感染和病毒感染，这些感染在免疫功能正常的患者中可能与 OT 相似。
