title: A Brazilian report using serological and molecular diagnosis to monitoring acute ocular toxoplasmosis.
abstract: BACKGROUND
  Toxoplasmosis was recently included as a neglected disease by the Center for Disease Control. Ocular toxoplasmosis is one clinical presentation of congenital or acquired infection. The laboratory diagnosis is being used worldwide to support the clinical diagnosis and imaging. The aim of this study was to evaluate the use of serology and molecular methods to monitor acute OT in immunocompetent patients during treatment.
  
  
  METHODS
  Five immunocompetent patients were clinically diagnosed with acute OT. The clinical evaluation was performed by ophthalmologic examination using the Early Treatment Diabetic Retinopathy Study, best-corrected visual acuity, slit lamp biomicroscopy, fundoscopic examination with indirect binocular ophthalmoscopy color fundus photography, fluorescein angiography and spectral optical coherence tomography (OCT). Serology were performed by ELISA (IgA, IgM, IgG) and confirmed by ELFA (IgG, IgM). Molecular diagnoses were performed in peripheral blood by cPCR using the Toxoplasma gondii B1 gene as the marker. Follow-up exams were performed on day +15 and day +45.
  
  
  RESULTS
  Only five non-immunocompromised male patients completed the follow up and their data were used for analysis. The mean age was 41.2 ± 11.3 years (median: 35; range 31-54 years). All of them were positive for IgG antibodies but with different profiles for IgM and IgA, as well as PCR. For all patients the OCT exam showed active lesions with the inner retinal layers being abnormally hyper-reflective with full-thickness disorganization of the retinal reflective layers, which assumed a blurred reflective appearance and the retina was thickened.
  
  
  CONCLUSIONS
  The presence of IgA and IgM confirmed the acute infection and thus was in agreement with the clinical evaluation. Our results show the adopted treatment modified the serological profile of IgM antibodies and the PCR results, but not the IgG and IgA antibodies and that imaging is a good tool to follow-up patients.
authors.affiliation: Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. mary_maris@hotmail.com.|FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. mary_maris@hotmail.com.
authors.forename: Mariana
authors.initials: M
authors.lastname: Previato
authors.affiliation: Retinopathy Outpatient Clinic, Hospital de Base da Fundação Faculdade Regional de Medicina-HB-FUNFARME, Avenida Brigadeiro Faria Lima, 5544, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. drfabiofrederico@gmail.com.|FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. drfabiofrederico@gmail.com.
authors.forename: Fábio Batista
authors.initials: FB
authors.lastname: Frederico
authors.affiliation: Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. fernandomurata@hotmail.com.|FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. fernandomurata@hotmail.com.
authors.forename: Fernando Henrique Antunes
authors.initials: FH
authors.lastname: Murata
authors.affiliation: Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. rubenssiqueira@terra.com.br.
authors.forename: Rubens Camargo
authors.initials: RC
authors.lastname: Siqueira
authors.affiliation: Retinopathy Outpatient Clinic, Hospital de Base da Fundação Faculdade Regional de Medicina-HB-FUNFARME, Avenida Brigadeiro Faria Lima, 5544, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. amandapbarbosa@yahoo.com.br.|FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. amandapbarbosa@yahoo.com.br.
authors.forename: Amanda Pires
authors.initials: AP
authors.lastname: Barbosa
authors.affiliation: Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. cidsilveira22@yahoo.com.br.
authors.forename: Aparecida Perpétuo
authors.initials: AP
authors.lastname: Silveira-Carvalho
authors.affiliation: Laboratory of Molecular Biology, of Parasites and Fungi, Instituto Adolfo Lutz-IAL, Aenida Dr Arnaldo,355, São Paulo, São Paulo state, 01246-000, Brazil. crismeira@ig.com.br.|IAL Toxoplasma Research Group, Instituto Adolfo Lutz, Avenida Dr Arnaldo, 355, São Paulo, Sao Paulo state, 01246-000, Brazil. crismeira@ig.com.br.
authors.forename: Cristina da Silva
authors.initials: Cda S
authors.lastname: Meira
authors.affiliation: Laboratory of Molecular Biology, of Parasites and Fungi, Instituto Adolfo Lutz-IAL, Aenida Dr Arnaldo,355, São Paulo, São Paulo state, 01246-000, Brazil. pchioccola@gmail.com.|IAL Toxoplasma Research Group, Instituto Adolfo Lutz, Avenida Dr Arnaldo, 355, São Paulo, Sao Paulo state, 01246-000, Brazil. pchioccola@gmail.com.
authors.forename: Vera Lúcia
authors.initials: VL
authors.lastname: Pereira-Chioccola
authors.affiliation: Laboratory of Molecular Biology, of Parasites and Fungi, Instituto Adolfo Lutz-IAL, Aenida Dr Arnaldo,355, São Paulo, São Paulo state, 01246-000, Brazil. gava44@gmail.com.|IAL Toxoplasma Research Group, Instituto Adolfo Lutz, Avenida Dr Arnaldo, 355, São Paulo, Sao Paulo state, 01246-000, Brazil. gava44@gmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gava
authors.affiliation: Retinopathy Outpatient Clinic, Hospital de Base da Fundação Faculdade Regional de Medicina-HB-FUNFARME, Avenida Brigadeiro Faria Lima, 5544, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. plinioneto33@hotmail.com.
authors.forename: Plínio Pereira
authors.initials: PP
authors.lastname: Martins Neto
authors.affiliation: Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. luiz.demattos@famerp.br.|FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. luiz.demattos@famerp.br.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: de Mattos
authors.affiliation: Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. Cinara.Brandao@famerp.br.|FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. Cinara.Brandao@famerp.br.
authors.forename: Cinara Cássia Brandão
authors.initials: CC
authors.lastname: de Mattos
mesh_terms: D000208:Acute Disease; D001938:Brazil; D005451:Fluorescein Angiography; D006801:Humans; D016133:Polymerase Chain Reaction; D041623:Tomography, Optical Coherence; D014126:Toxoplasmosis, Ocular / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology