Immunoblotting Can Help the Diagnosis of Ocular Toxoplasmosis

Aims: To determine whether IgG immunoblotting can improve the diagnosis of ocular toxoplasmosis.

Methods: Samples of serum were tested from patients with ocular lesions that could be caused by toxoplasmosis. All such samples from Scotland and Northern Ireland are usually referred to the Scottish Toxoplasma Reference Laboratory. From questionnaires filled out by the clinicians, two groups of sera were identified: ocular toxoplasmosis (active and quiescent), n = 54 (group 1); and eye disease as a result of other causes, n = 36 (group 2). Control groups were made up of sera from patients with no eye disease and a normal dye test result (< or = 125 IU/ml), n = 16 (group 3); and toxoplasma seronegative, cytomegalovirus (CMV) positive, and herpes simplex virus (HSV) positive sera (group 4), n = 18.

Results: Immunoblots with an active pattern could be identified (IgG antibodies against at least four antigens with molecular weight of 6, 20, 22, 23, 25, and 36 kDa). Significantly more of this pattern was found in group 1 (33 of 54; 61.1%) compared with group 2 (nine of 36; 25%) or group 3 (six of 16; 37.5%). Within group 1, significantly more sera with an active pattern had dye test results > or = 65 IU/ml compared with those without. More sera from patients < 30 years of age were found with the active pattern in group 1 compared with group 2. No group 4 sera had active immunoblot patterns.

Conclusions: The immunoblot result adds more support to the diagnosis of ocular toxoplasmosis. In cases where the clinical diagnosis is difficult, immunoblots are particularly indicated; if negative, other causes of eye disease should be sought.