Classification Criteria for Toxoplasmic Retinitis

Overview

Journal Am J Ophthalmol

Specialty Ophthalmology

Date 2021 Apr 12

PMID 33845002

Citations 9

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine classification criteria for toxoplasmic retinitis.

Design: Machine learning of cases with toxoplasmic retinitis and 4 other infectious posterior uveitides / panuveitides.

Methods: Cases of infectious posterior uveitides / panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior uveitides / panuveitides. The resulting criteria were evaluated on the validation set.

Results: Eight hundred three cases of infectious posterior uveitides / panuveitides, including 174 cases of toxoplasmic retinitis, were evaluated by machine learning. Key criteria for toxoplasmic retinitis included focal or paucifocal necrotizing retinitis and either positive polymerase chain reaction assay for Toxoplasma gondii from an intraocular specimen or the characteristic clinical picture of a round or oval retinitis lesion proximal to a hyperpigmented and/or atrophic chorioretinal scar. Overall accuracy for infectious posterior uveitides / panuveitides was 92.1% in the training set and 93.3% (95% confidence interval 88.2, 96.3) in the validation set. The misclassification rates for toxoplasmic retinitis were 8.2% in the training set and 10% in the validation set.

Conclusions: The criteria for toxoplasmic retinitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.

Citing Articles

Clinical characteristics, visual acuity outcomes, and factors associated with loss of vision among patients with active ocular toxoplasmosis: A retrospective study in a Thai tertiary center.

Sittivarakul W, Treerutpun W, Tungsattayathitthan U PLoS Negl Trop Dis. 2024; 18(6):e0012232.

PMID: 38843299 PMC: 11156401. DOI: 10.1371/journal.pntd.0012232.

Atypical acquired toxoplasmosis.

Shakha , Chawla R, Sinha A, Meena S Indian J Ophthalmol. 2024; 72(6):772-774.

PMID: 38804796 PMC: 11232862. DOI: 10.4103/IJO.IJO_3341_23.

Active toxoplasma chorioretinitis in immunocompromised patients: a case series.

Kayabasi M, Mammadov T, Koksaldi S, Arikan G, Kaynak S, Saatci A Arch Clin Cases. 2024; 11(1):5-12.

PMID: 38655271 PMC: 11034477. DOI: 10.22551/2024.42.1101.10278.

The role of age in ocular toxoplasmosis: clinical signs of immunosenescence and inflammaging.

Eraghi A, Garweg J, Pleyer U Front Med (Lausanne). 2024; 11:1311145.

PMID: 38504919 PMC: 10950095. DOI: 10.3389/fmed.2024.1311145.

Role of IgG avidity in eyes with active Toxoplasma retinochoroiditis.

Lakhmawar P, Kelgaonkar A, Patel A, Khalsa A, Basu S Indian J Ophthalmol. 2024; 72(Suppl 4):S601-S605.

PMID: 38324620 PMC: 11338399. DOI: 10.4103/IJO.IJO_3000_23.

References

Dodds E, Holland G, Stanford M, Yu F, Siu W, Shah K . Intraocular inflammation associated with ocular toxoplasmosis: relationships at initial examination. Am J Ophthalmol. 2008; 146(6):856-65.e2. DOI: 10.1016/j.ajo.2008.09.006. View

Okada A, Jabs D . The standardization of uveitis nomenclature project: the future is here. JAMA Ophthalmol. 2013; 131(6):787-9. DOI: 10.1001/jamaophthalmol.2013.1596. View

Silveira C, Belfort Jr R, Muccioli C, Holland G, Victora C, Horta B . The effect of long-term intermittent trimethoprim/sulfamethoxazole treatment on recurrences of toxoplasmic retinochoroiditis. Am J Ophthalmol. 2002; 134(1):41-6. DOI: 10.1016/s0002-9394(02)01527-1. View

Jones J, Kruszon-Moran D, Elder S, Rivera H, Press C, Montoya J . Infection in the United States, 2011-2014. Am J Trop Med Hyg. 2017; 98(2):551-557. PMC: 5929212. DOI: 10.4269/ajtmh.17-0677. View

Holland G, Engstrom Jr R, Glasgow B, BERGER B, Daniels S, Sidikaro Y . Ocular toxoplasmosis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol. 1988; 106(6):653-67. DOI: 10.1016/0002-9394(88)90697-6. View

Rothova A, de Boer J, Ten Dam-van Loon N, Postma G, de Visser L, Zuurveen S . Usefulness of aqueous humor analysis for the diagnosis of posterior uveitis. Ophthalmology. 2007; 115(2):306-11. DOI: 10.1016/j.ophtha.2007.05.014. View

Jones J, Holland G . Annual burden of ocular toxoplasmosis in the US. Am J Trop Med Hyg. 2010; 82(3):464-5. PMC: 2829910. DOI: 10.4269/ajtmh.2010.09-0664. View

De Groot-Mijnes J, Rothova A, van Loon A, Schuller M, Ten Dam-van Loon N, de Boer J . Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis. Am J Ophthalmol. 2006; 141(2):313-8. DOI: 10.1016/j.ajo.2005.09.017. View

Holland G . Ocular toxoplasmosis: a global reassessment. Part II: disease manifestations and management. Am J Ophthalmol. 2004; 137(1):1-17. View

10.

Fekkar A, Bodaghi B, Touafek F, Le Hoang P, Mazier D, Paris L . Comparison of immunoblotting, calculation of the Goldmann-Witmer coefficient, and real-time PCR using aqueous humor samples for diagnosis of ocular toxoplasmosis. J Clin Microbiol. 2008; 46(6):1965-7. PMC: 2446865. DOI: 10.1128/JCM.01900-07. View

11.

Soheilian M, Ramezani A, Azimzadeh A, Sadoughi M, Dehghan M, Shahghadami R . Randomized trial of intravitreal clindamycin and dexamethasone versus pyrimethamine, sulfadiazine, and prednisolone in treatment of ocular toxoplasmosis. Ophthalmology. 2010; 118(1):134-41. DOI: 10.1016/j.ophtha.2010.04.020. View

12.

Jabs D, Nussenblatt R, Rosenbaum J . Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005; 140(3):509-16. PMC: 8935739. DOI: 10.1016/j.ajo.2005.03.057. View

13.

Holland G . Ocular toxoplasmosis: a global reassessment. Part I: epidemiology and course of disease. Am J Ophthalmol. 2003; 136(6):973-88. DOI: 10.1016/j.ajo.2003.09.040. View

14.

Berendschot T, Ongkosuwito J, Rothova A . Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology. 2002; 109(5):869-78. DOI: 10.1016/s0161-6420(02)00990-9. View

15.

Glasner P, Silveira C, Martins M, Burnier Junior M, Silveira S, Camargo M . An unusually high prevalence of ocular toxoplasmosis in southern Brazil. Am J Ophthalmol. 1992; 114(2):136-44. DOI: 10.1016/s0002-9394(14)73976-5. View

16.

NEWMAN P, Ghosheh R, Tabbara K, OConnor G, Stern W . The role of hypersensitivity reactions to toxoplasma antigens in experimental ocular toxoplasmosis in nonhuman primates. Am J Ophthalmol. 1982; 94(2):159-64. DOI: 10.1016/0002-9394(82)90070-8. View

17.

Grigg M, Ganatra J, Boothroyd J, Margolis T . Unusual abundance of atypical strains associated with human ocular toxoplasmosis. J Infect Dis. 2001; 184(5):633-9. DOI: 10.1086/322800. View

18.

Friedmann C, KNOX D . Variations in recurrent active toxoplasmic retinochoroiditis. Arch Ophthalmol. 1969; 81(4):481-93. DOI: 10.1001/archopht.1969.00990010483005. View

19.

Silveira C, Belfort Jr R, Muccioli C, Abreu M, Martins M, Victora C . A follow-up study of Toxoplasma gondii infection in southern Brazil. Am J Ophthalmol. 2001; 131(3):351-4. DOI: 10.1016/s0002-9394(00)00830-8. View

20.

Smith J, Cunningham Jr E . Atypical presentations of ocular toxoplasmosis. Curr Opin Ophthalmol. 2002; 13(6):387-92. DOI: 10.1097/00055735-200212000-00008. View