Published: 2020-01-28

Usefulness of serology in diagnosis of different clinical presentations of ocular toxoplasmosis

Saritha V. Krishnankutty, Reni Philip, Vijayamma Narayani



Background: Large proportions of acquired cases of ocular toxoplasmosis are reported with atypical presentations. The objectives of the study were to find out whether any correlation existed between serological findings of typical and atypical presentations of ocular toxoplasmosis as compared to cases presenting with non-toxoplasmic uveitis and to find out the proportion of various atypical presentations of ocular toxoplasmosis.

Methods: It was a prospective observational study.The study subjects of ocular toxoplasmosis were tested for immunoglobulin M (IgM) and immunoglobulin G (IgG) toxoplasma antibody levels in serum by ELISA (enzyme-linked immunosorbent assay) technique. The proportion of atypical presentation among total toxoplasma cases and distribution of atypical cases were calculated.  Fisher’s exact test, one-way analysis of variance and Kruskal-wallis test were used as applicable.

Results: Among the cases (n=35) thirteen patients had typical presentation of a retinochoroidal focus with an adjacent scar and 22 patients had atypical features. Control group consisted of 24 patients. Various types of presentations in atypical cases were retinitis patch without an adjacent scar (31.8%), intermediate uveitis (27.3%), papillitis (22.7%) retinal vasculitis and dense vitritis (9.09% each).  Mean IgG levels in typical cases (85.3±82.9 IU/ml) and atypical cases (47.5±66.2) were significantly higher than control group (6.6±3.4, p<0.001).

Conclusions: Serology is a useful tool in the diagnosis of ocular toxoplasmosis with a compatible clinical picture as serum IgG levels are significantly elevated in both typical and atypical presentations of ocular toxoplasmosis as compared to cases presenting with non-toxoplasmic uveitis.


Ocular, Toxoplasmosis, Typical, Atypical, Serology

Full Text:



Furtado JM, Winthrop KL, Butler NJ, Smith JR. Ocular toxoplasmosis. I. Parasitology epidemiology and public health. Clin Exp Ophthalmol. 2013;41:82–94.

Hollad GN. Ocular toxoplasmosis: a global reassessment. Part 1: epidemiology and course of disease. Am J Ophthalmol. 2003;136;973-88.

Glasner PD, Silveira C, Kruszon-Moran D, Martins MC, Júnior MB, Silveira S, et al. An unusually high prevalence of ocular toxoplasmosis in southern Brazil. Am J Ophthalmol. 1992;114:136–44.

Holland GN. Ocular toxoplasmosis: new directions for clinical investigation. Ocul Immunol Inflamm. 2000;8:1–7.

Atmaca LS, Simsek T, Batioglu F. Clinical features and prognosis in ocular toxoplasmosis. Jpn J Ophthalmol. 2004;48:386–91.

SmithJR, Cunningham ET. Atypical presentations of ocular toxoplasmosis. Curr opin Ophthalmol. 2002;13;387-92.

Montoya JG, Liesenfeld O. Toxoplasmosis. Lancet. 2004;363:1965–76.

Papadia M, Aldigeri R, Herbort CP. The role of serology in active ocular toxoplasmosis. Int Ophthalmol. 2011;31:461–5.

Subauste CS, Ajzenberg D, Kijlstra A. Review of the series 'Disease of the year 2011: toxoplasmosis' pathophysiology of toxoplasmosis. Ocul Immunol Inflamm. 2011;19:297–306.

Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: from animals to humans. Int J Parasitol. 2000;30:1217–58.