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Ocular manifestations in congenital toxoplasmosis.

BACKGROUND: Retinochoroiditis is the most common ocular manifestation of congenital toxoplasmosis, but other associated ophthalmological pathologies can also occur. The aim of this study was to determine the nature of the latter in treated cases of the disease and to assess their impact on visual function. METHODS: Four hundred and thirty consecutive children with serologically confirmed congenital toxoplasmosis were included in this study. Data were prospectively collected using standardized ophthalmological assessment forms. The presence of retinochoroiditis and of associated pathologies was ascertained, and their impact on visual function was assessed. RESULTS: After a median follow-up of 12 years [range 0.6-26 years], 130 children manifested retinochoroiditis. We detected 22 foci of retinochoroiditis at birth and 264 additional ones during the follow-up period. Of these, 48 (17%) were active when first diagnosed. Twenty-five of the 130 children (19%) had other associated ocular pathologies. Of these, 21 (16%) had a strabismus, which was due to macular lesions in 86% of the cases; 7 (5.4%) presented with unilateral microphthalmia, and 4 (3%) with cataracts. Most of these events were detected after the onset of retinochoroiditis. None of the children presented with ocular involvement in the absence of chorioretinal lesions. Macular lesions occurred more frequently in children with associated pathologies (p<0.0001), and associated pathologies were likewise more common in individuals with macular lesions (p=0.0003). Visual impairment occurred in 31/130 cases, and in all but 3 of these eyes it was due not to an associated pathology but to macular retinochoroiditis. CONCLUSIONS: At the end of the follow-up period, ocular involvement existed in 30% of the treated children with congenital toxoplasmosis. Associated eye pathologies were manifested less frequently than anticipated. They may occur later in life and are an indirect marker of the severity of congenital toxoplasmosis, but they do not have a direct impact on visual acuity. The overall functional prognosis of congenital toxoplasmosis is better than would be expected on the basis of literature findings, with only 2 of the 130 children suffering bilateral visual impairment.

Adolescent↗

Unusual ocular presentation of acute toxoplasmosis.

Four patients with toxoplasmosis are reported with unusual presenting ocular lesions. One patient had an active lesion that appeared to involve the optic nerve as well as focal toxoplasmosis chorioretinitis at the macula. A second patient had a pale optic nerve in association with the classical chorioretinal scars of toxoplasmosis. The third patient had toxoplasmosis chorioretinitis of the macula with subretinal neovascularisation. The fourth patient had a branch artery occlusion complicating acute retinitis.

Acute Disease↗

Recurrent ocular disease in postnatally acquired toxoplasmosis.

PURPOSE: Although recurrences are typical of congenital toxoplasmosis, the long-term ocular manifestations in postnatally acquired toxoplasmosis have never been systematically studied. We report on the ocular manifestations complicating the chronic phase of postnatally acquired toxoplasmosis. METHODS: Review of the clinical data of 14 patients who presented with active ocular toxoplasmosis not associated with scars and who had serologic characteristics of recently acquired systemic toxoplasmosis. RESULTS: Mean follow-up was 4.6 years. Recurrent ocular disease developed in eight (57%) of 14 cases. The number of patients with recurrences increased with the follow-up time: four (29%) of 14 during the first year of follow-up; eight (57%) of 14 during the second year; and eight of nine during the third follow-up year. No risk factors for the development of recurrences were identified. Satellite lesions developed in five of eight patients with recurrences, whereas lesions not adjacent to old scars, located in areas of previously unaffected retina, developed in three patients. CONCLUSIONS: In postnatally acquired toxoplasmosis, frequent recurrences of ocular disease can be seen during the chronic phase of infection.

Adolescent↗

[Toxoplasmic retinochoroiditis].

Retinochoroiditis is a frequent ocular lesion in toxoplasmosis. It may be severe, and even lead to blindness. Sixteen cases of toxoplasmic retinochoroiditis verified through IFA were presented in this paper. Among these cases, 1 was of the multifocal type, its appearance being similar to that of the Coats disease; while the other 15 were of the focal type resembling to the central exudative retinitis (Rieger disease) or retinochoroidal scar. Serological finding of all the cases showed a positive IFA titer of > 1:80. A combination of pyrimethamine and sulfadiazine as well as spiramycin in addition to dexamethasone had been administered and proved effective. Since toxoplasmosis mostly occurs as latent and examination of the eye cannot differentiate from other causes of retinochoroiditis, so such clinical report of toxoplasmic retinochoroiditis was rare with particular reference in our country. The authors claimed that any individual presenting with retinochoroiditis suspected of toxoplasmosis should be subjected to serologic antibody test for establishing diagnosis.

Adolescent↗

[Seroprevalence, epidemiology and ocular evaluation of human toxoplasmosis in the rural zone Jauguapitã (Paraná) Brazil].

Toxoplasmosis is a protozoal zoonosis common among a great variety of species worldwide. The objective of this study was to assess the presence of toxoplasmosis among 345 residents in a rural area in Jagupitã municipality, Paraná state, Brazil. The frequency of titers in human serum samples was compared with the frequency of titers found in 1,420 samples obtained from various animal species with which local residents came into contact. Titers > or = 16 were considered positive. The highest titer found was 65,536 (1%), and the most frequent titer levels were 256 (29%) and 1,024 (19%). The comparisons between humans and animals revealed a positive and significant correlation between humans and felines (r = 0.78; P = 0.01) and humans and canines (r = 0.64; P = 0.05) in terms of titer distribution. Study participants were also tested with the Amsler grid. Seventy-five of the 345 people (22%) reported some type of ocular degradation. Of these 75, 58 of them (77%) were seropositive for toxoplasmosis. Forty-one of these 58 people underwent an ophthalmologic exam. Of these 41, 9 of them, who were between 34 and 78 years old, presented lesions characteristic of healed chorioretinitis, suggesting ocular toxoplasmosis. None of the 9 had ocular inflammation. Six of the 9 patients (67%) had unilateral lesions; 4 of these 6 presented a titer level of 256. The epidemiological survey showed that the probability of presenting ocular problems was 2.06 times as great for reactive patients as for nonreactive ones. No significant differences were observed in terms of sex, contact with felines or other animals, consumption of raw or rare meat and raw milk, and slaughtering of animals for personal consumption. Our results suggest that toxoplasmosis is common in the region, with a significant incidence of ocular lesions caused by Toxoplasma gondii. Health authorities should increase their monitoring and control activities in order to decrease the risk of toxoplasmic infections, especially among pregnant women.

Animals↗

[Cerebral CT scan alterations in children with ocular lesions caused by congenital toxoplasmosis]

OBJECTIVE: To evaluate the frequency and the types of cerebral CT scan alterations in patients with ocular lesions caused by congenital toxoplasmosis. METHODS: The patients should fit one of the following criteria: reagent IgM serology for toxoplasmosis at birth and mother with positive serology for toxoplasmosis; age less than ten years, with bilateral funduscopic lesions compatible with toxoplasmic retinochoroiditis; or reagent IgG serology for toxoplasmosis and mother with positive serology for toxoplasmosis. All patients were submitted to noncontrast cerebral CT scan. RESULTS: Twenty-two patients participated in this study (44 eyes). Thirteen eyes presented macular lesions (29.5%), eight had peripheral lesions (18.2%) and 22 eyes had concomitant macular and peripheral lesions (50%). Seventeen patients presented radiological alterations (77.3%). Among these, sixteen patients (94.1%) presented brain calcifications, two patients (11.7%) presented ventricular dilation, two patients (11.7%) had hydrocephalus, one had hydranencephaly (5.9%), one presented porencephalic cyst (cerebral hemiatrophy) (5.9%), one had arachnoid cyst (5.9%) and one had mild dilation of ventricles and subarachnoid cistern (5.9%). CONCLUSIONS: Patients diagnosed with congenital toxoplasmosis and ocular lesions should be investigated for concomitant neuroradiologic alterations.

Journal Article↗