Toxoplasmic papillitis with central retinal artery occlusion.
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The aim of the study was to assess the value of PCR method in laboratory diagnosis of T. gondii infections. The study was based on the identification of a fragment of B1 gene of Toxoplasma gondii 461 base pairs in length in 124 samples of blood, CSF, amniotic fluid and aqueous fluid obtained form humans and experimentally infected animals. Positive PCR results were found with CSF samples and blood sample from men. Moreover, the results were positive with blood samples from mice and rabbits bled on 5, 6, 11 and 12 days after infection. The obtained results showed that PCR is very useful in the laboratory diagnosis of toxoplasmosis, especially in cases suspected of cerebral toxoplasmosis. Furthermore, the results demonstrated that neurotoxoplasmosis occurs in Poland, more frequently that it is realized at present, however, the cases are not recognized because toxoplasmosis is not taken into account in differential diagnosis. Because of short and irregular parasitaemia, PCR is of limited value in the diagnosis of blood samples.
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Toxoplasmin skin test was performed on 574 suspected and 24 control cases. A positive reaction was noted in 92 of 481 ophthalmological cases; two of 17 lymphadenopathy cases; none in 36 cerebral palsy cases and four of 40 miscellaneous cases comprising pyrexia of unknown aetiology, recurrent abortions etc. None from the control group gave a positive reaction. The significance of the results is discussed and the need for further studies employing other investigative methods is stressed.
PURPOSE: We assessed the frequency of panophthalmitis in HIV-infected patients. MATERIALS AND METHODS: Thirty-seven cases of panophthalmitis were screened out of 420 hospitalized patients of ophthalmology department of Cocody Teaching University Hospital, Abidjan, Ivory Coast, from January to October 1995. HIV-tests were performed in 11 patients. RESULTS: Mean age was 40 years (from 10 months to 75 years). Four patients (36.4% of tested patients) were infected by HIV. Contrary to seronegative patients, panophthalmitis cases in HIV-infected patients occurred spontaneously without any apparent exogenous cause (foreign bodies). Most of patients were young (from 18 to 47 years old). CONCLUSION: We draw the attention of eye specialists of the frequency of panophthalmitis without exogenous apparent cause in HIV patients. It would be interesting to perform a transvitreal needle biopsy in order to search for intraocular toxoplasmosis that should be the first cause.
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Tbc has not yet been eradicated in Western Europe. Among 311 human/bovin-tuberculin tested cases out of 500 patients with uveitis (1971-1974), 37-50% (average age 40-45 years) reacted highly positive. Chorioretinitis disseminata and periphlebitis retinae (Eales' disease): 90% positive. The criteria for a long term tuberculostatic treatment are exposed. 20% of all cases of uveitis and 90% of Jensen Retinochorioditis have been interpreted as caused by toxoplasmosis. 75% are relapses. The gigantic toxoplasmotic lesions of the eyeground is stressed. As a rule low Sabin Feldmann titers are found. Quantitative serology is valuable. In the closing discussion the immunologically well known adjuvans-effect of Koch's bacillus-extract is supposed to be of importance in highly tuberculin positive uveitis.
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In a light and electron microscopical study of the morphological lesions of acute experimental Toxoplasma retinitis in the rabbit, produced by intravitreal inoculation with RH strain T gondii, all layers of the retina were found to be infected with the parasite. The Bruch membrane appeared to be a relatively impermeable barrier to invasion by the parasite. The underlying choroid showed an inflammatory cellular infiltrate but was free of organisms. Evidence of lateral spread of infection between the layers of the retinal tissue was observed. Examples of glial cell infection were also seen. Trophozoities may enter the brain by spreading along contiguous glial cell elements of the optic nerve; retinal tissue destruction occurs by direct invasion of cells by trophozoites. In other areas, tissue destruction by inflammatory cells occurred in the absence of organisms and may indicate an immunologically induced process of tissue destruction.
Recent advances in the epidemiology and life cycle of toxoplasmosis are reviewed. Cats play a key role. Toxoplasma has a coccidian-type entero-epithelial cycle with oocyst prodlction in the feline host. An extra-intestinal cycle occurs in both feline and non-feline hosts. The worldwide distribution and the public health significance of toxoplasmosis as a zoonosis is discussed, with particular reference to available data regarding Southern Africa.
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The major clinical infectious syndromes involving the retina and choroid are discussed. Means for successful diagnosis and treatment are presented, as well as the major complications. This work emphasizes the need to identify the infectious nature of these syndromes in order to avoid the all-too-common pitfall of just treating all cases of uveitis with steroids alone.