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PubMed1989

[Retinitis in AIDS patients: diagnosis, follow-up and treatment].

Of 147 patients with AIDS (Walter Reed 3-6), 28 showed signs of retinal infection. Toxoplasmic retinochoroiditis had developed in 5 eyes of 4 patients, whereas cytomegalovirus (CMV) retinitis occurred in 40 eyes of 24 patients. All patients with toxoplasmosis complained of visual symptoms at the first visit, but only 60% of patients with CMV retinitis had ocular symptoms at this time. The important problems involved in making a timely and correct diagnosis (early CMV retinitis vs cotton wool spots vs toxoplasmic retinitis; significance of laboratory data) are presented and discussed. The course of CMV retinitis is sometimes fast and devastating and requires immediate treatment to prevent blindness in patients who are in otherwise still fair general health. Eighteen patients (28 eyes) were treated by intravenous ganciclovir (DHPG) for 1-9 months. Initial therapy (10 mg/kg body wt., 2-4 weeks) led to regression of fundus lesions in all eyes. Under maintenance treatment (5 mg/kg BW body wt., 5 times a week), 14 eyes still demonstrated significant regression or cicatrization of the lesions, 9 eyes showed little progress and 5 eyes moderate recovery. However, 8 of 12 untreated eyes became legally blind before the patient died. None of the 23 treated eyes with useful initial visual acuity (greater than or equal to 0.2) lost visual function. Only in three cases did the drug have to be stopped because of serious side effects (severe leukopenia, pancytopenia, psychosis). Toxoplasmic retinochoroiditis healed in all affected eyes after specific treatment (pyrimethamine, sulfamethoxydiazine, clindamycin, and spiramycin in double or triple combination).(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1977

The complement-fixation test in the diagnosis of congenital toxoplasmosis.

We present serologic results on 26 patients with congenital toxoplasmosis and on 22 of their mothers. The infection was severe (central nervous system involvement) in 12 patients, 12 had only ocular manifestations, and two were asymptomatic. The dye test results were positive on all specimens, and were positive at a titer of 1:1,024 or higher if collected from patients younger than 2 years of age. The complement-fixation test (CFT) results were positive on all specimens from patients younger than 2 years of age and on 69% of specimens collected from older patients. These serologic results are contrasted with those obtained on two control groups: (1) 46 uninfected infants followed up after birth because of substantial antibody titers in their mothers during pregnancy; and (2) 190 infants and children tested because toxoplasmosis was tentatively included in the differential diagnosis of the current illness. In both control groups the positive results on the CFT were limited almost exclusively to cord blood specimens or specimens collected during the first 2 weeks of life. Lower CFT titers in follow-up specimens suggested that the antibodies were maternal in origin. These two tests are valuable in providing laboratory support for the diagnosis of congenital toxoplasmosis, particularly the test for the comparatively short-lived complement-fixing antibody.

Antibodies↗
PubMed1997

[Toxoplasmic chorioretinitis complicated by retinal detachment].

PURPOSE: To describe and analyse relationship between chorioretinal toxoplasmosis and retinal detachment. PATIENTS AND METHODS: Seven immunocompetent patients examined and treated between November 1992 and March 1996, with ocular toxoplasmic retinochoroiditis and retinal detachment. RESULTS: Of the 7 patients examined, 5 had active retinochoroiditis and 2 had typical inactive scars. Of the patients with active focus 3 had giant retinal tears, one had a posterior retinal tear and one had a retinal tear located at the edge of an atrophic scar. Of the patients with inactive lesions, one had tractional retinal detachment and the other presented with a complete retinal detachment, multiples tears and PVR. Five patients were treated by corticosteroid without antitoxoplasmic drug before they were referred. The seven patients underwent endo-ocular surgery with silicon oil or long actic gas tamponade. Three patients developed PVR and redetachment of the retina and two patients underwent further surgery. Good anatomical result was obtained in 6 patients. CONCLUSION: Retinal detachment associated with toxoplasmic retinochoroiditis is rare. However it represents a serious complication. Steroid administrated to salvage vision may then worsen the clinical course, these may be justified to reduce hypersensitivity to toxoplasma antigen, but they should be combined with an antimicrobial agent.

Adult↗
PubMed2003

[Toxoplasma gondii and necrotizing retinitis: a case report].

Toxoplasmic retinochoroiditis is an important opportunistic retinal infection in immunodeficiency and elderly patients. The diagnosis of toxoplasmic retinochoroiditis is based primarily on characteristic ocular findings, with supportive serological evidence. It may present as diffuse necrotizing retinitis instead of a focal lesion. We report the original case of a 74-year-old woman who presented with blurred vision in her left eye lasting 3 months. In her medical history, the patient described a tuberculous infection evolving for some months, as well as agranulocytosis treated with Rifadine. Fundus examination revealed diffuse necrotizing retinitis, mainly at the nasal quadrant, with marked vitreitis in the left eye. Clinical recognition of atypical presentations is critical for timely antiparasitic drug therapy. This case initially was misdiagnosed as acute retinal necrosis syndrome. The correct diagnosis was confirmed by response to polymerase chain reaction studies of an intraocular specimen and histopathological analysis. The extensive necrotizing retinitis was nonhemorrhagic but associated with retinal detachment. Significant visual loss accompanied the infection. Toxoplasmosis should be considered as a cause of diffuse necrotizing retinitis in elderly and immunosuppressive patients. Older patients may be more susceptible to severe ocular Toxoplasma infections because of age-related decline in cell-mediated immunity and chronic underlying diseases.

Aged↗
PubMed1992

[Recall of the importance of serological monitoring of children with suspected congenital toxoplasmosis].

Emphasis is put on the need for repeating serologic tests at regular intervals until one year of age in infants with suspected congenital toxoplasmosis. In 11 of 33 cases, antibody titer changes were the only evidence of toxoplasmosis, a disease which may induce severe ocular lesions if appropriate treatment is not given. Although well-recognized as indispensable, serologic monitoring is not always performed; in one group of 326 infants with suspected congenital toxoplasmosis, 133 (41%) were not followed up for more than six weeks.

Enzyme-Linked Immunosorbent Assay↗
PubMed2003

Frosted branch angiitis and late peripheral retinochoroidal scar in a patient with acquired toxoplasmosis.

PURPOSE: To report a case of acute frosted branch angiitis associated with acquired toxoplasmosis in which a late peripheral chorioretinal scar developed. RESULTS: A 32-year-old man without systemic symptoms presented with sudden visual loss in his left eye. Examination demonstrated frosted branch angiitis without necrotizing chorioretinitis. Serologic tests showed elevated Toxoplasma gondii-specific immunoglobulin M antibody titers. Antitoxoplasmic therapy and oral steroids healed the ocular inflammation. In a follow-up visit one year later, a peripheral chorioretinal scar was noted. CONCLUSIONS: Acute frosted branch angiitis without focal necrotizing chorioretinitis can be a manifestation of acquired toxoplasmosis. This could be an important, and sometimes forgotten, sign of the disease.

Adult↗
PubMed1995

Detection of Toxoplasma gondii-specific IgA in the serum of cats.

An ELISA for detection of Toxoplasma gondii-specific IgA in feline serum was developed. A group of cats (n = 7) was inoculated orally with T gondii bradyzoites. Toxoplasma gondii-specific serum IgM, IgG, and IgA responses were followed sequentially by use of the ELISA for 34 weeks. Serum IgA was detected later than IgM or IgG, and was detected in most cats on week 34 after inoculation. None of the cats was seropositive for IgA during the oocyst-shedding period. A group of client-owned cats with suspected clinical toxoplasmosis and a group of healthy cats were tested for T gondii-specific IgA in serum. A trend toward association of T gondii-specific IgA in serum of cats with ocular disease was observed.

Animals↗
PubMed1997

Atypical, severe toxoplasmic retinochoroiditis in elderly patients.

BACKGROUND: The diagnosis of toxoplasmic retinochoroiditis is based primarily on characteristic ocular findings, with supportive serologic evidence. Clinical recognition of atypical presentations is critical for timely antiparasitic drug therapy. METHODS: Case histories were reviewed for seven presumed immunocompetent elderly patients with atypically severe (multifocal or diffuse or both) toxoplasmic retinochoroiditis. Three cases initially were misdiagnosed as acute retinal necrosis syndrome. The correct diagnosis was confirmed in each case by response to antiparasitic drug therapy, polymerase chain reaction studies of intraocular specimens, or histopathologic analysis. RESULTS: The patients ranged in age from 69 to 82 years (median, 74 years). Only three patients had intercurrent medical conditions that may be associated with subtle immune dysfunction (diabetes mellitus and hepatitis C). The extensive necrotizing retinochoroiditis in each patient was nonhemorrhagic and not associated with occlusive retinal arteritis. Despite prompt response to antiparasitic drug therapy, prolonged treatment usually was required, and four patients had retinitis reactivation after discontinuing treatment. Significant visual loss accompanied the infection in most eyes. CONCLUSION: Toxoplasmosis should be considered as a cause of multifocal or diffuse necrotizing retinitis or both in elderly patients. Older patients may be more susceptible to severe ocular Toxoplasma infections because of age-related decline in cell-mediated immunity and chronic underlying diseases.

Aged↗
PubMedDate not supplied

[Immunoenzyme analysis in the diagnosis of ophthalmic toxoplasmosis].

Enzyme immunoassay (EIA) is a highly sensitive and specific method whose sensitivity is superior to that of the fluorescent antibody test. EIA helped detect IgG antibodies to Toxoplasma in almost 30% of examined adults and children with various ocular diseases, this indicating a high Toxoplasma infection rate in the population. IgM antibodies (indicating an acute infection) were detected in only three children, and Toxoplasma was not the agent of uveitis in these patients. It may be supposed that primary Toxoplasma infection takes place in utero, or the eye is involved long after the primary infection. Bearing this in mind, the authors recommend screening for IgM antibodies in infants aged under 6 months if congenital or acquired Toxoplasma uveitis is suspected.

Adolescent↗
PubMedDate not supplied

The eye in systemic infection.

Bacterial, fungal, viral, and parasitic pathogens all cause systemic infection and can spread to the eye. Dissemination of pathogens via the bloodstream can lead to direct involvement of the eye. Visual loss is common in bacterial or fungal endophthalmitis, and toxoplasmosis is a major cause of ocular morbidity and poor vision after congenital or acquired infection. Some infections cause intraocular damage by indirect mechanisms (eg, HIV-mediated immunosuppression), leading to opportunistic infections such as cytomegalovirus infection, periocular nerve involvement due to leprosy, and hypersensitivity reactions in tuberculosis. Eye symptoms might indicate the outcome of an underlying infection, such as development of retinal ischaemia in severe malaria, which is associated with a poor prognosis. Successful outcome for patients with ocular infection depends on close collaboration between clinicians identifying and treating underlying disease, specialist ophthalmic review, and ophthalmic interventional skills (when needed).

Eye Diseases↗
PubMedDate not supplied

Endogenous uveitis in Indian children: analysis of 94 cases.

Out of 1086 cases of endogenous uveitis registered in the uveitis clinic of Irwin Hospital, New Delhi, India, over a period of 10 years from 1963-1972, 94 cases (8.6%) were within the pediatric age group 0-15 years. These cases have been analyzed in detail and the data on age, sex distribution, clinical types, course, complications, various etiological factors, and associated conditions have been tabulated. There were 29 cases within the age group 0-10 years. The youngest was six weeks old. Brief clinical data were: boys, 61.7%; bilateral cases, 45.8%, anterior uveitis, 40.4%; posterior uveitis, 47.9%; generalized uveitis, 11.7% and chronic cases 81.9%. Complicated cataract was the most frequent complication (25.5%) followed by band keratopathy (10.6%). The etiology could be determined in 52.1% of the cases. Tuberculosis was the commonest cause (31.9%) followed by toxoplasmosis (10.6%). There was one case of Behcet's disease where the ocular lesions preceded oral and genital lesions by two years. The series is conspicuous by the notable absence of sarcoidosis as a cause of uveitis. Comparative data on the incidence of childhood uveitis and its various etiological factors as reported by other workers have also been tabulated.

Age Factors↗
PubMed2001

[Prevention of congenital toxoplasmosis in France. Risk assessment. Results and perspectives of prenatal screening and newborn follow up].

In France, a national program for the prevention of congenital toxoplasmosis has been set up 25 years ago. This program is here presented and discussed in details. It is based on a decision tree well defined, with pre and/or per gravidic serological screening with several different tests, completed, if necessary, by ultrasounds examinations of the fetus, biomolecular tests (PCR) on amniotic fluid, and by clinical, biological, and radiological surveillance of neo-nates. The purpose of this prevention program is to: 1/identify nonimmune young women and limit their contamination risk during pregnancy by appropriate counseling on hygiene and diet; 2/screen and treat per gravidic toxoplasmosis as early as possible so as to prevent or limit transmission to the fetus and its consequences. 3/in utero diagnose and treat infestation of the fetus; 4/diagnose and treat asymptomatic congenital toxoplasmosis in neonates, to prevent risks of reactivation and late complications, especially ocular. Such a prevention program has a cost validated by the prevalence of acquired toxoplasmosis in adults in France (over 50% of the population) and by the yearly incidence of congenital toxoplasmosis (at least 0.1% of births according to the best hypothesis). These 6 to 700 congenital toxoplasmosis cases per year may be compared to the 6 to 7,000 per gravidic seroconversions which could lead to fetal contamination if no preventive measures are taken. Nevertheless, as it is often the case in the field of prevention, it is very difficult to statistically assess the efficacy of this program even though several arguments show that it allows to eliminate the most serious toxoplasmosis, sources of serious handicaps at birth, and to limit the frequency of late complications (especially retino-choroiditis) of asymptomatic infections in neonates. The position of European countries varies as to prevention of congenital toxoplasmosis. Some countries (Austria, Belgium) have national prevention programs similar to the French one, whereas others have set up only limited programs or set up no systematic prevention. These differences may be accounted for by the different frequencies of toxoplasmic risk. It seems mandatory to forget all dogmatism and not to stick to a strictly statistical approach for a disease with not only medical but also social and human consequences.

Female↗
PubMed1999

Retinochoroiditis is induced by oral administration of Toxoplasma gondii cysts in the hamster model.

Administration of Toxoplasma cysts by intraperitoneal innoculation in the Syrian Golden Hamster provides a reproducible animal model of acquired Toxoplasmic retinochoroiditis and cysts are observed in the brain. However, toxoplasmosis is frequently acquired by oral ingestion of contaminated foodstuffs and it is recognised that the route by which disease is acquired may influence its pathogenesis and clinical expression. This study aimed to determine whether retinochorioiditis and cysts in the brain develop after oral ingestion in the Syrian Golden Hamster model as this is the route of induction akin to that in man and may therefore be more relevant in the study of disease pathogenesis. All animals developed disease by 4 weeks. Ocular and cerebral inflammation was confirmed by histology at 16 weeks and this was milder than in the original model.

Administration, Oral↗
PubMedDate not supplied

[The serology of toxoplasmosis in uveitis].

Determinations for decelerating the antitoxoplasma anticorps that have been effectuated for 696 uveas proved positivity at 123 aerums (17.6%). The repartition of the positive serology concerning the clinic form of the uvea has proved 48 iridocyclitis, 26 serous central corioretinals, 23 in panuveitis, 13 in posterior uveitis, 11 muscular chorioretinitis, 2 in hyalitis. Taking into consideration only the equal or less than 1:160 titrures, these have been at 7 iridocyclitis, 4 serous central chorioretinitis, 4 panuveitis, 3 posterior uveitis and 3 atrophic central chorioretinitis. It is shown that the diagnosis of ocular toxoplasma must be effectuated just corroborating the clinic data with the positive serology. The antiparasitic treatment doesn't influence upon the low titrures of serous anticorps, which generally maintain at the same value all the life.

Animals↗
PubMed1991

[Value and limitations of toxoplasmosis serology in HIV patients].

Antibody titers to Toxoplasma gondii were studied in 62 AIDS patients with active toxoplasmosis (cerebral in 42, pulmonary in 10 and ocular in 10), confirmed by biopsy or by imaging techniques with a therapeutic test, and in 1,499 HIV-positive patients. The purpose of this study was to evaluate the value of antibody assays for the diagnosis of active infection and the prevalence of toxoplasmosis in HIV-positive individuals. IgG antibodies to Toxoplasma were found in 61 of the 62 AIDS patients, but not in one patient with pulmonary toxoplasmosis, with no significant differences in mean titers obtained by dye test, indirect immunofluorescence and sensitized agglutination. Twenty patients (31.7%) had dye test titers of 400 IU/ml or more; three patients had IgM antibodies. Thirteen (38%) of the 34 patients who had serial antibody assays exhibited a rise in IgG titers with no detectable production of IgM antibodies. Antibodies to Toxoplasma were found in 75% of the 1,499 HIV-positive subjects, a proportion which is not significantly different from that seen in HIV-negative controls; however, HIV-positive subjects were significantly more likely than controls to have high titers (greater than or equal to 500 IU in 18.7% of patients versus 9.2% of controls, p less than 0.001). A follow-up study in 177 HIV-positive patients with antibodies to Toxoplasma showed an annual reactivation rate of 12%; in five of 30 patients, the rise in antibody titers occurred concomitantly with or a few months before clinical toxoplasmosis; 25 patients remained asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1989

Isotypic characterization of anti-Toxoplasma gondii antibodies in 18 cases of congenital toxoplasmic chorioretinitis.

A serological study was carried out by ELIFA (Enzyme Linked Immuno-Filtration Assay) for 50 children with congenital toxoplasmosis diagnosed by several parasitological and serological methods showing that the fetus had been infected by the parasite and had developed it's own specific immune response. At birth, anti-Toxoplasma gondii IgE antibodies were detected in the sera of 66% of the 18 children who had retinochoroiditis and in 32% of the 32 children without this complication. During the 4 months before or at the time of diagnosis of retinochoroiditis, specific IgE antibodies were detected in 70% of the 20 cases (2 children with 2 successive lesions); but during the 4 months following the discovery of ocular lesions, anti-Toxoplasma IgE antibodies were only detected in 30% of the 20 cases. Among all the 50 children, the prolonged detection of specific IgM + IgE association (for at least 4 months) was followed in 46% of cases by the appearance of chorioretinitis (predictive value).

Animals↗