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PubMed1990

[Serum immunosuppressive acidic protein (IAP) in inflammatory ocular disease].

The titer of serum immunosuppressive acidic protein (IAP) was determined by the method of single radial immunodiffusion (Matsuda et al) in Behçet's disease, sarcoidosis, tuberculosis, toxoplasmosis, etiology-unknown anterior uveitis (granulomatous, non-granulomatous), allergic conjunctivitis and scleritis. The titer of IAP in these diseases except allergic conjunctivitis was significantly higher than in normal controls. In all the diseases studied, the titer during the active stage was significantly higher than that during the inactive stage. The titer in Behçet's disease was significantly higher than that in sarcoidosis, particularly during the active stage. In three cases of Behcet's disease, the titer was increased markedly a few days before the ocular attacks. There was no difference in the titer between etiology-unknown granulomatous and non-granulomatous anterior uveitis. IAP may be useful as a clinical index in inflammatory ocular diseases.

Behcet Syndrome↗
PubMed2004

Patterns of uveitis in a tertiary eye care center in Iran.

PURPOSE: To identify the distribution and characteristics of new uveitis referrals to a tertiary eye care center in Tehran. METHODS: A three-year prospective study was carried out to obtain information on 544 new patients referred with uveitis. A complete ophthalmologic examination was performed in all cases; a routine set of tests and an additional battery of directed workup were conducted when indicated. RESULTS: Mean age was 32.3 years. There was no significant sex predominance. The most common forms of uveitis were anterior (38.4%) vs. other anatomical forms, chronic (62.1%) vs. acute (28.3%), nongranulomatous (85.5%) vs. granulomatous (14.5%), and noninfectious (83.5%) vs. infectious (16.5%). With regard to etiology, 45.5% were idiopathic, 19.9% were due to specific ocular disease, and 37.3% were associated with systemic disorders. Behcet's disease was the most common noninfectious disease and toxoplasmosis the most common infectious entity. The most prevalent causes were idiopathic, Fuchs' heterochromic iridocylitis, and seronegative spondyloarthropathies in anterior uveitis; toxoplasmosis, Eales disease, and toxocariasis in posterior uveitis; idiopathic, sarcoidosis, and multiple sclerosis in intermediate uveitis; and, finally, Behcet's disease, idiopathic, and Vogt-Koyanagi-Harada syndrome in panuveitis. The most frequent cause in patients under 16 years of age was pars planitis. Over 80% of the patients belonged to middle-to-upper socioeconomic classes. Uveitis significantly affected patients' lives in 63.1% of the cases. CONCLUSION: Although the current study was performed at a referral center, it may reflect to some extent the different distribution of uveitis in Iran and probably other Middle Eastern countries. Some entities such as presumed ocular histoplasmosis were not found, cytomegalovirus retinitis and birdshot chorioretinopathy were extremely rare, and HLA-B27-associated iridocyclitis was less commonly observed. In contrast, Behcet's disease, Fuchs' heterochromic iridocyclitis, Eales disease, and toxocariasis were among the more prevalent entities.

Adolescent↗
PubMed1994

Brainstem toxoplasmosis in patients with acquired immunodeficiency syndrome.

Brainstem involvement by Toxoplasma gondii is probably more common than other opportunistic infections, although it has not received adequate attention. Identification of toxoplasmosis is essential, as this condition responds to treatment with a significant increase in life expectancy. During the past 4 years, 366 AIDS patients with central nervous system toxoplasmosis diagnosed by biopsy or improvement following empirical treatment were evaluated. Among them, 8 (7 men, 1 woman; aged 25-55 yr) presented with signs of brainstem dysfunction. Six patients presented with an oculomotor nerve palsy and contralateral hemiplegia; 1 had an additional ipsilateral rubral tremor. The seventh patient had complete external ophthalmoplegia and the eighth had Parinaud's syndrome. Computed tomography revealed enhancing lesions in the brainstem of all patients. Seven responded to treatment with pyrimethamine and sulfadiazine.

AIDS-Related Opportunistic Infections↗
PubMed1999

Fetal cataract in congenital toxoplasmosis.

We report a case of the prenatal diagnosis of fetal cataract due to congenital toxoplasmosis. To the best of our knowledge, this is the first report of such a case. We discuss the long-term ocular sequelae of the condition and how they should affect prenatal counselling.

Adolescent↗
PubMedDate not supplied

Aicardi's syndrome: a report of four cases and review of the literature.

Four patients with Aicardi's syndrome (infantile flexion spasms, agenesis of the corpus callosum, and ocular anomalies) are reported, along with photographs of their characteristic fundus abnormalities. The etiology of the syndrome is unclear, but its occurrence exclusively in female patients suggests the possibility of a genetic factor. The ocular abnormalities of Aicardi's Syndrome are distinguishable from, but may be confused with, those of congenital toxoplasmosis and cytomegalic inclusion disease. The syndrome can be identified clinically with a high degree of certainty. Ophthalmologists who are familiar with the syndrome may be helpful in the differential diagnosis.

Adult↗
PubMed1999

[Problems of congenital toxoplasmosis. Evolution over four decades].

EFFECT OF PREVENTIVE MEASURES: The development of reliable routine serology tests and the demonstration of the high prevalence of toxoplasmosis in France led to mandatory prospective screening of pregnant women in 1978, followed by prenatal screening in 1985. In addition, in utero diagnosis, first on fetal blood and now with the reliable and safe method using polymerase chain reaction on amniotic fluid, formally identifies the parasite. THE SITUATION TODAY: A comparison of the experience of a specialized center in Paris during three different periods over the last 40 years showed that currently 71% of all cases of congenital toxoplasmosis are infraclinical at birth and only 5% are severe. Mean incidence of seroconversion during pregnancy is 1.48%, with a 40% risk of fetal contamination if no treatment is given. The risk of overt fetopathy predominantly concerns maternal infections occurring prior to 26 weeks gestation. IN UTERO TREATMENT: Positive PCR diagnosis on amniotic fluid imposes serial ultrasound examinations to identify any fetopathy and an in utero treatment by giving the mother the pyrimethamine-sulfadiazine combination. Biological results are favorable. POST-NATAL TREATMENT: Post-natal treatment is indicated even in latent forms and should be continued for the first year of life. The pyrimethamine-sulfadiazine combination is the only pharmaceutical regimen with well-proven efficacy. New compounds should allow better prophylaxis against maternofetal contamination or improved post-natal treatment. RECURRENCE: In 70% of the cases, serology tests become positive again, but are not associated with significantly increased risk of ocular recurrence.

Female↗
PubMed2006

Pattern of childhood-onset uveitis in a referral center in Tunisia, North Africa.

PURPOSE: To analyze the pattern of childhood uveitis in a referral center in Tunisia, North Africa. METHODS: The study included 64 patients with uveitis examined at the Department of Ophthalmology of Monastir (Tunisia) from January 1994 to July 2005. All patients had a comprehensive ocular and systemic history, including an extensive review of medical systems. Complete ophthalmic examination was performed in all cases, including best-corrected Snellen visual acuity, slit-lamp examination, applanation tonometry, and dilated fundus examination with 3-mirror lens. Standard diagnostic criteria were employed for all syndromes or entities of uveitis. RESULTS: The mean age at onset of uveitis was 12.4 years. The male-to-female ratio was 0.68. The process was unilateral in 51.6% of patients. Mean follow-up was 43.2 months. Anterior and intermediate uveitis each represented 31.25% of cases, posterior uveitis 20.3%, and panuveitis 17.2%. Noninfectious uveitis (75%) was the most frequent type of inflammation. Idiopathic uveitis was found in 50% of patients. Infectious uveitis was responsible for 25% of the cases, with toxoplasmosis (14.1%) being the most frequent cause. Twenty percent of the patients had systemic associations; juvenile idiopathic arthritis was found in 6.25%. Ocular complications occurred in 74.7% of affected eyes, of which the most common were posterior synechiae (28.4%), cataract (17.9%), cystoid macular edema (19%), and optic disc edema (32.6%). Fifty-seven affected eyes (60%) had a final visual acuity more than 20/40 and nine (9.5%) had a final visual acuity less than 20/200. CONCLUSIONS: In a hospital population in Tunisia, a specific cause of uveitis in children was found in half the patients. Idiopathic intermediate uveitis was the leading cause of uveitis in our study, followed by idiopathic anterior uveitis and toxoplasmosis. Uveitis associated with juvenile idiopathic arthritis was rare. Visual prognosis appeared to be good.

Adolescent↗
PubMed1996

Ocular manifestation of systemic infections.

Careful examination of external and internal ocular structures in patients with systemic infections may assist in early diagnosis and institution of appropriate therapy. Recent literature discussing ocular manifestations in the following systemic infectious diseases are reviewed: tuberculosis, Lyme borreliosis, cat scratch disease, toxocariasis, congenital toxoplasmosis, and invasive aspergillosis.

Animals↗
PubMed1996

[Pathology of the retina in patients with AIDS].

Changes in the fundus oculi are usually seen in patients with well-defined clinical features of the acquired immunodeficiency syndrome (AIDS). The commonest pathology of the retina, seen in 40-75% of the patients with advanced AIDS, is known as 'the microvascular complex of the retina associated with AIDS', and is characterized by the presence of cotton-wool exudates and retinal haemorrhages. Many of these lesions are casual findings on examination of the fundus oculi. Cytomegalic (CMV) retinitis appears in 20-30% of AIDS patients, and diagnosis is important so that treatment with foscarnet or ganciclovir may be started early to conserve vision. Occasionally necrotizing retinitis appears due to the varicella zoster virus, following the typical skin condition. There is little response to acyclovir treatment. Retinitis due to toxoplasma is much less common than cerebral toxoplasmosis. The retinal lesions are predominantly neuritic and respond well to treatment with antitoxoplasma. Other rarer causes of ocular disorders in AIDS are syphilis, tuberculosis, cryptococcus and lymphoma.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Extracerebral toxoplasmosis in patients infected with HIV. A French National Survey.

A French nationwide survey of extracerebral toxoplasmosis (ECT) in HIV-infected patients was performed between January 1990 and September 1992. All French hospitals were surveyed, and all but a few responded. Data collected included epidemiologic, clinical, and biologic features; therapy; and outcome. During the 33-month survey, 199 cases were collected. The prevalence of ECT in patients with AIDS can be estimated at 1.5%-2%. Age, sex, and HIV risk factors were similar to those of the general AIDS population in France. Extracerebral toxoplasmosis appeared mainly in HIV-infected patients with advanced immunosuppression: the mean CD4+ lymphocyte count was 57/mm3(+/- 99). The localizations observed were: eyes (50% of patients); lung (26%); disseminated (at least 2 extracerebral visceral localizations) (11.5%); peripheral blood (acute febrile syndrome with isolated positive parasitemia) (3%); heart (3%); bone marrow (3%); bladder (1%); and isolated cases of rhinopharynx, skin, liver, lymph nodes, conus medullaris, and pericardium. In this survey, muscular and pancreatic localizations were always associated with other extracerebral localizations. A cerebral localization was diagnosed in 41% of cases. Serologic data provided little information. Ocular fundus examination, bronchoalveolar lavage, tissue biopsy, and search for parasitemia were the main diagnostic procedures. Treatment was the same as for cerebral toxoplasmosis. A clinical response was observed in 64% of cases; 19% relapsed. Death occurred in 106 (53%) cases and was related to ECT in 34% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1997

[Eye infections in AIDS patients].

Inflammatory eye diseases in Aids patients are common. For CMV-retinitis an incidence of up to 45% is reported in the literature. Other retinal diseases such as acute retinal necrosis are less common but are difficult to treat and often follow a disastrous course. Ocular lues may present very different clinical pictures and is the great "imitator" in AIDS patients as well. In toxoplasmosis the typical chorioretinal scars next to the acute inflammatory infiltrates are commonly absent. Infections with candida occur in i.v. drug-addicts in particular. Bacterial corneal ulcers and herpetic keratitis are not more common in HIV-positive patients than in immunocompetent individuals, but the course of the disease is often more severe and prolonged. In patients with low CD4 counts Microsporus can cause painfull keratitis. Mollusca contagiosa are more common in AIDS patients and show the typical lesions, though these are greater in number (commonly more than 20) or in unusual localizations (mucous membrane).

AIDS-Related Opportunistic Infections↗
PubMed1985

Candida endophthalmitis after heroin abuse.

Three cases of ocular candidosis involving heroin abusers have been observed in 1983 in Toulouse department of ophthalmology. These three patients had used iranian brown heroin. Twenty similar cases have been published in these last years. This new pathology can be explained on two reasons. The first is that the drug abusers have some immunity pertubation; however, immunity exploration in these patients does not reveal any immunodeficiency. The second reason, certainly more important, is the method of using heroin. The diagnosis of Candida endophthalmitis of course based on clinical context must be proved by biological tests. Candida albicans is never identified in aqueous humor. For this reason, it seems very interesting to detect anti-candida antibodies in aqueous humor. It has been used as methods of dosage laser Nephelemetry for IgG and immunofluorescence for candidosis antibodies. The criterion used is similar to the toxoplasmosis coefficient established by Desmonts (3). In two cases, this test was the only way that permits us to have certitude of candidosis ocular diagnosis. Otherwise the observations show that anterior chamber punction is more significant when there is an anterior uveitis.

Adult↗
PubMed1986

Behçet's disease and streptococcal infection.

The streptococcal antigen was determined in the plasma of 26 patients with Behçet's disease, 30 patients with other uveitis (tuberculosis: 7, sarcoidosis: 6, Vogt-Koyanagi-Harada's disease: 6, toxoplasmosis: 6, trauma: 5), and 63 normal subjects with matched ages. The antigen titer in Behçet's patients, either during ocular attack or remission, was significantly higher than that in the normal control subjects (P less than 0.0001) and that of other uveitis subjects (P less than 0.001). Time-course study in the Behçet's disease cases showed that the titer was the highest during the attack and then decreased gradually as the ocular inflammation subsided. It was also found in two cases that the titer increased markedly just before the ocular attacks. There was no difference between the titer in other uveitis cases and that in the controls. By electron microscope, streptococcal L form-like structures were observed in the plasma and leukocyte layer of the blood of Behçet's patients sampled during the ocular attacks. Streptococcal infection may play a significant role in the pathogenesis of Behçet's disease.

Adolescent↗
PubMed1993

Septic shock due to toxoplasmosis in patients infected with the human immunodeficiency virus.

PURPOSE: To describe the presentation and clinical course of septic shock due to Toxoplasma gondii in patients infected with the human immunodeficiency virus (HIV). PATIENTS AND METHODS: From April 1988 to February 1992, nine HIV-infected patients were admitted because of predominant septic shock (7 patients) or developed septic shock in the ICU (2 patients). The recent CD4+ cell count ranged from 2 to 84 x 10(6)/L. RESULTS: The main clinical features were (1) a history of fever for longer than 15 days, with a recent increase to more than 39.5 degrees C; (2) a recent history of dyspnea (< 15 days, 8 cases; < 7 days, 3 cases); and (3) recent onset of thrombocytopenia (6 of 9 cases). All patients were in shock (hyperkinetic profile in 6 of 7; hypokinetic in 1 of 7), and 8 of 9 were in respiratory distress (ratio of PaO2 over fractional concentration of oxygen in the inspired gas of 117 +/- 23; range, 88 to 155). Chest roentgenograms revealed diffuse alveolar infiltrates in six of nine cases. The serum lactate dehydrogenase (LDH) activity was 6,510 +/- 5,080 IU/L (range, 1,010 to 15,450 IU/L). Serologic tests for T gondii were negative in two cases. Toxoplasma gondii was isolated from lung (9/9), bone marrow (5/7), or blood (2/2). One, 3, and 2 patients had brain, ocular, and myocardial involvement, respectively. No other microbial pathogens were isolated. Seven patients died, 5 less than 3 days after admission. CONCLUSION: Disseminated toxoplasmosis can cause septic shock in HIV-infected patients. In two cases, the disease was probably a primary infection. The association of high fever, acute dyspnea, recent onset of thrombocytopenia, and a very high level of LDH activity is suggestive of disseminated toxoplasmosis.

AIDS-Related Opportunistic Infections↗
PubMed1987

Congenital neuro-ophthalmic toxoplasmosis in the mouse.

Clinical examination of the eyes of mice with congenital toxoplasmosis provided a good indication of the extent of underlying histopathological damage in the eye, but was of little value for predicting neuropathological severity. Furthermore, the dye-test titre was not related either to the degree of ocular damage or to the severity of brain damage.

Animals↗
PubMed1980

Presumed ocular tuberculosis.

Tuberculosis, once thought to be the most common cause of uveitis, is now thought to be a relatively rare cause of ocular disease. This is because of a decreased incidence of tuberculosis as well as a lessened emphasis on its diagnosis. The majority of cases of posterior uveitis and retinitis today are toxoplasmosis, histoplasmosis and other viral causes along with undetermined etiology. Following is a case report of a retinitis and periphlebitis of presumed tuberculous etiology because of the systemic involvement of the patient.

Diagnosis, Differential↗