Ocular signs in diseases of infancy and childhood.
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Arachnodactyly↗
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Results for “TOXOPLASMOSIS, OCULAR”
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[Treatment of subclinical congenital toxoplasmosis by sulfadiazine and pyrimethamine continuously during 1 year: apropos of 46 cases].
UNLABELLED: In France, most of children suffering from congenital toxoplasmosis have an infraclinic or moderate type at birth. This study aimed at evaluating, on the mid term, tolerance and results of postnatal treatment previously given in severe toxoplasmosis. METHODS: A retrospective study considered 46 children with a mild or moderate congenital toxoplasmosis treated over 12 months with sulfadiazine-pyrimethamine and treatment was completed since three months. RESULTS: Five children suffered from a lesion of chorioretinitis during treatment and two after. After a mean follow-up of 27.1 months, ten children (21.7% 95%CI [12.1-35.9]) had at least one ocular injury. Specific IgG titers and immune load were diminished to become almost non-existent at the end of the year of treatment (respectively p < 10(-5) and p = 0.0005). No thrombocytopenia was observed. Twenty-three children (50%) had at least one episode of neutropenia < 1000/mm3, 14 had only one, nine presented two or more installment. None was followed by an infection. CONCLUSION: This therapeutic pathway is more demanding but shorter than those usually offered when associating pyrimethamine-sulfadiazine. Yet, it does give identical result on the mid term. Longer follow-up is needed to appreciate. Active molecule on cysts should be introduced.
Age Factors↗
Vitrectomy in eyes with unsuspected retinoblastoma.
OBJECTIVE: To analyze patient management and prognosis after vitrectomy in eyes with unsuspected retinoblastoma. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Eleven consecutive patients who had undergone vitrectomy on an eye with unsuspected retinoblastoma. MAIN OUTCOME MEASURES: The two main outcome measures were ultimate patient management and the development of retinoblastoma metastasis. RESULTS: Of more than 900 consecutive patients with retinoblastoma managed on the Ocular Oncology Service at Wills Eye Hospital in Philadelphia, 11 (1%) had prior vitrectomy in an eye with viable tumor before referral to us for suspected retinoblastoma. The main preoperative diagnoses included vitreous hemorrhage in seven patients (64%), toxocariasis in two patients (18%), toxoplasmosis in one patient (9%), and endophthalmitis in one patient (9%). In no case was retinoblastoma suspected before vitrectomy. The mean patient age at vitrectomy was 6 years. Retinoblastoma was later suspected during vitrectomy in two patients (18%), on cytologic examination of the vitrectomy specimen in eight patients (73%), and after referral in one patient (9%). The mean interval between vitrectomy and referral to us was 23 days. On examination, the globe was classified as Reese-Ellsworth group Vb in all 11 patients (100%). Anterior chamber tumor cells were clinically visible in four eyes (36%), hyphema in two eyes (18%), and iris neovascularization in two eyes (18%). Retinoblastoma cells were visualized in the vitreous in seven eyes (64%) and not visualized in four eyes (36%) that had vitreous blood. Enucleation was necessary in all 11 patients (100%). Adjuvant treatment was delivered in 10 patients (91%), using orbital radiotherapy in nine patients (82%) and chemotherapy in nine patients (82%). Histopathologic evidence of retinoblastoma invasion was documented in the episclera (two eyes; 18%), anterior chamber (seven eyes; 64%), iris (five eyes; 45%), ciliary body (five eyes; 45%), choroid (three eyes; 27%), and optic nerve (four eyes; 36%; prelaminar, two eyes; postlaminar, two eyes). The vitrectomy ports, Tenon's fascia, cut end of the optic nerve, and orbit were free of tumor. Of the 10 patients who received prophylactic chemotherapy, radiotherapy, or both in addition to enucleation for prevention of retinoblastoma metastasis, none (0%) experienced metastasis or orbital recurrence during the mean follow-up of 7 years (range, 0.2-24 years) from the time of retinoblastoma diagnosis. However, one patient was referred to us after the development of metastatic retinoblastoma, and despite aggressive chemotherapy and radiotherapy after enucleation, died 24 months later. CONCLUSIONS: Retinoblastoma may present with atypical features such as vitreous hemorrhage or signs of vitreous inflammation, particularly in older children. Vitrectomy should be avoided in these cases until the possibility of underlying retinoblastoma is excluded. If vitrectomy is performed in an eye with unsuspected retinoblastoma, enucleation combined with adjuvant chemotherapy, radiotherapy, or both without delay is advised to prevent systemic tumor dissemination.
Adolescent↗
[A case of toxoplasmic chorioretinitis and meningoencephalitis in an immunocompetent adult].
A 71-year-old man who presented with toxoplasmic chorioretinitis and meningoencephalitis is reported. He had been healthy and immunologically normal. Initially, he complained of blurring of vision without headache, nor fever. Neurological examinations revealed papilledema, nuchal rigidity, and disorientation. Fluorescent angiography of the ocular fundi disclosed hyperfluorescent leaks suggesting chrioretinitis. His EEG had dysrhythmic slow alpha wave with some theta slowing. CSF studies showed pleocytosis up to 80/mm3; the cells were predominantly lymphocytes. The titers of toxoplasma antibody in the serum and CSF were prominently increased. Toxoplasmosis was highly suspected and he was treated with predinsolone, acetylspiramycin, and pyrimethamine. After the treatment, ophthalmologic and neurological symptoms improved, and the laboratory findings including the titers of toxoplasma antibody in the serum and CSF were also improved. Recently, toxoplasmosis associated with neurological complications as an opportunistic infection is a serious problem in the immunocompromised hosts, especially in AIDS, but this infection is rare in immunologically normal adults. Our case and some other reports may suggest a chance of developing toxoplasmic meningoencephalitis even in healthy individuals. We have to think of the possibility of toxoplasmosis in the immunocompetent hosts when they are presenting with chorioretinitis and meningoencephalitis.
Aged↗
Congenital ocular anomalies in 800 mentally deficient patients.
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Asphyxia Neonatorum↗
Systemic diseases having ocular manifestations including metabolic disturbances.
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Amyloidosis↗
[Changes in the fundus in subacute sclerosing panencephalitis. Apropos of 23 cases].
Subacute sclerosing panencephalitis (SSPE) is a fatal slow encephalitis. It is related to a chronic infection of the central nervous system by a defective measles virus. Among 41 patients with SSPE, 23 had ocular involvement. The ophthalmologic involvement preceded the onset of neurological signs in 4 cases, they were detected at first presentation in 9 cases, and they occurred in the course of the disease in 10 cases. The ocular involvement was bilateral in 19 cases. Various ophthalmologic features were reported: retinitis (16 eyes), macular pigment disturbances (4 eyes), optical neuritis (33 eyes), visual agnosia (1 patient). The macular lesions were typical of the disease, but at the acute stage they were liable to be confused with toxoplasmosis. This complication of measles should disappear with the systematic vaccination of 12 month old children.
Adolescent↗
[Clinical view of toxoplasmosis in children--personal observations].
In this work we presented our own experience with recognized and treated toxoplasmosis among children. Treated cases were observed over several years afterwards. We analyzed the frequency and character of clinical changes, evaluated the validity of serological screening and the effectiveness of treatment. The largest age group treated were children 13 months to 5 years old. 13 children had the congenital and 12 the acquired form. The most cases occurred in the nodal, ocular and ocular-cranial forms. Thus, the most common symptoms were enlarged lymphatic nodes, strabismus, febrile seizures, intracranial calcifications. In the acquired forms of the illness a distinct correlation between treatment and the decrease antibody levels, the clinical pictures showed stagnation. The fall in antibody levels occurred earlier with intermediate immunofluorescence than with ELISA method. Among 20 children associated 30-day treatment was implemented (Daraprim, Rovamycine, Biseptol), among 4 with Fansidar and Rovamycine for 2-3 weeks. Few complications occurred at the end of or after treatment and did not require treatment/intervention. Usually it was leukopenia and thrombocytopenia. Long time observation allows to state that both therapeutic models prevent renewal of illness and can be recommended for further use.
Adolescent↗
Effect of sex hormones on the immune system of guinea-pigs and on the development of toxoplasmic lesions in non-lymphoid organs.
The role of cell-mediated immunity in the pathogenesis of toxoplasmic lesions in non-lymphoid organs and its significance in resistance to infection with Toxoplasma gondii were studied in guinea-pigs. Alteration of the sex hormonal environment in both sexes has significant effects on the immunological status of the guinea-pig, changing its reaction to toxoplasmic infection. Thus, gonadectomy appears to enhance delayed hypersensitivity, leading to a greater prominence of lesions in the non-lymphoid organs of gonadectomized male and female animals than in controls. This observation supports the possibility that delayed hypersensitivity plays a major role in the pathogenesis of non-lymphoid, toxoplasmic lesions. Hexoestrol administration for a long period of time induces complete thymic atrophy and severe involution of the thymus-dependent areas of the lymph nodes and spleen, leading to the suppression of cell-mediated immunity and overwhelming disease in those animals infected with Toxoplasma gondii, suggesting that cell-mediated immunity is of importance in resistance to toxoplasmic infection. In view of these findings, the difficulties in the treatment of non-lymphoid toxoplasmic lesions, such as ocular ones, by depressing cellular immunity, are discussed.
Animals↗
Pattern of uveitis in a referral uveitis clinic in India.
This report describes a retrospective study of all new patients in our uveitis clinic between January 1992 and December 1994, undertaken to identify the pattern of uveitis in the Indian subcontinent. A standard clinical protocol, and the naming-meshing system with tailored laboratory investigations were used to arrive at a final uveitic diagnosis. Uveitis comprised 1.5% of new cases seen at the centre. Out of 1,273 uveitis cases, anterior uveitis was the most common type (39.28%), followed by posterior uveitis (28.75%), intermediate uveitis (17.44%), and panuveitis (14.53%). The most commonly affected age group were patients in their forties (23.57%). Uveitis was less common in children below 10 years (3.61%) and in adults over 60 years of age (6.44%). Men (62.21%) were more commonly affected than women (37.79%). Aetiology remained undetermined in 59.31% of cases. Anterior uveitis was most commonly idiopathic (58.6%). The most common cause of posterior uveitis was toxoplasmosis (27.87%), and that of panuveitis was the Vogt-Koyanagi-Harada syndrome (21.08%). A higher incidence of microbiologically proven tubercular uveitis (5 cases), and uveitis due to live intraocular nematode (4 cases), and malaria (1 case), were seen, in contrast to other studies. Only 2 cases of AIDS with ocular lesions were seen. This paper reveals the pattern of uveitis seen at a major referral eye institute in India.
Adolescent↗
Mast cells in the eyes of Calomys callosus(Rodentia: Cricetidae) infected by Toxoplasma gondii.
The mast cell is a powerful effector cell for the innate immune system, acting through the secretion of several distinct mediators. Few studies have demonstrated the relationship between mast cells and toxoplasmosis. In this study, mast cells were investigated in two experimental Toxoplasma infections using Calomys callosus (Rodentia: Cricetidae) as the host. Animals were inoculated either intraperitoneally or via the conjunctiva with tachyzoites of Toxoplasma gondii (RH strain) and sacrificed after 5 days or 24 h, respectively. Enucleated eyes were processed for histological and ultrastructural analysis. Neither experimental infection altered the localization of mast cells compared to control eyes, but they did lead to an accumulation in some tissues as well as to their activation. There was a significant increase in the number of mast cells within 5 days and 24 h after infection. The ocular lesions were characterized by the presence of tachyzoites, inflammatory cells and vasodilatation in the iris and retina. In conclusion, mast cells were mobilized in these experimental infections, suggesting that they play an important role in the host inflammatory response after infection with T. gondii.
Animals↗
Vitritis as the primary manifestation of ocular syphilis in patients with HIV infection.
PURPOSE: To describe dense vitritis as the primary manifestation of ocular syphilis in three human immunodeficiency virus (HIV)-positive patients and to determine the response of these patients to the established regimen for neurosyphilis. METHODS: Anti-Toxoplasma gondii IgM and IgG antibody titers, tuberculin skin test, chest radiograph, and serum angiotensin-converting enzyme level were obtained because tuberculosis, sarcoidosis, and toxoplasmosis were in the differential diagnosis. Two of the three patients were not known to have HIV infection at the time of initial examination and consented to HIV testing. Treponemal and nontreponemal tests were performed on serum and cerebrospinal fluid to establish a definitive diagnosis. Treatment for neurosyphilis was initiated, and daily ophthalmic examinations were performed, with careful attention to signs commonly associated with syphilitic eye disease. RESULTS: All three patients exhibited improvement in visual acuity and resolution of vitreous haze. There was no evidence of other signs of posterior uveitis. The one patient for whom there has been a 6-month follow-up showed no sequelae of his eye disease. CONCLUSIONS: Human immunodeficiency virus-positive patients with syphilis may present atypically dense vitritis. In these patients, vitritis may be the first manifestation of syphilis. The regimen for neurosyphilis provides effective therapy. Moreover, in some patients, syphilitic vitritis may be the initial manifestation of HIV disease.
Adult↗
Soluble ICAM-1 serum levels in patients with intermediate uveitis.
AIM: To investigate whether serum levels of soluble intercellular adhesion molecule 1 (sICAM-1) can serve as a marker of the presence of systemic disease in intermediate uveitis. METHODS: In a multicentre study sICAM-1 serum levels were measured in 61 patients with idiopathic intermediate uveitis, controls included 56 uveitis patients with a systemic disease (26 sarcoid associated uveitis and 30 HLA-B27 positive acute anterior uveitis), 58 uveitis patients without systemic disease (30 toxoplasma chorioretinitis and 28 Fuchs' hetrochromic cyclitis), and 21 normal controls. The clinical records of the patients with intermediate uveitis were analysed for disease characteristics at the time of blood sampling and for a relation with the development of a systemic disease after a mean follow up of 4.5 years. RESULTS: Increased serum levels of sICAM-1 were found in 34 out of 61 patients with intermediate uveitis and were significantly different when compared with toxoplasmosis, Fuchs' cyclitis, and healthy controls (p<0.001). Elevated sICAM-1 levels were also found in 18 out of 26 patients with sarcoid uveitis and in 11 out of 30 patients with HLA-B27 associated anterior uveitis. Raised sICAM-1 levels in the intermediate uveitis group were significantly associated with active ocular disease (p<0.01) and the presence of vitreous exudates (p<0.05). Increased levels of sICAM-1 correlated with interleukin 8 levels (IL-8) (tested in a previous study in the same group of intermediate uveitis patients) in patients with active systemic involvement. Follow up of the patients showed that an established or suspected systemic disease was found more often in the 21 intermediate uveitis patients with increased sICAM-1 and IL-8 levels compared with the other 40 patients with intermediate uveitis (p<0.01). CONCLUSIONS: The measurement of both sICAM-1 and IL-8 can be used as a marker for ocular disease activity and for a predisposition of developing an associated systemic disease in intermediate uveitis patients.
Adult↗
Bartonella henselae neuroretinitis in cat scratch disease. Diagnosis, management, and sequelae.
OBJECTIVE: This study aimed to report the long-term outcomes of patients treated with an antibiotic drug combination for Bartonella henselae neuroretinitis. DESIGN: The study design was a retrospective case series. PARTICIPANTS: Seven consecutive patients with neuroretinitis and cat scratch disease participated. INTERVENTIONS: Patients underwent medical and ophthalmic evaluations. Blood cultures were obtained, and B. henselae antibody titers were measured. Tuberculosis, Lyme, toxoplasmosis, syphilis, and sarcoidosis were excluded. Patients received oral doxycycline 100 mg and rifampin 300 mg twice daily for 4 to 6 weeks and were observed for an average of 16 months (range, 10-24 months). Formal electrophysiologic testing was performed in three patients after resolution of neuroretinitis. MAIN OUTCOME MEASURES: The changes in ocular inflammation and visual function associated with treatment were recorded. Follow-up examinations and electrophysiologic testing documented sequelae. RESULTS: Patients presented following cat exposure with fever, malaise, and blurred vision. Decreased visual acuity (ranging from 20/40 to counting fingers) frequently was associated with dyschromatopsia and afferent pupillary defects. Ophthalmoscopic analysis showed signs of neuroretinitis, including nerve fiber layer hemorrhages, cotton-wool spots, multiple discrete lesions in the deep retina, and stellate macular exudates. B. henselae infection was confirmed with positive blood cultures or elevated immunofluorescent antibody titers or both. Therapy appeared to promote resolution of neuroretinitis, restoration of visual acuity, and clearance of bacteremia. After 1 to 2 years, two eyes had residual disc pallor, afferent pupillary defects, retinal pigmentary changes, and mildly decreased visual acuity. Electrophysiologic studies showed that when compared to the fellow eye, affected eyes had subnormal contrast sensitivity, abnormal color vision, and abnormal visually evoked potentials. Conversely, electroretinograms were normal in all subjects. CONCLUSIONS: B. henselae is a cause of neuroretinitis in cat scratch disease. Compared to historic cases, doxycycline and rifampin appeared to shorten the course of disease and hasten visual recovery. Long-term prognosis is good, but some individuals may acquire a mild postinfectious optic neuropathy.
Adult↗
[Monitoring and treatment of toxoplasmosis in the pregnant woman, fetus and newborn].
A protocol of monitoring and treatment in toxoplasmosis is suggested by the authors. During pregnancy, the administration of spiramycine at a 9 m UI daily dose remains the basic preventive treatment when a seroconversion occurs after a 4 week post-conception period. In the fetus, the antenatal diagnosis is made by ultrasound started on the 18th week after conception and repeated every 4 weeks, amniocentesis and eventually umbilical cord puncture associated with a pyrimethamine-sulfamide drug treatment in case of positive diagnosis. A therapeutic pregnancy termination is considered when lesions have been detected by ultrasound. In the newborn (neonatal or post-natal period), the diagnosis is made by transfontanel ultrasonography, ocular fundi and spinal fluid examination, detection of specific IgM antibodies in cord blood and the evolution and importance of serum antibodies response requiring a drug treatment during 15-18 months with spiramycine and pyrimethamine + sulfadoxine (Fansidar).
Amniocentesis↗
Evidence-based diagnosis of toxoplasma infection.
The aim of this study was to compare the performance of one in-house and four commercially available toxoplasma assays with the Sabin-Feldman dye test. One hundred fifty-seven routine sera and 20 potentially cross-reactive sera were tested blindly using four commercial assays: Abbott AxSym IgG (Abbott Laboratories, UK), Captia Select Toxo-G (Trinity Biotech, UK), Toxreagent 'Eiken' (Eiken Chemical, Japan) and Toxolatex Fumouze (Fumouze Laboratoires, France); an in-house IgG and IgM enzyme immunoassay (EIA); and the gold standard Sabin-Feldman dye test. The sensitivity, specificity and the values using the formulae for numbers needed to diagnose (NND) and the cost per positive diagnosis (CPPD) were calculated for each assay. These formulae use the sensitivity and specificity of the assay to allow for evidence-based comparisons between assays. The NND values for the in-house IgG EIA, AxSym, Eiken and Fumouze latex kits were similar (1.21-1.24), whereas the Captia yielded the poorest value (1.33). The in-house EIA IgG had the lowest CPPD value (pound sterling 0.57/$0.91), and the Fumouze and Eiken latex kits had the lowest CPPD values for commercial assays (pound sterling 1.42/$2.27 and pound sterling 1.81/$2.90, respectively). Both assays were simple and straightforward to use. Specialist laboratories should opt to use in-house assays, as they were most cost-effective. Although nonspecialist laboratories could use commercial assays, specimens from immunocompromised patients and patients with ocular disease should be forwarded to specialist laboratories without prior testing.
Animals↗
Diagnostic vitreous biopsy in patients with uveitis: a useful investigation?
PURPOSE: To assess whether the results of microbial and cytological investigations of vitreous biopsy specimens are useful in the management of patients with intraocular inflammation. METHOD: A retrospective review of the medical records of 59 consecutive patients from consulting rooms, outpatient clinics and inpatient consultation who underwent intravitreal sampling between January 1997 and December 2003. Results of the biopsies were examined to determine if they altered management of the patient. RESULTS: The clinical diagnosis was correct in 37 of 59 patients (62.7%) with ocular inflammation. The organism was identified in 50% (7/14) of vitreous biopsies in patients with postoperative endophthalmitis. Of patients with endogenous bacterial endophthalmitis 16.7% (1/6) had the diagnosis confirmed by vitreous tap and 83.3% (5/6) had positive cultures from other sites that provided the diagnosis. Of the fungal endophthalmitis 80% (4/5) grew the fungus from the vitreous biopsy. Viral polymerase chain reaction identified the causative organism in 87.5% (7/8) of patients with clinical diagnosis of viral infection. 30.8% (4/13) vitreous biopsies in patients with clinically suspected masquerade syndromes were diagnosed as lymphoma. Vitreous biopsy results altered management significantly in seven (11.9%) patients. These patients included toxoplasmosis that was thought to be viral retinitis; malignant melanoma thought to be fungal endophthalmitis; chronic inflammation secondary to retinal detachment that was thought to be a neoplasm; three patients with infective endophthalmitis thought to be idiopathic uveitis and a patient with known lung carcinoma thought to have metastases who had lymphoma. In 67.8% (40/59) the vitreous sample helped to either confirm the diagnosis or exclude an infective cause. Complications from vitrectomy were hypotony (1/29) and retinal detachment (1/29). CONCLUSION: Clinical diagnosis based on examination findings and vitreous biopsy is highly accurate. Vitreous sampling altered the management of seven of 59 patients. Vitreous biopsy is a safe and useful method for diagnosing and excluding malignancy and infection in patients with ocular inflammation. Viral polymerase chain reaction is highly sensitive and accurate. The sensitivity of microbiological culture techniques for bacteria and fungi limits their usefulness.
Adult↗
Longitudinal study of serum antibody responses to bovine retinal S-antigen in endogenous granulomatous uveitis.
Twelve patients with granulomatous uveitis were followed up longitudinally for as long as 20 months after their initial visit, and multiple serum antibody titres to bovine retinal S-antigen were determined and compared with the clinical activity at the time of each sampling. In those patients who presented with highly active lesions which then resolved during the course of the study without recurrences (7 toxoplasmosis and 1 pars planitis) the antibody titres reached a peak approximately 2 months after the initial visit and declined thereafter. No correlation of serum anti-S titres with clinical activity or predictable pattern of titres could be found in those patients who had recurrences during the course of the study (3 granulomatous iridocyclitis and 1 ocular sarcoidosis).
Antibodies↗