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Feline ocular toxoplasmosis.

Ocular infection with Toxoplasma gondii is a well-recognized and important clinical entity in many animal species. In the cat, ocular toxoplasmosis is commonly associated with systemic infection, yet its role in causing anterior uveitis in an otherwise healthy cat is unclear. The purpose of this article is to review the salient epidemiological, clinical, and histopathologic features of systemic and ocular toxoplasmosis in the cat. Additionally, pathogenesis and possible immunopathogenic mechanisms of ocular toxoplasmosis, which may account for the higher prevalence of anterior uveitis in cats seropositive for T. gondii, are discussed. Finally, diagnosis, treatment and prevention of feline toxoplasmosis are reviewed.

Journal Article↗

Fuchs' heterochromic cyclitis and ocular toxoplasmosis.

Ocular toxoplasmosis and Fuchs' heterochromic cyclitis are well-defined diseases that have completely different clinical courses. We studied 13 patients (seven men and six women, ranging in age from 18 to 73 years) who had Fuchs' heterochromic cyclitis and the focal necrotizing chorioretinal lesions characteristic of ocular toxoplasmosis. The reason for this association is still unknown, as is the pathogenesis of Fuchs' heterochromic cyclitis. None of the patients had ciliary injection or posterior synechiae, but 11 of the 13 (84.6%) had keratic precipitates, anterior chamber reaction, and cataracts. Six patients (38.4%) had iris transillumination, two (15.3%) had glaucoma, and four (30.7%) had lesions in the fellow eyes.

Adolescent↗

Visual impairment and blindness in ocular toxoplasmosis cases.

Ocular toxoplasmosis is a common vision-threatening disease in Indonesia. Diagnosis of this disease is based on characteristic ophthalmoscopic appearances and laboratory findings. Between 1985 and 1989, the authors retrospectively evaluated 41 children under 12 years of age. Thirteen cases had retinal lesions suspected to be toxoplasmosis but the laboratory findings were negative. The remaining 28 children had a total of 41 eyes diagnosed as ocular toxoplasmosis. Of the 41 affected eyes, vision had decreased to finger counting or less in 23 (56%) eyes and to less than 6/15 in 9 (22%) eyes. In five (12.2%) eyes vision was greater than 6/15, and in four (9.8%) eyes the status of vision was unknown. In addition to the usual signs of toxoplasmosis, signs of strabismus and nystagmus were evident in the cases reviewed. Thus, ocular toxoplasmosis should be suspected in patients, particularly children, with those clinical signs.

Blindness↗

Congenital ocular toxoplasmosis.

Congenital ocular toxoplasmosis is a significant cause of blindness. Retinochoroiditis is the most common finding, but other ocular manifestations include microphthalmus, nystagmus, strabismus, and ptosis. The serologic tests and lymphocyte stimulation test are the most useful aids in making the diagnosis. Pyrimethamine, sulfonamides, and corticosteroids are useful to treat active lesions. Primary care physicians, obstetricians, and ophthalmologists may help to prevent transmission of the disease and its serious ocular sequelae.

Chorioretinitis↗

Fas-FasL interaction involved in pathogenesis of ocular toxoplasmosis in mice.

Ocular toxoplasmosis is a potentially blinding intraocular inflammation. The intent of this study was to investigate the role of Fas-FasL interaction in a murine model of acquired ocular toxoplasmosis induced by intracameral inoculation of Toxoplasma gondii. Intraocular inflammation, Fas and FasL expression on lymphocytes and on ocular tissues, the occurrence of apoptosis, and the frequency of CD8(+) and CD4(+) T cells in the infected eyes were analyzed in C57BL/6 (B6) mice. Susceptibility to parasite-induced intraocular inflammation was observed in Fas-deficient (B6-lpr) and FasL-deficient (B6-gld) mice. Inoculation of 5,000 T. gondii tachyzoites induced significant intraocular inflammation associated with increase of Fas and FasL expression in the inoculated eyes of wild-type B6 mice. Flow cytometry demonstrated a significant increase of Fas and FasL expression on the splenocytes from naive mice incubated in vitro with the parasite and on the splenocytes harvested from the infected mice at day 8 after parasite inoculation. Apoptosis of inflammatory cells and cells in ocular tissues was seen, and a greater frequency of CD8(+) than CD4(+) T cells was observed in the infected eyes. The intensity of intraocular inflammation was greater in B6-lpr and B6-gld mice than in wild-type B6 mice (P < 0.05). The results suggest that Fas-FasL interaction associated with apoptosis is involved in the pathogenesis of acquired ocular toxoplasmosis in mice.

Animals↗

Ocular toxoplasmosis--clinical aspect.

Ocular toxoplasmosis in non immuno-deficients can take 3 major aspects: 1) Pseudo-acquired (congenital) forms in teenagers and young adults; 2) Congenital forms in the newborn; 3) Acquired toxoplasmosis.

Humans↗

Atypical presentations of ocular toxoplasmosis.

The diagnosis of ocular toxoplasmosis is based most often on the presence of characteristic clinical findings, which include focal retinochoroiditis, an adjacent or nearby retinochoroidal scar, and moderate to severe vitreous inflammation. However, a variety of less common, "atypical" presentations may be unfamiliar to clinicians, delaying both diagnosis and treatment. Patients who are immunocompromised or elderly may, for example, present with large, multiple and/or bilateral lesions. Other unusual manifestations include punctate outer retinal toxoplasmosis, retinal vasculitis, retinal vascular occlusions, rhegmatogenous and serous retinal detachments, a unilateral pigmentary retinopathy mimicking retinitis pigmentosa, neuroretinitis and other forms of optic neuropathy, and scleritis. Although in the past most cases of ocular toxoplasmosis were considered to result from reactivation of a congenital infection, it is now believed that postnatally acquired infection accounts for many cases of this disease. With appropriate use of antiparasitic therapy, the visual prognosis for patients with both typical and atypical forms of ocular toxoplasmosis may be good.

Choroiditis↗

[Ocular toxoplasmosis (author's transl)].

Ocular toxoplasmosis is a disease characterised by inflammation of posterior part of uvea. It can be either congenital or acquired. However, ocular toxoplasmosis is mostly congenital. The frequency of ocular involvement is 1/4 in ratio after invasion of central nervous system. Ocular and serological findings must be considered together for diagnosis. Pyrimethamine and sulphonamides are effective in the treatment of acute cases; however, they have no effect on chronic cases. It is not advised to use corticosteroids alone, but they may be used together with their depo-forms and other antimicrobial drugs. In addition, physical methods such as, laser photocoagulation or cryotherapy can be employed when drug treatment is not effective.

Humans↗

Restricted applicability of the polymerase chain reaction for the diagnosis of ocular toxoplasmosis.

The laboratory confirmation of ocular toxoplasmosis has been reported to be facilitated by the polymerase chain reaction (PCR) technique in anterior chamber taps. We utilized PCR specific for a sequence of the Toxoplasma gondii B 1 gene with a length of 194 bp. The sensitivity was adjusted to ten genomic copies per sample in stained gel and two copies after DNA hybridization using a digoxygenin-labeled probe. We amplified DNA from 43 aqueous, 14 serum, and 32 white blood cell (WBC) samples obtained from 31 consecutive otherwise healthy patients with the clinical diagnosis of ocular toxoplasmosis. In the series investigated, 1/43 aqueous samples and 2/32 WBC samples were found to contain detectable amounts of target DNA. An inhibition of the PCR by the aqueous humor as a reason for the low detection rates was excluded. Thus, we conclude that either the sensitivity of aqueous humor PCR is not sufficient for use in the routine diagnosis of ocular toxoplasmosis in immuno-competent individuals or the anterior chamber is not the proper compartment for investigation of this protozoal disease using this approach.

Adult↗

[Results of the treatment of ocular toxoplasmosis in personal experience].

Ocular toxoplasmosis manifested itself in following clinical forms: as central serous chorioretinitis, pars planitis, iritis, intrabulbar neuritis and central retinal degeneration. The diagnosis was based on the clinical picture, serological examinations, the course of the disease and the effect of the specific treatment. The authors used piridimide++ compounds, sulfonamides, steroids, folic acid and Tavegyl, Decaris as well as photo-coagulation. The efficacy of all these methods was compared.

Adult↗

Reactivations of ocular toxoplasmosis after cataract extraction.

PURPOSE: To determine the risk of reactivation of ocular toxoplasmosis following cataract extraction. DESIGN: Retrospective case-control study. PARTICIPANTS: Out of 154 patients with ocular toxoplasmosis, 14 patients (15 eyes) who had undergone a cataract extraction and 45 age- and sex- matched controls without cataract were selected. INTERVENTION: A review of the medical records of 14 patients with ocular toxoplasmosis and cataract and 45 control patients with ocular toxoplasmosis but without cataract. The clinical records of the controls and patients were assessed for an identical 4-month period following the date of the cataract extraction in the index patients. MAIN OUTCOME MEASURES: Development of a new active retinal lesion within 4 months after cataract surgery in patients and age -and sex matched-controls. The presence of risk factors such as sex, congenital or postnatal acquisition of ocular toxoplasmosis, age at first clinical manifestation of ocular toxoplasmosis, total number of attacks per affected eye, type of cataract, age at the time of cataract surgery and the intervals between surgery and first clinical manifestation of ocular toxoplasmosis and between surgery and the last recurrence of ocular toxoplasmosis, as well as the use of antiparasitic medication during surgery, type and complications of surgery and optimal visual acuity before and after cataract surgery. RESULTS: Reactivations of ocular toxoplasmosis following cataract extraction occurred in 5/14 patients (5/15 eyes), which was higher than the incidence of recurrences in age -and sex-matched controls (p < 0.001). No additional risk factors for the development of recurrences of ocular toxoplasmosis after cataract surgery were found. Incidence of recurrences preceding surgery did not differ between patients and controls. CONCLUSION: We identified an increased risk of reactivation of ocular toxoplasmosis following cataract extraction which implies that prophylactic treatment with antiparasitic drugs during and after the cataract surgery might be worthwhile for patients at risk of visual loss.

Adolescent↗

[Treatment of ocular toxoplasmosis. Part 1: Basic principles and diagnosis].

Ocular toxoplasmosis is a frequent cause of ocular inflammation which threatens central visual acuity. New concepts of treatment are important alternatives for the well known therapy with pyrimethamine and sulphadiazine. They cause less side effects and result in better compliance. Up to know prospective randomized trials are still missing although they might prove the value of medical treatment in ocular toxoplasmosis. Nevertheless it is generally accepted that ocular toxoplasmosis should be treated when central visual function is threatened. Treatment strategy is influenced by general symptoms, especially in children and immunocompromised patients. In this paper opportunities for treatment are discussed. Relevant microbiological, immunological and epidemiological fundamentals are mentioned as well as serological tests.

Clindamycin↗

Unusual presentation of acute ocular toxoplasmosis.

Two unusual cases of ocular toxoplasmosis are presented. A 24 year old woman developed retinal and optic nerve neovascularization in conjunction with acute ocular toxoplasmosis. The neovascularization regressed with resolution of the inflammation. The possibility of retinal ischemia or inflammation alone as an etiology are discussed. A 19 year old woman developed optic nerve edema and a marked decrease in vision associated with a nasal toxoplasma lesion and a macular star. With resolution of the process, optic atrophy developed but visual acuity returned to normal. Optic nerve edema and atrophy were felt to result from diffuse inflammation, but not from focal involvement in the nerve itself with the organism.

Adult↗