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Artiaga JCM, Azarcon CP, Levina FD, Bromeo AJ, Mesina BVQ, Arcinue CA. Considerations in the management of ocular toxoplasmosis in pregnancy: a review of literature. Eye (Lond) 2024; 38:1262-1268. [PMID: 38191658 DOI: 10.1038/s41433-023-02916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/27/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
Ocular toxoplasmosis is the most common cause of infectious posterior uveitis. Available literature is still conflicting regarding the incidence of recurrence during pregnancy as various calculations were employed in the different published studies. Although earlier reports have suggested a difference in presentation and an increase in severity during pregnancy, newer studies appear to show otherwise. Further diagnostic testing, including serologic and intraocular fluid sampling, may be indicated to increase the diagnostic accuracy in this special population of patients. The management of ocular toxoplasmosis during pregnancy is challenging as the foetus is additionally considered in the choice of treatment. Traditionally preferred anti-toxoplasmosis regimens containing antifolate drugs, such as pyrimethamine and trimethoprim-sulfamethoxazole, cannot be used routinely in pregnant patients, especially during the first trimester. This review includes literature on alternative treatments for ocular toxoplasmosis during pregnancy, including spiramycin and intravitreal treatment options.
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Affiliation(s)
- Jose Carlo M Artiaga
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Corrina P Azarcon
- Section of Ophthalmology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Faye D Levina
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | - Bryan Vincent Q Mesina
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Cheryl A Arcinue
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Asian Eye Institute, Makati City, Philippines
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2
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Journé A, Garweg J, Ksiazek E, Peyron F, Binquet C, Wallon M. Long-term Ocular Outcomes in Congenital Toxoplasmosis Treated Perinatally. Pediatrics 2024; 153:e2023064114. [PMID: 38454832 DOI: 10.1542/peds.2023-064114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Congenital toxoplasmosis (CT) can be accompanied by serious organ manifestations, particularly retinochoroiditis, and may occur throughout life. We aimed to monitor long-term ocular prognosis in a large French cohort of patients with CT and its changes over time in the context of mandatory prenatal screening (since 1992) and incidence decrease since 2008. METHODS Patients with CT diagnosed between 1987 and 2021 were prospectively included and followed for up to 35 years. The effect of the period of conception on the risk of first retinochoroiditis has been tested using a flexible extension of the Cox model. Incidence rates of retinochoroiditis were estimated. RESULTS A total of 646 infected live born children were followed for a median of 12 years (range, 0.5-35); 187 patients (29%) had at least 1 ocular lesion (first at a median age of 5 years; range, 0-26 years) with peaks at 7 and 12 years. Early maternal infection and the presence of nonocular signs at birth were associated with a higher risk of retinochoroiditis, whereas delayed diagnosis of CT (after birth versus before or at birth) was associated with a lower risk (13% decrease for each additional month after birth; P = .01). A period effect for the risk of developing retinochoroiditis in patients born after 2008 was not detected. CONCLUSIONS Despite prenatal screening and prolonged perinatal treatment, retinochoroiditis is not a rare event in French patients with CT and can occur well into adulthood, with peak incidences at 7 and 12 years of age. It rarely causes severe damage but warrants regular follow-up into adulthood.
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Affiliation(s)
- Antoine Journé
- CHU Dijon-Bourgogne, Inserm, Université de Bourgogne, CIC1432 Module Epidémiologie Clinique, Dijon, France
| | - Justus Garweg
- Swiss Eye Institute and University of Bern, Bern, Switzerland
| | - Eléa Ksiazek
- CHU Dijon-Bourgogne, Inserm, Université de Bourgogne, CIC1432 Module Epidémiologie Clinique, Dijon, France
| | - François Peyron
- Hospices Civils de Lyon, Institut des Agents Infectieux, Lyon, France
- Waking Team, Lyon Neurosciences Research Center, Bron, France
| | - Christine Binquet
- CHU Dijon-Bourgogne, Inserm, Université de Bourgogne, CIC1432 Module Epidémiologie Clinique, Dijon, France
| | - Martine Wallon
- Hospices Civils de Lyon, Institut des Agents Infectieux, Lyon, France
- Waking Team, Lyon Neurosciences Research Center, Bron, France
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3
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Hasanreisoglu M, Halim MS, Cakar Ozdal P, Ormaechea MS, Kesim C, Ozdemir HB, Uludag G, Sredar N, Cankurtaran M, Liu X, Denniston AK, Rudzinski MN, Colombero DN, Schlaen BA, Keane PA, Pavesio C, Nguyen QD. Fundus topographical distribution patterns of ocular toxoplasmosis. Br J Ophthalmol 2024; 108:530-535. [PMID: 36931697 DOI: 10.1136/bjo-2022-322747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND To establish topographic maps and determine fundus distribution patterns of ocular toxoplasmosis (OT) lesions. METHODS In this retrospective study, patients who presented with OT to ophthalmology clinics from four countries (Argentina, Turkey, UK, USA) were included. Size, shape and location of primary (1°)/recurrent (2°) and active/inactive lesions were converted into a two-dimensional retinal chart by a retinal drawing software. A final contour map of the merged image charts was then created using a custom Matlab programme. Descriptive analyses were performed. RESULTS 984 lesions in 514 eyes of 464 subjects (53% women) were included. Mean area of all 1° and 2° lesions was 5.96±12.26 and 5.21±12.77 mm2, respectively. For the subset group lesions (eyes with both 1° and 2° lesions), 1° lesions were significantly larger than 2° lesions (5.52±6.04 mm2 vs 4.09±8.90 mm2, p=0.038). Mean distances from foveola to 1° and 2° lesion centres were 6336±4267 and 5763±3491 µm, respectively. The majority of lesions were found in temporal quadrant (p<0.001). Maximum overlap of all lesions was at 278 µm inferotemporal to foveola. CONCLUSION The 1° lesions were larger than 2° lesions. The 2° lesions were not significantly closer to fovea than 1° lesions. Temporal quadrant and macular region were found to be densely affected underlining the vision threatening nature of the disease.
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Affiliation(s)
- Murat Hasanreisoglu
- Department of Ophthalmology, Koc University School of Medicine, Istanbul, Turkey
- Koc University Research Center for Translational Medicine, Koc University, Istanbul, Turkey
- Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey
| | | | - Pinar Cakar Ozdal
- Department of Ophthalmology, University of Health Sciences Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | | | - Cem Kesim
- Department of Ophthalmology, Koc University School of Medicine, Istanbul, Turkey
| | | | - Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Nripun Sredar
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Mahmut Cankurtaran
- Department of Ophthalmology, University of Health Sciences Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Xiaoxuan Liu
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Alastair Keith Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Marcelo N Rudzinski
- Department of Ophthalmology, Universidad Católica de las Misiones, Posadas, Argentina
| | - Daniel N Colombero
- Department of Ophthalmology, Universidad Nacional de Rosario, Rosario, Argentina
| | | | - Pearse Andrew Keane
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, UCL, London, UK
| | - Carlos Pavesio
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Biomedical Research Centre, UCL, London, UK
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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Patnaik G, Pyare R, Kaushik VV, Dutta Majumder P. Ocular toxoplasmosis following anti-tumour necrosis factor-α therapy combined with oral methotrexate therapy: A case report and review of literature. Eur J Ophthalmol 2024; 34:NP113-NP117. [PMID: 37818617 DOI: 10.1177/11206721231207513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Purpose: To report a case of ocular toxoplasmosis following long-term treatment with adalimumab and review the literature on ocular toxoplasmosis following anti-Tumour necrosis factor-α therapy. Method: A retrospective chart review of A 21-year-old male who developed retinochoroiditis in his left eye following adalimumab therapy combined with oral methotrexate. Result: A known patient of juvenile idiopathic arthritis (JIA) on adalimumab and oral methotrexate for the last four years presented to us with a blurring of vision for the last 15 days. Fundus examination of the left eye revealed severe vitritis and two patches of retinochoroiditis in the inferior part of the fundus. Subsequent investigations confirmed it to be a case of toxoplasma retinochoroiditis, and he responded to anti-toxoplasma treatment. A review of literature on a similar topic revealed five such cases, and the index case was the first such report in patients with JIA. Conclusion: The index case highlights the importance of early recognition and management of opportunistic infections in patients receiving biologicals.
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Affiliation(s)
- Gazal Patnaik
- Department of Uvea, Sankara Nethralaya, Kolkata, India
| | - Richa Pyare
- Department of Uvea, Sankara Nethralaya, Chennai, India
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Elmallawany MA, Abdel-Aal AA, Abu Eleinen KG, Nadar AH, El-Adawy AI, El-Dardiry MA, Abddel-Hafez YN, Kotb AA, Saif ATS, Shaheen HAA, Sayed A, Samir O, Alatyar AA, Sheble MA, Elnakib M, Badr MS, Nahnoush RK. Metagenomic analysis of the ocular toxoplasmosis in children uveitis from Fayoum governorate, Egypt. Infect Genet Evol 2024; 118:105551. [PMID: 38216107 DOI: 10.1016/j.meegid.2024.105551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
Granulomatous anterior uveitis with single or numerous gelatinous nodules was found in children living in rural Egypt. All ocular diseases were originally thought to be water-born and related to digenic flukes. The current study sought to learn more about the causes of anterior granulomatous uveitis in Egyptian youngsters who used to swim in rural water canals. 50 children with eye lesions that had not responded to medical treatment were recruited. Four samples were surgically extracted and examined using real-time PCR, transmission electron microscopy (TEM), and shotgun metagenomic sequencing (SMS). Toxoplasma gondii was detected free within the syncytium's distal section, while the proximal part exhibited active synthesis of a presumably extra-polymeric material, possibly released by the microbial population. Toxoplasma gondii was found in 30 samples. Serologically, distinct anti-Toxoplasma antibodies were not found in 91.6% of patients. SMS showed that the T. gondii ME 49 strain had the greatest percentage (29-25%) in all samples within an Acinetobacter-containing microbial community. These findings suggested that these bacteria entered the body via the exterior route rather than the circulatory route. The lack of genetic evidence for subsequent parasite stages invalidates the prior findings about the assumed trematode stage.
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Affiliation(s)
- Marwa A Elmallawany
- Medical Parasitology Department, Faculty of Medicine Kasr Al-Ainy, Cairo University, 11796 Giza, Egypt
| | - Amany A Abdel-Aal
- Medical Parasitology Department, Faculty of Medicine Kasr Al-Ainy, Cairo University, 11796 Giza, Egypt; Postgraduate Department, Armed Forces College of Medicine (AFCM), 11774 Cairo, Egypt
| | - Khaled G Abu Eleinen
- Ophthalmology Department, Faculty of Medicine Kasr Al-Ainy, Cairo University, 11796 Giza, Egypt
| | | | - Azza I El-Adawy
- Medical Parasitology Department, Faculty of Medicine Kasr Al-Ainy, Cairo University, 11796 Giza, Egypt; Medical Parasitology Department, Armed Forces College of Medicine (AFCM), 11774 Cairo, Egypt
| | - Marwa A El-Dardiry
- Medical Parasitology Department, Faculty of Medicine, Fayoum University, 63511 Fayoum, Egypt.
| | - Yosra N Abddel-Hafez
- Medical Parasitology Department, Faculty of Medicine, Fayoum University, 63511 Fayoum, Egypt
| | - Ahmed A Kotb
- Ophthalmology Department, Faculty of Medicine, Fayoum University, 63511 Fayoum, Egypt
| | - Ahmed T S Saif
- Ophthalmology Department, Faculty of Medicine, Fayoum University, 63511 Fayoum, Egypt
| | - Hoda A A Shaheen
- Medical Parasitology Department, Faculty of Medicine, Girl's Campus, Al-Azhar University, 11682 Cairo, Egypt
| | - Ahmed Sayed
- Basic Research Unit, Genomics/Epigenomics Program, Children's Cancer Hospital 57357, 11562 Cairo, Egypt
| | - Omar Samir
- Basic Research Unit, Genomics/Epigenomics Program, Children's Cancer Hospital 57357, 11562 Cairo, Egypt
| | | | | | - Mostafa Elnakib
- Medical Microbiology and Immunology Department, Military Medical Academy, Cairo 11711, Egypt
| | - Mohamed S Badr
- Department of Molecular Biology and Bioinformatics, Medical Research Center, Faculty of Medicine, Ain Shams University, 11566 Cairo, Egypt
| | - Reham K Nahnoush
- Medical Parasitology Department, Faculty of Medicine Kasr Al-Ainy, Cairo University, 11796 Giza, Egypt; Medical Parasitology Department, Armed Forces College of Medicine (AFCM), 11774 Cairo, Egypt
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de Araujo-Silva CA, Peclat-Araujo MR, de Souza W, Vommaro RC. An alternative method to establish an early acute ocular toxoplasmosis model for experimental tests. Int Ophthalmol 2024; 44:73. [PMID: 38349587 DOI: 10.1007/s10792-024-02985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/19/2023] [Indexed: 02/15/2024]
Abstract
PURPOSE To provide a simple alternative acute ocular toxoplasmosis model with great reproducibility for experimental tests that demand monitoring of the ocular lesion. METHODS ME49-wt and ME49-GFP tachyzoites from cell culture were used to infect male C57BL6 mice by intraperitoneal injection. B1 expression by real-time polymerase chain reaction (qPCR) assay was used to detect the presence of T. gondii in ocular tissue at the beginning of the infection. Fluorescence microscopy and histopathology analysis were carried out to assess the evolution of the acute infection up to 20 days in both eyes of infected mice. RESULTS All mice infected with the 104 tachyzoites showed B1 expression in the retina of both eyes, in the RPE (retinal pigment epithelium), and choroid structures, after 5 days of infection. Tachyzoites of the ME49-GFP strain were easily detected by fluorescence microscopy in the retina tissue of mice after 5 days post-infection. After 20 days, mice inflammatory cell infiltrates and a disorganized morphology of the retinal laminar architecture were observed. CONCLUSION Infection of C57BL6 mice via intraperitoneal with 104 tachyzoites of the ME49-GFP strain from cell culture is a suitable model for acute ocular toxoplasmosis. This model has great reproducibility in establishing the ocular lesion since day 5 post-infection. This model can be suitable for experimental tests of chemotherapy and the investigation of the role of the immune response on the development of uveitis.
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Affiliation(s)
- Carlla Assis de Araujo-Silva
- Laboratório de Ultraestrutura Celular Hertha Meyer, Centro de Pesquisa em Medicina de Precisão, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, Cidade Universitária, Rio de Janeiro, RJ, 21941-904, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Milena Ribeiro Peclat-Araujo
- Laboratório de Ultraestrutura Celular Hertha Meyer, Centro de Pesquisa em Medicina de Precisão, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, Cidade Universitária, Rio de Janeiro, RJ, 21941-904, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wanderley de Souza
- Laboratório de Ultraestrutura Celular Hertha Meyer, Centro de Pesquisa em Medicina de Precisão, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, Cidade Universitária, Rio de Janeiro, RJ, 21941-904, Brazil
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rossiane Claudia Vommaro
- Laboratório de Ultraestrutura Celular Hertha Meyer, Centro de Pesquisa em Medicina de Precisão, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, Cidade Universitária, Rio de Janeiro, RJ, 21941-904, Brazil.
- Instituto Nacional de Ciência e Tecnologia em Biologia Estrutural e Bioimagens, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Souza GM, Finamor LP, Belfort R. Neuroretinitis: A Rare Manifestation of Acute Ocular Toxoplasmosis in a Child. Ophthalmol Retina 2024; 8:48. [PMID: 37943205 DOI: 10.1016/j.oret.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Guilherme Macedo Souza
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Luciana Peixoto Finamor
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil; Instituto Paulista de Estudos e Pesquisas em Oftalmologia, IPEPO, Vision Institute, São Paulo, São Paulo, Brazil
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Cirone D, Pellegrini F, Cuna A, Caruso E, Cimino L, Leonardi F. Serous macular detachment in ocular toxoplasmosis: A review. Eur J Ophthalmol 2024; 34:30-38. [PMID: 37016744 DOI: 10.1177/11206721231168148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Ocular toxoplasmosis, a disease of the eye caused by the protozoan parasite Toxoplasma gondii, represents a common cause of posterior uveitis. The Authors review the current Literature regarding the uncommon presentation of ocular toxoplasmosis as macular serous retinal detachment (SRD). It is imperative to keep in mind that inflammatory SRD is a possible presentation of toxoplasmic retinochoroiditis. Underestimation of this clinical scenario and treatment with steroids alone without appropriate antiparasitic drugs, could lead to devastating consequences.
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Affiliation(s)
- Daniele Cirone
- Department of Ophthalmology, Villa Anna Hospital, San Benedetto del Tronto, AP, Italy
| | | | - Alessandra Cuna
- Department of Ophthalmology, De Gironcoli Hospital, AULSS2 Marca Trevigiana, Conegliano, TV, Italy
| | - Ettore Caruso
- Department of Ophthalmology, De Gironcoli Hospital, AULSS2 Marca Trevigiana, Conegliano, TV, Italy
| | - Luca Cimino
- Department of Ophthalmology, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia (RE), Italy
| | - Francesca Leonardi
- Department of Ophthalmology, De Gironcoli Hospital, AULSS2 Marca Trevigiana, Conegliano, TV, Italy
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Yamada K, Tazaki A, Ushio-Watanabe N, Usui Y, Takeda A, Matsunaga M, Suzumura A, Shimizu H, Zheng H, Ariefta NR, Yamamoto M, Hara H, Goto H, Sonoda KH, Nishiguchi KM, Kato M, Nishikawa Y, Toyokuni S, Kaneko H. Retinal ferroptosis as a critical mechanism for the induction of retinochoroiditis during ocular toxoplasmosis. Redox Biol 2023; 67:102890. [PMID: 37738924 PMCID: PMC10519826 DOI: 10.1016/j.redox.2023.102890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Abstract
Toxoplasmosis is a major infectious disease, affecting approximately one-third of the world's population; its main clinical manifestation, ocular toxoplasmosis (OT), is a severe sight-threatening disease. Nevertheless, the diagnosis of OT is based on clinical findings, which needs improvement, even with biochemical tests, such as polymerase chain reaction and antibody detections. Furthermore, the efficacy of OT-targeted treatment is limited; thus, additional measures for diagnosis and treatments are needed. Here, we for the first time report a significantly reduced iron concentration in the vitreous humor (VH) of human patients infected with OT. To obtain further insights into molecular mechanisms, we established a mouse model of T. gondii infection, in which intravitreally injected tracer 57Fe, was accumulated in the neurosensory retina. T. gondii-infected eyes showed increased lipid peroxidation, reduction of glutathione peroxidase-4 expression and mitochondrial deformity in the photoreceptor as cristae loss. These findings strongly suggest the involvement of ferroptotic process in the photoreceptor of OT. In addition, deferiprone, an FDA-approved iron chelator, reduced the iron uptake but also ameliorated toxoplasma-induced retinochoroiditis by reducing retinal inflammation. In conclusion, the iron levels in the VH could serve as diagnostic markers and iron chelators as potential treatments for OT.
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Affiliation(s)
- Kazuhisa Yamada
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Akira Tazaki
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Nanako Ushio-Watanabe
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, 080-8555, Japan.
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo, 160-8402, Japan.
| | - Atsunobu Takeda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Masaaki Matsunaga
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan.
| | - Ayana Suzumura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Hideyuki Shimizu
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Hao Zheng
- Department of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Nanang R Ariefta
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, 080-8555, Japan.
| | - Masahiro Yamamoto
- Department of Immunoparasitology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan.
| | - Hideaki Hara
- Department of Biofunctional Evaluation, Molecular Pharmacology, Gifu Pharmaceutical University, Gifu, 501-1196, Japan.
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo, 160-8402, Japan.
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Koji M Nishiguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Masashi Kato
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Yoshifumi Nishikawa
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, 080-8555, Japan.
| | - Shinya Toyokuni
- Department of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan; Center for Low-Temperature Plasma Sciences, Nagoya University, Furo-Cho, Chikusa-ku, Nagoya, 464-8603, Japan.
| | - Hiroki Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
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10
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Kelgaonkar A, Patel A. Round bodies in the outer plexiform layer in eyes with active Toxoplasma retinochoroiditis. BMJ Case Rep 2023; 16:e255661. [PMID: 37666565 PMCID: PMC10481744 DOI: 10.1136/bcr-2023-255661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Affiliation(s)
- Anup Kelgaonkar
- Vitreo-Retina and uveitis services, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneshwar, Odisha, India
| | - Anamika Patel
- Vitreoretina and Uveitis Services, LV Prasad Eye Institute GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India
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11
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Goh EJH, Putera I, La Distia Nora R, Mahendradas P, Biswas J, Chee SP, Testi I, Pavesio CE, Curi ALL, Vasconcelos-Santos DV, Arora A, Gupta V, de-la-Torre A, Agrawal R. Ocular Toxoplasmosis. Ocul Immunol Inflamm 2023; 31:1342-1361. [PMID: 36095008 DOI: 10.1080/09273948.2022.2117705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide, affecting individuals acrossdifferent age groups. The key to reducing vision loss includes prompt diagnosis and treatment. However, despite the prevalence of ocular toxoplasmosis, there has been little consensus regarding its pathophysiology,clinical features, diagnosis, and especially management. METHODS The data sources were literature reviews, including Pub Med and Medline databases. Search terms included toxoplasmosis, retinitis, vasculitis, vitritis, uveitis alone or in combination with, serum, aqueous, vitreous eye, ocular and review. RESULTS In this review paper, we have sought to provide an overview of the pathophysiology, epidemiology, and clinical features of the disease, both based on current literature and our own clinical experience. We have also discussed the use of serology, ocular fluid, and ophthalmic investigations that could further facilitate the diagnosis of ocular toxoplasmosis.Different management strategies have been reported worldwide, including newer approaches such as local therapy. CONCLUSION A better understanding of critical aspects of ocular toxoplasmosis will hopefully lead to reduced morbidity, including blindness associated with this condition.
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Affiliation(s)
- Eunice Jin Hui Goh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Soon-Phaik Chee
- Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ilaria Testi
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | | | - Andre Luiz Land Curi
- Infectious Ophthalmology Laboratory, Evandro Chagas National Institute of Infectious Diseases-FIOCRUZ, Rio de Janeiro, Brazil
| | - Daniel Vitor Vasconcelos-Santos
- Departamento de Oftalmologia e Otorrinolaringologia e Laboratório de Ciências Visuais, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Hospital São Geraldo, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, The Academia, Singapore
- Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Lee Kong Chian School of Medicine, Singapore
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12
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Kim GH, Kwak JH, Park YH. Elevated interleukin-10 levels in patients with ocular toxoplasmosis. Parasites Hosts Dis 2023; 61:310-316. [PMID: 37648237 PMCID: PMC10471474 DOI: 10.3347/phd.22172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/18/2023] [Indexed: 09/01/2023]
Abstract
In elderly patients, ocular toxoplasmosis is one of the most common etiologies of uveitis, which should be differentially diagnosed from ocular lymphoma, another common pathology of uveitis in older adults. The high level of interleukin (IL)-10 and an IL-10/IL-6 ratio higher than 1 (>1.0) are helpful parameters to diagnose ocular lymphoma. In this study, we used aqueous humor samples to detect 4 cases of ocular toxoplasmosis in patients with high levels of IL-10 and an IL-10/IL-6 ratio higher than 1. Our results show that ocular toxoplasmosis may be associated with increased cytokine levels in aqueous humor.
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Affiliation(s)
- Gee-Hyun Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591,
Korea
| | - Jae Hyuck Kwak
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591,
Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591,
Korea
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13
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Yogeswaran K, Furtado JM, Bodaghi B, Matthews JM, Smith JR. Current practice in the management of ocular toxoplasmosis. Br J Ophthalmol 2023; 107:973-979. [PMID: 35197262 DOI: 10.1136/bjophthalmol-2022-321091] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice. METHODS 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy. RESULTS For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing-usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%. CONCLUSION Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists.
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Affiliation(s)
- Kengadhevi Yogeswaran
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - João M Furtado
- Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Janet M Matthews
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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14
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Sanchez-Quiros J, Burgos-Blasco B, Montolío-Marzo E, Medina-García E, Ramos-Amador JT, Diaz-Valle D. Toxoplasmic maculopathy with bacillary layer detachment in a pediatric patient. J AAPOS 2023; 27:176-179. [PMID: 37054965 DOI: 10.1016/j.jaapos.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 04/15/2023]
Abstract
We report the case of a 14-year-old girl with ocular toxoplasmosis presenting with severe panuveitis with anterior segment involvement, moderate vitreous haze, focal retinochoroiditis, extensive retinal periphlebitis, and macular bacillary layer detachment. Toxoplasmosis treatment was complicated by Stevens-Johnson syndrome, which developed 8 days after starting trimethoprim-sulfamethoxazole.
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Affiliation(s)
- Julia Sanchez-Quiros
- Departments of Ophthalmology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Barbara Burgos-Blasco
- Departments of Ophthalmology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Elena Montolío-Marzo
- Departments of Ophthalmology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Elena Medina-García
- Pediatrics, Hospital Clínico San Carlos, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jose Tomas Ramos-Amador
- Pediatrics, Hospital Clínico San Carlos, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Diaz-Valle
- Departments of Ophthalmology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Departments of Immunology, Ophthalmology, and ENT, Faculty of Medicine, Complutense University of Madrid, IdISSC, Madrid, Spain
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15
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Guru T, Daigavane S. Ocular toxoplasmic scar: a rare clinical image of an immunocompetent patient. Pan Afr Med J 2023; 45:2. [PMID: 37346922 PMCID: PMC10280695 DOI: 10.11604/pamj.2023.45.2.39808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/07/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Tanvi Guru
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sachin Daigavane
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha, Maharashtra, India
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16
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Polanía D, Reyes-Guanes J, Rojas-Carabali W, Pardo-Pizza D, Barraquer-Lopez D, Cifuentes-González C, Neira-Segura N, de-la-Torre A. A new look into uveitis in Colombia: changes in distribution patterns and clinical characteristics over the last 25 years. Graefes Arch Clin Exp Ophthalmol 2023; 261:561-573. [PMID: 35994112 PMCID: PMC9836979 DOI: 10.1007/s00417-022-05796-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To describe the distribution patterns and clinical characteristics of patients diagnosed with uveitis at a specialized uveitis center in Bogotá, Colombia, from 2013 to 2021 and compare these patterns with the previously reported between 1996 and 2006. METHODS We performed an observational descriptive cross-sectional study systematically reviewing clinical records of patients attending between 2013 and 2021. Data were analyzed and compared with previous reports. RESULTS Of the 489 patients with uveitis, 310 were females (63.4%). The mean age of onset was 38.7, with a range between 1 and 83 years. Bilateral (52.8%), anterior (45.8%), non-granulomatous (90.8%), and recurrent (47.6%) were the most common types of uveitis found in our population sample. The most common cause of uveitis in this study was idiopathic, followed by toxoplasmosis and HLA-B27 + associated uveitis, which differs from the previous Colombian study where ocular toxoplasmosis was the most frequent cause. This highlights a significant shift from infectious etiologies to more immune-mediated processes as the cause of uveitis in Colombia nowadays. CONCLUSION The results of this study provide a comparison between the clinical patterns of presentation of uveitis from 1996 to 2006 and the patterns observed from 2013 to 2021, enhancing awareness about the changing dynamics of uveitis in Colombia to guide a better understanding of the diagnosis, classification, and correlation with other systemic conditions of the disease.
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Affiliation(s)
- Diego Polanía
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Daniella Pardo-Pizza
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Doménico Barraquer-Lopez
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Natalia Neira-Segura
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia.
- Ophthalmology Interest Group, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Bogotá, Colombia.
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17
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Niu L, Wang S, Li Y, Liu J. Antibodies against Toxoplasma gondii positive in serum and aqueous humor to diagnose clinically suspected ocular toxoplasmosis: A case report. Medicine (Baltimore) 2022; 101:e30956. [PMID: 36221364 PMCID: PMC9543069 DOI: 10.1097/md.0000000000030956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Previously, diagnosis of ocular toxoplasmosis is based on clinical symptoms and Toxoplasma serology. Checking serological indicators often cannot reflect the real intraocular situation, and may even mislead clinicians to make wrong judgments. PATIENT CONCERNS A 38-year-old male patient visited our ophthalmology clinic with a chief complaint of decreased vision for about 5 days in his right eye. DIAGNOSIS Aqueous humor sample analysis found Toxoplasma DNA detectable, and Toxoplasma immunoglobulin G (IgG) and immunoglobulin M (IgM) to be positive. His serum Toxoplasma IgG was also positive (10.04 IU/mL; reference range: 0 to 7.2 IU/mL). Therefore, the final diagnose was ocular toxoplasmosis involving his right eye. INTERVENTIONS Oral prednisone 60 mg/day and azithromycin 0.25 g/day were started. Oral antibiotic treatment for toxoplasma was continued for 4 weeks, and prednisone followed by weekly stepwise tapering in steps of 10 mg/day. OUTCOMES The BCVA and fundus of right eye remained stable after treatment at follow-up. CONCLUSIONS This article reported a case of ocular Toxoplasma gondii infection diagnosis by serum and aqueous humor antibody tests. We provide some additional information on the T gondii infection diagnosis.
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Affiliation(s)
- Lixia Niu
- Department of Ophthalmology, Changzhi People’s Hospital, Changzhi, China
| | - Sufang Wang
- Department of Ophthalmology, Changzhi People’s Hospital, Changzhi, China
| | - Yunyun Li
- Department of Ophthalmology, Changzhi People’s Hospital, Changzhi, China
| | - Jun Liu
- Department of Ophthalmology, Changzhi People’s Hospital, Changzhi, China
- *Correspondence: Jun Liu, Department of Ophthalmology, Changzhi People’s Hospital, Changzhi 046000, China (e-mail: )
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18
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Zhang Y, Zhang Q, Li H, Cong H, Qu Y. In vitro and in vivo anti−Toxoplasma activities of HDAC inhibitor Panobinostat on experimental acute ocular toxoplasmosis. Front Cell Infect Microbiol 2022; 12:1002817. [PMID: 36171756 PMCID: PMC9510647 DOI: 10.3389/fcimb.2022.1002817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/24/2022] [Indexed: 11/21/2022] Open
Abstract
Ocular toxoplasmosis (OT) is retinochoroiditis caused by Toxoplasma gondii infection, which poses a huge threat to vision. However, most traditional oral drugs for this disease have multiple side effects and have difficulty crossing the blood-retinal barrier, so the new alternative strategy is required to be developed urgently. Histone deacetylases (HDAC) inhibitors, initially applied to cancer, have attracted considerable attention as potential anti-Toxoplasma gondii drugs. Here, the efficacy of a novel HDAC inhibitor, Panobinostat (LBH589), against T. gondii has been investigated. In vitro, LBH589 inhibited the proliferation and activity of T. gondii in a dose-dependent manner with low toxicity to retinal pigment epithelial (RPE) cells. In vivo, optical coherence tomography (OCT) examination and histopathological studies showed that the inflammatory cell infiltration and the damage to retinal architecture were drastically reduced in C57BL/6 mice upon treatment with intravitreal injection of LBH589. Furthermore, we have found the mRNA expression levels of inflammatory cytokines were significantly decreased in LBH589–treated group. Collectively, our study demonstrates that LBH589 holds great promise as a preclinical candidate for control and cure of ocular toxoplasmosis.
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Affiliation(s)
- Yu Zhang
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Qingqing Zhang
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Haiming Li
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Hua Cong
- Department of Pathogen Biology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Hua Cong, ; Yi Qu,
| | - Yi Qu
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Hua Cong, ; Yi Qu,
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Adam CR, Abrams GW. TOXOPLASMOSIS RETINOCHOROIDITIS MASQUERADING AS ENDOGENOUS ENDOPHTHALMITIS IN A CASE OF CONGENITAL LONG QT SYNDROME. Retin Cases Brief Rep 2022; 16:637-642. [PMID: 32910025 DOI: 10.1097/icb.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe the diagnostic and treatment challenges of a case of presumed acquired macula-involving toxoplasmosis retinochoroiditis. METHODS Case report of a woman with congenital long QT syndrome presenting with retinochoroiditis after undergoing a cardiac procedure. Laboratory analysis, ocular fluid biopsy, and multimodal imaging were obtained. RESULTS Ophthalmic examination was significant for decreased vision and a macula-involving chorioretinal lesion concerning for endogenous endophthalmitis. Multimodal imaging showed a focal, full-thickness necrotizing process associated with vitritis, retinal edema, and choroidal thickening. Analysis of peripheral blood revealed elevated serum toxoplasma Immunoglobulin G titers. Blood cultures and a transesophageal echocardiogram were negative for endocarditis. Aqueous and vitreous specimens were negative for an infectious polymerase chain reaction panel, including toxoplasmosis and negative bacterial and fungal cultures. A diagnosis of presumed acquired toxoplasmosis retinochoroiditis was made and treated with a combination of oral and intravitreal antiparasitic medications resulting in healing of the retinochoroiditis. CONCLUSION To the authors' knowledge, this is the first reported case of acquired toxoplasmosis retinochoroiditis in an immunocompetent patient with congenital long QT syndrome masquerading as endogenous endophthalmitis. The association of congenital long QT syndrome and a recent cardiac procedure with a risk for endogenous endophthalmitis complicated the diagnosis, clinical course, and treatment options. Our case emphasizes the importance of a thorough patient history, comprehensive clinical examination, and supportive multimodal imaging that were used to characterize the infectious process and guide empirical treatment. In addition, laboratory analysis, comanagement with other specialists, and evaluating the response to antitoxoplasma therapy were all instrumental in the eventual diagnosis and treatment of ocular toxoplasmosis in this atypical case.
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Affiliation(s)
- Christopher R Adam
- Department of Ophthalmology, Visual and Anatomic Sciences, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan
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20
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21
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Erol MK, Bozdogan YC, Suren E, Gedik B. Treatment of a full-thickness macular hole and retinal detachment secondary to toxoplasma chorioretinitis that developed shortly after COVID-19: A case report. J Fr Ophtalmol 2022; 45:446-451. [PMID: 35034856 PMCID: PMC8733215 DOI: 10.1016/j.jfo.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022]
Abstract
Although ocular toxoplasmosis is usually a self-limiting infection, it can lead to severe reduction in visual acuity due to intense vitreous inflammation or involvement of posterior segment structures. Depending on the severity of intraocular inflammation, serious complications, including epiretinal membrane or retinal detachment may develop. In this paper, we aim to present a case that complicated by both a full-thickness macular hole and retinal detachment secondary to toxoplasmosis chorioretinitis that developed shortly after the novel coronavirus disease (COVID-19) and discuss our treatment approach. After the patient was diagnosed based on a routine ophthalmological examination, fundus imaging, and serological examination, functional and anatomical recovery was achieved through systemic antibiotherapy and vitreoretinal surgery. Full-thickness macular hole and retinal detachment are rare complications of ocular toxoplasmosis. However, there are only few publications in the literature concerning these complications and their surgical treatment. In this case report, we demonstrated the success of vitreoretinal surgery combined with antibiotic therapy on the posterior segment complications of ocular toxoplasmosis.
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Affiliation(s)
- M K Erol
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Y C Bozdogan
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey.
| | - E Suren
- Department of Ophthalmology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - B Gedik
- Serik State Hospital, Antalya, Turkey
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22
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Kalogeropoulos D, Sakkas H, Mohammed B, Vartholomatos G, Malamos K, Sreekantam S, Kanavaros P, Kalogeropoulos C. Ocular toxoplasmosis: a review of the current diagnostic and therapeutic approaches. Int Ophthalmol 2022; 42:295-321. [PMID: 34370174 PMCID: PMC8351587 DOI: 10.1007/s10792-021-01994-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly on the postnatally acquired form of the disease. METHODS A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items. RESULTS Ocular toxoplasmosis is one of the most frequent infectious etiologies of posterior uveitis. It typically presents with retinochoroiditis. Setting an accurate diagnosis depends to a considerable degree on detecting characteristic clinical characteristics. In addition to the evaluation of clinical features, the diagnosis of toxoplasmosis relies at a large degree on serologic testing. The detection of the parasite DNA in the aqueous or vitreous humor can provide evidence for a definitive diagnosis. The current mainstay for the treatment, if necessary, is the use of oral antibiotic with systemic corticosteroids. Recent evidence suggests other therapeutic approaches, such as intravitreal antibiotics can be used. CONCLUSION Recent developments in the diagnostic and therapeutic approach have contributed to preventing or limiting vision loss of patients suffering from ocular toxoplasmosis. Further studies are required to provide a better understanding of epidemiology, pathogenesis, diagnosis, and treatment with a significant impact on the management of this challenging clinical entity.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece.
| | - Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Malamos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | | | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
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Krásný J, Šach J, Daňková E. ATYPICAL FORMS OF EYE TOXOPLASMOSIS IN CHILDHOOD. CASE REPORTS. Cesk Slov Oftalmol 2022; 78:258-270. [PMID: 36220366 DOI: 10.31348/2022/27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIM To present an outline of acquired atypical forms of ocular toxoplasmosis (OT) in childhood, with reference to the 100th anniversary of the discovery of this etiology by Professor Janků from Czechoslovakia, who was first to describe the clinical congenital picture of OT characterised by macular scar. MATERIAL AND METHODS Symptoms of intraocular bilateral neuritis appeared in a 6-year-old girl, with visual acuity (VA) bilaterally 0.1. Toxoplasmic etiology was demonstrated in laboratory tests, and the patient was immunocompetent. Following treatment with macrolide antibiotic and parabulbar application of corticosteroid, the condition was normalised stably at VA 1.0 in both eyes. Bilateral retinal vasculitis was determined in an 8-year-old boy, with VA of 0.25 in the right eye and 0.25 in the left, with a medical history of strabismus detected after suffering from varicella. The examination for toxoplasmosis was negative, but pronounced general hypogammaglobulinaemia classes IgG, IgM and IgA was detected. Immunosuppressive and immunomodulatory therapy did not produce the desired effect, and the condition progressed to retinochoroiditis. Due to blindness and dolorous glaucoma, enucleation of the right eye was performed at the age of 15 years. Histologically toxoplasmic cysts with bradyzoites were detected, a subsequent laboratory test demonstrated toxoplasmic etiology upon a background of persistent regressing hypogammaglobulinaemia. General anti-toxoplasma and subsequent immunosuppressive treatment did not produce the desired effect, and at the age of 22 years the patient lost his sight also in the left eye. CONCLUSION Atypical form of OT intraocular neuritis in an immunocompetent patient had a favourable course, whereas retinal vasculitis with retinochoroiditis in a temporarily immunocompromised patient ended in bilateral blindness.
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Filipowicz A, Coca MN, Blair BM, Chang PY. ACUTE MYOCARDITIS WITH CARDIOGENIC SHOCK AND MULTIPLE ORGAN FAILURE, FOLLOWED BY BILATERAL PANUVEITIS MASQUERADING AS ENDOGENOUS ENDOPHTHALMITIS, DUE TO TOXOPLASMA GONDII IN AN IMMUNOCOMPETENT PATIENT. Retin Cases Brief Rep 2021; 15:575-580. [PMID: 30664080 DOI: 10.1097/icb.0000000000000855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of systemic and ocular toxoplasmosis in an immunocompetent patient, who developed myocarditis with resulting cardiogenic shock and multiple organ failure, followed by bilateral panuveitis masquerading as endogenous endophthalmitis. METHODS Single case report with images. RESULTS A 59-year-old man with a history of monoclonal gammopathy of undetermined significance and associated scleromyxedema but otherwise immunocompetent was admitted to the intensive care unit for cardiogenic shock and multiple organ failure due to presumed viral myocarditis. After hospital discharge, ophthalmic examination revealed what seemed to be endogenous fungal endophthalmitis in both eyes. The ocular inflammation failed to improve on local and systemic antifungal therapies. After repeated testing and vitrectomy, the causative organism responsible for his intraocular inflammation remained elusive. The patient was then found to have significantly elevated serum titers of anti-Toxoplasma gondii IgG and IgM, followed by an appearance of a focal retinochoroidal lesion more typical of ocular toxoplasmosis. Systemic anti-Toxoplasma therapy led to resolution of intraocular inflammation, and the patient had since fully recovered from the myocarditis and its multiple comorbidities. Of note, myocardial biopsy and polymerase chain reaction testing of aqueous and vitreous fluids were all negative for Toxoplasma. CONCLUSION Even in an immunocompetent patient, Toxoplasma can result in myocarditis with significant morbidities and even death, and its ocular manifestation may be quite different from the classic focal retinochoroiditis. In addition, polymerase chain reaction analysis of ocular fluids can be unreliable in an immunocompetent host, and thus treatment decision should be guided by clinical history and examination findings.
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Affiliation(s)
- Artur Filipowicz
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, Massachusetts
| | - Mircea N Coca
- Everett Hurite Ophthalmic Association, Pittsburgh, Pennsylvania
| | - Barbra M Blair
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
- Harvard Medical School, Boston, Massachusetts
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, Massachusetts
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Abstract
PURPOSE To determine classification criteria for toxoplasmic retinitis. DESIGN Machine learning of cases with toxoplasmic retinitis and 4 other infectious posterior uveitides / panuveitides. METHODS Cases of infectious posterior uveitides / panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior uveitides / panuveitides. The resulting criteria were evaluated on the validation set. RESULTS Eight hundred three cases of infectious posterior uveitides / panuveitides, including 174 cases of toxoplasmic retinitis, were evaluated by machine learning. Key criteria for toxoplasmic retinitis included focal or paucifocal necrotizing retinitis and either positive polymerase chain reaction assay for Toxoplasma gondii from an intraocular specimen or the characteristic clinical picture of a round or oval retinitis lesion proximal to a hyperpigmented and/or atrophic chorioretinal scar. Overall accuracy for infectious posterior uveitides / panuveitides was 92.1% in the training set and 93.3% (95% confidence interval 88.2, 96.3) in the validation set. The misclassification rates for toxoplasmic retinitis were 8.2% in the training set and 10% in the validation set. CONCLUSIONS The criteria for toxoplasmic retinitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
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Abstract
PURPOSE We report a case of congenital toxoplasmosis associated with retinal detachment. METHODS A 9-month-old white boy presented a unilateral tractional retina detachment associated with congenital toxoplasmosis retinochoroiditis. RESULTS The diagnosis is supported by positive IgG (>400) for toxoplasmosis and intracranial calcification on magnetic resonance imaging, along with positive family history of Toxoplasma infection in the mother. CONCLUSION Tractional retinal detachment is an infrequent and unconventional presentation of congenital Toxoplasma infection. Inflammatory interference with normal sequence of vitreous development may explain pathogenesis of tractional retinal detachments in the setting of congenital ocular toxoplasmosis.
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Affiliation(s)
- Alessandra Rassi
- Centro de Referencia em Oftalmologia, Universidade Federal de Goias, Goiania, Goias, Brazil ; and
| | - Bozho Todorich
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Lisa J Faia
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Michael Trese
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Kimberly Drenser
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
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Abraham EG, Moses AE, Motilewa USOO, Uwah AI, Itina EI, Umoh AN. Ocular Toxoplasmosis among Livestock Farmers and Raw Meat Handlers in Uyo, Nigeria. Ethiop J Health Sci 2021; 31:257-266. [PMID: 34158777 PMCID: PMC8188092 DOI: 10.4314/ejhs.v31i2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Toxoplasmosis is the commonest cause of infectious posterior uveitis in humans and can lead to blindness and low vision in both immune-competent and immunecompromised persons worldwide. The aim of this study was to determine the prevalence of Ocular Toxoplasmosis (OT) and potential risk factors among livestock farmers and raw meat handlers in Uyo. METHODS This was a descriptive cross-sectional community-based study involving clinical eye examination, laboratory detection of anti-Toxoplasma gondii IgG antibody and HIV testing. Participants' other information was obtained using interviewer-administered questionnaire. RESULTS There were 339 participants aged 15-78 (mean 34.8±11.6) years,283 (83.5%) were males 56(16.5%) were females; 189 (55.8%) tested seropositive for anti-Toxo. gondiiIgG antibodies. Eight (2.4%) had presumed ocular toxoplasmosis (POT); 6 of the 8 were seropositive for anti-T.gondiiIgG antibody; and 2 of the 8 POT (25%) were HIV-seropositive. Of the 189 who were anti-T.gondiiIgG antibody seropositive, 6 (3.2%) had OT. Factors associated with OT were age (31-50 years) and female gender (P = 0.049 and 0.001, respectively). HIV infection was associated with POT (P=0.033). Most of the ocular lesions (87.5%) were unilateral and located at the posterior pole (77.7%). CONCLUSION The prevalence of presumed ocular toxoplasmosis (POT) and ocular toxoplasmosis (OT) among livestock farmers and raw meat handlers in Uyo are 2.4% and 1.8%, respectively. Potential risk factors are being female, and persons between fourth and fifth decades of life. Awareness creation on toxoplasmosis among this occupational group is advocated.
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Affiliation(s)
- Emem Godwin Abraham
- Department of Ophthalmology, University of Uyo Teaching Hospital, Uyo, Nigeria
| | | | | | | | - Eme Iwat Itina
- Department of Ophthalmology, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Anthony N Umoh
- Department of Microbiology, University of Uyo Teaching Hospital, Uyo, Nigeria
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Ajamil-Rodanes S, Luis J, Bourkiza R, Girling B, Rees A, Cosgrove C, Pavesio C, Westcott M. Ocular toxoplasmosis: phenotype differences between toxoplasma IgM positive and IgM negative patients in a large cohort. Br J Ophthalmol 2021; 105:210-215. [PMID: 32345603 DOI: 10.1136/bjophthalmol-2019-315522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate the differences in demographics and clinical characteristics of patients diagnosed with ocular toxoplasmosis according to their IgM status. METHODS Retrospective case note analysis was carried out on patients who tested positive for serum Toxoplasma gondii-specific IgM antibodies (IgM+) as well as a comparator group who tested negative for serum IgM (IgM-), but positive for serum IgG. Patient demographics and clinical features were compared between the two groups to evaluate for any significant differences. RESULTS One hundred and six patients were included in the study between March 2011 and June 2018, consisting of 37 in the IgM +group and 69 in the IgM- group. Patients in the IgM +group were significantly older (51.1 vs 34.1 years, p<0.0001), more likely to present with central macular lesions (32% vs 12%, p=0.012), and more likely to develop rhegmatogenous retinal detachment (11% vs 1%, p=0.049). In contrast, patients in the IgM- group were more likely present with pain (20% vs 3%, 0.017) and exhibit more severe inflammation of the anterior chamber and vitreous (p<0.05). Overall, retinal lesions were more likely to be superotemporal (55%) and superonasal (31%). Furthermore, age was associated with larger (p=0.003) and more peripheral lesions (p=0.007). CONCLUSIONS This study demonstrated significant differences in clinical characteristics of ocular toxoplasmosis according to serum IgM status. IgM+ patients were older, less likely to report pain, had lower levels of intraocular inflammation, but were more likely to have macular involvement. We also found age to be correlated with larger and more peripheral lesions.
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Affiliation(s)
| | - Joshua Luis
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Rabia Bourkiza
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Benedict Girling
- Ophthalmology Department, Barts Health NHS Trust, London, London, UK
| | - Angela Rees
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Catherine Cosgrove
- Infectious Department, St George's University Hospital NHS Foundation Trust, London, UK
| | - Carlos Pavesio
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Mark Westcott
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Ophthalmology Department, Barts Health NHS Trust, London, London, UK
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Fernandes Felix JP, Cavalcanti Lira RP, Grupenmacher AT, de Assis Filho HLG, Cosimo AB, Nascimento MA, Leite Arieta CE. Reply to Comment on: Long-term Results of Trimethoprim Sulfamethoxazole Versus Placebo to Reduce the Risk of Recurrent Toxoplasma gondii Retinochoroiditis. Am J Ophthalmol 2020; 220:217-218. [PMID: 33097174 DOI: 10.1016/j.ajo.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022]
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Abstract
INTRODUCTION Focal choroidal excavation (FCE) is a concavity of the choroid detected on optical coherence tomography (OCT). It is usually idiopathic and the affected eyes are otherwise healthy with near-normal overlying retinal architecture and good visual acuity. PURPOSE To report a case of bilateral conforming FCE in the setting of Stargardt disease and inactive ocular toxoplasmosis. CASE REPORT A 20-year-old man with known history of Stargardt disease, healed toxoplasmosis, and high myopia presented to our ophthalmology department for follow-up examination and was found with bilateral FCEs not present in any of his previous examinations. CONCLUSION FCEs have been reported in the literature in otherwise healthy eyes as well as a broad spectrum of ocular diseases. The case herein reported Stargardt disease, toxoplasmosis, and high myopia all could potentially contribute to the pathogenesis of these findings. Further studies are needed to define etiologies as well as clinical significance and course of FCEs.
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Affiliation(s)
- Marco H Ji
- Horngren Family Vitreoretinal Center, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sayena Jabbehdari
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Natalia F Callaway
- Horngren Family Vitreoretinal Center, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Darius M Moshfeghi
- Horngren Family Vitreoretinal Center, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
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Mouinga Abayi DA, Kougou Ntoutoume AR, Mve Mengome E. [Bilateral congenital toxoplasmosis giant macular scars]. J Fr Ophtalmol 2020; 43:564-565. [PMID: 32386900 DOI: 10.1016/j.jfo.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 11/20/2022]
Affiliation(s)
- D-A Mouinga Abayi
- Service d'Ophtalmologie de l'Hôpital d'Instruction des Armées Omar Bongo Ondimba, BP 20404 Libreville, Gabon.
| | - A-R Kougou Ntoutoume
- Service d'Ophtalmologie de l'Hôpital d'Instruction des Armées Omar Bongo Ondimba, BP 20404 Libreville, Gabon
| | - E Mve Mengome
- Service d'Ophtalmologie de l'Hôpital d'Instruction des Armées Omar Bongo Ondimba, BP 20404 Libreville, Gabon
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Fernandes Felix JP, Cavalcanti Lira RP, Grupenmacher AT, Assis Filho HLGD, Cosimo AB, Nascimento MA, Leite Arieta CE. Long-term Results of Trimethoprim-Sulfamethoxazole Versus Placebo to Reduce the Risk of Recurrent Toxoplasma gondii Retinochoroiditis. Am J Ophthalmol 2020; 213:195-202. [PMID: 31926883 DOI: 10.1016/j.ajo.2019.12.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 09/25/2019] [Accepted: 12/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the effects of 1 year of treatment with trimethoprim-sulfamethoxazole (TMP-SMZ) vs placebo in reducing the risk of recurrence of toxoplasmic retinochoroiditis during a 6-year follow-up period. DESIGN Randomized, double-masked clinical trial. METHODS This cohort included 141 subjects recruited in Campinas, Brazil. The inclusion criterion was unilateral active recurrent toxoplasmic retinochoroiditis. All subjects were treated with 1 dose of TMP-SMZ (160 mg/800 mg) twice daily for 45 days, and all lesions healed after this treatment. After this initial treatment, subjects were randomly assigned to group 1 (1 TMP-SMZ dose every other day for 311 days) or group 2 (1 identical placebo tablet containing starch with no active ingredients every other day for 311 days). Between the second and sixth years of follow-up appointments, none of the subjects received treatment unless a new recurrence episode had occurred. The primary outcomes were recurrent toxoplasmic retinochoroiditis within the first year of follow-up and recurrent toxoplasmic retinochoroiditis in the 6 years of follow-up. RESULTS The cumulative probability of recurrence 1, 2, 3, 4, 5, and 6 years after the initial infection was, respectively, 13.0% (9/69), 17.4% (12/69), 20.3% (14/69), 23.2% (16/69), 26.1% (18/69), and 27.5% (19/69) in the placebo group and 0%, 0%, 0%, 0%, 0%, and 1.4% (1/72) in the TMP-SMZ group (P < .001; log-rank test). There were 3 cases (3/69; 4.3%) of multiple recurrences in the same individual in the placebo group. No treatment-limiting toxicity or side effects were observed in either group. New recurrences were more frequent among female subjects. CONCLUSIONS TMP-SMZ may be used safely for prophylaxis of recurrent toxoplasmic retinochoroiditis and may provide long-term benefits.
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Yannuzzi NA, Gal-Or O, Motulsky E, Swaminathan SS, Cunningham ET, Davis JL, Fisher Y, Gregori G, Rosenfeld PJ, Freund KB. Multimodal Imaging of Punctate Outer Retinal Toxoplasmosis. Ophthalmic Surg Lasers Imaging Retina 2019; 50:281-287. [PMID: 31100158 DOI: 10.3928/23258160-20190503-04] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/06/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the multimodal imaging characteristics associated with punctate outer retinal toxoplasmosis (PORT). PATIENTS AND METHODS Multicenter, retrospective, observational case series of three patients who presented with PORT. Multimodal imaging was reviewed including optical coherence tomography (OCT), fundus autofluorescence, optical coherence tomography angiography, and conventional dye-based angiography. RESULTS Patient ages ranged from 13 years to 55 years. Each patient had multiple white, punctate outer retinal lesions in the affected eye at initial diagnosis. OCT showed both inner and outer retinal changes, including disruption of the ellipsoid and interdigitation zones and retinal pigment epithelium/Bruch's membrane complex, as well as punctate, preretinal, hyperreflective lesions at the vitreoretinal interface, which regressed with treatment. CONCLUSION Multimodal imaging is useful in diagnosing and monitoring treatment response in PORT, an uncommon presentation of ocular toxoplasmosis that must be differentiated from white dot syndromes or other causes of unilateral retinitis. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:281-287.].
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Yates WB, Chiong F, Zagora S, Post JJ, Wakefield D, McCluskey P. Ocular Toxoplasmosis in a Tertiary Referral Center in Sydney Australia-Clinical Features, Treatment, and Prognosis. Asia Pac J Ophthalmol (Phila) 2019; 8:280-284. [PMID: 31369405 PMCID: PMC6727929 DOI: 10.1097/apo.0000000000000244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to provide a retrospective analysis of the presentation, demographics, and treatment regimens for ocular toxoplasmosis at a large tertiary referral uveitis center. DESIGN Retrospective cohort study. PARTICIPANTS A total of 48 patients with ocular toxoplasmosis who presented to Sydney Eye Hospital participated in this study. METHODS This is a retrospective review of patient files who presented to Sydney Eye Hospital between 2007 and 2016 with clinical features consistent with ocular toxoplasmosis. Baseline risk factors and treatment details were recorded and analyzed. Main outcome measures were visual acuity and relapse rate compared with other studies in ocular toxoplasmosis. RESULTS The median age was 35.5 (interquartile range 21-50) with 30 (60%) patients having no previous symptomatic episodes or evidence of chorioretinal scarring. Visual acuity at presentation was 0.51 or 6/19 (SE 0.096) and at follow-up 0.31 or 6/12 (SE 0.094). Nine patients experienced a recurrence during the period of observation with median time to recurrence 2.2 years (SE 0.45) and the relapse rate was 0.09/person-years. Location of lesion was predominantly within the vascular arcades (n = 44) with macular involvement in 9 patients. Most patients received clindamycin therapy (n = 34) with pyrimethamine and sulfadiazine was used for those with macula involvement. CONCLUSIONS Patients with ocular toxoplasmosis had fewer recurrences compared with other published series and had better visual recovery. The majority of patients received clindamycin and oral prednisolone which were well tolerated with pyrimethazine and sulfadiazine reserved for those with macula-involving disease.
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MESH Headings
- Administration, Oral
- Adult
- Anti-Infective Agents/administration & dosage
- Antibodies, Protozoan/analysis
- Australia/epidemiology
- DNA, Protozoan/analysis
- Drug Therapy, Combination
- Eye Infections, Parasitic/diagnosis
- Eye Infections, Parasitic/drug therapy
- Eye Infections, Parasitic/epidemiology
- Female
- Fluorescein Angiography/methods
- Follow-Up Studies
- Fundus Oculi
- Glucocorticoids/administration & dosage
- Humans
- Incidence
- Male
- Middle Aged
- Polymerase Chain Reaction
- Prognosis
- Retrospective Studies
- Tertiary Care Centers
- Tomography, Optical Coherence/methods
- Toxoplasma/genetics
- Toxoplasma/immunology
- Toxoplasma/isolation & purification
- Toxoplasmosis, Ocular/diagnosis
- Toxoplasmosis, Ocular/drug therapy
- Toxoplasmosis, Ocular/epidemiology
- Visual Acuity
- Young Adult
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Affiliation(s)
- William B. Yates
- The University of Sydney, Save Sight Institute, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Fabian Chiong
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Sophia Zagora
- The University of Sydney, Save Sight Institute, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Jeffrey J. Post
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Denis Wakefield
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- NSW Health Pathology, NSW Health, New South Wales, Australia
| | - Peter McCluskey
- The University of Sydney, Save Sight Institute, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
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Maršolková K, Timkovič J, Lesková V, Němčanský J, Wiedermannová H. Congenital central toxoplasmic chorioretinitis - case study. Cesk Slov Oftalmol 2019; 74:114-118. [PMID: 30650975 DOI: 10.31348/2018/1/6-3-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital toxoplasmosis is a globally spread infectious disease caused by transplacental transmission of an intracellular parasitic protozoan Toxoplasma gondii. The infection can cause serious multi-organ complications, and in the case of vertical transmission, can lead up to fetal death - depending on the stage of pregnancy at the time of infection and the overall condition of the mothers immune system. Chorioretinitis, hydrocephalus and intracranial calcifications are a typical triad of symptoms associated with the disease. Toxoplasmic chorioretinitis in particular is the most common ocular manifestation. If the central retina is affected, it can cause a severe impairment of central visual acuity or lead up to blindness in the child. Prenatal screening of this disease is presently voluntary in the Czech Republic. This article reports on a case study of a toxoplasmic chorioretinitis in a newborn child observed from the active stage and the development of the affected retina over time. Further is also reported on the diagnostics and the treatment of multi-organ complications which occurred in this patient. Ophthalmologic examination was performed after diagnosis of hydrocephalus, which revealed severe changes of retina. Hydrocephalus was then properly treated. An overview of the diagnostic and therapeutic methods and the screening options available in the Czech Republic compare with other countries is also presented in the report. Key words: congenital toxoplasmosis, chorioretinitis, multi-organ complications, screening, hydrocephalus.
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36
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Mac Grory B, Cheng D, Fisayo A. Toxoplasma Neuroretinitis. R I Med J (2013) 2019; 102:39-40. [PMID: 30823700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
[Full article available at http://rimed.org/rimedicaljournal-2019-03.asp].
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Affiliation(s)
- Brian Mac Grory
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Derrick Cheng
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Adeniyi Fisayo
- Departments of Neurology and of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT
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Matet A, Paris L, Fardeau C, Terrada C, Champion E, Fekkar A, Cassoux N, Touitou V, LeHoang P, Bodaghi B. Clinical and Biological Factors Associated With Recurrences of Severe Toxoplasmic Retinochoroiditis Confirmed by Aqueous Humor Analysis. Am J Ophthalmol 2019; 199:82-93. [PMID: 30502335 DOI: 10.1016/j.ajo.2018.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate clinical and biological factors influencing recurrences of severe toxoplasmic retinochoroiditis (TRC) confirmed by aqueous humor analysis. DESIGN Retrospective case series. METHODS Retrospective analysis of 87 subjects with severe TRC, proven by positive Goldmann-Witmer coefficient (GWC), Toxoplasma gondii (T. gondii) immunoblot, or T. gondii-specific polymerase chain reaction (PCR) in aqueous humor. Cases with immunosuppression or retinal scars without previous recorded episode were excluded. Time-dependent, clinical, treatment-related, and biological factors were explored by univariate and multivariate shared frailty survival analyses. RESULTS Among 44 included subjects (age, 40.4 ± 17.6 years; follow-up, 8.3 ± 2.7 years), 22 presented recurrences. There was 0.11 recurrence/patient/year and mean disease-free interval was 5.0 ± 2.9 years. The risk of recurrence was higher immediately after an episode (P < .0001). Among recurrent cases, the risk of multiple recurrences was higher when the first recurrence occurred after longer disease-free intervals (P = .046). In univariate analysis, the recurrence risk declined with higher number of intense bands on aqueous T. gondii immunoblot (P = .006), and increased when venous vasculitis was present initially (P = .019). Multivariate analysis confirmed that eyes with more intense bands on immunoblot had fewer recurrences (P = .041). There was a near-significant risk elevation after pyrimethamine/azithromycin treatment (P = .078 and P = .054, univariate and multivariate). Intravenous corticosteroid administration, oral corticosteroid administration, aqueous GWC, and T. gondii PCR did not influence recurrences (P = .12, P = .10, P = .39, and P = .96, respectively). CONCLUSIONS Recurrences of severe TRC are not random and may be influenced by clinical and biological factors possibly related to blood-retinal barrier alterations. These results may contribute to identifying biomarkers for TRC reactivation.
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MESH Headings
- Administration, Oral
- Adolescent
- Adult
- Aged
- Antibodies, Protozoan/immunology
- Aqueous Humor/parasitology
- Biological Factors
- Chorioretinitis/diagnosis
- Chorioretinitis/genetics
- Chorioretinitis/immunology
- Chorioretinitis/parasitology
- DNA, Protozoan/genetics
- Eye Infections, Parasitic/diagnosis
- Eye Infections, Parasitic/genetics
- Eye Infections, Parasitic/immunology
- Eye Infections, Parasitic/parasitology
- Female
- Follow-Up Studies
- Glucocorticoids/administration & dosage
- Humans
- Immunoblotting
- Infusions, Intravenous
- Male
- Middle Aged
- Polymerase Chain Reaction
- Recurrence
- Retrospective Studies
- Toxoplasma/genetics
- Toxoplasma/immunology
- Toxoplasmosis, Ocular/diagnosis
- Toxoplasmosis, Ocular/genetics
- Toxoplasmosis, Ocular/immunology
- Toxoplasmosis, Ocular/parasitology
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Affiliation(s)
- Alexandre Matet
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France.
| | - Luc Paris
- Parasitology Department, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Christine Fardeau
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Céline Terrada
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Emmanuelle Champion
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Arnaud Fekkar
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Nathalie Cassoux
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Valérie Touitou
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Phuc LeHoang
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, Reference Center in Rare Diseases, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris VI University, F-75013 Paris, France
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Lv X, Yu P. Early diagnosis and successful treatment of acquired toxoplasmosis infectious retinochoroiditis: A case report. Medicine (Baltimore) 2018; 97:e11231. [PMID: 29952985 PMCID: PMC6039674 DOI: 10.1097/md.0000000000011231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Toxoplasma gondii is distributed worldwide, infecting a large population. It can cause focal necrotic retinitis or retinochoroiditis in the human eyes and is one of the most common causes of posterior uveitis. PATIENT CONCERNS A 68-year-old patient with normal immunity was complained about blurred vision and black shadow in the right eye for 1 week. DIAGNOSES Combined Yellow-and-white bulged lesions in the fundus of the right eye with the Goldmann-Witmer coefficient = 2 and based on the serological indicators, we considered the diagnosis of T. gondii infection-induced retinochondritis. INTERVENTIONS Acetylspiramycin 0.4 QID × 3 weeks, concussive 20 days treatment after 3 days, for a total of 3 months, prednisone 20 mg/day with a weekly reduction of 5 mg for 1 month. OUTCOMES After oral acetylspiramycin, topical and systemic corticosteroids for 3 months, the retinal lesions were scarred, and inflammation of the anterior chamber and vitreum disappeared. After a 9-month follow-up, the visual acuity was 0.6, and no active lesions were observed in the fundus. LESSONS The immunocompetent elderly who are in contact with domestic cats may have an opportunistic infection with toxoplasmosis leading to primary retinochoroiditis. Prompt diagnosis and effective treatment can get a good clinical prognosis.
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Affiliation(s)
- Xiaoli Lv
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pingping Yu
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang
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Abstract
The objective of this study was to describe demographic and clinical features of ocular toxoplasmosis (OT) in Korean patients compared to those in other countries.This retrospective study comprised 46 patients diagnosed with OT. All participants were recruited at the uveitis clinic in Seoul St. Mary's Hospital.The mean age of patients was 54 years. Of 46 patients, 31 (67.4%) were females. Of all patients, 24 (52.2%) had definite eating history of wild boar meat or deer blood while 5 (10.9%) had history of close contact with cats. The most common forms of OT were vitritis (91.3%) combined with retinochoroiditis (65.2%). Active retinochoroidal lesion was located at the peripheral retina in 18 (39.1%) patients, central retina in 8 (17.4%) patients, and peripapillary retina in 4 (8.7%) patients. Seven (15.2%) cases were clinically diagnosed with typical OT without serologic evidence. Thirty-nine (84.8%) had serum IgG for toxoplasmosis. However, only 8 (17.4%) had serum IgM. In 65.2% of patients, there was no complication after treatment. The most common ocular complication was macular scar (8.7%).The present study provides demographic and clinical characteristics of OT in Korea, a low endemic area of Toxoplasma gondii. Acquired infection is the major cause of OT in Korea. Even though Korea is a low endemic area of Toxoplasma gondii, OT is a preventable and common cause of acquired infectious uveitis.
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Affiliation(s)
- Mirinae Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital
| | - Seung Yong Choi
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital
| | - Jae Yon Won
- Department of Ophthalmology and Visual Science, St. Paul's Hospital
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Türkcü FM, Şahin A, Yüksel H, Şahin M, Karaalp Ü. OCTA Imaging of Choroidal Neovascular Membrane Secondary to Toxoplasma Retinochoroiditis. Ophthalmic Surg Lasers Imaging Retina 2017; 48:509-511. [PMID: 28613359 DOI: 10.3928/23258160-20170601-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
Abstract
Two patients (a 37-year-old man and a 28-year-old woman) who had choroidal neovascular membrane (CNVM) secondary to inactive toxoplasma retinochoroiditis scarring were evaluated. Multimodal imaging including fluorescein angiography, optical coherence tomography (OCT), and OCT angiography (OCTA) was used. CNVM secondary to inactive toxoplasma retinochoroiditis scarring was detected. Representative images of CNVM were demonstrated in the outer retinal layer and choriocapillary layer on OCTA. OCTA, a relatively new technique, is useful in the diagnosis of the CNVMs secondary to retinochoroiditis. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:509-511.].
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41
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Commodaro AG, Chiasson M, Sundar N, Rizzo LV, Belfort R, Grigg ME. Elevated Toxoplasma gondii Infection Rates for Retinas from Eye Banks, Southern Brazil. Emerg Infect Dis 2016; 22:691-3. [PMID: 26982526 PMCID: PMC4806975 DOI: 10.3201/eid2204.141819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We found significantly higher incidence of Toxoplasma gondii DNA in eye bank specimens from Joinville in southern Brazil (13/15, 87%) than in São Paulo (3/42, 7%; p = 2.1 × 10E–8). PCR DNA sequence analysis was more sensitive at locus NTS2 than at locus B1; a high frequency of mixed co-infections was detected.
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42
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Samudio M, Acosta ME, Castillo V, Guillén Y, Licitra G, Aria L, Cibils P, Rojas A, Cibils D, Meza T, Infanzón B, Miño de Kaspar H. [Clinical and epidemiological aspects of toxoplasmosis in patients with vision problems]. Rev Chilena Infectol 2016; 32:658-63. [PMID: 26928502 DOI: 10.4067/s0716-10182015000700007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Toxoplasmosis is a worldwide disease; it can cause decreased vision or even blindness. The route of transmission in humans may vary according to the habits of the region; probably the ingestion of raw or undercooked meat is the main source of infection. OBJECTIVE To determine the seroprevalence of toxoplasmosis in an eye clinic, the frequency of ocular toxoplasmosis (OT) and risk habits for acquiring the infection. MATERIALS AND METHODS Adult patients consulting in the Retina Department of the Teaching Hospital of the National University of Asuncion, Paraguay between August and September, 2014 were included. Prior informed consent, socio-demographic and epidemiological data related to T. gondii infection were obtained. In addition a blood sample for the determination of anti T. gondii IgG antibodies by the ELISA method was taken and ophthalmologic evaluation for the diagnosis of OT was made. RESULTS A total of 80 patients with mean ± SD age of 53 ± 20 years were studied, with slight predominance of women (55%). The seroprevalence of toxoplasmosis was 84% (67/80) and OT was detected in 8.9% of the 67 seropositive persons. The habit of not washing vegetables with sodium hypochlorite and eat meat from wild animals was related to higher risk of infection in this population. CONCLUSION It is important to conduct research at the population level to establish the epidemiology of toxoplasmosis in our country. Information on prophylactic measures to prevent infection by T. gondii should be given to the population.
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Abstract
We report a case of toxoplasmosis with bilateral maculopathy in a 7-year-old boy diagnosed with ataxia telangiectasia (AT) at age 6. AT manifests as ataxia, apraxia, telangiectasia, and dysarthria. Common ophthalmologic findings in AT include fine conjunctival telangiectasia. Patients also suffer from recurrent sinopulmonary infections; however, serious opportunistic infection is rarely diagnosed. At 8 years of age he developed disseminated Toxoplasma gondii (toxoplasmosis) infection and meningoencephalitis. This ophthalmologic finding and the subsequent toxoplasmosis meningoencephalitis have not been previously reported in AT.
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Affiliation(s)
| | | | - Kathryn Moffett
- WVU Pediatrics and WVU Infectious Diseases, Morgantown, West Virginia
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44
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Chudoba T, Borkowski P, Sempińska-Szewczyk J, Filipiak E. [Unilateral optic disc oedema as a first sign of ocular toxoplasmosis – case report]. Klin Oczna 2016; 118:246-249. [PMID: 30088392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Diagnostic procedure for unilateral optic disc oedema needs detailed medical history, careful physical examination and multiple additional tests. We present a very rare case of atypical unilateral anterior optic neuropathy as a sign of ocular toxoplasmosis in a young female. All diagnostic and therapeutic challenges have been discussed.
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45
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Ayo CM, Camargo AVDS, Frederico FB, Siqueira RC, Previato M, Murata FHA, Silveira-Carvalho AP, Barbosa AP, Brandão de Mattos CDC, de Mattos LC. MHC Class I Chain-Related Gene A Polymorphisms and Linkage Disequilibrium with HLA-B and HLA-C Alleles in Ocular Toxoplasmosis. PLoS One 2015; 10:e0144534. [PMID: 26672749 PMCID: PMC4682939 DOI: 10.1371/journal.pone.0144534] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/19/2015] [Indexed: 12/05/2022] Open
Abstract
This study investigated whether polymorphisms of the MICA (major histocompatibility complex class I chain-related gene A) gene are associated with eye lesions due to Toxoplasma gondii infection in a group of immunocompetent patients from southeastern Brazil. The study enrolled 297 patients with serological diagnosis of toxoplasmosis. Participants were classified into two distinct groups after conducting fundoscopic exams according to the presence (n = 148) or absence (n = 149) of ocular scars/lesions due to toxoplasmosis. The group of patients with scars/lesions was further subdivided into two groups according to the type of the ocular manifestation observed: primary (n = 120) or recurrent (n = 28). Genotyping of the MICA and HLA alleles was performed by the polymerase chain reaction-sequence specific oligonucleotide technique (PCR-SSO; One Lambda®) and the MICA-129 polymorphism (rs1051792) was identified by nested polymerase chain reaction (PCR-RFLP). Significant associations involving MICA polymorphisms were not found. Although the MICA*002~HLA-B*35 haplotype was associated with increased risk of developing ocular toxoplasmosis (P-value = 0.04; OR = 2.20; 95% CI = 1.05–4.60), and the MICA*008~HLA-C*07 haplotype was associated with protection against the development of manifestations of ocular toxoplasmosis (P-value = 0.009; OR: 0.44; 95% CI: 0.22–0.76), these associations were not statistically significant after adjusting for multiple comparisons. MICA polymorphisms do not appear to influence the development of ocular lesions in patients diagnosed with toxoplasmosis in this study population.
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Affiliation(s)
- Christiane Maria Ayo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Ana Vitória da Silveira Camargo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Fábio Batista Frederico
- Ophthalmology Outpatient Clinic, Hospital de Base de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Rubens Camargo Siqueira
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
| | - Mariana Previato
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Fernando Henrique Antunes Murata
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | - Amanda Pires Barbosa
- Ophthalmology Outpatient Clinic, Hospital de Base de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Cinara de Cássia Brandão de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Luiz Carlos de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
- * E-mail: or (LCM)
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Choudhury H, Jindal A, Pathengay A, Bawdekar A, Albini T, Flynn HW. The role of intravitreal trimethoprim/sulfamethoxazole in the treatment of toxoplasma retinochoroiditis. Ophthalmic Surg Lasers Imaging Retina 2015; 46:137-40. [PMID: 25559528 DOI: 10.3928/23258160-20150101-27] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/20/2014] [Indexed: 11/20/2022]
Abstract
The authors evaluate the role of intravitreal trimethoprim/sulfamethoxazole in the treatment of toxoplasma retinochoroiditis (TRC) in four patients. Intravitreal injection of trimethoprim/sulfamethoxazole 1.28 mg/0.08 mL with dexamethasone 400 µg/0.1 mL was injected weekly or biweekly. After the initiation of treatment, a reduction in intraocular inflammation was observed clinically and on optical coherence tomography within 1 week. Three patients regained visual acuity of 20/20, and one patient improved to 20/40 with residual macular scarring. No evidence of retinal toxicity was noted on full-field electroretinogram. Intravitreal trimethoprim/sulfamethoxazole and dexamethasone combination may be an alternative treatment strategy in patients with TRC.
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47
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Ouyang Y, Li F, Shao Q, Heussen FM, Keane PA, Stübiger N, Sadda SR, Pleyer U. Subretinal fluid in eyes with active ocular toxoplasmosis observed using spectral domain optical coherence tomography. PLoS One 2015; 10:e0127683. [PMID: 26010656 PMCID: PMC4444256 DOI: 10.1371/journal.pone.0127683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 04/17/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To describe the clinical finding of subretinal fluid (SRF) in the posterior pole by spectral domain optical coherence tomography (SD-OCT) in eyes with active ocular toxoplasmosis (OT). DESIGN Retrospective case series. PARTICIPANTS Thirty-nine eyes from 38 patients with active OT [corrected].. METHODS Eyes with active OT which underwent SD-OCT were reviewed. SRFs in the posterior pole were further analyzed. MAIN OUTCOME MEASURES Presence of SRF; its accompanying features, e.g. retinal necrosis, cystoid macular edema (CME), choroidal neovascularization (CNV); and longitudinal changes of SRF, including maximum height and total volume before and after treatment. RESULTS SRF presented in 45.5% (or 15/33) of eyes with typical active OT and in 51.3% (or 20/39) of eyes with active OT. The mean maximum height and total volume of SRF were 161.0 (range: 23-478) µm and 0.47 (range: 0.005-4.12) mm3, respectively. For 12 eyes with SRF related to active retinal necrosis, SRF was observed with complete absorption after conventional anti-toxoplasmosis treatment. The mean duration for observation of SRF clearance was 33.8 (range: 7-84) days. The mean rate of SRF clearance was 0.0128 (range: 0.0002-0.0665) mm3/day. CONCLUSIONS SRF (i.e., serous retinal detachment) is a common feature in patients with active OT when SD-OCT is performed. The majority of SRF was associated with retinal necrosis and reacted well to conventional therapy, regardless of total fluid volume. However, SRF accompanying with CME or CNV responded less favorably or remained refractory to conventional or combined intravitreal treatment, even when the SRF was small in size.
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Affiliation(s)
- Yanling Ouyang
- Charité, University Medicine Berlin, Department of Ophthalmology, Berlin, Germany
- * E-mail:
| | - Fuqiang Li
- Eye Center affiliated with 2nd Hospital, Jilin University, Changchun, China
| | - Qing Shao
- Charité, University Medicine Berlin, Department of Ophthalmology, Berlin, Germany
| | - Florian M. Heussen
- Charité, University Medicine Berlin, Department of Ophthalmology, Berlin, Germany
| | - Pearse A. Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Nicole Stübiger
- Charité, University Medicine Berlin, Department of Ophthalmology, Berlin, Germany
| | - Srinivas R. Sadda
- Doheny Eye Institute and Department of Ophthalmology, Los Angeles, California, United States of America
| | - Uwe Pleyer
- Charité, University Medicine Berlin, Department of Ophthalmology, Berlin, Germany
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48
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Bettendorf BA, Thomson M, Reichstein D, Thomas J. Acute Central Vision Loss in an IV Drug User. WMJ 2015; 114:69-72. [PMID: 26756060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This report describes the case of a 21-year-old heroin user who presented with a 6-day history of decreased vision in her right eye, preceded by 1 week of headache and tender scalp nodules, neck stiffness, and photophobia. A broad infectious workup for acute vision loss was completed, and she was ultimately presumed to have acquired toxoplasmic chorioretinitis (ocular toxoplasmosis). We review the initial workup for chorioretinitis, and the epidemiology, diagnosis, and treatment of ocular toxoplasmosis. Intravenous drug users may be at increased risk of acquired ocular toxoplasmosis.
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49
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Tanaka R, Obata R, Sawamura H, Ohtomo K, Kaburaki T. Temporal changes in a giant macular hole formed secondary to toxoplasmic retinochoroiditis. Can J Ophthalmol 2015; 49:e115-8. [PMID: 25284113 DOI: 10.1016/j.jcjo.2014.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 06/16/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Rie Tanaka
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
| | - Ryo Obata
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiromasa Sawamura
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazuyoshi Ohtomo
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Toshikatsu Kaburaki
- The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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50
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Oray M, Onal S, Bayraktar S, Izgi B, Tugal-Tutkun I. Nonglaucomatous localized retinal nerve fiber layer defects in Behçet uveitis. Am J Ophthalmol 2015; 159:475-81.e1. [PMID: 25461299 DOI: 10.1016/j.ajo.2014.11.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/16/2014] [Accepted: 11/19/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE To describe nonglaucomatous retinal nerve fiber layer (RNFL) defects in patients with Behçet uveitis. DESIGN Cross-sectional study and observational case series. METHODS We reviewed the clinical photographs of patients with Behçet uveitis (n = 259), ocular toxoplasmosis (n = 120), and multiple sclerosis (MS)-associated uveitis (n = 40) for the presence of localized RNFL defects. Behçet patients with localized RNFL defects were invited to participate in a prospective evaluation including standard automated perimetry, spectral-domain optical coherence tomography (SD OCT), and RNFL thickness analysis. Main outcome measures were the prevalence of localized RNFL defects, perimetric and SD OCT findings, and RNFL thickness analysis. RESULTS Sixty-two patients with Behçet uveitis (24%) had localized RNFL defect(s) without any visible scar. Twenty patients (17%) with ocular toxoplasmosis had a localized RNFL defect associated with a retinochoroidal scar in all. None of the MS patients had a localized RNFL defect. Of the 19 patients (24 eyes) with RNFL defect associated with Behçet uveitis who returned for follow-up, there was a corollary thinning on SD OCT B-scan in all and a corresponding visual field defect in 83%. RNFL thickness analysis was within normal limits in 54%, but revealed thinning in the thickness profile scale in 46% and in the pie chart in 21%. CONCLUSION In Behçet uveitis, localized RNFL defects may be caused by microvascular ischemia at the optic nerve head and/or at the posterior pole and may serve as a helpful ocular diagnostic clue and an indicator of posterior pole involvement, a risk factor for poor visual prognosis.
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Affiliation(s)
- Merih Oray
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sumru Onal
- Department of Ophthalmology, Koc University, School of Medicine, Istanbul, Turkey; Department of Ophthalmology, Vehbi Koc Foundation, American Hospital, Istanbul, Turkey
| | - Serife Bayraktar
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Belgin Izgi
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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