1/125. Upward extension of an atrophic tract of the retinal pigment epithelium associated with congenital macular toxoplasmosis. PURPOSE: To report an unusual case of gravitational atrophic tract of the retinal pigment epithelium in a 20-year old woman. methods: Case Report. RESULTS: The patient had macular cicatricial congenital toxoplasmic chorioretinitis in both eyes. In the right eye, an atrophic tract of the retinal pigment epithelium originating from the upper margin of the macular scar extended upwards toward the retinal periphery. CONCLUSION: The unusual upward direction of the atrophic tract of retinal pigment epithelium may be explained by the in utero head position during the active phase of the chorioretinal disease. ( info) |
2/125. Punctate outer retinal toxoplasmosis in an hiv-positive child. PURPOSE: To discover whether the outer layer of the retina can be the site for toxoplasmosis in AIDS patients. methods: An hiv-positive child, who previously had a normal ocular examination, was reexamined three months later. This examination showed outer retinal lesions compatible with toxoplasmosis and positive IgM and IgG titers specific for that organism, despite the small drop in the CD4 count. RESULTS: During the first examination, the antibodies for toxoplasmosis were negative. At the three-months follow-up, the anti-toxoplasmosis antibodies were positive and the rest of the workup was negative, suggesting a strong correlation with the patient's fundus pattern. CONCLUSION: We describe a case of punctate outer retinal toxoplasmosis uveitis, which has been previously associated with immunocompetent hosts. We, however, believe that it can be seen in immunocompromised patients as well. ( info) |
| OBJECTIVE: To report a cohort of patients in whom polymerase chain reaction (PCR) was performed on vitreous samples and to place in perspective the current role of PCR in the diagnosis of ocular toxoplasmosis. DESIGN: Noncomparative case series. PARTICIPANTS: Fifteen patients in whom toxoplasmic retinochoroiditis was considered in the differential diagnosis and in whom the clinical presentation was not diagnostic and/or response to treatment was inadequate. INTERVENTION: Examination of vitreous fluid by PCR and of serum for the presence of toxoplasma-specific antibodies. MAIN OUTCOME MEASURES: Presence of toxoplasma gondii dna, serologic test results, clinical findings, treatment, and outcome. RESULTS: In 7 of 15 patients, vitreous fluid examination results by PCR were positive for the presence of T. gondii dna. Five of these seven patients had serologic test results consistent with toxoplasma infection acquired in the distant past; the other two patients had serologic test results consistent with retinochoroiditis in the setting of acute toxoplasmosis. The PCR results influenced the management of these patients in six of the seven positive cases. In the eight patients in whom vitreous examination results were negative by PCR, either toxoplasma serology was negative (6), the retinal lesions were caused by cytomegalovirus (1), or, on further consideration, the eye signs were not consistent with those of toxoplasmic retinochoroiditis (1). CONCLUSION: In patients in whom toxoplasmosis is considered in the differential diagnosis but in whom the presentation is atypical, PCR was frequently a useful diagnostic aid. ( info) |
4/125. Presumed congenital ocular toxoplasmosis in two successive siblings. We present the cases of 2 consecutive siblings with bilateral macular lesions, for which there is strong clinical and laboratory evidence supporting the diagnosis of congenital ocular toxoplasmosis. These cases raise the possibility of maternal parasitemia during toxoplasma gondii reinfection, leading to transmission to the fetus and congenital ocular toxoplasmosis despite prior immunity and lack of an immune disturbance in the mother. ( info) |
5/125. Diffuse toxoplasmic retinochoroiditis as the initial manifestation of acquired immunodeficiency syndrome. Toxoplasmic retinochoroiditis is an important opportunistic retinal infection in human immunodeficiency virus (hiv)-infected patients. It may present as diffuse necrotizing retinochoroiditis instead of a focal lesion and may be the initial manifestation of hiv infection. A 50-year-old heterosexual man presented with blurred vision in his left eye of 3 months' duration. Fundus examination revealed diffuse necrotizing retinochoroiditis, mainly at the posterior pole, with marked vitritis in the left eye. Serologic studies and aqueous fluid antibody titers indicated recent toxoplasmic infection. Positive enzyme immunoassays (EIA) and Western blot tests proved hiv infection. The retinochoroiditis and vitritis improved after an antitoxoplasmic regimen with trimethoprim-sulfamethoxazole (TMP-SMX). Nonetheless, toxoplasmic encephalitis developed 6 months after the onset of ocular toxoplasmosis and responded well to TMP-SMX. This is the first case of toxoplasmic retinochoroiditis as the initial manifestation of AIDS reported in taiwan. We suggest that toxoplasma infection should be included in the differential diagnosis of diffuse necrotizing retinochoroiditis and vitritis. We also recommend that adults with newly diagnosed ocular toxoplasmosis be screened for hiv infection. ( info) |
6/125. Acute iridocyclitis in a patient with AIDS diagnosed as toxoplasmosis by PCR. PURPOSE: To study the etiology of an acute iridocyclitis in a patient with AIDS using polymerase chain reaction (PCR) analysis of aqueous humor. methods: Case report describing a patient diagnosed with toxoplasmic retinochoroiditis in his left eye. He stopped his treatment after three weeks and subsequently developed an acute iridocyclitis without chorioretinitis in the fellow eye. anterior chamber paracentesis was performed and aqueous humor was assayed by PCR. RESULTS: PCR of the aqueous humor showed positivity for toxoplasma gondii. The iridocyclitis responded to topical dexamethasone and oral treatment with pyrimethamine and sulfadiazine. CONCLUSION: PCR is an effective method to diagnose toxoplasmic iridocyclitis in a patient with AIDS. ( info) |
| PURPOSE: To report unilateral macular lesions, mimicking toxoplasmic scars, in two children with serological evidence for lymphocytic choriomeningitis virus infection. methods: case reports. RESULTS: patients were 4 and 5 years old, with negative toxoplasma serologies and no sign of rubella, cytomegalovirus, or herpes simplex infection (TORCH evaluation). lymphocytic choriomeningitis virus infection was detected in both cases by enzyme-linked immunosorbent assay and confirmed by Western immunoblotting. The modes of infection were unknown; no history of symptomatic systemic lymphocytic choriomeningitis virus infection was reported, and lymphocytic choriomeningitis virus serologies were negative in the mothers of the patients. Neurological examinations and brain magnetic resonance imaging were normal. CONCLUSION: Our observations suggest that chorioretinal scars can be an isolated manifestation of lymphocytic choriomeningitis virus infection. ( info) |
8/125. Ophthalmological findings in children with congenital toxoplasmosis. Report from a Swedish prospective screening study of congenital toxoplasmosis with two years of follow-up. Congenital toxoplasmosis may lead to severe visual impairment or neurological sequelae in the child. PURPOSE: To study the severity of the primary and late ophthalmological dysfunction during a prospective incidence study of congenital toxoplasmosis in the Stockholm and Skane counties. methods: blood collected on phenylketonuria (PKU) cards from 40,978 consecutively born children were investigated for antitoxoplasma antibodies. Children with verified congenital toxoplasmosis were treated for 12 months with antiparasitic therapy and followed ophthalmologically, neurologically and serologically every third month. RESULTS: Three children had congenital toxoplasmosis. Two of these were asymptomatic at birth and would have escaped early detection without screening. One child had unilateral severe visual impairment and CNS involvement. The incidence of congenital toxoplasmosis was less than 1:10,000. CONCLUSION: neonatal screening is of importance to diagnose asymptomatic infected children with congenital toxoplasmosis as treatment has been shown to reduce long-term sequelae. Ophthalmological investigations should start early and continue in co-operation with paediatricians. ( info) |
9/125. Ocular involvement in systemic toxoplasmosis: a case report. We report a case of adult acquired toxoplasmosis with ocular involvement in a 29 year old immunocompetent female. The patient had an illness for approximately 3 weeks characterized by lymphadenopathy, malaise and rash that was diagnosed serologically as toxoplasmosis. At the time of diagnosis, she developed signs and symptoms of retino choroiditis. She had serologic evidence of cytomegalovirus (CMV) infection as well as the recent toxoplasma infection. The patient was treated with pyrimethanime, sulfadiazone and folic acid for 6 weeks, plus prednisone for 4 weeks, during which the illness resolved. toxoplasmosis is a protozoan infection that occurs worldwide, and is the most common cause of infectious retinochoroiditis in otherwise healthy individuals. Most cases of toxoplasma infection in the immunocompetent adult are asymptomatic. The most common clinical presentation is localized lymphadenopathy. Ocular signs, which are common in congenitally acquired toxoplasmosis, may rarely be the only manifestation of acquired systemic toxoplasmosis. It has been suggested that concomitant infection with a dna virus, such as CMV or herpes simplex virus, may facilitate the penetration of protozoa into cells, or that antigenic stimulation from toxoplasma antigens may activate endogenous latent CMV in the recipient. The occurrence of ocular involvement during toxoplasmosis and its association with a dna virus is reviewed. ( info) |
10/125. Intravitreal clindamycin and dexamethasone for toxoplasmic retinochoroiditis. BACKGROUND AND OBJECTIVE: To present a new method for the management of toxoplasmic retinochoroiditis (TRC). methods: The patients were females ranging in age from 10 to 61 years (average 26.5). Four eyes of 4 patients were treated with intravitreal injections of 1.0 mg clindamycin in 0.1 mL and 1.0 mg of dexamethasone in 0.1 mL. The injections were given under general or peribulbar anesthesia. Three patients continued one systemic drug. Follow-up ranged from 11 to 26 months (mean 17.5). RESULTS: A favorable response was noted in each eye within two weeks after the intravitreal injections. All patients required 2 to 4 intravitreal injections in the affected eye for the control of TRC. visual acuity improved in each eye. The disc and macula were preserved in all eyes. recurrence was noted in one case, which responded to a repeated intravitreal injection of clindamycin and dexamethasone. CONCLUSIONS: intravitreal injections of clindamycin and dexamethasone are well tolerated and may offer an additional strategy to treat TRC in patients who are unable to afford or tolerate systemic therapy, or whose disease progresses despite systemic therapy. ( info) |