11/125. Presumed acquired ocular toxoplasmosis in deer hunters. PURPOSE: To describe acquired ocular toxoplasmosis in deer hunters. methods AND RESULTS: The authors describe five young men presenting with flu-like symptoms followed by visual loss due to a unilateral, focal necrotizing retinitis. All five men gave a history of ingesting undercooked or uncooked venison. All five had elevated toxoplasma serology, and all five improved clinically with an antitoxoplasma regimen. CONCLUSION: In previously healthy young men, flu-like symptoms associated with visual loss and retinitis should prompt questioning about hunting and raw game meat ingestion, especially when toxoplasmosis is suspected. ( info) |
12/125. Atypical anterior optic neuropathy caused by toxoplasmosis. PURPOSE: To report atypical anterior optic neuropathy due to toxoplasmosis. methods: Interventional case report. A 33-year-old male presented with sudden painless loss of vision and floaters in the right eye. Examination demonstrated a best-corrected visual acuity of 20/200, optic nerve head edema, retinal hemorrhages, and vitreous opacities. RESULTS: Nine days later, a granuloma at the optic nerve head was apparent, and the patient was treated with pyrimethamine, sulfadiazine, folinic acid, and prednisone. Six weeks after initiating therapy, best-corrected visual acuity had improved to 20/25. CONCLUSION: optic nerve involvement in toxoplasmosis is uncommon and, when it occurs, usually presents with a white inflammatory mass on the optic disk. The current case demonstrates the importance of including toxoplasmosis in the differential diagnosis of unilateral anterior optic neuropathy, even if a focal inflammatory mass is not apparent. ( info) |
| A Caucasian woman presenting with recurrence of intra-ocular toxoplasmosis was given intravitreal clindamycin. She subsequently developed a hypersensitivity reaction in the form of a generalized erythematous rash. To the authors' knowledge, hypersensitivity reactions to an antibiotic given by the intra-vitreal route have not previously been reported. ( info) |
14/125. Ocular toxoplasmosis in an adult receiving long-term corticosteroid therapy. Sudden death of a 58-year-old woman who developed ocular toxoplasmosis while receiving long-term systemic corticosteroid therapy permitted correlation of early histopathologic lesions with their clinical counterpart recorded on fundus photographs. A wide-spread, paravascular, whitish, retinal opacification dominated the initial clinical picture. These lesions were represented histologically by focal zones of inner retinal necrosis located adjacent to arteries and veins. No associated inflammatory cell infiltrate was present, and numerous viable free toxoplasma organisms were consistently present at the interface between necrotic and healthy retina. Electron microscopy of formaldehyde-fixed tissue provided a useful technique for confirming the identity of the infecting organism in the absence of serologic or culture data. ( info) |
15/125. Surgery for subfoveal choroidal neovascularization in toxoplasmic retinochoroiditis. PURPOSE: To report a case of subfoveal choroidal neovascularization in a patient with toxoplasmic retinochoroiditis who underwent surgical excision. DESIGN: Interventional case report. methods: A 36-year-old woman with toxoplasmic retinochoroiditis presented with sudden dimness of vision and metamorphopsia in the left eye. The patient was examined with ophthalmoscopy and fluorescein angiography. RESULTS: Fundus examination and fluorescein angiography of the left eye revealed a subfoveal choroidal neovascularization. Pars plana vitrectomy with submacular surgery was performed, with a postoperative improvement of visual acuity and resolution of the distortion. CONCLUSIONS: This case report describes a case of subfoveal choroidal neovascularization associated with toxoplasmic retinochoroiditis that responded remarkably well to vitrectomy surgery. ( info) |
| PURPOSE: To report 4 cases of toxoplasma gondii retinochoroiditis in patients having recently undergone cardiac transplantation. methods: review of medical records for 4 patients presenting retinochoroiditis and evidence of T. gondii infection. RESULTS: Patient ranged in age from 25 to 53 years. Ocular symptoms began between 3 and 6 months after transplantation. All patients were under immunosuppressive therapy. Foci of retinochoroiditis were observed unilaterally in three patients and bilaterally in one. Intraocular inflammation was minimal in all cases. Serologic responses were highly suggestive of T. gondii as the etiology in all cases; other causes (CMV retinitis and syphilis) were actively sought and were not found. All patients underwent classic therapy. The three unilateral cases evolved favorably, but the bilateral case, seen late, showed extensive macular scarring. CONCLUSION: Infectious retinochoroiditis is a potentially blinding complication seen after cardiac transplantation, justifying close clinical and serological surveillance or, in certain cases such as mismatched donors, anti-parasitic prophylaxis. ( info) |
17/125. Ocular toxoplasmosis presenting as neuroretinitis: report of two cases. BACKGROUND: Neuroretinitis is a clinical entity usually seen in young healthy adults, that is characterized by rapid profound unilateral loss of vision and includes optic nerve head edema, splinter hemorrhages, macular exudate in a stellate pattern, and variable vitreous inflammation. There are numerous entities that can cause a picture of neuroretinitis ranging from vascular to infectious to autoimmune. PATIENT AND methods: We report two patients with neuroretinitis, who presented with unilateral blurred vision and had serologic evidence of toxoplasma gondii infection. RESULTS: Both patients responded well to treatment with systemic antibiotics and corticosteroids. visual acuity returned to 20/60 in one patient and 20/20 in the other. CONCLUSION: Although the etiology is usually idiopathic, infectious causes of neuroretinitis, including toxoplasmosis, should be kept in mind in order to maintain visual acuity by early diagnosis and appropriate therapy. ( info) |
18/125. toxoplasmosis transmitted to a newborn from the mother infected 20 years earlier. PURPOSE: To present a case of congenital toxoplasmosis in a newborn whose mother had a 20-year history of a chorioretinal macular scar and positive serology for toxoplasmosis. DESIGN/methods: Case report. SETTING/RESULTS: A 38-year-old woman who had been treated for ocular toxoplasmosis 20 years earlier delivered a newborn who presented with a focal necrotizing retinochoroiditis characteristic of toxoplasmosis, as well as positive immunoglobulin (Ig) G and M serology for toxoplasmosis. The workup was negative for other entities. CONCLUSION: This case suggests that women with old retinal scars due to toxoplasmosis and long-standing IgG antibodies to toxoplasmosis are also at risk of transmitting this disease to the fetus. ( info) |
19/125. Laboratory passage and characterization of an isolate of toxoplasma gondii from an ocular patient in Korea. toxoplasma gondii tachyzoites were isolated from the blood of an ocular patient, and have been successfully passaged in the laboratory, for over a year, by peritoneal inoculation in mice. The isolated parasite was designated the Korean Isolate-1 (KI-1) and its characteristics were compared with those of the RH strain, a wellknown virulent strain originating from a child who suffered from encephalitis. The morphology, pathogenicity, infectivity and cell culture characteristics of the KI-1 were similar to those of the RH strain. Both RH and KI-1 antigens were detected by an anti-T. gondii monoclonal antibody (mAb), Tg563, against the major surface protein SAG1 (30 kDa), whereas no reaction was observed against an anti-neospora caninum mAb, 12B4. The KI-1 was confirmed as an isolate of T. gondii. A long-term laboratory maintenance and characterization of a local T. gondii isolate is reported for the first time in the republic of korea. ( info) |
20/125. Prophylaxis for ocular toxoplasmosis. The protozoan parasite toxoplasma gondii is an important cause of ocular disease. Ocular toxoplasmosis (OT) can be a progressive and recurring disease that can threaten visual function. We present 2 cases of recurrent OT in immunocompetent patients for whom prophylaxis prevented recurrence of disease. ( info) |