PurposeTo ascertain the clinical features and visual outcome of toxoplasma retinochoroiditis in a large series of cases.Subjects and MethodsTwo hundred and thirty subjects diagnosed with active toxoplasma retinochoroiditis were prospectively followed for periods ranging from 269 to 1976 days. All patients presented with active retinochoroiditis and positive IgG T. gondii serology at the beginning of the study and received a standardized drug treatment for toxoplasmosis, both in the first episode and in the subsequent recurrences.ResultsThe group involved 118 (51.3%) men and 112 (48.7%) women, with ages ranging from 14 to 77 years, mean of 32.4 years (SD = 11.38). Primary retinochoroidal lesions were observed in 52 (22.6%) cases and active retinochoroiditis combined with old scars in 178 (77.4%) subjects at the beginning of the study. A hundred sixty-two recurrent episodes in 104 (45.2%) patients were observed during follow-up. New subclinical retinochoroidal lesions were detected in 23 of 162 (14.2%) recurrences episodes during the follow-up. Posterior segment complications were observed in 73 (31.7%) subjects. Retinochoroidal lesions adjacent to the optic nerve and in the macular area were observed in 27 of 40 (67.5%) cases of severe visual impairment (VA = 20/200 or worse).ConclusionToxoplasma retinochoroiditis in this population had a high recurrence rate after an active episode. Severe visual impairment was associated with location of the retinochoroidal scar, recurrences and posterior segment complications. It is crucial to consider the location of the lesion in studies analyzing visual prognosis as a measure for treatment effectiveness and prevention strategies.

Toxoplasmosis is a worldwide zoonosis that generally produces an asymptomatic infection. In some cases, however, toxoplasmosis infection

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Purpose To analyze risk factors for recurrent toxoplasmic retinochoroiditis. Design Single center prospective case series. Population and Methods A total of 230 patients with toxoplasmic retinochoroiditis were prospectively followed to assess recurrences. All patients were treated with a specific drug regime for toxoplasmosis in each episode of active retinochoroiditis. Individuals with chronic diseases and pregnant women were excluded. Survival analysis by extended Cox regression model (Prentice-Williams-Peterson counting process model) was performed to evaluate the time between recurrences according to some potential risk factors: age, number of retinochoroidal lesions at initial evaluation, sex and interferon gamma +874 T/A gene polymorphism. Hazard Ratios (HR) and 95% confidence intervals (CI) were provided to interpret the risk effects. Results One hundred sixty-two recurrence episodes were observed in 104 (45.2%) patients during follow-up that lasted from 269 to 1976 days. Mean age at presentation was 32.8 years (Standard deviation = 11.38). The risk of recurrence during follow up was influenced by age (HR = 1.02, 95% CI = 1.01–1.04) and number of retinochoroidal lesions at the beginning of the study (HR = 1.60, 95% CI = 1.07–2.40). Heterozygosis for IFN-γ gene polymorphism at position +874 T/A was also associated with recurrence (HR = 1.49, 95% CI = 1.04–2.14). Conclusion The risk of ocular toxoplasmosis recurrence after an active episode increased with age and was significantly higher in individuals with primary lesions, which suggests that individuals with this characteristic and the elderly could benefit from recurrence prophylactic strategies with antimicrobials. Results suggest an association between IFN-γ gene polymorphism at position +874T/A and recurrence.

Infection caused by Toxoplasma gondii, toxoplasmosis, is one of the most frequent zoonoses in the world; it normally affects both genders equally. Humans are one of several possible intermediate hosts, and the disease is oligosymptomatic in most cases. Vertical transmission is an important cause of fetal malformation and sequels in newborns. Approximately 10% of postnatal cases present multiple manifestations, ranging from low fever and mild lymphadenopathy to severe encephalitis. In moderate cases, lesions such as retinochoroiditis may emerge during acute infection or even years later. We analyzed 313 cases of toxoplasmosis from 1992 to 2004, including 261 acute cases. Most patients were women (68.1%), and 39% of these were pregnant. Among acute infection cases, 64.8% presented symptomatic disease; the most frequent manifestations were lymphadenomegaly (59.8%), fever (27.2%), headache (10.7%), asthenia (10%), weight loss (8.4%), myalgia (8%), retinochoroiditis (3.4%) and hepatosplenomegaly (1.5%). Although ocular lesions by T. gondii are well documented as a possible consequence of postnatal infection, two patients developed retinochoroiditis only two years after primary infection. This demonstrates the need for toxoplasmosis case surveillance, even long after acute manifestations.

Objetivo: Determinar a freqüência e o tipo de comprometimento ocular em pacientes portadores de hanseníase no momento do diagnóstico.Metodologia: O estudo foi realizado na Fundação Oswaldo Cruz (Rio de Janeiro) e avalia 77 casos classificados como multibacilares. O exame oftalmológico foi realizado de acordo com o sistema de classificação de discapacidades recomendado pela Organização Mundial de Saúde.Resultados: Referiam queixas especificas 36,3%: dor e ardência ocular, lacrimejamento e dificuldade para enxergar. Em 55,8% dos pacientes foram detectadas alterações oculares no exame oftalmoló-gico. A diminuição da sensibilidade da córnea, que predispõe a ulceração e opacificação, foi a alteração mais freqüente (29,3%).Conclusão: Os achados desta pesquisa demonstram a gravidade e a alta freqüência das lesões oculares nos casos avaliados e alertam para a importância do exame oftalmológico como rotina em portadores de hanseníase multibacilar. Ophthalmological examination in multibacillary leprosyTrabalho realizado na Fundação Oswaldo Cruz (RJ).( RESULTADOSA idade dos pacientes examinados variou de 9 a 70 anos com média de 36 anos.A avaliação dos casos em relação a distribuição por sexo, anamnese dirigida aos sintomas oculares e exame oftalmoló-gico, são apresentadas na Tabela 1.Os sintomas referidos, ardência ou dor ocular, lacrimejamento e dificuldade para enxergar foram encontrados em 36,3% (28/77) dos casos. O exame oftalmológico constatou alterações em 55,8% (43/77) demonstrando que, 15 casos assintomáticos apresentaram comprometimento ocular. Na Tabela 2, são apresentados o tipo e a ocorrência das alterações observadas. DISCUSSÃOAs variações nas qualidades dos registros dos programas de controle, os diferentes métodos de avaliação e padronização dificultam estimativas sobre o envolvimento ocular na hanseníase. Além destas divergências operacionais a incidên-cia do comprometimento ocular é influenciado por múltiplos fatores, especialmente a forma clínica e o tempo de evolução da doença. A literatura refere que aproximadamente 1/3 do total de pacientes de hanseníase do mundo, estimado em 12 milhões de casos, apresentem algum tipo de incapacidade, incluindo alterações sensoriais de extremidades 9 . Autores que estudam os fatores de risco para o desenvolvimento das manifestações de agudização da doença, denominadas episódios reacionais 10,11 , referem que os pacientes classificados como multibacilares apresentam maior risco em apresentar reações, conseqüentemente maior probabilidade de desenvolver incapacidade, incluindo as lesões oculares. Oréfice e cols 12 referem a presença do M.leprae na conjuntiva, esclera, córnea, íris, corpo ciliar, corpo vítreo e retina em paciente multibacilar. Portanto, além dos mecanismos imunológicos temos os ocasionados pela presença do bacilo na etiopatogenia do comprometimento do olho e anexos.Em nosso estudo, todos os casos estudados foram classificados como multibacilares com predomínio do sexo masculino (73,5% . Considerando os resultados encontrados nesta pesquisa podemos conclu...

To determine the prevalence of ocular toxoplasmosis among the general population of the district of Santa Rita de Cassia, Barra Mansa, State of Rio de Janeiro, a cross-sectional study on 1,071 individuals was performed. These subjects underwent serological tests (anti-Toxoplasma IgG and IgM) and physical and ophthalmological examinations. The diagnosis of presumed ocular toxoplasmosis was based on clinical and serological criteria and the appearance of the retinochoroidal lesion. The lesions were classified into three morphological types: 1. Limits marked with a halo of hyperpigmentation and an area of central chorioretinal atrophy; 2. Hypopigmented halo and hyperpigmented central area; and 3. Hyperpigmented or hypopigmented. The prevalence of healed lesions compatible with ocular toxoplasmosis was 3.8% among the general population and 5.8% among individuals who were seropositive for Toxoplasma gondii (65.9% of the individuals evaluated). Type-1 lesions (41.5%), female sex (68.3%), peripheral lesions (58.5%) and lesions smaller than three disc diameters predominated.