Toxoplasmic Retinochoroiditis: Clinical Characteristics and Visual Outcome in a Prospective Study

Abstract

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.

Congenital toxoplasmosis: perception of knowledge and primary prevention measures among healthcare professionals and pregnant women treated in public healthcare facilities

“…As infection in the last months of gestation is more common, most cases of congenital toxoplasmosis are asymptomatic at birth. Even these cases, however, need treatment [6][7][8][9].…”

Ocular toxoplasmosis: susceptibility in respect to the genes encoding the KIR receptors and their HLA class I ligands

“…Briefly, T. gondii infection can occur at any time of life, and although most cases of ocular toxoplasmosis occur due to infections acquired after birth, a significant number of patients can acquire the disease congenitally and the resulting scars trend to be persistent1. It has also been demonstrated that the risk of recurrence is higher in the year following the first infection than in future years3031. As no distinction was made between congenital and acquired disease in the analysis of the characteristics of eye injuries, this may be one of the possible explanations for the lower mean age observed for patients who developed ocular toxoplasmosis, including those who present with recurrent signs of the disease.…”

Rezidivprophylaxe bei okulärer Toxoplasmose

“…Der klinische Spontanverlauf nach erfolgreicher Behandlung bei aktiver OT und der Einfluss von Rezidiven auf die Sehfunktion ohne sekundäre Rezidivprophylaxe wurde in einer prospektiven Fallserie mit 230 Patienten analysiert [18]. Die Patienten waren im Mittel 32 Jahre alt, eine primäre Läsion ohne Narben wurde in 22,6 % und eine reaktivierte Läsion mit vorbestehenden Narben in 77,4 % gefunden und mit PY/SA behandelt.…”

“…Der klinisch schwierigere und oft fulminante Verlauf wird auf eine schnellere Replikation, extrazelluläre Migration des Erregers und verminderte Differenzierung hin zu Bradyzoiten zurückgeführt [9]. Das Risiko für Rezidive liegt in den ersten beiden Jahren nach einer aktiven Retinochoroiditis in Europa [11 -14] ähnlich wie in Brasilien [15 -17] bei 12-15 % pro Jahr, wobei in Brasilien Rezidivraten in den ersten beiden Jahren von bis zu 32 % beobachtet wurden [18]. Das kumulative Risiko nach 5 und mehr Jahren liegt in Europa bei 50-79 % [11 -13, 19] [24].…”