Toxoplasmic Scieritis

Toxoplasmosis is a ubiquitous infection affecting 500 million persons around the world, with a range of incidence 12%-90%, increasing with age, education, crowding and sanitary habits. Cats are the definitive host. Infection is primarily congenital but acquired ocular infection has been documented. The review focuses on the immunopathogenesis of toxoplasmosis with emphasis on the eye problem due to its morbidity. The response to infection correlates with both parasitic and retinal antigens. The clinical picture and histopathology is a reflection of the immune response which constitutes early humeral response which presents both systemically and locally primary infection and is elevated with reactivation. This is followed by the cellular response, varying from low grade monocular infilterate a total tissue destruction with response of live parasites especially in immuno-compromised patients. Penetration of the parasite and its enclosure within the parasitophorous vacuole and its eneyst all make its eradicatier impossible. This reflects the variability of antiparasitic therapy that include folate antagonists, macrolides, hydroxy naphthoquindones and fluoroquinolones. Use of corticosteroid should be limited to severe reactions and should be associated with specific therapy.

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“…These reactions may be associated with glaucoma [287,301,302]. Scleral involvement has been described by a number of authors [291,303,304].…”

Section: Clinical Picturementioning

confidence: 99%

Immunopathogenesis of toxoplasmosis

Hegab

Al-Mutawa²

2003

Clinical and Experimental Medicine

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“…Infections such as toxoplasmosis, syphilis, tuberculosis, and toxocariasis have also been reported to cause scleritis. [7][8][9][10][11][12] A case of necrotizing nocardial scleritis with intraocular extension is reported. 13 Reynolds and Alfonso reported infectious scleritis in a patient with acquired immunodeficiency syndrome.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous Scleritis in a Patient with Rheumatoid Arthritis

Biswas

Aparna

Annamalai

et al. 2011

Ocular Immunology and Inflammation

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“…3,4 None of those signs were detected in our case with confirmed toxoplasmosis, which is known to cause only rarely scleritis. 5 In addition, an orbital MRI with contrast disclosed no posterior scleral thickening or retrobulbar oedema, which is often seen in posterior scleritis with orbital CT or MRI. 6 In the complete absence of all these clinical and radiological signs, we felt that posterior scleritis was unlikely to be present in our patient, although we cannot formally rule out some scleral involvement, which was undetectable by a thorough orbital MRI.…”

mentioning

confidence: 80%