"Substantial toxicity of this drug combination has spurred interest in alternative antimicrobials, as well as local forms of drug delivery. At this time, however, no therapeutic approach is curative of ocular toxoplasmosis  "
[Show abstract][Hide abstract] ABSTRACT: Infection with the protozoan Toxoplasma gondii is one of the most frequent parasitic infections worldwide and the common infection of the retina in the general population. We describe a case report of a chorioretinitis in an immunocompetent 8-year-old patient as a consequence of a underdiagnosed neonatal toxoplasmosis. The boy was successfully managed with pyrimethamine and sulfadiazine. The present case we would like to empathize the importance of considering toxoplasma gondii as a possible cause of chorioretinitis in children living in developed countries and we provide a detailed reviewed of the literature about treatment of Toxoplasma gondii infection.
Asian Pacific Journal of Tropical Disease 08/2014; 4(4):323–328. DOI:10.1016/S2222-1808(14)60582-X
"Ocular manifestations associated with toxoplasmosis may be caused by an active infection or an immunologic reaction in the absence of any infectious agent.1 Our case presented with CRAO with optic disc involvement and multifocal retinitis with perivascular sheathing as a primary manifestation, in contrast to cases with this condition diagnosed as a secondary manifestation to preexisting retinochoroiditis. "
[Show abstract][Hide abstract] ABSTRACT: Central retinal artery occlusion (CRAO) and multifocal retinitis with perivascular sheathing are rare in ocular toxoplasmosis. We report a case of toxoplasmic CRAO and multifocal retinitis with perivascular sheathing. A healthy 83-year-old male developed left panuveitis. Funduscopic examination of the left eye showed a swollen optic disc and sheathing of the retinal artery with a dense vitreous haze and a white retinal lesion. Serum anti-toxoplasma antibodies were positive in a latex agglutination assay. Vitrectomy was performed to improve visualization of the retinal lesions and for examination of causative microorganisms. A postoperative fundus examination revealed CRAO with optic disc involvement and multifocal retinitis with perivascular sheathing. Qualitative multiplex polymerase chain reaction detected the Toxoplasma gondii B1 gene in ocular fluid from both the aqueous and vitreous humor. The presumed diagnosis of ocular toxoplasmosis was made and treatment was started with prednisone and acetylspiramycin with subsequent improvement. Two months later, the patient developed active retinochoroiditis in the left eye. After 6 weeks of anti-toxoplasma therapy, the disease involuted. Retinal vascular occlusions and multifocal retinitis with perivascular sheathing are rare in toxoplasmosis. This is the first case report of toxoplasmic CRAO and multifocal retinitis with perivascular sheathing. The diagnosis of ocular toxoplasmosis should be considered in patients with retinal artery occlusions and multifocal retinitis with perivascular sheathing associated with inflammation.
"Due to the very limited access to ocular tissue, pathophysiological studies on humans are rare. Some post-mortem examinations described histopathological features (Butler et al., 2013), but immunological investigations usually looked at immune mediators in the peripheral blood or genetic markers (see below). Therefore, we assessed cytokine concentrations in aqueous humor, taken by puncture at the same time as the diagnosis, as ocular fluids are the most reliable samples to test for the presence of Toxoplasma DNA and/or local specific antibody production (Villard et al., 2003). "
[Show abstract][Hide abstract] ABSTRACT: Retinal lesions or other ocular manifestations are serious consequences of infection with the protozoan parasite Toxoplasma gondii. Whilst classically considered a consequence of congenital transmission, recent screening studies estimated that 2% of T. gondii seropositive persons in Europe and North America have retinal lesions, most of them persisting unnoticed. The situation is more dramatic in South America, probably due to the predominance of virulent strains. Some of these strains seem to exhibit ocular or neuronal tropism and are responsible for severe ocular lesions. Despite the medical importance, the physiopathological mechanisms have only recently begun to be elucidated. The particular immune-privileged situation in the eye has to be considered. Studies on French patients showed low or undetectable ocular parasite loads, but a clear Th1/Th17 type immune reaction. Suitable mouse models have appeared in the last few years. Using such a model, IL-17A proved to impair parasite control and induce pathology. In contrast, in South American patients, the parasite seems to be much less efficiently controlled through a Th2 type or suppressive immune response that favors parasite replication. Finally, several host genetic markers controlling immune response factors have been associated with ocular involvement of T. gondii infection, mainly in South America.
International journal for parasitology 11/2013; 44(2). DOI:10.1016/j.ijpara.2013.09.007 · 3.87 Impact Factor
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