A Case Series of Retinochoroidal Toxoplasmosis from Western India: Guide to Salient Features, Diagnosis and Treatment
Keywords:
Toxoplasmosis, Posterior Uveitis, Retinochoroiditis, Floaters
Abstract
Background: To study a series of cases of retinochoroidal toxoplasmosis with special mention of its clinical features, investigations & treatment. Although rare, it represents a significant number of all causes of posterior uveitis. Settings and Design: Retrospective Observational study.Methods: 5 cases of primary and 2 cases of recurrence of acquired ocular toxoplasmosis in immunocompetent adults, from western India are included in these series. We study the clinical features & optical coherence tomography & fundus fluorescein angiography characteristics and the outcome with the quadruple drug therapy.Results: In our study, we confirm that presence of specific symptoms and classical signs along with typical fundus fluorescein angiography (FFA) & optical coherence tomography (OCT) findings makes the diagnosis precise. A positive serology further aids in the diagnosis. Treatment with the quadruple regimen resulted in good visual prognosis in all but one case complicated with scarring at macula.Conclusions: This study revives the diagnostic findings and helps as a guide to identify this potentially treatable cause of visual morbidity.References
[1] Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: from animals to humans. Int J Parasitol 2000;30:1217–58.
[2] Holland GN. Ocular toxoplasmosis: a global reassessment. Part I: epidemiology and course of disease. Am J Ophthalmol 2003;136:973–88.
[3] Jones J, Kruszon-Moran D, Wilson M, et al.Toxoplasma gondii infection in the United States. Am J Epidemiol 2001;154:357–65.
[4] Bowie WR, King AS. Outbreak of toxoplasmosis associated with municipal drinking water. Lancet 1997;350:173–8.
[5] Burnett AJ, Shortt SG, Isaac-Renton J, et al. Multiple cases of acquired toxoplasmosis retinitis presenting in an outbreak. Ophthalmology 1998;105:1032–7.
[6] Holland GN, Muccioli C, Silveira C, et al. Intraocular inflammatory reactions without focal necrotizing retinochoroiditis in patients with acquired systemic toxoplasmosis. Am J Ophthalmol1999;128:413–20.
[7] Glasner PD, Silveira C, Kruszon-Moran D, et al. An unusually high prevalence of ocular toxoplasmosis in southern Brazil. Am J Ophthalmol 1992;114:136–44.
[8] Silveira C, Belfort R Jr, Burnier M, et al. Acquired toxoplasmosis infection as the cause of toxoplasmic retinichoroiditis in families. Am J Ophthalmol 1988;106:362–4.
[9] Matos K, Muccioli C, Belfort R Jr, et al. Correlation between clinical diagnosis and PCR analysis of serum, aqueous, and vitreous samples in patients with inflammatory eye disease. Arq Bras Oftalmol 2007;70:109–14.
[10] Woods AC, Jacobs L, Wood RM. A study of the role of toxoplasmosis in adult chorioretinitis. Am J Ophthalmol 1954;37:163–77.
[11] McCannel CA, Holland GN, Helm CJ, et al. Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group. Am J Ophthalmol 1996;121:35–46.
[12] Arevalo JF, Belfort R, Muccioli C, et al. Ocular toxoplasmosis in the developing world. Int Ophthalmol Clin 2010;50(2):57–69.
[13] de-la-Torre A, López-Castillo CA, Rueda JC, et al. Clinical patterns of uveitis in two ophthalmology centres in Bogota, Colombia. Clin Exp Ophthalmol 2009 Jul;37(5):458–66.
[14] Acers TE. Toxoplasmicretinochoroiditis: a double-blind therapeutic study. Arch Ophthalmol 1964;71:58–62.
[15] Soheilian M, Sadoughi MM, Ghajarnia M, et al. Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis. Ophthalmology 2005;11:1876–82.
[16] Holland G, Lewis K. An update on current practices in the management of ocular toxoplasmosis. Am J Ophthalmol 2002;134(6):102–14.
[17] Stanford MR, Gilbert RE. Treating ocular toxoplasmosis: current evidence. Mem Inst Oswaldo Cruz 2009;104(2):312–15.
[18] Smith JR, Franc DT, Carter NS, et al. Susceptibility of retinal vascular endothelium to infection with Toxoplasma gondii tachyzoites. Invest Ophthalmol Vis Sci 2004;45:1157–61.
[19] Emmanuelle Delair, Paul Latkany, A. Gwendolyn Noble, et al. Clinical Manifestations of ocular toxoplasmosis. Ocular Immunology & Inflammation 2011;19(2):91–102.
[20] Adan A, Giralt J, Alvarez G, et al. Pars plana vitrectomy for vitreoretinal complications of ocular toxoplasmosis. Eur J Ophthalmol 2009;19:1039–43.
[21] Francis JM, Joynson DH. Duration of specific immunoglobulin A antibody following acute toxoplasmosis as determined by enzyme immunoassay and immunosorbent agglutination assay. Eur J Clin Microbiol Infect Dis 1993;12:556–9.
[22] Gaete MIL, Malaguenio E, Cordeiro F, et al. Relacao entre IgA excretora na lagrima X IgA serica na toxoplasmose ocular com lesao ativa. Dissertacao de Mestrado defendida em junho de 2003;2007:03-08.
[23] Holliman RE, Stevens PJ, Duffy KT, Johnson JD. Serological investigation of ocular toxoplasmosis. Br J Ophthalmol 1991;75:353–5.
[24] Chapman DJ, Ashburn D, Ogston SA, et al. The relationship between ocular toxoplasmosis and levels of specific toxoplasma antibodies. Epidemiol Infect 1999;122:299–303.
[25] Bou G, Figueroa MS, Marti-Belda P, et al. Value of PCR for detection of Toxoplasma gondii in aqueous humor and blood samples from immunocompetent patients with ocular toxoplasmosis. J Clin Microbiol 1999;37:3465–8.
[26] Winterhalter S, Severing K, Stammen J, et al. Does atovaquone prolong the disease free interval of toxoplasmic retinochoroiditis? Graefes Arch Clin Exp Ophthalmol 2010;248:1187–92.
[27] Soheilian M, Ramezani A, Azimzadeh A, et al. Randomized trial of intravitreal clindamycin and dexamethasone versus pyrimethamine, sulfadiazine, and prednisolone in treatment of ocular toxoplasmosis. Ophthalmology 2011;118(1):134-41.
[28] Kishore K, Conway MD, Peyman GA. Intravitreal clindamycin and dexamethasone for toxoplasmic retinochoroiditis. Ophthalmic Surg Lasers 2001;32(3):183–92.
[2] Holland GN. Ocular toxoplasmosis: a global reassessment. Part I: epidemiology and course of disease. Am J Ophthalmol 2003;136:973–88.
[3] Jones J, Kruszon-Moran D, Wilson M, et al.Toxoplasma gondii infection in the United States. Am J Epidemiol 2001;154:357–65.
[4] Bowie WR, King AS. Outbreak of toxoplasmosis associated with municipal drinking water. Lancet 1997;350:173–8.
[5] Burnett AJ, Shortt SG, Isaac-Renton J, et al. Multiple cases of acquired toxoplasmosis retinitis presenting in an outbreak. Ophthalmology 1998;105:1032–7.
[6] Holland GN, Muccioli C, Silveira C, et al. Intraocular inflammatory reactions without focal necrotizing retinochoroiditis in patients with acquired systemic toxoplasmosis. Am J Ophthalmol1999;128:413–20.
[7] Glasner PD, Silveira C, Kruszon-Moran D, et al. An unusually high prevalence of ocular toxoplasmosis in southern Brazil. Am J Ophthalmol 1992;114:136–44.
[8] Silveira C, Belfort R Jr, Burnier M, et al. Acquired toxoplasmosis infection as the cause of toxoplasmic retinichoroiditis in families. Am J Ophthalmol 1988;106:362–4.
[9] Matos K, Muccioli C, Belfort R Jr, et al. Correlation between clinical diagnosis and PCR analysis of serum, aqueous, and vitreous samples in patients with inflammatory eye disease. Arq Bras Oftalmol 2007;70:109–14.
[10] Woods AC, Jacobs L, Wood RM. A study of the role of toxoplasmosis in adult chorioretinitis. Am J Ophthalmol 1954;37:163–77.
[11] McCannel CA, Holland GN, Helm CJ, et al. Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group. Am J Ophthalmol 1996;121:35–46.
[12] Arevalo JF, Belfort R, Muccioli C, et al. Ocular toxoplasmosis in the developing world. Int Ophthalmol Clin 2010;50(2):57–69.
[13] de-la-Torre A, López-Castillo CA, Rueda JC, et al. Clinical patterns of uveitis in two ophthalmology centres in Bogota, Colombia. Clin Exp Ophthalmol 2009 Jul;37(5):458–66.
[14] Acers TE. Toxoplasmicretinochoroiditis: a double-blind therapeutic study. Arch Ophthalmol 1964;71:58–62.
[15] Soheilian M, Sadoughi MM, Ghajarnia M, et al. Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis. Ophthalmology 2005;11:1876–82.
[16] Holland G, Lewis K. An update on current practices in the management of ocular toxoplasmosis. Am J Ophthalmol 2002;134(6):102–14.
[17] Stanford MR, Gilbert RE. Treating ocular toxoplasmosis: current evidence. Mem Inst Oswaldo Cruz 2009;104(2):312–15.
[18] Smith JR, Franc DT, Carter NS, et al. Susceptibility of retinal vascular endothelium to infection with Toxoplasma gondii tachyzoites. Invest Ophthalmol Vis Sci 2004;45:1157–61.
[19] Emmanuelle Delair, Paul Latkany, A. Gwendolyn Noble, et al. Clinical Manifestations of ocular toxoplasmosis. Ocular Immunology & Inflammation 2011;19(2):91–102.
[20] Adan A, Giralt J, Alvarez G, et al. Pars plana vitrectomy for vitreoretinal complications of ocular toxoplasmosis. Eur J Ophthalmol 2009;19:1039–43.
[21] Francis JM, Joynson DH. Duration of specific immunoglobulin A antibody following acute toxoplasmosis as determined by enzyme immunoassay and immunosorbent agglutination assay. Eur J Clin Microbiol Infect Dis 1993;12:556–9.
[22] Gaete MIL, Malaguenio E, Cordeiro F, et al. Relacao entre IgA excretora na lagrima X IgA serica na toxoplasmose ocular com lesao ativa. Dissertacao de Mestrado defendida em junho de 2003;2007:03-08.
[23] Holliman RE, Stevens PJ, Duffy KT, Johnson JD. Serological investigation of ocular toxoplasmosis. Br J Ophthalmol 1991;75:353–5.
[24] Chapman DJ, Ashburn D, Ogston SA, et al. The relationship between ocular toxoplasmosis and levels of specific toxoplasma antibodies. Epidemiol Infect 1999;122:299–303.
[25] Bou G, Figueroa MS, Marti-Belda P, et al. Value of PCR for detection of Toxoplasma gondii in aqueous humor and blood samples from immunocompetent patients with ocular toxoplasmosis. J Clin Microbiol 1999;37:3465–8.
[26] Winterhalter S, Severing K, Stammen J, et al. Does atovaquone prolong the disease free interval of toxoplasmic retinochoroiditis? Graefes Arch Clin Exp Ophthalmol 2010;248:1187–92.
[27] Soheilian M, Ramezani A, Azimzadeh A, et al. Randomized trial of intravitreal clindamycin and dexamethasone versus pyrimethamine, sulfadiazine, and prednisolone in treatment of ocular toxoplasmosis. Ophthalmology 2011;118(1):134-41.
[28] Kishore K, Conway MD, Peyman GA. Intravitreal clindamycin and dexamethasone for toxoplasmic retinochoroiditis. Ophthalmic Surg Lasers 2001;32(3):183–92.
Published
2016-01-02
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