RESUMEN
Purpose: To report a case of ocular dirofilariasis causing extensive chorio-retinal damage.Method: Surgical removal of the worm and identification of the same by microscopic examinationand polymerase chain reaction.Results: The worm was identified as Dirofilaria repens.Conclusion: Ocular dirofilariasis is an arthropod borne parasitic infestation affecting the subconjunctival tissue and anterior chamber. Vitreous involvement in Dirofilaria is very rare. Dirofilaria repens can cause extensive chorio-retinal damage resembling diffuse unilateralsubacute neuroretinitis.
Asunto(s)
Enfermedades de la Coroides/parasitología , Dirofilaria repens/aislamiento & purificación , Dirofilariasis/parasitología , Infecciones Parasitarias del Ojo/parasitología , Enfermedades de la Retina/parasitología , Cuerpo Vítreo/parasitología , Adulto , Animales , Enfermedades de la Coroides/fisiopatología , Enfermedades de la Coroides/cirugía , ADN Protozoario/genética , Dirofilaria repens/genética , Dirofilariasis/fisiopatología , Dirofilariasis/cirugía , Electrorretinografía , Infecciones Parasitarias del Ojo/fisiopatología , Infecciones Parasitarias del Ojo/cirugía , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Retina/fisiopatología , Enfermedades de la Retina/fisiopatología , Enfermedades de la Retina/cirugía , Agudeza Visual/fisiología , Campos Visuales/fisiología , VitrectomíaRESUMEN
Ocular lesions are frequently associated with different parasitic infections. The classes of infection include protozoa, nematodes, cestodes, and ectoparasites. Ocular parasitic infections can manifest in any part of the eye; the disease manifestations are frequently characterized as either posterior or anterior eye disease. Parasite-induced lesions may be due to damage directly caused by the parasite, indirect pathology caused by toxic products or the immune response initiated by infectious parasitism. This review characterized the parasite-induced lesions in the posterior segment of the eye. Prompt diagnosis and early treatment of these lesions can reduce ocular morbidity. The method of the literature search was conducted on PubMed, Elsevier Scopus database, and Google Scholar with no limitation on the year of publication databases. It was limited to English articles published for ocular lesions in clinical studies and was focused on parasitic infections of the eye.
Asunto(s)
Enfermedades de la Coroides/parasitología , Infecciones Parasitarias del Ojo/parasitología , Segmento Posterior del Ojo/parasitología , Enfermedades de la Retina/parasitología , Enfermedades de la Coroides/diagnóstico , Infecciones Parasitarias del Ojo/diagnóstico , Humanos , Enfermedades de la Retina/diagnósticoRESUMEN
A 16-year-old Brazilian female patient presented with blurring of vision in the right eye. Corrected visual acuity was OD 2/20, OS 20/20. Afferent pupillary defect was absent and anterior segment examination revealed anterior uveitis. Fundus examination showed light vitritis and a raised grey-white granuloma located at posterior pole with focal serous retinal detachment on optical coherence. Indocyacnine green angiography disclosed a complete mask effect in granuloma's area. Differential diagnoses were infectious (bacterial, viral, fungal and parasites) diseases, systemic inflammatory diseases, tumours. Blood serologies (HIV, toxoplasma, Borrelia, cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), rubeola) showed positive results for IgM and IgG for toxoplasma, and anterior chamber tap (PCR for toxoplasma, CMV, HSV, VZV) revealed toxoplasma DNA. Anti-toxoplasma therapy, pyrimethamine, sulfadiazine and calcium folinate, was administered immediately. On follow-up granuloma regression was observed, with complete visual restoration. This case demonstrates a clinically challenging posterior pole granuloma.
Asunto(s)
Enfermedades de la Coroides/parasitología , Granuloma/parasitología , Enfermedades de la Retina/parasitología , Toxoplasmosis Ocular , Adolescente , Enfermedades de la Coroides/diagnóstico , Enfermedades de la Coroides/tratamiento farmacológico , Femenino , Granuloma/diagnóstico , Granuloma/tratamiento farmacológico , Humanos , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/tratamiento farmacológico , Toxoplasmosis Ocular/diagnóstico , Toxoplasmosis Ocular/tratamiento farmacológicoRESUMEN
The association of single nucleotide polymorphisms (SNPs) in the interferon (IFN)-γ gene ( IFNG ) with different types of retinal scar lesions presumably caused by toxoplasmosis were investigated in a cross-sectional population-based genetic study. Ten SNPs were investigated and after Bonferroni correction, only the associations between SNPs rs2069718 and rs3181035 with retinal/retinochoroidal scar lesions type A (most severe scar lesions) and C (least severe scar lesions), respectively, remained significant. The associations of two different IFNG SNPs with two different types of retinal lesions attributable to toxoplasmosis support the hypothesis that different inflammatory mechanisms underlie the development of these lesions. The in vitro analysis of IFN-γ secretion by peripheral blood mononuclear cells stimulated with Toxoplasma gondii antigens was also investigated. The association between SNP rs2069718 and type A scar lesions revealed that differential IFN-γ levels are correlated with distinct genotypes. However, no correlation was observed with IFN-γ secretion levels and the SNP rs3181035 , which was significantly associated with type C scar lesions. Our findings strongly suggest that immunogenetic studies of individuals with congenital or postnatally acquired infection are needed to better understand the role of IFN-γ and its polymorphisms in the pathogenesis of ocular toxoplasmosis.
Asunto(s)
Enfermedades de la Coroides/parasitología , Cicatriz/parasitología , Interferón gamma/genética , Polimorfismo de Nucleótido Simple/genética , Enfermedades de la Retina/parasitología , Toxoplasmosis Ocular/complicaciones , Adulto , Antígenos de Protozoos/inmunología , Estudios Transversales , Femenino , Frecuencia de los Genes/inmunología , Estudios de Asociación Genética , Genotipo , Humanos , Interferón gamma/metabolismo , Leucocitos Mononucleares/parasitología , Masculino , Persona de Mediana Edad , Fenotipo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Toxoplasmosis Ocular/sangre , Toxoplasmosis Ocular/inmunologíaRESUMEN
The association of single nucleotide polymorphisms (SNPs) in the interferon (IFN)-γ gene ( IFNG ) with different types of retinal scar lesions presumably caused by toxoplasmosis were investigated in a cross-sectional population-based genetic study. Ten SNPs were investigated and after Bonferroni correction, only the associations between SNPs rs2069718 and rs3181035 with retinal/retinochoroidal scar lesions type A (most severe scar lesions) and C (least severe scar lesions), respectively, remained significant. The associations of two different IFNG SNPs with two different types of retinal lesions attributable to toxoplasmosis support the hypothesis that different inflammatory mechanisms underlie the development of these lesions. The in vitro analysis of IFN-γ secretion by peripheral blood mononuclear cells stimulated with Toxoplasma gondii antigens was also investigated. The association between SNP rs2069718 and type A scar lesions revealed that differential IFN-γ levels are correlated with distinct genotypes. However, no correlation was observed with IFN-γ secretion levels and the SNP rs3181035 , which was significantly associated with type C scar lesions. Our findings strongly suggest that immunogenetic studies of individuals with congenital or postnatally acquired infection are needed to better understand the role of IFN-γ and its polymorphisms in the pathogenesis of ocular toxoplasmosis.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Coroides/parasitología , Cicatriz/parasitología , Interferón gamma/genética , Polimorfismo de Nucleótido Simple/genética , Enfermedades de la Retina/parasitología , Toxoplasmosis Ocular/complicaciones , Antígenos de Protozoos/inmunología , Estudios Transversales , Estudios de Asociación Genética , Genotipo , Frecuencia de los Genes/inmunología , Interferón gamma , Leucocitos Mononucleares/parasitología , Fenotipo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Toxoplasmosis Ocular/sangre , Toxoplasmosis Ocular/inmunologíaRESUMEN
BACKGROUND: The aim of our study was to investigate vitreal, retinal, and choroidal morphologic changes in active and scarred toxoplasmosis lesions using spectral-domain optical coherence tomography (SD-OCT). METHODS: In this prospective study, 19 eyes of 15 consecutive patients with ocular toxoplasmosis were included. Complete ophthalmologic examination and SD-OCT were done at the initial visit and during follow-up. Retina and choroid SD-OCT protocols directed to macular area and lesions observed on clinical examination were used. RESULTS: Seventeen active lesions and 56 retinochoroidal scars were studied. In the acute phase, disruption, thickening, and hyper-reflectivity of the neurosensory retina with photoreceptor (PR) interruption and retinal pigment epithelial (RPE) elevation were found. The choroid became thickened and hyporeflective. During follow-up, neurosensory retinal layers thinning and disorganization, PR interruption, and RPE elevation and/or atrophy were demonstrated. The choroid returned to normal thickness and became more hyperreflective. Five active lesions presented with hyperreflective oval deposits within the vitreoretinal interface, adjacent to or far away from the lesions. During follow-up, the deposits became smaller, entered into the inner retina layers and faded with time until complete resolution. Multiple hyperreflective dots in the vitreous cavity, compatible with vitritis, and posterior hyaloid thickening were demonstrated in the acute phase, with complete resolution and detachment of the posterior hyaloid during follow-up. Four types of scars were specified according to outer retina-choroid interface changes; atrophic, elevated, deep, and combined (atrophic & elevated). Epiretinal membrane segments were found over active and scarred lesions. CONCLUSIONS: SD-OCT imaging showed toxoplasmic retinochoroidal lesions and scars to be complex and characterized acutely by thickening and disorganization of both the retina and underlying choroid, and following scar formation by varying degrees of thinning, often in conjunction with irregularity of the outer retinal layers.
Asunto(s)
Enfermedades de la Coroides/diagnóstico , Oftalmopatías/diagnóstico , Enfermedades de la Retina/diagnóstico , Tomografía de Coherencia Óptica , Toxoplasmosis Ocular/diagnóstico , Cuerpo Vítreo/patología , Adolescente , Adulto , Antibacterianos/uso terapéutico , Atrofia , Niño , Enfermedades de la Coroides/tratamiento farmacológico , Enfermedades de la Coroides/parasitología , Clindamicina/uso terapéutico , Quimioterapia Combinada , Membrana Epirretinal/diagnóstico , Oftalmopatías/tratamiento farmacológico , Oftalmopatías/parasitología , Femenino , Glucocorticoides/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Estudios Prospectivos , Enfermedades de la Retina/tratamiento farmacológico , Enfermedades de la Retina/parasitología , Epitelio Pigmentado de la Retina/patología , Toxoplasmosis Ocular/tratamiento farmacológico , Toxoplasmosis Ocular/parasitología , Agudeza Visual/fisiología , Adulto JovenAsunto(s)
Enfermedades de la Coroides/parasitología , Infecciones Parasitarias del Ojo/parasitología , Granuloma/parasitología , Enfermedades de la Retina/parasitología , Toxocara canis/aislamiento & purificación , Toxocariasis/parasitología , Cuerpo Vítreo/parasitología , Adolescente , Albendazol/uso terapéutico , Animales , Anticuerpos Antihelmínticos/sangre , Enfermedades de la Coroides/diagnóstico , Enfermedades de la Coroides/terapia , Criocirugía , Quimioterapia Combinada , Ensayo de Inmunoadsorción Enzimática , Infecciones Parasitarias del Ojo/diagnóstico , Infecciones Parasitarias del Ojo/terapia , Granuloma/diagnóstico , Granuloma/terapia , Humanos , Masculino , Prednisolona/uso terapéutico , Recurrencia , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/terapia , Toxocara canis/inmunología , Toxocariasis/diagnóstico , Toxocariasis/terapia , Cuerpo Vítreo/patologíaRESUMEN
PURPOSE: To report a case of acute frosted branch angiitis associated with acquired toxoplasmosis in which a late peripheral chorioretinal scar developed. RESULTS: A 32-year-old man without systemic symptoms presented with sudden visual loss in his left eye. Examination demonstrated frosted branch angiitis without necrotizing chorioretinitis. Serologic tests showed elevated Toxoplasma gondii-specific immunoglobulin M antibody titers. Antitoxoplasmic therapy and oral steroids healed the ocular inflammation. In a follow-up visit one year later, a peripheral chorioretinal scar was noted. CONCLUSIONS: Acute frosted branch angiitis without focal necrotizing chorioretinitis can be a manifestation of acquired toxoplasmosis. This could be an important, and sometimes forgotten, sign of the disease.
Asunto(s)
Enfermedades de la Coroides/parasitología , Cicatriz/parasitología , Enfermedades de la Retina/parasitología , Vasculitis Retiniana/parasitología , Toxoplasmosis Ocular/complicaciones , Adulto , Animales , Anticuerpos Antiprotozoarios/análisis , Antiprotozoarios/uso terapéutico , Enfermedades de la Coroides/patología , Cicatriz/patología , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulina M/análisis , Masculino , Prednisona/uso terapéutico , Enfermedades de la Retina/patología , Vasculitis Retiniana/patología , Toxoplasma/inmunología , Toxoplasmosis Ocular/tratamiento farmacológico , Toxoplasmosis Ocular/inmunología , Toxoplasmosis Ocular/parasitologíaRESUMEN
PURPOSE: To report childhood infection with Baylisascaris procyonis (raccoon round worm) manifesting as diffuse unilateral subacute neuroretinitis (DUSN) and choroidal infiltrates in association with neurologic disease (neural larva migrans). METHOD: Observational case series, one with eye manifestations of DUSN, the other with choroidal infiltrates, both with severe neurologic degeneration. RESULTS: Indirect immunofluorescence assays on serum and cerebrospinal fluid were positive for B. procyonis in one and serially positive and increasing in the other. Both children had a history of pica and raccoon exposure. CONCLUSIONS: Baylisascaris procyonis infection is associated with two cases of severe neurologic degeneration with ocular lesions: DUSN and choroidal infiltrates. Although B. procyonis is known to cause DUSN, these cases indicate that concomitant ocular migration may accompany neural larva migrans. These are the third and forth cases in the US literature of neural larva migrans due to B. procyonis with eye findings.
Asunto(s)
Infecciones por Ascaridida/parasitología , Ascaridoidea/aislamiento & purificación , Enfermedades de la Coroides/parasitología , Infecciones Parasitarias del Ojo/parasitología , Larva Migrans/parasitología , Retinitis/parasitología , Enfermedad Aguda , Animales , Anticuerpos Antihelmínticos/sangre , Anticuerpos Antihelmínticos/líquido cefalorraquídeo , Antígenos Helmínticos/inmunología , Ascaridoidea/inmunología , Niño , Preescolar , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , MasculinoRESUMEN
PURPOSE: To describe the occurrence of intraocular inflammatory reactions as the sole ophthalmic manifestation of acquired systemic toxoplasmosis. METHODS: Review of medical records for 10 patients with uveitis and evidence of recent Toxoplasma gondii infection. RESULTS: Patient ages ranged from 3 to 51 years. Ocular symptoms were present in each of eight adult patients. Inflammation was unilateral in nine patients; it manifested as vitreous humor cells and haze (10 patients), anterior chamber cells (seven patients), and retinal vasculitis (seven patients). No patient had necrotizing retinochoroiditis upon initial examination. Inflammation resolved in each of nine patients who had follow-up examinations. Foci of retinitis or inactive retinochoroidal scars were seen in four of these nine patients during follow-up examinations, at intervals of 2.0 weeks to 2.5 years after initial examination. CONCLUSIONS: Retinal vasculitis and associated inflammatory reactions may be the only ophthalmic disorder during the early stages of a newly acquired T. gondii infection. Later development of retinitis or scars consistent with toxoplasmic retinochoroiditis in the same eyes suggests that the initial, isolated inflammation may be caused by the presence of parasites in retinal tissue. These cases may have implications for understanding the original source of retinal infection in patients who have recurrent toxoplasmic retinochoroiditis and for treatment of newly acquired T gondii infection.
Asunto(s)
Endoftalmitis/parasitología , Toxoplasmosis , Adolescente , Adulto , Permeabilidad Capilar , Niño , Preescolar , Enfermedades de la Coroides/parasitología , Coroiditis/parasitología , Coroiditis/patología , Cicatriz/parasitología , Endoftalmitis/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Enfermedades de la Retina/parasitología , Enfermedades de la Retina/patología , Vasos Retinianos/metabolismo , Vasos Retinianos/patología , Retinitis/parasitología , Retinitis/patología , Toxoplasmosis/complicaciones , Vasculitis/parasitología , Vasculitis/patologíaRESUMEN
OBJECTIVE: Toxoplasmosis during pregnancy can cause fetal infection, with unpredictable sequelae in later life. We measured the effects of prenatal antibiotic therapy on the fetomaternal transmission of Toxoplasma gondii and on the appearance of sequelae in the congenitally infected child at age 1 year. STUDY DESIGN: In a multicenter study we investigated consecutive women with Toxoplasma seroconversion during pregnancy. Data were obtained from 144 women recruited in 5 different Toxoplasma reference centers. Through multivariate analysis we assessed the association between transmission and appearance of sequelae as a function of the following parameters: estimated gestational age at infection, administration of antibiotic therapy, duration of antibiotic therapy, and time lapse between infection and the start of antibiotic therapy. RESULTS: Sixty-four of the 144 women (44%) gave birth to a congenitally infected infant. Multivariate analysis showed that transmission was predicted neither by whether antibiotics had been administered nor by the time lapse between infection and the start of antibiotic therapy, but only by the gestational age at which maternal infection occurred (P <.0001). Sequelae were found in 19 children (13%), 9 of whom (6%) had severe sequelae. Administration of antibiotics was predictive of the absence of sequelae (P =.026, odds ratio 0.30, 95% confidence interval 0.104-0.863), in particular the absence of severe sequelae (P =.007, odds ratio 0.14, 95% confidence interval 0.036-0.584). The sooner antibiotics were given after the infection, the less frequently sequelae were seen (P =. 021). CONCLUSION: Prenatal antibiotic therapy after toxoplasmosis during pregnancy had no impact on the fetomaternal transmission rate but reduced the rate of sequelae among the infected infants. The early start of treatment resulted in a significant reduction in the number of severely affected infants.
Asunto(s)
Antiprotozoarios/uso terapéutico , Edad Gestacional , Complicaciones Parasitarias del Embarazo/tratamiento farmacológico , Toxoplasmosis Congénita/transmisión , Toxoplasmosis/tratamiento farmacológico , Animales , Anticuerpos Antiprotozoarios/sangre , Encefalopatías/parasitología , Calcinosis/parasitología , Enfermedades de la Coroides/parasitología , Femenino , Humanos , Hidrocefalia/parasitología , Recién Nacido , Embarazo , Pirimetamina/uso terapéutico , Enfermedades de la Retina/parasitología , Espiramicina/uso terapéutico , Toxoplasma/inmunología , Toxoplasmosis Congénita/prevención & controlRESUMEN
BACKGROUND AND OBJECTIVE: The purpose of this study was to evaluate the incidence and characteristics of retinal and choroidal manifestations of toxoplasmosis and/or Mycobacterium avium-intracellulare complex (MAC) in patients with acquired immunodeficiency syndrome (AIDS). PATIENTS AND METHODS: The authors analyzed their prospectively collected data and found 120 patients with new retinal lesions (group A) that were diagnosed 3 months or longer following the diagnosis of MAC and/or toxoplasmic encephalitis. The authors also performed a point prevalence study of retinal/choroidal findings in 25 consecutive AIDS patients (group B) without known eye disease who had been recently treated for toxoplasmic encephalitis and/or disseminated MAC infections. In addition, the characteristics of retinochoroidal toxoplasmosis scars in 5 AIDS patients were studied and compared with the characteristics of scars in 18 immunocompetent patients. RESULTS: In this study the incidence of ocular manifestations of MAC was zero (95% confidence interval [CI] 0.0% to 3.8%). Two of 25 patients (8%) (95% CI 1% to 26%) in group A and 2 of 11 patients (18.1%) (95% CI 3.3% to 51.8%) in group B had toxoplasmic retinochoroiditis. CONCLUSION: In AIDS patients, ocular manifestations of toxoplasmosis are more common than ocular MAC. In addition, when compared with immunocompetent patients, AIDS patients tend to have retinochoroidal scars with less retinal pigment epithelium hyperplasia (1.8+ vs 3+) (P = .03).
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/etiología , Bacteriemia/complicaciones , Encefalitis/parasitología , Infecciones Bacterianas del Ojo/etiología , Infección por Mycobacterium avium-intracellulare/complicaciones , Enfermedades de la Retina/parasitología , Toxoplasmosis Cerebral/complicaciones , Toxoplasmosis Ocular/etiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , California/epidemiología , Enfermedades de la Coroides/epidemiología , Enfermedades de la Coroides/microbiología , Enfermedades de la Coroides/parasitología , Infecciones Bacterianas del Ojo/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Enfermedades de la Retina/epidemiología , Enfermedades de la Retina/microbiología , Toxoplasmosis Ocular/epidemiologíaRESUMEN
In congenital cases, ocular toxoplasmosis often presents as a focal whitish fluffy lesion in the retina adjacent to an inactive chorioretinal scar. We examined a girl who has visible floaters in the right eye. The patient had focal active retinitis in the right fundus, a focal chorioretinal scar in the left fundus, a positive enzyme-linked immunosorbent assay (ELISA) for IgG anti-Toxoplasma antibodies and a negative ELISA for IgM antibodies. We believe that active focal retinitis in one eye and a focal chorioretinal scar in the fellow eye in congenital toxoplasmosis, as demonstrated in our patient, may be rare.