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Clinical manifestation and prognosis of active ocular toxoplasmosis in Iran

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Abstract

Toxoplasmosis is the most common cause of posterior uveitis in the world. This study described the clinical characteristics and visual outcome of 193 patients with ocular toxoplasmosis at Feiz Hospital (Isfahan, Iran) during the last six years. The setting and design used was a retrospective non-comparative observational case series. In this study, 193 patients with ocular toxoplasmosis (111 female, 82 male) were enrolled. The distribution of symptoms and fundoscopic findings were studied. The most-reported chief complaint was blurred vision in 96 % (184 patients) and floaters in 13.47 % (25 patients) of cases and most frequent clinical manifestations were chorioretinitis 98.48 % (190 patients), macular scars 50.7 % (98 patients), and atrophic optic papilla two (1.03 %) patients. Primary retinal lesions were observed in 16 (8.2 %) and combination of active lesions and old retinochoroidal scars in 177 (91.7 %) of the patients. Retinal detachment occurred in 11 (5.69 %) patients. Bilateral involvement was found in 27 % of patients. Blindness was 0.05 % after treatment. Recurrence rate was 14.5 %. In conclusion, ocular toxoplasmosis substantially varies among patients with different age, gender, site of lesion and other factors. Suddenly blurred vision, floater, and pain could be caused by Toxoplasma gondii. Flashing, may necessitate a more precise peripheral fundus examination.

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References

  1. Whittle RM, Wallace GR, Whiston RA, Dumondea DC, Stanfordb MR et al (1998) Human antiretinal antibodies in toxoplasma retinochoroiditis. Br J Ophthalmol 82:1017–1021

    Article  PubMed  CAS  Google Scholar 

  2. Da Mata AP, Orefice F (2002) Toxoplasmosis. In: Foster S, Vitale A (eds) Diagnosis and treatment of uveitis. Saunders, Philadelphia, pp 385–410

    Google Scholar 

  3. Koppe JG, Rothova A (1989) Congenital toxoplasmosis: a long term follow up of 20 years. Int Ophthalmol 13:387–390

    Article  PubMed  CAS  Google Scholar 

  4. Wilson CB, Remington JS, Stagno S, Reynolds DW (1980) Development of adverse sequelae in children born with subclinical congenital toxoplasma infection. Pediatrics 66:767–774

    PubMed  CAS  Google Scholar 

  5. Courvreur J, Desmonts G (1988) Acquired and congenital toxoplasmosis. In: Harris AA (ed) Handbook of clinical neurology. Microbial disease, vol 8. Elsevier, Amsterdam, pp 351–363

    Google Scholar 

  6. Holland GN, O’Connor GR, Belfort R Jr, Remington JS (1996) Toxoplasmosis. In: Pepose JS, Holland GN, Wilhelmus KR (eds) Ocular infection and immunity. Mosby Yearbook, St Louis, pp 1183–1223

    Google Scholar 

  7. de-la-Torre A, López-Castillo CA, Gómez-Marín JE (2009) Incidence and clinical characteristics in a Colombian cohort of ocular toxoplasmosis. Eye 23:1090–1093

    Article  PubMed  CAS  Google Scholar 

  8. Kupfer C, Underwood B, Gillen T (1994) Leading causes of visual impairment worldwide. In: Albert DM, Jakobiec FA (eds) Principles and practice of ophthalmology: clinical practice. Saunders, Philadelphia, pp 1249–1255

    Google Scholar 

  9. McGavin DDM (1993) The world health organization categories of visual impairment. Commun Eye Health 6:2

    Google Scholar 

  10. Thylefors B, Negrel AD, Pararajasegaram R, Dadzie KY (1995) Global data on blindness. Bull World Health Organ 73:115–121

    PubMed  CAS  Google Scholar 

  11. Friedmann CT, Knox DL (1969) Variations in recurrent active toxoplasmic retinochoroiditis. Arch Ophthalmol 81:481–493

    Article  PubMed  CAS  Google Scholar 

  12. Gilbert RE, Dunn DT, Lightman S, Murray PI, Pavesio CE, Gormley PD, Masters J, Parker SP, Stanford MR (1999) Incidence of symptomatic toxoplasma eye disease: aetiology and public health implications. Epidemiol Infect 123:283–289

    Article  PubMed  CAS  Google Scholar 

  13. O’Connor GR (1974) Manifestations and management of ocular toxoplasmosis. Bull NY Acad Med 50:192–210

    Google Scholar 

  14. Rothova A (1993) Ocular involvement in toxoplasmosis [published erratum appears in Br J Ophthalmol 1993;77:683] [review]. Br J Ophthalmol 77:371–7

    Google Scholar 

  15. Salahi-Moghaddam A, Hafizi A (2009) A serological study on toxoplasma gondii infection among people in south of Tehran. Iran Korean J Parasitol 47(1):61–63

    Article  Google Scholar 

  16. Dodds EM, Holland GN, Stanford MR, Yu F, Siu WO, Shah KH, Ten Dam-van Loon N, Muccioli C, Hovakimyan A, Barisani-Asenbauer T, International Ocular Toxoplasmosis Research Group (2008) Intraocular inflammation associated with ocular toxoplasmosis: relationships at initial examination. Am J Ophthalmol 146(6):856–865

    Article  PubMed  Google Scholar 

  17. Montoya JG, Remington JS (1996) Toxoplasmic chorioretinitis in the setting of acute acquired toxoplasmosis. Clin Infect Dis 23:277–282

    Article  PubMed  CAS  Google Scholar 

  18. Johnson MW, Greven CM, Jaffe GJ, Sudhalker H, Vine AK (1997) Atypical, severe toxoplasmic retinochoroiditis in elderly patients. Ophthalmology 104:48–57

    PubMed  CAS  Google Scholar 

  19. Aleixo AL, Benchimol EI, Neves Ede S, Silva CS, Coura LC, Amendoeira MR (2009) Frequency of lesions suggestive of ocular toxoplasmosis among a rural population in the State of Rio de Janeiro. Rev Soc Bras Med Trop 42(2):165–169

    Article  PubMed  Google Scholar 

  20. Soheilian M, Sadoughi MM, Ghajarnia M, Dehghan MH, Yazdani S, Behboudi H, Anisian A (2005) Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis. Ophthalmology 112:1876–1882

    Article  PubMed  Google Scholar 

  21. Gomez-Marin JE, Montoya-De-Londono MT, Castano-Osorio JC, Heine FA, Duque AM, Chemla C, Aubert D, Bonhomme A, Pinon JM (2000) Frequency of specific anti-Toxoplasma gondii IgM, IgA and IgE in Colombian patients with acute and chronic ocular toxoplasmosis. Mem Inst Oswaldo Cruz 95:89–94

    Article  PubMed  CAS  Google Scholar 

  22. Koppe JG, Loewer-Sieger DH, De Roever-Bonnet H (1986) Results of 20-year follow-up of congenital toxoplasmosis. Lancet 1:254–256

    Article  PubMed  CAS  Google Scholar 

  23. Roizen N, Swisher CN, Stein MA, Hopkins J, Boyer KM, Holfels E, Mets MB (1995) Neurologic and developmental outcome in treated congenital toxoplasmosis. Pediatrics 95:11–20

    PubMed  CAS  Google Scholar 

  24. Accorinti M, Bruscolini A, Pirraglia MP, Liverani M, Caggiano C (2009) Toxoplasmic retinochoroiditis in an Italian referral center. Eur J Ophthakmol 19(5):824–830

    Google Scholar 

  25. Arevalo JF, Belfort R Jr, Muccioli C, Espinoza JV (2010) Ocular toxoplasmosis in the developing world. Int Ophthalmol Clin 50(2):57–69

    Article  PubMed  Google Scholar 

  26. Atmaca LS, Simsek T, Batioglu F (2004) Clinical features and prognosis in ocular toxoplasmosis. Jpn J Ophthalmol 48:386–391

    Article  PubMed  Google Scholar 

  27. Saari M (1977) Toxoplasmic chorioretinitis affecting the macula. Acta Ophthalmol (Copenh) 55:539–547

    Article  CAS  Google Scholar 

  28. Hogan MJ (1961) Ocular toxoplasmosis in adult patients. Surv Ophthalmol 6:935–951

    Google Scholar 

  29. Melamed J (1993) Clinical appearance of toxoplasmic retinochoroiditis. In: Dernouchamps JP, Verougstraete C, Caspers-Velu L, Tassignon MJ (eds) Recent advances in uveitis: proceedings of the third international symposium on uveitis. Kugler Publications, New York, pp 283–288

    Google Scholar 

  30. Gilbert RE, Stanford MR, Jackson H, Holliman RE, Sanders MD (1995) Incidence of acute symptomatic toxoplasma retinochoroiditis in south London according to country of birth. BMJ 310:1037–1040

    Article  PubMed  CAS  Google Scholar 

  31. Ronday MJH, Luyendijk L, Baarsma GS, Bollemeijer J-G, Van der Lelij A, Rothova A (1995) Presumed acquired ocular toxoplasmosis. Arch Ophthalmol 113(12):1524–1529

    Article  PubMed  CAS  Google Scholar 

  32. Scherrer J, Iliev ME, Halberstadt M, Kodjikian L, Garweg JG (2007) Visual function in human ocular toxoplasmosis. Br J Ophthalmol 91(2):233–236

    Article  PubMed  Google Scholar 

  33. Rehder JR, Burnier MB Jr, Pavesio CE, Kim MK, Rigueiro M, Petrilli AM, Belfort R Jr (1988) Acute unilateral toxoplasmic iridocyclitis in an AIDS patient. Am J Ophthalmol 106:740–741

    Article  PubMed  CAS  Google Scholar 

  34. Auer C, Bernasconi O, Herbort CP (1999) Indocyanine green angiography features in toxoplasmic retinochoroiditis. Retina 19:22–29

    Article  PubMed  CAS  Google Scholar 

  35. Bosch-Driessen L, Berendscho T, Ongkosuwito JV, Rothova A (2002) Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology 109:869–878

    Article  PubMed  Google Scholar 

  36. Spaulding AG, Font RL (1967) Acquired toxoplasmic chorioretinitis. Surv Ophthalmol 12:16–23

    PubMed  CAS  Google Scholar 

  37. Bosch-Driessen LH, Karimi S, Stilma JS, Rothova A (2000) Retinal detachment in ocular toxoplasmosis. Ophthalmology I07:36–40

    Article  Google Scholar 

  38. Rothova A, Buitenhuis HJ, Meenken C, Baarsma GS, Boen-Tan TN, de Jong PT, Schweitzer CM, Timmerman Z, de Vries J, Zaal MJ (1989) Therapy of ocular toxoplasmosis. Int Ophthalmol 13:415–419

    Article  PubMed  CAS  Google Scholar 

  39. Timsit JC, Bloch-Michel E (1987) Efficacy of specific chemotherapy in the prevention of recurrences of toxoplasmic chorioretinitis during the 4 years following treatment. J Fr Ophtalmol 10:15–23

    PubMed  CAS  Google Scholar 

  40. Fajardo RV, Furgiuele FP, Leopold IH (1962) Treatment of toxoplasmosis uveitis. Arch Ophthalmol 67:712–720

    Article  PubMed  CAS  Google Scholar 

  41. Lakhanpal V, Schocket SS, Nirankari VS (1983) Clindamycin in the treatment of toxoplasmic retinochoroiditis. Am J Ophthalmol 95:605–613

    PubMed  CAS  Google Scholar 

  42. Lam S, Tessler HH (1993) Quadruple therapy for ocular toxoplasmosis. Can J Ophthalmol 28:58–61

    PubMed  CAS  Google Scholar 

  43. Canamucio CJ, Hallett JW, Leopold IH (1963) Recurrence of treated toxoplasmic uveitis. Am J Ophthalmol 55:1035–1039

    PubMed  CAS  Google Scholar 

  44. Guldsten H (1983) Clindamycin and sulphonamides in the treatment of ocular toxoplasmosis. Acta Ophthalmol (Copenh) 61:51–57

    Article  CAS  Google Scholar 

Download references

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Correspondence to Afsaneh Naderi Beni.

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Kianersi, F., Naderi Beni, A. & Naderi Beni, Z. Clinical manifestation and prognosis of active ocular toxoplasmosis in Iran. Int Ophthalmol 32, 539–545 (2012). https://doi.org/10.1007/s10792-012-9599-0

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