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.
Similar content being viewed by others
References
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
Da Mata AP, Orefice F (2002) Toxoplasmosis. In: Foster S, Vitale A (eds) Diagnosis and treatment of uveitis. Saunders, Philadelphia, pp 385–410
Koppe JG, Rothova A (1989) Congenital toxoplasmosis: a long term follow up of 20 years. Int Ophthalmol 13:387–390
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
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
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
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
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
McGavin DDM (1993) The world health organization categories of visual impairment. Commun Eye Health 6:2
Thylefors B, Negrel AD, Pararajasegaram R, Dadzie KY (1995) Global data on blindness. Bull World Health Organ 73:115–121
Friedmann CT, Knox DL (1969) Variations in recurrent active toxoplasmic retinochoroiditis. Arch Ophthalmol 81:481–493
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
O’Connor GR (1974) Manifestations and management of ocular toxoplasmosis. Bull NY Acad Med 50:192–210
Rothova A (1993) Ocular involvement in toxoplasmosis [published erratum appears in Br J Ophthalmol 1993;77:683] [review]. Br J Ophthalmol 77:371–7
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
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
Montoya JG, Remington JS (1996) Toxoplasmic chorioretinitis in the setting of acute acquired toxoplasmosis. Clin Infect Dis 23:277–282
Johnson MW, Greven CM, Jaffe GJ, Sudhalker H, Vine AK (1997) Atypical, severe toxoplasmic retinochoroiditis in elderly patients. Ophthalmology 104:48–57
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
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
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
Koppe JG, Loewer-Sieger DH, De Roever-Bonnet H (1986) Results of 20-year follow-up of congenital toxoplasmosis. Lancet 1:254–256
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
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
Arevalo JF, Belfort R Jr, Muccioli C, Espinoza JV (2010) Ocular toxoplasmosis in the developing world. Int Ophthalmol Clin 50(2):57–69
Atmaca LS, Simsek T, Batioglu F (2004) Clinical features and prognosis in ocular toxoplasmosis. Jpn J Ophthalmol 48:386–391
Saari M (1977) Toxoplasmic chorioretinitis affecting the macula. Acta Ophthalmol (Copenh) 55:539–547
Hogan MJ (1961) Ocular toxoplasmosis in adult patients. Surv Ophthalmol 6:935–951
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
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
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
Scherrer J, Iliev ME, Halberstadt M, Kodjikian L, Garweg JG (2007) Visual function in human ocular toxoplasmosis. Br J Ophthalmol 91(2):233–236
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
Auer C, Bernasconi O, Herbort CP (1999) Indocyanine green angiography features in toxoplasmic retinochoroiditis. Retina 19:22–29
Bosch-Driessen L, Berendscho T, Ongkosuwito JV, Rothova A (2002) Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology 109:869–878
Spaulding AG, Font RL (1967) Acquired toxoplasmic chorioretinitis. Surv Ophthalmol 12:16–23
Bosch-Driessen LH, Karimi S, Stilma JS, Rothova A (2000) Retinal detachment in ocular toxoplasmosis. Ophthalmology I07:36–40
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
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
Fajardo RV, Furgiuele FP, Leopold IH (1962) Treatment of toxoplasmosis uveitis. Arch Ophthalmol 67:712–720
Lakhanpal V, Schocket SS, Nirankari VS (1983) Clindamycin in the treatment of toxoplasmic retinochoroiditis. Am J Ophthalmol 95:605–613
Lam S, Tessler HH (1993) Quadruple therapy for ocular toxoplasmosis. Can J Ophthalmol 28:58–61
Canamucio CJ, Hallett JW, Leopold IH (1963) Recurrence of treated toxoplasmic uveitis. Am J Ophthalmol 55:1035–1039
Guldsten H (1983) Clindamycin and sulphonamides in the treatment of ocular toxoplasmosis. Acta Ophthalmol (Copenh) 61:51–57
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-012-9599-0