Clinical characteristics and treatments of patients with ocular toxoplasmosis_Chinese Journal of Ocular Fundus Diseases

Authors：

Cheng Shiming ¹ , Zhang Maoju ² , Ruan Kunwei ³ , Zhang Yong ¹ ,  Tao Yong ⁴

1. Department of Ophthalmology, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan 442000, China;
2. Department of Ophthalmology, Central Hospital of Enshi Autonomous Prefecture, Enshi 445000, China;
3. Graduate School of Jinzhou Medical University, Jinzhou 121001, China;
4. Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
Ruankunwei, graduate student, is working on the Department of Ophthalmology, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan 442000, China;

Corresponding author：

Tao Yong, Email: taoyong@bjcyh.com

Keywords：

Toxoplasmosis, ocular/diagnosis; Toxoplasmosis, ocular/therapy; Prognosis

DOI：

10.3760/cma.j.cn511434-20191015-00329

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the clinical characteristics, treatments and prognosis of ocular toxoplasmosis (OT).Methods A retrospective clinical trial. Twelve cases (14 eyes) with OT which was confirmed by clinical and laboratory tests were included in the Department of Ophthalmology, Taihe Hospital in Shiyan and the Department of Ophthalmology, Beijing Chaoyang Hospital in Beijing from July 2011 to June 2019. Among the 12 cases, 6 cases were female (7 eyes) and 6 cases were male (7 eyes). The mean age of the participants was 33.4±12.8 years and the duration of illness ranged from 7 days to 30 years. Fungal endophthalmitis, viral uveitis and non-infectious uveitis were misdiagnosed in 2 cases respectively at the first visit. All the patients underwent BCVA, intraocular pressure, slit-lamp microscope, fundus color photography examinations and toxoplasma-specific serological antibodies tests. Intraocular influid were detected for 7 cases, among which 1 case for antibody only, and 6 cases for Goldmann-witmer coefficient (GWC). Of the 6 cases tested for GWC, 4 cases were tested with PCR assay in the ocular fluid addtionally. FFA was performed in 5 cases (6 eyes) and OCT in 6 cases (6 eyes). Eleven cases were treated with antitoxoplasma therapy. The follow-up duration after treatment varied from 1 week to 39 months. BCVA, clinical features and prognosis were retrospectively analyzed.Results Specific antibody seropositivity of Toxoplasma gondii was detected in all 12 patients. Of the 7 cases tested with intraocular fluid, 1 case was IgG positive and the other 6 cases with 5 cases with GWC ＞4 and 1 case with 2＜ GWC ＜4. Only 1 case (25%) was positive among 4 cases with PCR assays meanwhile. BCVA was:＜0.1 in 4 eyes, 0.1～0.3 in 6 eyes and ＞0.3 in 4 eyes. KPs with or without anterior chamber flash or cells could be detected in 6 eyes,congenital macular defect 1 eye, vitreitis 3 eyes (2 eyes with multiple retinal pigmentation foci and 1 eye with tractive retinal detachment), and coexistence of new and old lesions with Kyrieleis arteritis 2 eyes. Nine eyes showed different degrees of vitreous inflammation (75% of 12 active eyes). Single lesion was present in 4 case (4 eyes) and multiple lesions were present in 8 cases (10 eyes). There were no statistically significant changes in BCVA of OT patients before and after treatment (P=0.83). Involvement or adjacent to macula of he primary lesions, misdiagnosis and mistreatment led to the poor prognosisi of visual acuity.Conclusions The fundus of OT can show single lesion or multiple lesions, and the active phase is often accompanied by vitreous inflammation. The primary lesion involves or is close to the macular area, misdiagnosis and mistreatment are the main reasons for the poor visual prognosis of patients.

Citation： Cheng Shiming, Zhang Maoju, Ruan Kunwei, Zhang Yong, Tao Yong. Clinical characteristics and treatments of patients with ocular toxoplasmosis. Chinese Journal of Ocular Fundus Diseases, 2020, 36(9): 680-684. doi: 10.3760/cma.j.cn511434-20191015-00329 Copy

1.	Jones N. Uveitis[M]. 2nd ed. New Delhi: Jaypee Publishers Medical Company Limited, 2013: 225-240.
2.	Fuh UC, Omoti AE, Enock ME. Clinical features and risk factors of patients with presumed ocular toxoplasmosis[J]. J Ophthalmic Vis Res, 2016, 11(1): 48-53. DOI: 10.4103/2008-322X.180694.
3.	Shoeibi N, Hosseini SM, Bayani R. Toxoplasmosis neuroretinitis: a case report[J/OL]. Iran Red Crescent Med J, 2016, 18(4): 33115[2016-02-22]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916323/. DOI: 10.5812/ircmj.33115.
4.	Willerson D Jr, Aaberg TM, Reeser F, et al. Unusual ocular presentation of acute toxoplasmosis[J]. Br J Ophthalmol, 1977, 61(11): 693-698. DOI: 10.1136/bjo.61.11.693.
5.	Westfall AC, Lauer AK, Suhler EB, et al. Toxoplasmosis retinochoroiditis and elevated intraocular pressure: a retrospective study[J]. J Glaucoma, 2005, 14(1): 3-10. DOI: 10.1097/01.ijg.0000146373.51495.c1.
6.	Tabatabaei S, Soleimani M, Foroutan A, et al. Ocular toxoplasmosis in Iran: 40 cases analysis[J]. Int J Ophthalmol, 2011, 4(2): 199-201. DOI: 10.3980/j.issn.2222-3959.2011.02.19.
7.	Mikhail MA, Varikkara M. The absence of vitreous inflammation: one more challenge in diagnosing toxoplasma papillitis[J]. BMJ Case Rep, 2013, 6(1): 1-3. DOI: 10.1136/bcr-2013-008962.
8.	Faridi A, Yeh S, Suhler EB, et al. Retinal detachment associated with ocular toxoplasmosis[J]. Retina, 2015, 35(2): 358-363. DOI: 10.1097/IAE.0000000000000279.
9.	Cho DY, Nam W. A case of ocular toxoplasmosis imaged with spectral domain optical coherence tomography[J]. Korean J Ophthalmol, 2012, 26(1): 58-60. DOI: 10.3341/kjo.2012.26.1.58.
10.	Li K, Wang M, Zhang H, et al. Epidemiology of toxoplasma gondii infection in native Tibetans in Tibet, China[J]. Acta Parasitol, 2017, 62(3): 529-532. DOI: 10.1515/ap-2017-0063.
11.	Dubey JP, Lago EG, Gennari SM, et al. Toxoplasmosis in humans and animals in Brazil: high prevalence, high burden of disease, and epidemiology[J]. Parasitology, 2012, 139(11): 1375-1424. DOI: 10.1017/S0031182012000765.
12.	de-la-Torre A, López-Castillo CA, Gómez-Marín JE. Incidence and clinical characteristics in a Colombian cohort of ocular toxoplasmosis[J]. Eye (Lond), 2009, 23(5): 1090-1093. DOI: 10.1038/eye.2008.219.
13.	Suresh S, Nor-Masniwati S, Nor-Idahriani MN, et al. Serological IgG avidity test for ocular toxoplasmosis[J]. Clin Ophthalmol, 2012, 6: 147-150. DOI: 10.2147/OPTH.S26844.
14.	Brown KM, Blader IJ. The role of DNA microarrays in toxoplasma gondii research, the causative agent of ocular toxoplasmosis[J]. J Ocul Biol Dis Infor, 2009, 2(4): 214-222. DOI: 10.1007/s12177-009-9040-8.
15.	Fekkar A, Bodaghi B, Touafek F, et al. Comparison of immunoblotting, calculation of the Goldmann-Witmer coefficient, and real-time PCR using aqueous humor samples for diagnosis of ocular toxoplasmosis[J]. J Clin Microbiol, 2008, 46(6): 1965-1967. DOI: 10.1128/JCM.01900-07.
16.	Durand ML. Bacterial and fungal endophthalmitis[J]. Clin Microbiol Rev, 2017, 30(3): 597-613. DOI: 10.1128/CMR.00113-16.
17.	Adam CR, Sigler EJ. Multimodal imaging findings in endogenous aspergillus endophthalmitis[J]. Retina, 2014, 34(9): 1914-1915. DOI: 10.1097/IAE.0000000000000135.
18.	吴泽群, 孙熠. 急性视网膜坏死综合征诊治新进展[J]. 国际眼科杂志, 2017, 17(7): 1261-1264. DOI: 10.3980/j.issn.1672-5123.2017.7.15.Wu ZQ, Sun Y. Advancement in diagnosis and treatment of acute retinal necrosis syndrome[J]. Int Eye Sci, 2017, 17(7): 1261-1264. DOI: 10.3980/j.issn.1672-5123.2017.7.15.
19.	Bosch-Driessen LE, Berendschot TT, Ongkosuwito JV, et al. Ocular toxoplasmosis: clinical features and prognosis of 154 patients[J]. Ophthalmology, 2002, 109(5): 869-878. DOI: 10.1016/s0161-6420(02)00990-9.

1. Jones N. Uveitis[M]. 2nd ed. New Delhi: Jaypee Publishers Medical Company Limited, 2013: 225-240.
2. Fuh UC, Omoti AE, Enock ME. Clinical features and risk factors of patients with presumed ocular toxoplasmosis[J]. J Ophthalmic Vis Res, 2016, 11(1): 48-53. DOI: 10.4103/2008-322X.180694.
3. Shoeibi N, Hosseini SM, Bayani R. Toxoplasmosis neuroretinitis: a case report[J/OL]. Iran Red Crescent Med J, 2016, 18(4): 33115[2016-02-22]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916323/. DOI: 10.5812/ircmj.33115.
4. Willerson D Jr, Aaberg TM, Reeser F, et al. Unusual ocular presentation of acute toxoplasmosis[J]. Br J Ophthalmol, 1977, 61(11): 693-698. DOI: 10.1136/bjo.61.11.693.
5. Westfall AC, Lauer AK, Suhler EB, et al. Toxoplasmosis retinochoroiditis and elevated intraocular pressure: a retrospective study[J]. J Glaucoma, 2005, 14(1): 3-10. DOI: 10.1097/01.ijg.0000146373.51495.c1.
6. Tabatabaei S, Soleimani M, Foroutan A, et al. Ocular toxoplasmosis in Iran: 40 cases analysis[J]. Int J Ophthalmol, 2011, 4(2): 199-201. DOI: 10.3980/j.issn.2222-3959.2011.02.19.
7. Mikhail MA, Varikkara M. The absence of vitreous inflammation: one more challenge in diagnosing toxoplasma papillitis[J]. BMJ Case Rep, 2013, 6(1): 1-3. DOI: 10.1136/bcr-2013-008962.
8. Faridi A, Yeh S, Suhler EB, et al. Retinal detachment associated with ocular toxoplasmosis[J]. Retina, 2015, 35(2): 358-363. DOI: 10.1097/IAE.0000000000000279.
9. Cho DY, Nam W. A case of ocular toxoplasmosis imaged with spectral domain optical coherence tomography[J]. Korean J Ophthalmol, 2012, 26(1): 58-60. DOI: 10.3341/kjo.2012.26.1.58.
10. Li K, Wang M, Zhang H, et al. Epidemiology of toxoplasma gondii infection in native Tibetans in Tibet, China[J]. Acta Parasitol, 2017, 62(3): 529-532. DOI: 10.1515/ap-2017-0063.
11. Dubey JP, Lago EG, Gennari SM, et al. Toxoplasmosis in humans and animals in Brazil: high prevalence, high burden of disease, and epidemiology[J]. Parasitology, 2012, 139(11): 1375-1424. DOI: 10.1017/S0031182012000765.
12. de-la-Torre A, López-Castillo CA, Gómez-Marín JE. Incidence and clinical characteristics in a Colombian cohort of ocular toxoplasmosis[J]. Eye (Lond), 2009, 23(5): 1090-1093. DOI: 10.1038/eye.2008.219.
13. Suresh S, Nor-Masniwati S, Nor-Idahriani MN, et al. Serological IgG avidity test for ocular toxoplasmosis[J]. Clin Ophthalmol, 2012, 6: 147-150. DOI: 10.2147/OPTH.S26844.
14. Brown KM, Blader IJ. The role of DNA microarrays in toxoplasma gondii research, the causative agent of ocular toxoplasmosis[J]. J Ocul Biol Dis Infor, 2009, 2(4): 214-222. DOI: 10.1007/s12177-009-9040-8.
15. Fekkar A, Bodaghi B, Touafek F, et al. Comparison of immunoblotting, calculation of the Goldmann-Witmer coefficient, and real-time PCR using aqueous humor samples for diagnosis of ocular toxoplasmosis[J]. J Clin Microbiol, 2008, 46(6): 1965-1967. DOI: 10.1128/JCM.01900-07.
16. Durand ML. Bacterial and fungal endophthalmitis[J]. Clin Microbiol Rev, 2017, 30(3): 597-613. DOI: 10.1128/CMR.00113-16.
17. Adam CR, Sigler EJ. Multimodal imaging findings in endogenous aspergillus endophthalmitis[J]. Retina, 2014, 34(9): 1914-1915. DOI: 10.1097/IAE.0000000000000135.
18. 吴泽群, 孙熠. 急性视网膜坏死综合征诊治新进展[J]. 国际眼科杂志, 2017, 17(7): 1261-1264. DOI: 10.3980/j.issn.1672-5123.2017.7.15.Wu ZQ, Sun Y. Advancement in diagnosis and treatment of acute retinal necrosis syndrome[J]. Int Eye Sci, 2017, 17(7): 1261-1264. DOI: 10.3980/j.issn.1672-5123.2017.7.15.
19. Bosch-Driessen LE, Berendschot TT, Ongkosuwito JV, et al. Ocular toxoplasmosis: clinical features and prognosis of 154 patients[J]. Ophthalmology, 2002, 109(5): 869-878. DOI: 10.1016/s0161-6420(02)00990-9.

Previous Article
Pathogenic microorganisms in ocular fluid of infectious uveitis patients with acquired immunodeficiency syndrome
Next Article
Clinical characteristics of ocular toxocariasis in adults

Chinese Journal of Ocular Fundus Diseases

Clinical characteristics and treatments of patients with ocular toxoplasmosis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content