OCULAR TOXOPLASMOSIS
Abstract
Background. Ocular toxoplasmosis is one of the important causes of severe visual loss in young otherwise healthy people. Diagnosis is clinical, supported by laboratory tests. Current evidence about the timing of toxoplasma infection leading to ocular disease suggests, that recurrent toxoplasmic retinochoroiditis is the result of prenatal (congenital) or remote, postnatal (acquired) infection. The timing of infection is rarely exactly known, and retinitis is not only a late manifestation of congenital disease as previously believed. The purpose is to review recent observations regarding ocular toxoplasmosis, and to review our experiences in the treatment of our patients with this illness.
Methods. A review of the medical literature about ocular toxoplasmosis, especially regarding pathogenesis, therapy and prevention of the disease.
Results. Epidemiological data for toxoplasmosis are various in different parts of the world. The highest rate is in Brasil. In Slovenia the rate is similar like in France or in the Netherlands (at age 40 there is 60% population seropositive). Toxoplasmosis screening in pregnant women is partly performed since 1991 and systematically since 1995 in Slovenia. No retinochorioditis was found in newborns so far. In the pathogenesis there are some several potential sources and routes of infections, that were previously unrecognized. Ocular involvement in cases of acquired infection appears to be more common than believed before. Classical therapy for ocular toxoplasmosis is still most commonly used. In prevention the education of pregnant women, and correct treatment of infected patients is recommended.
Conclusions. The time of infection with Toxoplasma gondii and consequential retinochoroiditis is rarely confirmed. Patients with acquired infection after birth are probably more numerous than with congenital disease. As potentially treatable and preventable cause of visual loss these facts must be considered in primary and secondary prevention of the disease.
Downloads
References
Kansky JJ. Toxoplasmosis. In: Kansky JJ. Clinical ophthalmology. Third edition. Oxford: Butterrworth-Heinemann, 1995: 175–9.
Holland GN, O’Connor GR, Belfort R, Remington JS. Toxoplasmosis. In: Pepose JS, Holland GN, Wilhelmus KR eds. Ocular infections and immunity. St. Louis: Mosby-Year Book, Inc., 1996: 1183–223.
BenEzra D. Toxoplasmosis. In: BenEzra D. Ocular inflammation, basic and clinical concepts. London: Martin Dunitz; 1999: 393–411.
Dodds EM. Ocular toxoplasmosis: clinical presentations, diagnosis, and therapy. Focal Points of American Academy of Ophthalmology 1999; XVII, N° 10: 1–13.
Holland GN. Reconsidering the pathogenesis of ocular toxoplasmosis. Am J Ophthalmol 1999; 128: 502–5.
Gilbert RE, Stanord MR. Is ocular toxoplasmosis caused by prenatal or postnatal infection? Br J Ophthalmol 2000; 84: 224–6.
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.
Logar J, Novak-Antolič Ž, Zore A. Serological screening for toxoplasmosis in pregnancy in Slovenia. Scan J Infect Dis 1995; 27: 163–4.
McAuley J, Boyer KM, Patel D, Mets M et al. Early and longitudinal evaluations of treated infants and children and untreated historical patients with congenital toxoplasmosis: the Chicago collaborative treatment trial. Clin Infect Dis 1994; 18: 38–72.
Cook AJC, Gilbert RE, Buffolano W, Zufferey J et al. Sources of toxoplasma infection in pregnant women: European multicentre case-control study. BMJ 2000; 321: 142–7.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
