Toxoplasmose ocular na infância

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Alterações do nervo óptico na toxoplasmose ocular

02

Toxoplasmosis : ocular manifestations

No Brasil, as doenças inflamatórias oculares são uma das principais causas de cegueira ou severa deficiência visual, no Rio Grande do Sul (RS) a toxoplasmose é responsável pela maioria das uveítes posteriores. Se considerarmos a origem dos pacientes portadores de toxoplasmose ocular do R.S., delimitam-se três regiões geográficas, com prevalência decrescente: Escosta do Nordeste e Alto Uruguai, Planalto Médio, Depressão Central e Campanha. A presença de retinocoroidite é imprescindível. A lesão ativa típica caracteriza-se por ser primariamente uma retinite com exsudato, embora precoce, só é visualizada na evolução da doença. Evolutivamente a lesão parece começar num ponto central, estendendo-se centrifugamente. A fase de cicatrização se processa em sentido inverso, desde a periferia até o centro. O diagnóstico é sempre presuntivo. Apóia-se na presença de retinocoroidite, aliada à presença de soro reagente que detecta anticorpos antitoxoplásmicos, sem considerar a sua titulagem. O êxito do tratamento desta doença está alicerçado na prevenção e precocidade diagnóstica.Ocular inflammatory diseases are one of the main causes of blindnes5 or severe visual impairment in Brasil. In Rio Grande do Sul (RS) toxoplasmosis is the predominant etiology of posterior uveitis. According to the origin of patients with ocular toxoplasmosis in R.S.,we can delimit three main geographic areas with decrea· sing prevalence: Northeast, Central and Southwest regions. Retinochoroiditis is essential, to the diagnosis of ocular toxoplasmosis: the typical active lesion is a retinitis, with an exudate overlying. Retina! necrosis occurs early but becomes evident only as the disease develops. The lesion begins a central point and proceeds centrifugally, the healing process occurring in the opposite direction, from the periphery to the center. Diagnosis is always presumptive, based on the presence of retinochoroiditis associated to a positive serologic reaction which detects specific antibodies.Therapeutic success is based on prevention and early diagnosis

Contributions to the history of ocular toxoplasmosis in Southern Brazil

The evolution of knowledge regarding ocular toxoplasmosis over the last 30 years is described based on studies and observations performed in Southern Brazil. The isolation of Toxoplasma gondii established the definitive diagnosis of the disease. It was proven that in most cases, the disease was acquired after birth, a concept supported by the description of numerous familial cases and observation of the disease many years after primary infection. Epidemiological studies showed important regional variations in the prevalence of the disease due to different factors, including the types of strains involved, of which type I predominates. The large number of patients also enabled detailed study of the different forms of clinical presentation of the disease and its complications. New parameters have been established for the use of steroids and the management of pregnant women with active lesions. Studies on the epidemiology of toxoplasmic infection in pregnant women and newborns showed a high prevalence of infection. The different factors of exposure to infection have also been studied. Gradually, preventive actions have been developed in the sphere of public health, although they have not been sufficiently effective. Trends for future research over the next few years are also outlined

Contributions to the history of ocular toxoplasmosis in Southern Brazil

The evolution of knowledge regarding ocular toxoplasmosis over the last 30 years is described based on studies and observations performed in Southern Brazil. The isolation of Toxoplasma gondii established the definitive diagnosis of the disease. It was proven that in most cases, the disease was acquired after birth, a concept supported by the description of numerous familial cases and observation of the disease many years after primary infection. Epidemiological studies showed important regional variations in the prevalence of the disease due to different factors, including the types of strains involved, of which type I predominates. The large number of patients also enabled detailed study of the different forms of clinical presentation of the disease and its complications. New parameters have been established for the use of steroids and the management of pregnant women with active lesions. Studies on the epidemiology of toxoplasmic infection in pregnant women and newborns showed a high prevalence of infection. The different factors of exposure to infection have also been studied. Gradually, preventive actions have been developed in the sphere of public health, although they have not been sufficiently effective. Trends for future research over the next few years are also outlined

Toxoplasmose ocular na infância

20

Alterações do nervo óptico na toxoplasmose ocular

02

Alterações tomográficas cerebrais em crianças com lesões oculares por toxoplasmose congênita

Objetivos: avaliar a freqüência e o tipo de alterações tomográficas cerebrais em pacientes com diagnóstico de toxoplasmose congênita, que apresentam alterações oftalmológicas. Métodos: neste trabalho prospectivo, os indivíduos estudados deveriam preencher um dos seguintes critérios: paciente com dosagem de IgM anti-T.gondii reagente ao nascimento e mãe com sorologia reagente para toxoplasmose, ou menor de dez anos com exame clínico oftalmológico mostrando lesões fundoscópicas bilaterais, compatíveis com retinocoroidite toxoplásmica congênita, IgG anti- T. gondii reagente, e mãe com sorologia compatível. Todos os pacientes foram submetidos à tomografia cerebral sem contraste. Resultados: fizeram parte do estudo 22 pacientes (44 olhos). Treze olhos apresentavam lesões oculares maculares (29,5%), oito lesões periféricas (18,2%), e 22 olhos tinham lesões periféricas e maculares concomitantes (50%). Dezessete pacientes (77,3%) apresentaram alterações radiológicas. Dentre estes, 16 pacientes (94,1%) apresentaram calcificações encefálicas, dois pacientes (11,7%) apresentaram dilatação ventricular, dois hidrocefalia (11,7%), um (5,9%) hidroanencefalia, um (5,9%) cisto porencefálico (hemiatrofia cerebral), um (5,9%) cisto de aracnóide, e um (5,9%) aumento discreto dos ventrículos e das cisternas subaracnoideas. Conclusão: em pacientes com diagnóstico de toxoplasmose congênita e lesões oculares, deve-se suspeitar e investigar alterações neurorradiológicas concomitantes, devido a importância desses achados na maioria dos pacientes.Objective: to evaluate the frequency and the types of cerebral CT scan alterations in patients with ocular lesions caused by congenital toxoplasmosis. Methods: the patients should fit one of the following criteria: reagent IgM serology for toxoplasmosis at birth and mother with positive serology for toxoplasmosis; age less than ten years, with bilateral funduscopic lesions compatible with toxoplasmic retinochoroiditis; or reagent IgG serology for toxoplasmosis and mother with positive serology for toxoplasmosis. All patients were submitted to noncontrast cerebral CT scan. Results: twenty-two patients participated in this study (44 eyes). Thirteen eyes presented macular lesions (29.5%), eight had peripheral lesions (18.2%) and 22 eyes had concomitant macular and peripheral lesions (50%). Seventeen patients presented radiological alterations (77.3%). Among these, sixteen patients (94.1%) presented brain calcifications, two patients (11.7%) presented ventricular dilation, two patients (11.7%) had hydrocephalus, one had hydranencephaly (5.9%), one presented porencephalic cyst (cerebral hemiatrophy) (5.9%), one had arachnoid cyst (5.9%) and one had mild dilation of ventricles and subarachnoid cistern (5.9%). Conclusions: patients diagnosed with congenital toxoplasmosis and ocular lesions should be investigated for concomitant neuroradiologic alterations