Postnatal acquired toxoplasmosis patients in an infectious diseases reference center

Infection caused by Toxoplasma gondii, toxoplasmosis, is one of the most frequent zoonoses in the world; it normally affects both genders equally. Humans are one of several possible intermediate hosts, and the disease is oligosymptomatic in most cases. Vertical transmission is an important cause of fetal malformation and sequels in newborns. Approximately 10% of postnatal cases present multiple manifestations, ranging from low fever and mild lymphadenopathy to severe encephalitis. In moderate cases, lesions such as retinochoroiditis may emerge during acute infection or even years later. We analyzed 313 cases of toxoplasmosis from 1992 to 2004, including 261 acute cases. Most patients were women (68.1%), and 39% of these were pregnant. Among acute infection cases, 64.8% presented symptomatic disease; the most frequent manifestations were lymphadenomegaly (59.8%), fever (27.2%), headache (10.7%), asthenia (10%), weight loss (8.4%), myalgia (8%), retinochoroiditis (3.4%) and hepatosplenomegaly (1.5%). Although ocular lesions by T. gondii are well documented as a possible consequence of postnatal infection, two patients developed retinochoroiditis only two years after primary infection. This demonstrates the need for toxoplasmosis case surveillance, even long after acute manifestations

Postnatal acquired toxoplasmosis patients in an infectious diseases reference center

Infection caused by Toxoplasma gondii, toxoplasmosis, is one of the most frequent zoonoses in the world; it normally affects both genders equally. Humans are one of several possible intermediate hosts, and the disease is oligosymptomatic in most cases. Vertical transmission is an important cause of fetal malformation and sequels in newborns. Approximately 10% of postnatal cases present multiple manifestations, ranging from low fever and mild lymphadenopathy to severe encephalitis. In moderate cases, lesions such as retinochoroiditis may emerge during acute infection or even years later. We analyzed 313 cases of toxoplasmosis from 1992 to 2004, including 261 acute cases. Most patients were women (68.1%), and 39% of these were pregnant. Among acute infection cases, 64.8% presented symptomatic disease; the most frequent manifestations were lymphadenomegaly (59.8%), fever (27.2%), headache (10.7%), asthenia (10%), weight loss (8.4%), myalgia (8%), retinochoroiditis (3.4%) and hepatosplenomegaly (1.5%). Although ocular lesions by T. gondii are well documented as a possible consequence of postnatal infection, two patients developed retinochoroiditis only two years after primary infection. This demonstrates the need for toxoplasmosis case surveillance, even long after acute manifestations

Toxoplasmic Retinochoroiditis: Clinical Characteristics and Visual Outcome in a Prospective Study

Submitted by Sandra Infurna ([email protected]) on 2017-01-03T10:42:23Z No. of bitstreams: 1 maria_amendoeira_etal_IOC_2016.pdf: 2854505 bytes, checksum: 375146a4a7d42c039630914e9afa7f7c (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2017-01-03T10:52:40Z (GMT) No. of bitstreams: 1 maria_amendoeira_etal_IOC_2016.pdf: 2854505 bytes, checksum: 375146a4a7d42c039630914e9afa7f7c (MD5)Made available in DSpace on 2017-01-03T10:52:40Z (GMT). No. of bitstreams: 1 maria_amendoeira_etal_IOC_2016.pdf: 2854505 bytes, checksum: 375146a4a7d42c039630914e9afa7f7c (MD5) Previous issue date: 2016Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Oftalmologia Infecciosa,. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Oftalmologia Infecciosa,. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Oftalmologia Infecciosa,. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Toxoplasmose. Rio de Janeiro, RJ. Brasil.Purpose To ascertain the clinical features and visual outcome of toxoplasma retinochoroiditis in a large series of cases. Subjects and Methods Two hundred and thirty subjects diagnosed with active toxoplasma retinochoroiditis were prospectively followed for periods ranging from 269 to 1976 days. All patients presented with active retinochoroiditis and positive IgG T. gondii serology at the beginning of the study and received a standardized drug treatment for toxoplasmosis, both in the first episode and in the subsequent recurrences. Results The group involved 118 (51.3%) men and 112 (48.7%) women, with ages ranging from 14 to 77 years, mean of 32.4 years (SD = 11.38). Primary retinochoroidal lesions were observed in 52 (22.6%) cases and active retinochoroiditis combined with old scars in 178 (77.4%) subjects at the beginning of the study. A hundred sixty-two recurrent episodes in 104 (45.2%) patients were observed during follow-up. New subclinical retinochoroidal lesions were detected in 23 of 162 (14.2%) recurrences episodes during the follow-up. Posterior segment complications were observed in 73 (31.7%) subjects. Retinochoroidal lesions adjacent to the optic nerve and in the macular area were observed in 27 of 40 (67.5%) cases of severe visual impairment (VA = 20/200 or worse). Conclusion Toxoplasma retinochoroiditis in this population had a high recurrence rate after an active episode. Severe visual impairment was associated with location of the retinochoroidal scar, recurrences and posterior segment complications. It is crucial to consider the location of the lesion in studies analyzing visual prognosis as a measure for treatment effectiveness and prevention strategies

Retinography of a subject with focal exudative retinochoroiditis associated with a pigmented scar.

<p>Credits: ALQCA.</p

Age distribution of 230 subjects with toxoplasma retinochoroiditis observed at INI.

<p>Age distribution of 230 subjects with toxoplasma retinochoroiditis observed at INI.</p

Retinography of a subject with focal exudative retinochoroiditis associated with a pigmented scar.

<p>Credits: ALQCA.</p

Complications of posterior segment attributable to toxoplasma retinochoroiditis in 73 of 230 subjects followed at the INI.

<p>Complications of posterior segment attributable to toxoplasma retinochoroiditis in 73 of 230 subjects followed at the INI.</p

Factors related do severe vision loss in 230 subjects with ocular toxoplasmosis (univariate analysis).

<p>Factors related do severe vision loss in 230 subjects with ocular toxoplasmosis (univariate analysis).</p

Retinography of the same subject of Fig 2 after standardized drug scheme for toxoplasmosis, showing healed lesions (scars).

<p>Credits: ALQCA.</p