levoleucovorin and Retinal-Diseases

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Colonoscopy; Combined Modality Therapy; Electroretinography; Evoked Potentials, Visual; Female; Fluorouracil; Humans; Leucovorin; Middle Aged; Optic Nerve Diseases; Organoplatinum Compounds; Paraneoplastic Syndromes, Ocular; Radiotherapy; Retinal Diseases; Vision Disorders; Visual Acuity; Visual Field Tests; Visual Fields

To determine the incidence of new chorioretinal lesions in patients with congenital toxoplasmosis who were treated throughout their first year of life.. Prospective longitudinal observation of a cohort.. One hundred thirty-two children were studied as part of the longitudinal observation.. One hundred thirty-two children were treated during their first year of life with pyrimethamine, sulfadiazine, and leucovorin. They had eye examinations at prespecified intervals.. New chorioretinal lesions on fundus examination and fundus photographs.. The mean age (+/- standard deviation) is 10.8+/-5.1 years (range, 0.2-23). One hundred eight children have been evaluated for new chorioretinal lesions. Thirty-four (31%; 95% confidence interval, 23%-41%) of 108 children developed at least one chorioretinal lesion that was previously undetected. These occurred at varying times during their follow-up course. Fifteen children (14%) developed new central lesions, and 27 (25%) had newly detected lesions peripherally. Ten (9%) had more than one occurrence of new lesions developing, and 13 (12%) had new lesions in both eyes. Of those who developed new lesions, 14 children (41%) did so at age 10 or later.. New central chorioretinal lesions are uncommon in children with congenital toxoplasmosis who are treated during their first year of life. This finding contrasts markedly with earlier reports in the literature for untreated children or those treated for only 1 month near birth, in whom new lesions were much more prevalent (>/=82%). Our observation that 14 (41%) of the 34 children with new chorioretinal lesions had occurrences when they were 10 years or older indicates that long-term follow-up into the second decade of life is important in assessing the efficacy of treating toxoplasmosis during infancy.

Topics: Adolescent; Adult; Antiprotozoal Agents; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Incidence; Infant; Leucovorin; Longitudinal Studies; Male; Prospective Studies; Pyrimethamine; Recurrence; Retinal Diseases; Sulfadiazine; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

Most infants with congenital Toxoplasma gondii infection have no symptoms at birth, but many will have retinal disease or neurologic abnormalities later in life. Early detection and treatment of congenital toxoplasmosis may reduce these sequelae.. In Massachusetts since January 1986, and in New Hampshire since July 1988, newborns have been screened for intrauterine infection with T. gondii by means of an IgM capture immunoassay of blood specimens routinely collected for screening for metabolic disorders. Congenital infection is confirmed by assays for specific IgG and IgM antibodies in serum from infants and their mothers. For this study, infants with serologic evidence of infection underwent extensive clinical evaluation and received one year of treatment.. Through June 1992, 100 of 635,000 infants tested had positive screening tests. Congenital infection was confirmed in 52 infants, 50 of whom were identified only through neonatal screening and not through initial clinical examination. However, after the serologic results became available, more detailed examinations revealed abnormalities of either the central nervous system or the retina in 19 of 48 infants evaluated (40 percent). After treatment, only 1 of 46 children had a neurologic deficit (hemiplegia attributable to a cerebral lesion present at birth). Thirty-nine treated children had follow-up ophthalmologic examinations when one to six years old; four (10 percent) had eye lesions that may have developed postnatally (a macular lesion in one child and minor retinal scars in three).. Routine neonatal screening for toxoplasmosis identifies congenital infections that are subclinical, and early treatment may reduce the severe long-term sequelae.

Topics: Antibodies, Protozoan; Central Nervous System Diseases; Follow-Up Studies; Humans; Immunoglobulin G; Immunoglobulin M; Infant, Newborn; Leucovorin; Neonatal Screening; Pyrimethamine; Retinal Diseases; Spiramycin; Sulfadiazine; Toxoplasmosis, Congenital

A case of therapy-resistant bilateral intermediate uveitis is presented. Vitreous biopsy and lumbar puncture resulted in the diagnosis of high-grade malignant non-Hodgkin's lymphoma (NHL). Because chemotherapy and radiotherapy continue to yield better results in the treatment of NHL and a cure can be reached in a large group of patients with high-grade malignant NHL, early diagnosis is very important. We therefore recommend early vitreous biopsy in persistent, bilateral, granulomatous intermediate uveitis, especially in older patients. Our patient achieved a complete remission (follow-up period at the time of writing, 18 months after the beginning of polychemotherapy and radiotherapy). The chemotherapy modalities are briefly discussed.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cyclophosphamide; Cytarabine; Doxorubicin; Eye Neoplasms; Female; Humans; Injections, Spinal; Leucovorin; Lymphoma, Non-Hodgkin; Methotrexate; Middle Aged; Prednisone; Retinal Diseases; Uveitis; Vincristine; Visual Acuity; Vitreous Body