levoleucovorin and Toxoplasmosis--Ocular

Topics: Abortion, Spontaneous; Adult; Animals; Diagnosis, Differential; Eye Diseases; Female; Humans; Hypersensitivity; Infant, Newborn; Inflammation; Leucovorin; Male; Prednisone; Pregnancy; Pregnancy Complications, Infectious; Pyrimethamine; Sulfadiazine; Syphilis; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular; Tuberculosis

Between December 1981 and May 1991, 44 infants and children with congenital toxoplasmosis were referred to our study group. A uniform approach to evaluation and therapy was developed and is described herein along with the clinical characteristics of these infants and children. In addition, case histories that illustrate especially important clinical features or previously undescribed findings are presented. Factors that contributed to the more severe disabilities included delayed diagnosis and initiation of therapy; prolonged, concomitant neonatal hypoxia and hypoglycemia; profound visual impairment; and prolonged, uncorrected increased intracranial pressure with hydrocephalus and compression of the brain. Years after therapy was discontinued, three children developed new retinal lesions (without loss of visual acuity when therapy for Toxoplasma gondii was initiated promptly), and three children experienced a new onset of afebrile seizures. Most remarkable were the normal developmental, neurological, and ophthalmologic findings at the early follow-up evaluations of many--but not all--of the treated children despite severe manifestations, such as substantial systemic disease, hydrocephalus, microcephalus, multiple intracranial calcifications, and extensive macular destruction detected at birth. These favorable outcomes contrast markedly with outcomes reported previously for children with congenital toxoplasmosis who were untreated or treated for only 1 month.

Topics: Animals; Calcinosis; Chemistry, Pharmaceutical; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Feasibility Studies; Humans; Infant; Leucovorin; Magnetic Resonance Imaging; Neutropenia; Physical Examination; Pilot Projects; Prenatal Care; Pyrimethamine; Spiramycin; Sulfadiazine; Tomography, X-Ray Computed; Toxoplasma; Toxoplasmosis, Cerebral; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular; Treatment Outcome

We investigated the prevalence of ocular abnormalities in infants vertically exposed to Toxoplasma gondii infection during an outbreak in Santa Maria City, Brazil.. Consecutive case series.. A total of 187 infants were included.. The infants were recruited from January 2018 to November 2019. All mothers were screened for syphilis and human immunodeficiency virus before delivery. Toxoplasmosis infection was confirmed in all mothers and infants based on the presence of serum anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies. All infants underwent an ophthalmologic examination; ocular abnormalities were documented using a wide-field digital imaging system. Neonatal cranial sonography or head computed tomography was performed in 181 infants, and the cerebrospinal fluid (CSF) was screened for anti-T. gondii IgG and IgM antibodies in 159 infants. Peripheral blood samples from 9 infants and their mothers were analyzed for the presence of T. gondii DNA by real-time polymerase chain reaction.. Ocular abnormalities associated with congenital toxoplasmosis.. A total of 187 infants were examined. Twenty-nine infants (15.5%) had congenital toxoplasmosis, of whom 19 (10.2%) had ocular abnormalities, including retinochoroiditis in 29 of 38 eyes (76.3%), optic nerve abnormalities in 5 eyes (13.2%), microphthalmia in 1 eye (2.6%), and cataract in 2 eyes (5.3%). Bilateral retinal choroidal lesions were found in 10 of 19 infants (52.6%). Nine eyes of 6 infants had active lesions, with retinal choroidal cellular infiltrates at the first examination. Thirteen (7.2%) of 181 infants screened presented with cerebral calcifications. Eighty-three percent of the screened infants were positive for anti-T. gondii IgG and negative for IgM antibodies in the CSF. Congenital toxoplasmosis was higher in mothers infected during the third pregnancy trimester, and maternal treatment during pregnancy was not associated with a lower rate of congenital toxoplasmosis.. High prevalence rates of clinical manifestations were observed in infants with congenital toxoplasmosis after a waterborne toxoplasmosis outbreak, the largest yet described. Cerebral calcifications were higher in infants with ocular abnormalities, and maternal infection during the third pregnancy trimester was associated with a higher rate of congenital toxoplasmosis independent of maternal treatment.

Topics: Antibodies, Protozoan; Antiprotozoal Agents; Disease Outbreaks; DNA, Protozoan; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immunoglobulin G; Immunoglobulin M; Infant, Newborn; Leucovorin; Male; Pregnancy; Prevalence; Pyrimethamine; Real-Time Polymerase Chain Reaction; Retrospective Studies; Sulfadiazine; Tomography, X-Ray Computed; Toxoplasma; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular; Ultrasonography

Topics: Chorioretinitis; Drug Administration Schedule; Female; Fluorescein Angiography; Fundus Oculi; Humans; Leucovorin; Pyrimethamine; Retinal Detachment; Sulfadiazine; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Young Adult

Congenital toxoplasmosis (CT) is a parasitic disease that causes serious fetal and neonatal harm or death. In countries that do not have antenatal screening programs, the initiation of CT treatment relies on a postnatal diagnosis. Until recently, diagnosis was based on clinical signs and immunoglobulin seropositivity, which is fraught with difficulty. In these cases, diagnosis was often delayed or treatment, which carries risk, started empirically. We highlight the use of polymerase chain reaction to diagnose a case of congenital toxoplasmosis, allowing early treatment and justifying the treatment burden.

Topics: Antiprotozoal Agents; DNA, Protozoan; Drug Therapy, Combination; Early Diagnosis; Electroencephalography; Humans; Infant; Leucovorin; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction; Pyrimethamine; Spinal Puncture; Sulfadiazine; Tomography, X-Ray Computed; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular; Ultrasonography

The purpose of this study was to estimate the frequency and describe the adverse drug reactions (ADRs) associated with the classic treatment of ocular toxoplasmosis (OT), namely sulfadiazine, pyrimethamine, corticosteroids and folinic acid.. We performed a descriptive study of a prospective cohort of patients with OT treated with the classic therapy. Data were collected during medical consultations and treatment.. Of the 147 patients studied, 85% developed one or more ADR. Women presented more ADRs than men (95% vs 77%). Of the total reactions (n=394), 82% were mild, but we found one life-threatening event (Stevens-Johnson syndrome). The most frequent types (71%) of ADRs were gastrointestinal, skin and neurological or psychiatric. The majority of ADRs (90.3%) occurred before the second week of treatment. A third of the patients were treated for the ADR and 10% dropped out of OT treatment. Most (70%) of the ADRs were characterized as being probably caused by the drugs and may be associated with prednisone, sulfadiazine and sulfadiazine/prednisone. Six percent of ADRs were not previously described, such as taste alteration, constipation/bloating, dyspnoea, sweating and somnolence.. Our results suggest a high rate of ADRs to OT classic treatment, which requires careful follow-up in order to identify and treat ADRs early.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Adverse Drug Reaction Reporting Systems; Aged; Antidotes; Antiprotozoal Agents; Brazil; Comorbidity; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Leucovorin; Male; Middle Aged; Prospective Studies; Pyrimethamine; Sulfadiazine; Toxoplasmosis, Ocular; Treatment Outcome; Young Adult

To investigate ocular involvement (prevalence, incidence, lesion characteristics) following postnatally acquired infection with an "atypical" genotype of Toxoplasma gondii during a well-characterized 2001 outbreak in Santa Isabel do Ivaí, Brazil, attributed to a contaminated municipal reservoir.. Prospective longitudinal cohort study.. We performed ophthalmic examinations on 290 of 454 individuals with serologic evidence of T gondii infection during the epidemic (positive IgM antibody tests). Prevalence of ophthalmic findings (intraocular inflammatory reactions [including transient, isolated retinal whitening without clinically apparent retinal necrosis] and necrotizing retinochoroiditis) at initial examination (baseline) and incidence of new findings during 10.5 months of follow-up were calculated. Cumulative risks of ophthalmic events were determined (Kaplan-Meier technique).. Ocular involvement was present in 33 of 288 IgM+ individuals (11.5%) at baseline, including 17 with focal retinal whitening only and 13 with necrotizing retinochoroiditis. Incidence of new ocular involvement was estimated to be 1.73 events per 100 person-months (PM); cumulative risk at 10.5 months was 30.1%. Incident necrotizing retinochoroiditis was more common among those with focal retinal whitening at baseline (6.7/100 PM) than among those with no ocular involvement at baseline (1.11/100 PM; hazard ratio 6.07 [1.94-19.01]; P < .0001).. Waterborne infection with an atypical genotype of T gondii is associated with substantial risk of ocular involvement. Lesions may continue to develop during the first year after infection. The increased risk of late necrotizing retinochoroiditis associated with isolated focal retinal whitening at presentation suggests the early presence of parasites in the retina, despite initial lack of observable retinal necrosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Protozoan; Antiprotozoal Agents; Brazil; Child; Child, Preschool; Chorioretinitis; Cohort Studies; Disease Outbreaks; Endemic Diseases; Enzyme-Linked Immunosorbent Assay; Female; Folic Acid Antagonists; Humans; Immunoglobulin M; Incidence; Infant; Infant, Newborn; Leucovorin; Longitudinal Studies; Male; Middle Aged; Prevalence; Prospective Studies; Pyrimethamine; Seroepidemiologic Studies; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular; Water; Water Supply

Children treated for toxoplasma retinochoroiditis may experience a range of severe adverse drug responses. Drug reaction with eosinophilia and systemic symptoms syndrome is a life-threatening idiosyncratic drug reaction with a 10% mortality. We present a case of drug reaction with eosinophilia and systemic symptoms syndrome in a child on standard combination treatment with oral sulfadiazine, pyrimethamine, folinic acid, and steroids for toxoplasma retinochoroiditis. Early clinical recognition and appropriate treatment led to a complete recovery and no longterm sequelae. The parents of children during sulfadiazine treatment should be counseled on the potential significance of nonspecific illness.

Topics: Adolescent; Antiprotozoal Agents; Chorioretinitis; Drug Eruptions; Drug Hypersensitivity; Drug Therapy, Combination; Eosinophilia; Female; Humans; Leucovorin; Pyrimethamine; Steroids; Sulfadiazine; Toxoplasmosis, Ocular

Toxoplasma gondii is a widely distributed obligatory intracellular parasite that causes severe disease to the fetus when transmitted during pregnancy. Drugs used to avoid congenital transmission have shown side effects, and their efficacy is controversial. The most widely used treatment for acute toxoplasmosis during pregnancy is pyrimethamine plus sulfadiazine, which has several side effects. In this work, we tested the efficacy of azithromycin in reducing congenital transmission of T. gondii in the large vesper mouse, Calomys callosus, a rodent. Females of C callosus were inoculated perorally with 20 cysts of ME49 strain of T. gondii on the day of fertilization, and fetuses were collected from the 15th to the 19th day of gestation. Azithromycin (300 mg/kg), in association with pyrimethamine (100 or 50 mg/kg) plus sulfadiazine (100 or 75 mg/kg) and folinic acid (15 mg/kg) (SPAf), or vehicle, were administered orally on different days after infection. Brain and ocular tissues were removed and processed for immunohistochemistry using a polyclonal antibody against T. gondii, or were processed for parasite DNA quantification. Toxoplasma gondii was detected in the brains of all females and in fetuses' eyes of C. callosus treated with SPAf. On the other hand, in females treated with azithromycin, there was a reduction of T. gondii in the brains of mothers, and no parasites were detected in eyes of fetuses, indicating that azithromycin may represent an alternative treatment for toxoplasmosis during pregnancy.

Topics: Animals; Anti-Infective Agents; Antiprotozoal Agents; Azithromycin; Brain; Disease Models, Animal; DNA, Protozoan; Drug Therapy, Combination; Eye; Female; Fetus; Immunohistochemistry; Infectious Disease Transmission, Vertical; Leucovorin; Male; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Parasitic; Pyrimethamine; Sigmodontinae; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular; Vitamin B Complex

Topics: Adult; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antiprotozoal Agents; Child; Choroidal Neovascularization; Drug Therapy, Combination; Fluorescein Angiography; Humans; Injections; Leucovorin; Male; Pyrimethamine; Ranibizumab; Retinal Hemorrhage; Sulfadiazine; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Visual Acuity; Vitreous Body

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

Acquired multifocal white retinal lesions in an immunosuppressed patient are diagnostically challenging.. Case report of a 34-year-old woman who underwent bone marrow transplantation for chronic myelogenous leukemia. Four months after the transplant, while on relatively high doses of immunosuppressive drugs, she developed bilateral multifocal retinitis versus leukemic retinal infiltration. Fine-needle aspiration biopsy was performed on one eye in an attempt to establish a cytological diagnosis.. The aspirate was found to contain individual crescent-shaped intraretinal organisms and cysts, consistent with the diagnosis of toxoplasmic retinitis. The patient was started immediately on an anti-toxoplasmosis regimen consisting of sulfadiazine, pyrimethamine, and folinic acid. Follow-up examinations revealed complete inactivation of the retinitis and no delayed complications of the biopsy.. Fine-needle aspiration biopsy can be a useful diagnostic tool in selected patients with acquired retinal infiltrates.

Topics: Adult; Antiprotozoal Agents; Biopsy, Fine-Needle; Bone Marrow Transplantation; Drug Therapy, Combination; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Leucovorin; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Pyrimethamine; Retinitis; Sulfadiazine; Toxoplasmosis, Ocular; Vitreous Body

Chemokines have been implicated in the control of leucocyte infiltration in uveitis and in modulating angiogenesis in several ocular conditions. Toxoplasmic retinochoroiditis is a common cause of posterior uveitis. This study aimed to evaluate the serum concentrations of CC and CXC chemokines in patients with acute toxoplasmic retinochoroiditis.. The levels of five chemokines (CCL2, CCL11, CXCL9, CXCL8 and CXCL10) were evaluated in the serum of patients with active toxoplasmic retinochoroiditis (n = 55) and control subjects (n = 40). In a subset of patients (n = 18), a second measure of serum levels of chemokines was performed after the completion of oral treatment with pyrimethamine (25 mg/day), sulphadiazine (1 g, four times per day), folinic acid (7.5 mg/day) and prednisone (initial dose: 1 mg/kg/day) for approximately 30 days.. Patients with toxoplasmic retinochoroiditis, notably those presenting with vasculitis, had increased serum levels of CXCL8 (mean +/- standard error of the mean [SEM] 35.1 +/- 6.5 pg/ml) compared with control subjects (mean +/- SEM 16.0 +/- 2.3 pg/ml; p = 0.01). There were no differences between patients and controls in serum levels of the other chemokines measured. The size of ocular lesions correlated significantly with serum levels of CXCL8 and CXCL9. After treatment, there was a significant reduction in serum levels of CXCL8. Severity of vitreous opacities did not correlate with serum levels of these chemokines.. These data suggest a role for CXCL8 in the inflammatory process of acute toxoplasmic retinochoroiditis. Furthermore, CXCL8 may be a useful marker for patient follow-up.

Topics: Acute Disease; Adult; Anti-Inflammatory Agents; Antiprotozoal Agents; Chorioretinitis; Female; Humans; Interleukin-8; Leucovorin; Male; Optic Disk; Prednisone; Pyrimethamine; Sulfadiazine; Toxoplasmosis, Ocular; Vasculitis; Visual Acuity

To describe eight patients with active toxoplasmic retinochoroiditis (RC) who had features suggestive of acute choroidal ischemia.. A retrospective review of the clinical records of 23 consecutive patients with acute toxoplasmic RC was performed. All patients underwent detailed ophthalmic examination at presentation and throughout follow-up, including dilated biomicroscopic fundus examination, fundus photography, fluorescein angiography, and indocyanine green (ICG) angiography.. Of 23 patients, 8 (34.8%) had a large area of retinal whitening surrounding a small focus of RC. Fluorescein as well as ICG angiography showed a well demarcated geographic area of early choroidal hypofluorescence that extended beyond the clinical borders of the white retinal lesion, particularly by ICG angiography. Associated findings for these 8 patients included old retinochoroidal scars (7 [87.5%]), serous retinal detachment (3 [37.5%]), retinal hemorrhages (1 [12.5%]), and multiple satellite dark dots by ICG angiography (6 [75%]). Seven of eight patients were treated using a combination of antitoxoplasmic drugs and corticosteroids. All findings seen at the acute stage resolved in 2 weeks to 6 weeks. A small atrophic retinochoroidal scar replaced the active toxoplasmic lesion and was surrounded with mild or moderate retinal pigment epithelium changes that were associated with decreased final visual acuity in 2 patients (25%).. Patients with toxoplasmic RC may develop features suggestive of choroidal ischemia that can result in a transient or permanent decrease in vision. Choroidal ischemia can only be suspected clinically, and fluorescein angiography and ICG angiography are required to establish the definitive diagnosis.

Topics: Acute Disease; Adult; Azithromycin; Chorioretinitis; Choroid; Coloring Agents; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Indocyanine Green; Ischemia; Leucovorin; Male; Prednisone; Pyrimethamine; Retrospective Studies; Toxoplasmosis, Ocular

To report a case of toxoplasmosis with optic nerve and orbital involvement as the initial presentation of HIV infection.. Case report.. A 46-year-old zookeeper, who had had right central retinal vein occlusion (CRVO) 2 weeks previously, presented with painless lid and conjunctival swelling and profound visual loss in his right eye (RE). Examination revealed no light perception (NLP) RE with axial proptosis and ocular motility restriction; fundal examination revealed a clinical picture of an ischaemic CRVO. MRI of the brain and orbit showed ring-enhancing targetoid lesions in the brain and inflammatory changes in the right optic nerve, extraocular muscles and orbital fat. He was subsequently found to be HIV positive and had positive toxoplasma IgG serology.. Immunocompromised individuals have an increased likelihood for more severe and atypical presentations; this highlights the need for increased index of suspicion for HIV infection as ocular or orbital disease may be the first manifestation of life-threatening systemic toxoplasmosis.

Topics: AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Blepharitis; CD4 Lymphocyte Count; Conjunctivitis; Drug Therapy, Combination; HIV Seropositivity; Humans; Leucovorin; Magnetic Resonance Imaging; Male; Methylprednisolone; Middle Aged; Optic Nerve Diseases; Orbital Pseudotumor; Pyrimethamine; Retinal Vein Occlusion; Sulfadiazine; Toxoplasmosis, Ocular

To describe a case of recurrent frosted branch angiitis after treatment of ocular toxoplasmosis.. In a 6-year-old boy, we found perivascular, creamy, patchy, retinal sheathing in both eyes without any focal necrotizing retinochoroiditis or scarring. IgM antibodies for toxoplasma gondii were also found. The patient was treated with antitoxoplasmosis medication and a systemic steroid.. Several years after treatment of the toxoplasmosis, frosted branch angiitis occurred twice without any retinal scarring or serological evidence of toxoplasmosis. After systemic steroid therapy, the angiitis improved without further complications.. Toxoplasmic retinal vasculitis should be considered as a cause of frosted branch angiitis.

Topics: Antiprotozoal Agents; Child; Chorioretinitis; Drug Therapy, Combination; Fluorescein Angiography; Glucocorticoids; Humans; Leucovorin; Male; Pyrimethamine; Recurrence; Retinal Vasculitis; Toxoplasmosis, Ocular

The clinical management of perinatal toxoplasmosis involves a gynaecologist during pregnancy and a neonatologist after delivery. Then, in the absence of a uniform approach, early evaluation of infected infants requires a thorough long-term follow-up also in asymptomatic children, who have to be observed for at least one year due to unpredictable sequelae in later life. We retrospectively analyzed pregnancy management of 54 women with certain infection from Toxoplasma gondii (TG) and prospectively enrolled their infants to compare prenatal management with postnatal clinical outcome. All mothers with seroconversion for TG infection were from the Palermo area and were retrospectively analyzed, whereas their newborns referred to G. Di Cristina Children Clinical Hospital between 1999-2004 were prospectively enrolled in a 48-month follow-up. Timing of infection was dated for 24 women (45%) to the first trimester, 18 (33%) to the second and 12 (22%) the third. The maternal-fetal transmission rate was 17.2%. Prenatal diagnosis from amniotic fluid was performed in 25/54 pregnant subjects and showed positive results in 6. Despite diagnosis of TG infection, 9 women were untreated and only 2 with positive amniocentesis received combined therapy. 10/55 enrolled infants were infected and half of them were preterm and/or SGA at birth. None showed peculiar signs of TG at birth but 4 had abnormalities during the follow-up. 9/10 infected children were born to mothers who had undergone neither amniocentesis nor combined therapy.. Our work confirms the difficulty of applying standardized therapeutic protocol for TG infection during pregnancy. The asymptomatic course of TG infection at birth confirms the importance of an instrumental long-term follow-up to identify typical TG lesion to prevent sequelae.

Topics: Adolescent; Adult; Amniocentesis; Animals; Antibodies, Protozoan; Antiprotozoal Agents; Chorioretinitis; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Hydrocephalus; Immunoglobulin G; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Small for Gestational Age; Infectious Disease Transmission, Vertical; Italy; Leucovorin; Male; Prednisone; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimesters; Prenatal Care; Prospective Studies; Pyrimethamine; Retrospective Studies; Spiramycin; Sulfadiazine; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Cerebral; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

Topics: Animals; Antibodies, Protozoan; Antiprotozoal Agents; Chorioretinitis; DNA, Protozoan; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Immunoglobulin G; Infant; Leucovorin; Panuveitis; Pyrimethamine; Retina; Retinal Detachment; Sulfadiazine; Toxoplasma; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

Topics: Animals; Antibodies, Protozoan; Antiprotozoal Agents; Child; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Glucocorticoids; Humans; Immunocompetence; Immunoglobulin G; Leucovorin; Magnetic Resonance Imaging; Male; Optic Atrophy; Prednisone; Pyrimethamine; Retinitis; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular

To evaluate the diagnostic sensitivity of a panel of laboratory tests for ocular toxoplasmosis performed at the time of presentation, paired samples of aqueous humor and serum were collected from 49 consecutive episodes of ocular toxoplasmosis with a clinical course of less than 3 weeks. Total immunoglobulin G (IgG) and Toxoplasma gondii-specific IgG, IgM, and IgA were quantified by enzyme-linked immunosorbent assay. The avidity of T. gondii-specific IgG was determined, and DNA extracted from aqueous humor was amplified for detection of a glycoprotein B gene sequence of T. gondii. The diagnosis was confirmed for 73% (36 of 49) of the patients; this rate rose to 79.5% if data from a later analysis of aqueous humor derived from five of the negative patients were included. The analysis of serum (detection of T. gondii-specific IgM and analysis of consecutive serum samples) alone did not contribute to the diagnosis. Calculation of local antibody production lacked diagnostic sensitivity when it was determined less than 3 weeks after the manifestation of clinical symptoms (28 of 49 patients [57%]), but this rose to 70% after an analysis of a second aqueous humor sample. The antibody avidity index attained diagnostic significance in only 8 of 43 instances (19%), and T. gondii DNA was amplified from no more than 6 of 39 (16%) aqueous humor samples. However, T. gondii-specific IgA was found within the aqueous humors of 11 of 43 patients (26%); measurement of the T. gondii-specific IgA level thus contributed substantially to the diagnostic sensitivity of the laboratory tests.

Topics: Animals; Antibodies, Protozoan; Antibody Formation; Antibody Specificity; Antiprotozoal Agents; Aqueous Humor; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Leucovorin; Pyrimethamine; Sensitivity and Specificity; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular

To evaluate the diagnostic value of polymerase chain reaction (PCR) in blood and aqueous humor samples from immunocompetent patients with reactivated ocular toxoplasmosis.. Group 1 was composed of seven patients with a clinical diagnosis of reactivated ocular toxoplasmosis. Group 2 consisted of 33 controls. In each subject, blood and aqueous humor samples were obtained for detection of Toxoplasma gondii DNA by means of simple PCR, seminested PCR, and Southern blot hybridization.. Group 1: Simple PCR was positive in 3 of 7 blood samples (42%) and in 2 of 7 (28%) aqueous humor samples. Seminested PCR was positive in 4 of 7 (57%) blood samples and in 3 of 7 (42%) aqueous humor samples. Group 2: Simple and seminested PCR were positive in both samples in 2 of 33 (6%) and 4 of 33 (12%), respectively. Sensitivity 57% (18.41-90.10), specificity 87% (71.80-96.60); positive and negative likelihood ratio 4.38 and 0.49, respectively.. Polymerase chain reaction can be useful for confirming the diagnosis of ocular toxoplasmosis, especially in those eyes where fundus examination does not yield conclusive results. The detection of T. gondii DNA in blood suggests that reactivation of ocular toxoplasmosis cannot be considered a local event.

Topics: Adult; Aged; Aged, 80 and over; Animals; Antiprotozoal Agents; Aqueous Humor; Blotting, Southern; DNA, Protozoan; Drug Therapy, Combination; Humans; Immunocompetence; Leucovorin; Middle Aged; Parasitemia; Polymerase Chain Reaction; Predictive Value of Tests; Prospective Studies; Pyrimethamine; Recurrence; Sensitivity and Specificity; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular

To describe a case of severe congenital toxoplasmosis because of inadequate surveillance of a seronegative pregnant woman and to evaluate the usefulness of different microbiological diagnostic methods after birth.. We applied serology, DNA amplification by one-tube semi-nested PCR, cell culture and mice inoculation analysis.. Anti. T. gondii serology was useful for the diagnosis of congenital toxoplasmosis. PCR analysis of neonate cerebrospinal fluid and peripheral blood were positive, and yielded negative results after a few days of specific treatment. Cellular culture and mice inoculation yielded negative results.. Our results suggest that serology and PCR are useful methods for the diagnosis of toxoplasmosis in newborns. Prenatal toxoplasmosis screening and suitable follow up of the seronegative pregnant women are necessary to prevent cases of severe infection in our area.

Topics: Acute Disease; Administration, Topical; Adult; Animals; Anti-Inflammatory Agents; Antibodies, Protozoan; Antiprotozoal Agents; Blood; Brain; Cerebrospinal Fluid; Chorioretinitis; Dexamethasone; Female; Glucocorticoids; Humans; Infant, Newborn; Leucovorin; Male; Methylprednisolone; Mice; Neonatal Screening; Ophthalmic Solutions; Polymerase Chain Reaction; Pregnancy; Pyrimethamine; Random Amplified Polymorphic DNA Technique; Sulfadiazine; Tomography, X-Ray Computed; Toxoplasma; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

Life-threatening conditions requiring urgent medical treatment rarely present to the ophthalmologist. This case report describes a patient with precipitious visual loss as the primary complaint and which subsequently led to the diagnosis of Toxoplasmic papillitis and life-threatening cerebral involvement as an initial manifestation of AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Drug Therapy, Combination; Humans; Leucovorin; Male; Optic Disk; Optic Neuritis; Pyrimethamine; Sulfadiazine; Tomography, X-Ray Computed; Toxoplasmosis, Cerebral; Toxoplasmosis, Ocular; Vision Disorders

The authors discuss a possible relationship between systematic corticosteroid use and reactivation of ocular toxoplasmosis.. Patients were identified who developed foci of recurrent toxoplasmic retinochoroiditis while being treated with systemic corticosteroids. Case histories were reviewed retrospectively.. During a 10-year interval, three patients were identified at the University of California, Los Angeles, who had been receiving systemic corticosteroid therapy (dose range, 0.27-1.23 mg/kg/day) when they developed recurrent toxoplasmic retinochoroiditis. Disease occurred at intervals of 20 days to approximately 1 year after start of corticosteroid therapy. Lesions were typical in appearance, course, and manner in which they responded to antimicrobial therapy.. Recurrent toxoplasmosis in patients receiving corticosteroid therapy probably is uncommon. These cases do not confirm a causal relationship between corticosteroid use and initiation of disease recurrence.

Topics: Adolescent; Animals; Anti-Infective Agents; Anti-Inflammatory Agents; Antibodies, Protozoan; Antidotes; Child; Chorioretinitis; Enzyme-Linked Immunosorbent Assay; Female; Humans; Leucovorin; Male; Middle Aged; Prednisolone; Pyrimethamine; Recurrence; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular

The clinical aspect of congenital toxoplasmosis is sometimes typical, sometimes atypical. The advantage of the serological study of the aqueous is an early diagnosis and an early treatment for less expense. The classical treatment relies on the therapeutic association Pyrimethamine + Adiazine + corticosteroids which will be used during acute phases, at ordinary doses, but may be prolonged further over many months in difficult cases. Severe forms are those that are spontaneously severe or increased with the exclusive use of corticosteroids in previous attacks, noticeably when injected by local route, and in bilateral forms. Prevention of ocular toxoplasmosis is represented by the detection of sero-conversion in mother and treatment in the newborn. Due to the legal aspect of this procedure in France, the incidence of congenital toxoplasmosis has already decreased during the past years and will continue to diminish in the next future. However the possibility of acquired forms cannot be excluded, even in non immuno-depressed patients.

Topics: Adrenal Cortex Hormones; Chronic Disease; Drug Therapy, Combination; Humans; Infant, Newborn; Leucovorin; Pyrimethamine; Toxoplasmosis, Ocular

Topics: Adult; Female; Humans; Leucovorin; Leukopenia; Pyrimethamine; Thrombocytopenia; Toxoplasmosis, Ocular

Active, recurrent, protracted toxoplasmic retinochoroiditis that had been unresponsive to intensive medical therapy with pyrimethamine, sulfamethoxypyridazine, intramuscular folicic acid, or clindamycin and corticosteroids, was treated with photocoagulation in five eyes. Four eyes healed rapidly within a few weeks. In one patient's eye, lens and vitreous opacities prevented adequate treatment with the red III intensity level of the xenon are photocoagulator. Subsequent surgical diathermy and cryocoagulation resulted in prompt healing of the lesion. Noninvasive photocoagulation of active toxoplasmosis retinochoroiditis is recommended in protracted cases if the media are clear, the macula is threatened, or there are severe complications from systemic medications.

Topics: Adolescent; Adult; Chorioretinitis; Chronic Disease; Drug Therapy, Combination; Female; Humans; Leucovorin; Light Coagulation; Male; Middle Aged; Prednisone; Pyrimethamine; Sulfadiazine; Toxoplasmosis, Ocular

Topics: Chorioretinitis; Glucocorticoids; Humans; Leucomycins; Leucovorin; Pyrimethamine; Sulfonamides; Toxoplasmosis, Ocular

Topics: Diagnosis, Differential; Eye; Female; Humans; Leucovorin; Prednisone; Pregnancy; Pregnancy Complications, Infectious; Pyrimethamine; Sulfadiazine; Toxoplasmosis; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

Topics: Adrenal Cortex Hormones; Chorioretinitis; Humans; Leucovorin; Pyrimethamine; Sulfadiazine; Toxoplasmosis, Ocular

Topics: Anemia; Anemia, Macrocytic; Blood Platelets; Drug Therapy; Folic Acid; Hemoglobinometry; Humans; Leucovorin; Leukocyte Count; Metabolism; Myocarditis; Pigmentation Disorders; Purpura; Purpura, Thrombocytopenic; Pyrimethamine; Sulfonamides; Thrombocytopenia; Toxicology; Toxoplasmosis; Toxoplasmosis, Ocular

Topics: Eye; Folic Acid; Injections; Injections, Intraperitoneal; Injections, Subcutaneous; Leucovorin; Mice; Pyrimethamine; Research; Statistics as Topic; Toxicology; Toxoplasmosis; Toxoplasmosis, Animal; Toxoplasmosis, Ocular

Topics: Adrenal Cortex Hormones; Blood Platelets; Drug Therapy; Erythrocyte Count; Hematocrit; Hemoglobinometry; Humans; Leucovorin; Pyrimethamine; Sulfadiazine; Toxicology; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Ocular; Uveitis