trimethoprim--sulfamethoxazole-drug-combination and Retinitis

Topics: Anti-Infective Agents; Choroiditis; Dose-Response Relationship, Drug; Follow-Up Studies; Forecasting; Humans; Recurrence; Retinitis; Retrospective Studies; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To determine if patients with inactive chorioretinitis lesions who experience chronic toxoplasmic uveitis test PCR positive for Toxoplasma in their ocular fluids.. Two patients undergoing long-term anti-toxoplasmic treatment developed chronic uveitis and vitritis. They underwent therapeutic and diagnostic pars plana vitrectomy. Patient specimens were tested for toxoplasmosis by real-time PCR and nested PCR. Patient specimens were also tested for the presence of Toxoplasma antibodies that recognise allelic peptide motifs to determine parasite serotype.. Patients tested positive for Toxoplasma by real-time PCR at the B1 gene in the vitreous and aqueous humours of patient 1, but only the vitreous of patient 2. Patients were not parasitemic by real-time PCR in plasma and blood. During surgery, only old hyperpigmented toxoplasmic scars were observed; there was no sign of active retinitis. Multilocus PCR-DNA sequence genotyping at B1, NTS2 and SAG1 loci established that two different non-archetypal Toxoplasma strains had infected patients 1 and 2. A peptide-based serotyping ELISA confirmed the molecular findings.. No active lesions were observed, but both patients possessed sufficient parasite DNA in their vitreous to permit genotyping. Several hypotheses to explain the persistence of the vitritis and anterior uveitis in the absence of active retinitis are discussed.

Topics: Anti-Infective Agents; Antibodies, Protozoan; Antiprotozoal Agents; Chronic Disease; DNA, Protozoan; Enzyme-Linked Immunosorbent Assay; Female; Genotyping Techniques; Glucocorticoids; Humans; Male; Middle Aged; Prednisone; Real-Time Polymerase Chain Reaction; Retinitis; Serotyping; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Uveitis; Vitrectomy; Vitreous Body

Topics: Adolescent; Anti-Infective Agents; Child; Female; Humans; Immunoglobulin G; Male; Pigment Epithelium of Eye; Prednisone; Retinitis; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

Cat-scratch disease is a self-limited infection characterized by subacute regional lymphadenitis, which is usually preceded by a history of being scratched by a cat infected with the Bartonella species. Neuroretinitis, retinochoroiditis, isolated papillitis and peripapillary angiomatosis are features of posterior segment involvement. However, vision loss is very rare. We report a patient with cat-scratch disease associated with unilateral neuroretinitis and peripapillary serous retinal detachment, and discuss its fluorescein and indocyanine green angiographic features.

Topics: Adolescent; Animals; Anti-Infective Agents; Cat-Scratch Disease; Cats; Fluorescein Angiography; Humans; Indocyanine Green; Lymph Nodes; Male; Retinal Detachment; Retinitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

Neuroretinitis is a clinical entity usually seen in young healthy adults, that is characterized by rapid profound unilateral loss of vision and includes optic nerve head edema, splinter hemorrhages, macular exudate in a stellate pattern, and variable vitreous inflammation. There are numerous entities that can cause a picture of neuroretinitis ranging from vascular to infectious to autoimmune.. We report two patients with neuroretinitis, who presented with unilateral blurred vision and had serologic evidence of Toxoplasma gondii infection.. Both patients responded well to treatment with systemic antibiotics and corticosteroids. Visual acuity returned to 20/60 in one patient and 20/20 in the other.. Although the etiology is usually idiopathic, infectious causes of neuroretinitis, including toxoplasmosis, should be kept in mind in order to maintain visual acuity by early diagnosis and appropriate therapy.

Topics: Animals; Antibodies, Protozoan; Antiprotozoal Agents; Child; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Male; Middle Aged; Optic Neuritis; Prednisolone; Retinitis; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

Cat scratch disease is a subacute regional lymphadenitis usually preceded by a history of being scratched by a cat or young kitten. The spectrum of illness ranges from mild self-limited adenopathy to severe systemic disease, including hepatosplenomegaly, encephalopathy, osteolytic lesions, splenic abscesses, mediastinal masses, and neuroretinitis. Vision loss is a rare complication of the disease. The authors report a patient with cat scratch disease associated with acute febrile illness, lymphocytic meningitis, and acute vision loss secondary to neuroretinitis. To their knowledge, this is the first ophthalmic case reported in which the diagnosis is supported by both a positive skin test and positive histopathology.

Topics: Cat-Scratch Disease; Child; Dexamethasone; Female; Fundus Oculi; Humans; Optic Neuritis; Retinitis; Skin Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Vision Disorders; Visual Acuity