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ATYPICAL FORMS OF EYE TOXOPLASMOSIS IN CHILDHOOD. CASE REPORTS


Authors: J. Krásný 1;  J. Šach 2;  E. Daňková 3
Authors place of work: Oční klinika FN Královské Vinohrady, Praha 1;  Ústav patologie, 3. lékařská fakulta Univerzity Karlovy, Praha 2;  Imunia s. r. o. a Imumed s. r. o., Praha 3
Published in the journal: Čes. a slov. Oftal., 78, 2022, No. 5, p. 258-270
Category: Case Report
doi: https://doi.org/10.31348/2022/27

Summary

Aim: To present an outline of acquired atypical forms of ocular toxoplasmosis (OT) in childhood, with reference to the 100th anniversary of the discovery of this etiology by Professor Janků from Czechoslovakia, who was first to describe the clinical congenital picture of OT characterised by macular scar.

Material and Methods: Symptoms of intraocular bilateral neuritis appeared in a 6-year-old girl, with visual acuity (VA) bilaterally 0.1. Toxoplasmic etiology was demonstrated in laboratory tests, and the patient was immunocompetent. Following treatment with macrolide antibiotic and parabulbar application of corticosteroid, the condition was normalised stably at VA 1.0 in both eyes. Bilateral retinal vasculitis was determined in an 8-year-old boy, with VA of 0.25 in the right eye and 0.25 in the left, with a medical history of strabismus detected after suffering from varicella. The examination for toxoplasmosis was negative, but pronounced general hypogammaglobulinaemia classes IgG, IgM and IgA was detected. Immunosuppressive and immunomodulatory therapy did not produce the desired effect, and the condition progressed to retinochoroiditis. Due to blindness and dolorous glaucoma, enucleation of the right eye was performed at the age of 15 years. Histologically toxoplasmic cysts with bradyzoites were detected, a subsequent laboratory test demonstrated toxoplasmic etiology upon a background of persistent regressing hypogammaglobulinaemia. General anti-toxoplasma and subsequent immunosuppressive treatment did not produce the desired effect, and at the age of 22 years the patient lost his sight also in the left eye.

Conclusion: Atypical form of OT intraocular neuritis in an immunocompetent patient had a favourable course, whereas retinal vasculitis with retinochoroiditis in a temporarily immunocompromised patient ended in bilateral blindness.

Keywords:

Toxoplasmosis – Professor Janků – hypogammaglobulinaemia – intraocular neuritis – retinal vasculitis – retinochoroiditis – varicella


Zdroje

1. Říhová E, et al. Uvetitidy [Uveites], 1.ed., Praha (Czech Republic); Grada; 2009; Jeníčková D. Toxoplasmóza [Toxoplamosis], Chapter 2.1.2. pp. 32-34. Czech.

2. Kolin J. Odhalení pamětní desky Prof. MUDr. Josefa Janků (1886-1968). [The uveiling of the memorial plaque of professor Josef Janků, MD. (1886-1968)]. Ces Slov Oftalmol. 2008;64:252. Czech.

3. Řehák S, Řehák J. Historie očního lékařství v Čechách, na Moravě a na Slovensku. [History of ophthalmology in the Bohemia, Moravia and Slovakia]. Ces Slov Oftalmol. 2002;58: suppl. 35-36. Czech.

4. Janků J. Patogenese a patologická anatomie vrozeného kolobómu Toxoplasmosy žluté skvrny oka na normálně velikém a mikroftalmickém oku s nálezem parazita v sítnici [Patogenesis and pathologic anatomy of congenital coloboma of toxoplasmosis yellow spot of the eye on a normaly large and microophthalmia a finding of a parasite in the retina]. Cas Lek Ces. 1923;62:1021- 1027. Czech.

5. Janku. J. Die pathogenese und pathologische anatomie des sogenannten ageborenen koloboms des gelhen flecks in normal grossen sowie mikrophalmischen auge mit parasi- tenbefunl in der netzhaut. Cls Parasit.1959;6:9-16. German

6. Pepose JS, Holland GH, Wilhalmus KR. Ocular Infection Immunity. St. Louis (USA); Mosby; 1996; Holland GH. O´Connor R, Belfort R, Remington JS. Toxoplasmosis, Chapter 85. pp. 1183- 1224.

7. Scherer J, Iliev ME, Halberstadt M, et al. Visual function in human ocular toxoplasmosis. Br J Ophthalmol. 2007;91:233-236.

8. Divišová G, Kadlecová V, Lomíčková H, Brůnová B. Dětské uveitidy. [Childhood uveitis]. Cesk Oftalmol. 1967; 23:86-94. Czech.

9. Lomíčková H. Endogenní uveitid u dětí. [Endogenous uveitis in childhood]. Cesk Oftalmol. 1973; 29:213-220. Czech.

10. Maršolková K. Timkovič J. Lesková V. et al. Congenital central toxoplasma chorioretinitis – Case study. Ces Slov Oftal. 2018;74:114- 118. doi:10.31348/2018/1/6-3-2018

11. Bosch-Driessen L, Berendschot Z, Ongkosuwito J, Rothova A. Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology. 2002;109:869-878.

12. Simek M. Ozdal PC, Kocer AM. Optic nerve involoment in ocular toxoplasmosis: 12 year data from a tertiary center in Turkey. Arq Bras Oftalmol. 2019;82:302-309.

13. Garza-Leon M, Garcia LA. Ocular toxoplasmosis: clinical characteristics in pediatric patients. Ocul Immunol Inflamm. 2012;20:130- 138.

14. Kraus-Mackiw E, O´Connor GR. Uveitis - Pathophysiology and Therapy. New York (USA); Thieme – Stratton; 1983; O´Connor GR. Endogenous uveitis, Chapter 4. pp. 117-151.

15. Wyler DJ, Blockman HJ, Lunda MN. Cellular hypersensitivity to toxoplamosis and retinal antigens in patients with toxoplasmal retinochoroiditis. Am J Trop Med. 1980;29:1181-1192.

16. Nussenblatt RB, Gery I, Ballontine EJ, Wacker WB. Cellular immune responsiveness of uveitis patient to retinal S-antigen. Am J Ophthalmol. 1980; 173:89-95.

17. Bečvář R. Primární vaskulitidy – aktuální diagnostika a léčba. [Primary vascultitis – current diagnosis and treatment]. Ces Slov Patol. 2020; 56:74-82. Czech.

18. Krásný J, Šach J, Daňková, E. Oboustranná panuveitida komplikovaná toxoplasmovou infekcí při vrozené hypogamaglobulinémii. [Bilateral panuvetis with complicity of toxoplasmosa infection in congenitale hypogamaglobulinemia]. Volume of abstrakt XIV. Symposium of pediatric ophthalmology, ISBN 978-80-89797-47-9, Bratislava, 2019: 13.

19. Liu Q, Wang ZD, Huang SY, et al. Diagnosis of toxoplasmosis and typing of toxoplamosis gondi. Ocul Immunol Inflamm. 2018;26:1200- 1202.

20. Rajput R, Denniston AK, Murray PI. False negative toxoplasmosis serology in an immunocopromised patient with PCR positive ocular toxoplasmosis. doi: 10.1080/09273948.2017.1332769

21. Munoz-Ortiz J, Rubio-Romero OL, Cedeno MC, et al. A white circular- spot pattern of iridis atrophy associated with Varicella-zooster virus and Toxoplamosis gondii coinfection: a case report. BMC Ophthalmol. 2020;20:479. doi: 10.1186/s12886-020-01748-8

22. Yanoff M, Sassani JW. Ocular Pathology, 6th ed. New York (USA); Mosby; 2009; Yanoff M. Parasitic diseases, Chapter 5, pp. 88-90.

23. Holland G.N. Ocular toxoplasmosis: a globalreassessment. Part I: epidemiology and course of disease. Am J Ophthalmol. 2003;136:973-988.

24. Eyles DE, Coleman N. Synergitic effect of sulfodiazine and daraprim against experimental toxoplasmosis in the mouse. Antibiotic chemother. 1953;3:483-490.

25. Geleneky M, Prášil P, Kodym, P. Doporučený postup pro diagnostiku a léčbu toxoplasmózy. [Recommended diagnosis and treatment of toxoplamosis]. Czech. www.infekce.cz/doportoxo17

26. Ozgonul C, Besirdi CG. Recent development in the diagnosis and treatment of ocular toxoplasmosis. Ophthmol Res. 2017;57:57:1- 12.

27. Tabbara KF, O´Connor GR. Treatment of ocular toxoplasmosis with Clindamycin and Sufadiazine. Ophthalmology. 1980;87:129-134.

28. Del Barno LT, Morelo HH, Cuadro MM, et al. Intravitreal clindamycin as a therapeutic alternative in severe ocular toxoplasmosis. Arch Soc Esp Oftamol. 2019;94:602-604.

29. Zamora YF, Arantes T, Reis FA, et al. Local treatment of toxoplasmosis retinochorioiditis with intravitreal clindamycin and dexamethazone. Arq Bras Oftalmol. 2015;78:216-219.

30. Rothova A, Meenken C, Buitenhuis HJ, et al. Therapy for ocular toxoplasmosis. Am J Ophthalmol. 1993;115:517-523.

31. Matias M, Gomes A, Marques T, Fonseca AC. Ocular toxoplasmosis: a very rare presentation in an immunocompetent paient. BMJ Case Rep. 2014: doi. 11:11136/BCR-2014-205846

32. Pleyer U, Ness T, Garweg J. Prävention das Wiederauftretens von Toxoplasmosis – Was? Wie? Dem? [Prevention of Recurrence of Toxoplasmosis – What? How? Whom? ]. Klin Monbl. Augenheilkd. 2020;237:559-604. German.

33. Holland G.N. Ocular toxoplasmosis: a globalreassessment. Part II: disease manifestation and management. Am J Ophthalmol. 2004;137:1-17.

34. Reich M, Becker MD, Mackensen F. Influence of drug therapy on the risk of recurrence of ocular toxoplasmosis. Br J Ophthalmol. 2016;100:195-199.

35. Shah NJ, Shah U. Intravitreal ranibizulab for the treatment of choriodal neovascularization secundary to ocular toxoplasmosis. Indian J Ophthalmol. 2011;59:318-319.

36. Korol AR, Zborovska O, Kustrym T, et al. Intravitreal aflibercept for choriodal neovacularization associated with chorioretinitis: a pilot study. Clin Ophthalmol. 2017;11.1351-1320.

37. Hrodek O, Vavřinec J et al. Pediatrics (Pediatrie). Praha (Czech Republik): Galén; 2002. Chapter 28. Havlík J Infectious disease (Infektologie): pp. 626-627. Czech.

38. Pepose JS, Holland GH, Wilhalmus KR. Ocular Infection Immunity. St. Louis (USA); Mosby; 1996; Paulat-Longiton D, Danken E. Varicella- zoster virus disease. Chapter 72. pp.: 932-957.

39. Kitamei H, Namba K, Kitaichi N, et al. Chickenpox chorioretinitis with retinal exudates and periphlebitis. Case Rep Ophthalmol. 2012;3:180-184.

40. Poonyathalang A, Sukavatcharin S, Sujirakal T. Ischemic retinal vasculitis ab 18-year-old man with chickenpox infection. Clin Ophthalmol. 2014;8:441-443.

41. Shin YU, Kim J, Hong EH, et al. Varicella-Zoster virus associated necrotizing retinitis after chickenpox in a 10-year-old female: a case report. Pediatric Infect Dis J. 2017; 36:1008-1011.

42. Fernandez de Castro LE, Sarraf OA, Hawthorne KM, et al. Ocular manifestation after primary varicella infection. Cornea. 2006;25:866-867.

43. Tappeiner C, Aebi C, Garweg JG. Retinitis and optic neuritis a child with chickenpox: case report and review of literature. Pediatric Infect Dis J. 2010;29:1150-1152.

44. Ross A, McLean TW, Farber R, et al. Retinitis following varicella in a vaccinated child with acute lymphoblastic leukemia. Pediatr Blodd Cancer. 2005;45:191-194.

45 Kumar A, Ziahosseini K, Saeed MU, et al. Bilateral viral retinitis with immune deficiency because of purine nucleoside phosphorylase deficiency. Retin Cases Brief Rep. 2012; 6:153-155.

46. Šach J, Krásný J. Ocular toxoplasmosis. Protocol of 49. annular meeting of EOPS (Europen Ophthalmological Pathology Society), Dublin, 2010.

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