1/7. Diffuse toxoplasmic retinochoroiditis as the initial manifestation of acquired immunodeficiency syndrome.Toxoplasmic retinochoroiditis is an important opportunistic retinal infection in human immunodeficiency virus (hiv)-infected patients. It may present as diffuse necrotizing retinochoroiditis instead of a focal lesion and may be the initial manifestation of hiv infection. A 50-year-old heterosexual man presented with blurred vision in his left eye of 3 months' duration. Fundus examination revealed diffuse necrotizing retinochoroiditis, mainly at the posterior pole, with marked vitritis in the left eye. Serologic studies and aqueous fluid antibody titers indicated recent toxoplasmic infection. Positive enzyme immunoassays (EIA) and Western blot tests proved hiv infection. The retinochoroiditis and vitritis improved after an antitoxoplasmic regimen with trimethoprim-sulfamethoxazole (TMP-SMX). Nonetheless, toxoplasmic encephalitis developed 6 months after the onset of ocular toxoplasmosis and responded well to TMP-SMX. This is the first case of toxoplasmic retinochoroiditis as the initial manifestation of AIDS reported in taiwan. We suggest that toxoplasma infection should be included in the differential diagnosis of diffuse necrotizing retinochoroiditis and vitritis. We also recommend that adults with newly diagnosed ocular toxoplasmosis be screened for hiv infection.- - - - - - - - - - ranking = 1keywords = toxoplasmosis (Clic here for more details about this article) |
2/7. Too late prenatal diagnosis of fetal toxoplasmosis: a case report.OBJECTIVE: We describe a case of severe fetal hydrocephalus due to toxoplasmosis which could not be diagnosed until late gestational age due to the lack of a serologic surveillance program during pregnancy; moreover, this case points to the usefulness of molecular biology tools in the diagnostic process. Abnormal ultrasound in the 2nd trimester was noticed and toxoplasma gondii was demonstrated in amniotic fluid at the 28th week of gestation both by PCR and by mice inoculation. Fansidar and folinic acid were administered. The newborn suffered from progressive hydrocephalus, seizures, and pathological muscular tonus; ultrasound examination showed massive cerebral calcifications. Ophthalmologic examination revealed bilateral choroidoretinitis. Congenital toxoplasmosis was confirmed by the detection of anti- T. gondii IgM and IgA in the neonatal serum. CONCLUSION: The presented case is an example of severe fetal toxoplasmosis diagnosed and treated in utero.- - - - - - - - - - ranking = 3.9857942547905keywords = toxoplasmosis, gondii (Clic here for more details about this article) |
3/7. toxoplasma gondii retinochoroiditis and optic neuritis in acquired immune deficiency syndrome. Report of a case.A 29-year-old man with acquired immune deficiency syndrome (AIDS) was found to have a retinochoroiditis and optic neuritis of his left eye. Results of fundus examination showed inflammatory and hemorrhagic retinal lesions consistent with retinitis due to cytomegalovirus infection. A computed tomographic (CT) scan demonstrated enlargement of the optic nerve. The eye was enucleated and results of histopathologic examination showed retinal necrosis with underlying choroiditis and an optic neuritis. Numerous encysted toxoplasma gondii organisms were present in the retina and tachyzoites were present in the optic nerve. To the authors' knowledge this is the second histologically documented case of toxoplasma optic neuritis in a patient with AIDS.- - - - - - - - - - ranking = 1.2144856369762keywords = gondii (Clic here for more details about this article) |
4/7. Toxoplasmic retinochoroiditis: electron-microscopic and immunofluorescence studies of formalin-fixed tissue.An 82-year-old white man had bilateral, chronic recurrent uveitis caused by toxoplasma gondii. In spite of extensive therapy for toxoplasmosis, the left eye became painful and blind and was enucleated. Histopathologically, the retina disclosed unusually large numbers of necrotic cysts and a few presumably viable cysts containing crescent-shaped organisms and scanty free forms of T gondii. Electron-microscopic studies confirmed the presence of a true wall of the cysts as well as additional ultrastructural features highly characteristic of the parasite. Immunofluorescent studies of the formalin-fixed tissue demonstrated quite vividly the cysts, which stained variably according to the stage of viability of the organisms. In cases in which toxoplasmic retinochoroiditis has been suspected clinically but routine histologic preparations fail to reveal the organisms, the remaining formalin-fixed tissue should be examined by specific immunofluorescent methods to demonstrate antigenic material of the causative parasite.- - - - - - - - - - ranking = 0.98579425479049keywords = toxoplasmosis, gondii (Clic here for more details about this article) |
5/7. Bilateral toxoplasma retinochoroiditis in a patient with acquired immune deficiency syndrome.A 32-year-old patient with acquired immune deficiency syndrome (AIDS) was evaluated for bilateral visual loss accompanied by uveitis, vitritis and retinochoroiditis. Diagnostic vitrectomy was performed on the right eye, and the diagnosis of ocular toxoplasmosis made. central nervous system involvement was suggested by ring enhancing lesions on CT scan. The patient improved on a pyrimethamine, sulfadiazine and clindamycin, but succumbed to disseminated toxoplasmosis when treatment was discontinued.- - - - - - - - - - ranking = 6.1825308097274keywords = toxoplasma, toxoplasmosis (Clic here for more details about this article) |
6/7. Opportunistic toxoplasmic retinochoroiditis following chemotherapy for systemic lymphoma. A light and electron microscopic study.After a prolonged period of chemotherapy for a disseminated nodular lymphoma, a 51-year-old woman developed a white lesion in the left macular region, in the absence of any overt lymphomatous disease elsewhere. The initial retinal diagnosis was nonetheless a lymphomatous infiltrate. Due to her severely immunocompromised state, the patient developed pneumonia and died. The involved left eye was examined postmortem by light and electron microscopy. The retinal lesion was discovered to be caused by infection with toxoplasma gondii, which on postmortem evaluation was also found in the brain together with subclinical lymphomatous disease and multifocal leucoencelphalopathy. Many viable and intact cysts were observed floating within the necrotic retina as well as lodged within recognizable retinal cells. Most of the organisms were encysted bradyzoites, although a rare tachyzoite was discovered in the extracellular space. Unusual features examined ultrastructurally were a preretinal membrane formed exclusively by glial cells, residual proliferating glial cells within the retina that were frequently related to surviving capillaries, and a multilaminar spindle cell placoid proliferation of pigment epithelial cells, assuming almost pseudo-sarcomatous proportions. Banded extracellular membrane material was focally observed between the proliferating pigment epithelial cells. No neoplastic lymphoreticular cells were discovered within the choroid, but a curious feature was the production of basement membranes by the surviving choroidal melanocytes. toxoplasmosis should therefore be considered along with fungi and viruses in the differential diagnosis of white retinal lesions appearing in immunocompromised patients.- - - - - - - - - - ranking = 0.24289712739524keywords = gondii (Clic here for more details about this article) |
7/7. Evaluation of laser flare-cell photometry in the appraisal and management of intraocular inflammation in uveitis.BACKGROUND: Laser flare-cell photometry enables objective and quantitative measurement of anterior chamber inflammation. Systematic data currently are used mainly for clinical research; few are yet available in uveitis. The authors prospectively studied the amount, duration, and pattern of inflammation for well-defined uveitic conditions and evaluated the potential usefulness of laser flare-cell photometry in uveitis. methods: Mean initial flare was calculated in HLA-B27-positive acute anterior uveitis, acute herpes zoster uveitis, acute retinal necrosis (ARN), Fuchs heterochromic cyclitis, intermediate uveitis (pars planitis-type), posterior sarcoidosis, posterior pole toxoplasmosis, and birdshot chorioretinopathy. Evolution of aqueous flare and cells was analyzed for acute anterior uveitis, ARN, and pars planitis treated for cystoid macular edema (CME), all of which received a standardized therapy. RESULTS: blood-aqueous barrier disruption was very pronounced in acute anterior uveitis (170.2 /- 33 photons/msecond), ARN (177.4 /- 88 photons/msecond), moderate in posterior sarcoidosis (38.1 /- 11 photons/msecond), acute zoster uveitis (25.8 /- 6.1 photons/msecond), and pars planitis (19.1 /- 2.9 photons/msecond) but only minimal in Fuchs heterochromic cyclitis (10.2 /- 3.5 photons/msecond), toxoplasmosis (9.0 /- 1.2 photons/msecond) and birdshot chorioretinopathy (5.7 /- 1.1 photons/msecond). For acute anterior uveitis, ARN, and pars planitis with CME, the inflammatory patterns were determined. The potential of laser flare-cell photometry for precise follow-up and adjustment of therapy was illustrated in cases of anterior and posterior uveitis. CONCLUSION: The authors' findings show that laser flare-cell photometry allows quantitative assessment of inflammation in uveitis and contributes to improved management of patients with uveitis.- - - - - - - - - - ranking = 1keywords = toxoplasmosis (Clic here for more details about this article) |