Ophthalmological findings in children with congenital toxoplasmosis. Report from a Swedish prospective screening study of congenital toxoplasmosis with two years of follow-up

Congenital toxoplasmosis may lead to severe visual impairment or neurological sequelae in the child. PURPOSE: To study the severity of the primary and late ophthalmological dysfunction during a prospective incidence study of congenital toxoplasmosis in the Stockholm and Sk?ne counties. METHODS: Blood collected on phenylketonuria (PKU) cards from 40,978 consecutively born children were investigated for antitoxoplasma antibodies. Children with verified congenital toxoplasmosis were treated for 12 months with antiparasitic therapy and followed ophthalmologically, neurologically and serologically every third month. RESULTS: Three children had congenital toxoplasmosis. Two of these were asymptomatic at birth and would have escaped early detection without screening. One child had unilateral severe visual impairment and CNS involvement. The incidence of congenital toxoplasmosis was less than 1:10,000. CONCLUSION: Neonatal screening is of importance to diagnose asymptomatic infected children with congenital toxoplasmosis as treatment has been shown to reduce long-term sequelae. Ophthalmological investigations should start early and continue in co-operation with paediatricians.     

Vasoproliferative retinal tumors associated with peripheral chorioretinal scars in presumed congenital toxoplasmosis

· Background: The purpose of this retrospective clinical study was to demonstrate vascularization of peripheral hyperplastic chorioretinal scars in presumed congenital toxoplasmosis by choroidal vessels and secondly to report vasoproliferative tumors of the sensory retina seen in association with such lesions. · Methods: Retrospective study of a cohort of 13 patients with peripheral hypertrophic chorioretinal scars, including fluorescein angiography (eight eyes) and indocyanine green angiography (seven eyes). Congenital toxoplasmosis was serologically confirmed in seven cases and suspected on clinical grounds in six cases. · Results: Sixteen eyes exhibited a peripheral complex scar with a posterior atrophic and an anterior hypertrophic part. These scars were vascularized from the choroid. In eight of these eyes an additional vasoproliferative tumor was seen within or adjacent to the scar and in one fellow eye a vasoproliferative retinal tumor was found as well. These eyes experience visual loss, resulting from vitritis and exudative/traction retinal detachment. Regression of exudation was seen in five of seven cryocoagulated or endophotocoagulated tumors. · Conclusion: Peripheral hypertrophic scars in presumed congenital toxoplasmosis can be vascularized from the choroid. A vasoproliferative tumor of the sensory retina, secondary to presumed congenital toxoplasmosis scars, can cause vitritis and exudative/traction retinal detachment. Early coagulation of this lesion may prevent a poor outcome. Received: 22 June 1999 Accepted: 25 August 1999     

Upward extension of an atrophic tract of the retinal pigment epithelium associated with congenital macular toxoplasmosis

PURPOSE: To report an unusual case of gravitational atrophic tract of the retinal pigment epithelium in a 20-year old woman. METHODS: Case Report. RESULTS: The patient had macular cicatricial congenital toxoplasmic chorioretinitis in both eyes. In the right eye, an atrophic tract of the retinal pigment epithelium originating from the upper margin of the macular scar extended upwards toward the retinal periphery. CONCLUSION: The unusual upward direction of the atrophic tract of retinal pigment epithelium may be explained by the in utero head position during the active phase of the chorioretinal disease.     

Prevention of congenital toxoplasmosis; experience in the Netherlands

Prevention is the pre-eminent strategy to control congenital toxoplasmosis. In a trial study in the province South-Holland a program of both primary and secondary prevention during pregnancy was applied. 28000 women were enrolled. 55% of them were seronegative, and only 55 primary infections were traced amongst them. Although a conclusive evaluation of the results of the study has not yet been accomplished, this low figure will be discussed within the scope of certain logistic and organizational obstacles incurred in the so-called TIP (Toxoplasma Infection Prevention)-study in the Netherlands.     

Acute ophthalmoparesis (without ataxia) associated with anti-GQ1b IgG antibody: clinical features

OBJECTIVE: To examine the clinical features of acute ophthalmoparesis (AO) (without ataxia) associated with anti-GQ1b immunoglobulin G (IgG) antibody. DESIGN: Retrospective observational case series. PARTICIPANTS: Twenty-one subjects with AO (without ataxia) who had anti-GQ1b IgG. METHODS: Clinical features of 21 subjects with AO were analyzed. RESULTS: Seventeen had symptoms of antecedent infection. Gaze limitation was bilateral in 16 subjects and unilateral in five, indicative that laterality does not always negate AO. Nine subjects showed abducens paresis, and two limitation of abduction and adduction. Eight, who initially had bilateral abducens palsy, subsequently had impairment of adduction and vertical movement. These showed that bilateral abducens palsy followed by oculomotor nerve involvement is characteristic of AO. Muscle stretch reflexes were normal in nine subjects, hypoactive in eight, absent in three, and brisk in one. Distal paresthesias were present in seven subjects. Acellular cerebrospinal fluid (CSF) associated with raised protein concentration was detected in three. CONCLUSIONS: Antecedent infectious symptoms, characteristic limitation of ocular movement, areflexia, distal paresthesias, and CSF albuminocytologic dissociation are useful markers for diagnosing AO as well as anti-GQ1b IgG. AO can be considered a mild form of Miller Fisher syndrome or a regional variant of Guillain-Barré syndrome.     

Recent developments in the prevention and treatment of congenital toxoplasmosis

The manifestations of congenital toxoplasmosis vary considerably in degree, characteristics and time of onset. Options for prevention of the disease include the appropriate disposal of cat litter and the avoidance of ingestion of both contaminated food and undercooked meat by pregnant women. Immunisation of the domestic cat population is a consideration for the future. Alternatively, immunisation of sero-negative pregnant women awaits the introduction of an effective and safe reagent. Current treatment modalities are not universally effective and new drugs are the subject of active development and research. Screening of pregnant women or perhaps newborn infants are potential options but the cost effectivity has yet to be established in many countries and the results of treatment during pregnancy and early childhood are encouraging but are as yet unproven. The majority of patients with congenital toxoplasmosis eventually develop toxoplasmic retinochoroiditis. Current treatment options for this condition are outlined. Acquired immune deficiency syndrome (AIDS) may, in some cases, represent a recrudescence of congenital intracerebral infection. Current treatment strategies for this condition are discussed.     

State of the vitreous body in children with congenital uveitis

Comprehensive examinations of 150 children (229 eyes) with congenital uveitis have revealed vitreous changes in 75.9 percent. The structure of different opacities is presented and relationship between vitreous opacities patterns and subatrophy severity and intraocular pressure parameters detected. Recommendations are given on how to interpret the data of ultrasonic scanning and define the indications for opticoreconstructive surgery.     

儿童先天性重度上睑下垂的手术治疗

目的 探讨额肌腱膜瓣悬吊手术治疗先天性重度上睑下垂的时机、临床疗效和并发症.方法 对24例(36眼)施行了额肌腱膜瓣悬吊术治疗先天性上睑下垂的儿童患者进行回顾性分析.结果 随访3～6个月24例(36眼)全部都获得矫正,手术后2d35眼上睑下垂被矫正、仅1眼手术后第2天出现上眼睑血肿,打开释放血肿后次日恢复正常.手术后患者有不同程度眼睑闭合不全,于6个月内恢复正常.无眼睑内、外翻、睑缘畸形或暴露性角膜炎等并发症发生.结论 额肌腱膜瓣悬吊手术是治疗儿童先天性重度上睑下垂的良好方法.     

Thinning of the anterior capsule associated with congenital aniridia

PURPOSE: To report the unusual finding of intraoperative fragility of the anterior capsule in some patients with congenital aniridia and determine the histopathologic etiology of this finding. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Anterior lens capsule specimens were obtained from aniridic and nonaniridic patients during cataract surgery. The intraoperative behavior of each capsule was noted, after which the specimens were submitted for histopathologic evaluation. RESULTS: All anterior capsule specimens from the nonaniridic patients were of normal thickness. Some, but not all, anterior capsule specimens from the aniridic patients were remarkably thin. Thin capsules were associated with extreme intraoperative fragility. CONCLUSIONS: Greater awareness of anterior capsule fragility in some aniridic patients may reduce the risk of capsule complications and lead to safer surgical outcomes.     

Diagnostic value of specific local antibody production and nucleic acid amplification technique-nested polymerase chain reaction (nPCR) in clinically suspected ocular toxoplasmosis

OBJECTIVE: The study was to evaluate the diagnostic efficacy of nested polymerase chain reaction (nPCR) using primers targeting B1 gene of Toxoplasma gondii (T. gondii) with Witmer Desmonts coefficient (WDC) technique in intraocular fluids of clinically suspected toxoplasma retino choroiditis (TRC) patients. MATERIALS AND METHODS: Two hundred and seventy eight specimens from 189 patients (25 TRC patients and 164 controls) consisting of 189 serum samples and 89 intraocular fluids were included in the study. The clinical specimens were categorized into TRC patients (typical TRC lesion-group I & atypical TRC lesion-group II) and controls (voluntary blood donors-group III, patients undergoing uncomplicated cataract surgery-group IV, ocular inflammation of non-toxoplasma origin-group V). Detection of anti T. gondii IgG and IgM antibodies in serum samples and intraocular fluids were performed and WDC was calculated by the standard method. The standardized nPCR was applied on the 89 intraocular fluids. RESULTS: Clinical diagnosis of TRC based on fundus examination was considered to be the "gold standard." Anti T. gondii IgG/IgM antibodies were detected in serum by ELISA in 95.6% of 25 clinically suspected TRC patients (gp I and II), 28% of gp III, 40.4% of gp IV, and in 58.3% of gpV. Witmer Desmont's coefficient was positive in 72.7% (16/22) and nPCR in 59.1% (13/22) of TRC patients (gp I and II). Both WDC and nPCR were negative in all the controls. The difference in sensitivity of WDC and nPCR was not statistically significant (p=0.5247). CONCLUSIONS: Though both WDC and nPCR were reliable diagnostic techniques for ocular toxoplasmosis, nPCR is more acceptable because of the amount of specimen(s) required, rapidity, cost effectiveness, and direct evidence of T. gondii DNA in the intraocular fluids.     

Clinical and pathogenetic significance of Proteus mirabilis antibodies in uveitis associated with joint lesions in children and adolescents

Immunological studies in 95 children with uveitis associated with juvenile chronic arthritis revealed infection with Proteus mirabilis in 14.7% cases, mainly in cases with reactive arthritis and juvenile rheumatoid arthritis (JRA). A clear-cut relationship between P. mirabilis infection and severity of the disease was detected. In 85% children infected with P. mirabilis uveitis was associated with a rapid decrease of ocular functions and development of complications, one of the most frequent of which was vitreous fibrosis, generally not typical of classical rheumatoid uveitis. Antibodies to P. mirabilis were detected in 72.2% children with positive antinuclear factor, a marker of ophthalmoarticular rheumatic diseases. The pathogenetic significance of P. mirabilis in uveitis associated with articular involvement deserves further investigation, but even now the detection of P. mirabilis can be used as a marker of uveitis exacerbations and severity.     

先天性白内障儿童眼球发育的观察

目的通过观察眼轴和角膜屈光力,了解先天性白内障儿童的眼球发育状况.方法将64例单眼先天性白内障和107例双眼先天性白内障患儿分为1岁以下、1～3岁、4～5岁、6～9岁、10岁以上5个年龄组比较分析其眼轴和角膜屈光力情况.结果在P＝0.05水平上只有1～3岁组单眼先天性白内障患眼眼轴较健眼有显著性差异;单眼先天性白内障与双眼先天性白内障患眼轴长度无显著性差异;64.4%先天性白内障眼眼轴长于正常同龄儿童均值;单眼先天性白内障患儿的患眼与健眼间角膜屈光力无显著性差异.结论形觉剥夺只是影响先天性白内障眼轴发育的诸多因素之一,为儿童先天性白内障选择人工晶状体屈光度时也应考虑其他因素对眼轴发育的影响.