We report a literature review and a case of ocular toxoplasmosis in a patient with multiple drug allergies, who was successfully treated with regular intravitreal clindamycin and subconjunctival dexamethasone. A Malay lady in her twenties presented to us with right eye blurring of vision of 2 weeks duration, which she described as a central scotoma. Visual acuity at presentation was hand movements. Examination revealed intense ocular inflammation. The right eye had anterior segment inflammation of 3+ cells with fine keratic precipitates, whilst the posterior segment revealed papillitis, vitritis, retinitis, choroiditis, vasculitis and hyperpigmented chorioretinal scar inferotemporal to fovea. Ocular coherence tomography showed intraretinal fluid and retinal thickening. Fluorescein angiography showed early hypofluorescence of the lesion with progressive hyperfluorescence and leakage from the optic disc. Immunoglobulin G serology of Toxoplasma gondii was raised and immunoglobulin M levels were normal. The patient developed an allergic reaction with classical antibiotic and antifolate therapy. She was successfully treated with regular two-weekly intravitreal clindamycin and subconjunctival dexamethasone and her best corrected visual acuity was 6/18 at the end of her treatment. Intravitreal injection of clindamycin and subconjunctival dexamethasone is a good option in patients of ocular toxoplasmosis who are allergic to oral medications.
Toxoplasmosis, Ocular

The authors have recently experienced 2 cases of ocular texoplasmosis which had poor vision. These cases were presumptive diagnosis of ocular toxoplasmosis by typical ocular lesion and hemmagglutinin test for toxoplasmosis. In addition to clinical observations, a brief review of literature has been described.
Diagnosis ; Toxoplasmosis ; Toxoplasmosis, Ocular*

The authors have recently experienced 3 cases of ocular toxoplasmosis. The diagnosis was based on typical ocular lesions and hemagglutination test for toxoplasmosis. In addition to some clinical observations, a brief review of literature has been described.
Diagnosis ; Hemagglutination Tests ; Toxoplasmosis ; Toxoplasmosis, Ocular*

Systemic infections that are caused by various types of pathogenic organisms can be spread to the eyes as well as to other solid organs. Bacteria, parasites, and viruses can invade the eyes via the bloodstream. Despite advances in the diagnosis and treatment of systemic infections, many patients still suffer from endogenous ocular infections; this is particularly due to an increase in the number of immunosuppressed patients such as those with human immunodeficiency virus infection, those who have had organ transplantations, and those being administered systemic chemotherapeutic and immunomodulating agents, which may increase the chance of ocular involvement. In this review, we clinically evaluated posterior segment manifestations in the eye caused by hematogenous penetration of systemic infections. We focused on the conditions that ophthalmologists encounter most often and that require cooperation with other medical specialists. Posterior segment manifestations and clinical characteristics of cytomegalovirus retinitis, endogenous endophthalmitis, toxoplasmosis, toxocariasis, and ocular syphilis are included in this brief review.
Bacteria ; Cytomegalovirus Retinitis ; Diagnosis ; Endophthalmitis ; Eye Infections ; HIV ; Humans ; Inflammation* ; Organ Transplantation ; Parasites ; Specialization ; Syphilis ; Toxocariasis ; Toxoplasmosis ; Toxoplasmosis, Ocular ; Transplants

Ocular toxoplasmosis is the most frequent etiological factor of the known retinochoroiditis in the world. But there are very few cases of confirmed toxoplasmosis in Korea. In this paper we report a 5 year old girl who had suffered from left visual disturbance since Aug, 1978. The HA. titer for toxoplasmosis was 1:2048 and she had a typical focal exudative retinochoroiditis in the macular lesion and one small daughter lesion on superior temporal retinal arteriolar branch. She was treated with oral acetyl spiramycin(600 mg.) for 6 months. After all the active retinochoroidal lesion was changed into scar tissue and the vision has improved slightly from 0.02 to 0.2 during the followup period of one year. And also the HA. titer had decreased to 1:512. The fluorescein angiographic finding could be a helpful method to determine the healed lesion after anti toxoplasmic theraphy.
Child, Preschool ; Cicatrix ; Female ; Fluorescein ; Follow-Up Studies ; Humans ; Korea ; Nuclear Family ; Retinaldehyde ; Spiramycin* ; Toxoplasmosis ; Toxoplasmosis, Ocular*

Ocular toxoplasmosis is a disease caused by the infection with Toxoplasma gondii through congenital or acquired routes. Once the parasite reaches the retina, it proliferates within host cells followed by rupture of the host cells and invasion into neighboring cells to make primary lesions. Sometimes the restricted parasite by the host immunity in the first scar is activated to infect another lesion nearby the scar. Blurred vision is the main complaint of ocular toxoplasmic patients and can be diagnosed by detection of antibodies or parasite DNA. Ocular toxoplasmosis needs therapy with several combinations of drugs to eliminate the parasite and accompanying inflammation; if not treated it sometimes leads to loss of vision. We describe here clinical features and currently available chemotherapy of ocular toxoplasmosis.
Animals ; Antiprotozoal Agents/therapeutic use ; Humans ; Toxoplasma/*isolation & purification ; Toxoplasmosis, Ocular/*drug therapy/parasitology

This prospective study was aimed to detect acute and chronic ocular toxoplasmosis by comparison of anti-Toxoplasma gondii IgM and IgG antibody levels and IgG avidity test. One hundred and seventeen patients with ocular toxoplasmosis (OT) who referred to the Farabi Eye Hospital, Tehran, Iran were included in this study. Of the patients, 77 cases were positive for anti-T. gondii IgG, and 8 cases were positive for anti-T. gondii IgM. IgG avidity test revealed 11, 4, and 102 cases were low, intermediate, and high, respectively, and 6.8% and 9.4% of cases were positive for IgM and IgG avidity tests, respectively (P=0.632). Agreement (Kappa value) between paired tests IgG-IgM, IgG-IgG avidity, and IgM-IgG avidity was 0.080, 0.099, and 0.721, respectively (P < 0.05). This study showed that conventional serologic tests (IgM and IgG levels) and IgG avidity correlate well each other and can be used to differentiate recent infections from old OT. It seems that reactivated old infections rather than recently acquired infections are majority of Iranian OT patients.
Antibodies ; Diagnosis ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Iran ; Prospective Studies ; Serologic Tests ; Toxoplasma ; Toxoplasmosis, Ocular

PURPOSE: This study sought to describe the different clinical features and presentations of primary ocular toxoplasmosis in a setting not demonstrating an outbreak of disease.METHODS: This was a retrospective review of patients presenting to uveitis management services in Auckland and Hamilton, New Zealand between 2003 to 2018 with uveitis and positive toxoplasmosis immunoglobulin M serology.RESULTS: We identified 16 patients with primary acquired toxoplasmosis infection and ocular involvement. The mean age was 53 years. Systemic symptoms were reported in 56% (9 / 16). Visual acuity was reduced to 20 / 30 or less in 50% of patients (8 / 16). A single focus of retinitis without a pigmented scar was the salient clinical feature in 69% (11 / 16). Optic nerve inflammation was the sole clinical finding in 19% (3 / 16). Bilateral arterial vasculitis was the sole clinical finding in 13% (2 / 16). A delay in the diagnosis of toxoplasmosis of more than two weeks occurred in 38% (6 / 16) due to an initial alternative diagnosis. Antibiotic therapy was prescribed in all cases. Vision was maintained or improved in 69% (11 / 16) at the most recent follow-up visit (15 months to 10 years). Relapse occurred in 69% (11 / 16), typically within four years from the initial presentation.CONCLUSIONS: Primary ocular toxoplasmosis presenting in adulthood is a relatively uncommon cause of posterior uveitis in New Zealand. This condition should be considered in any patient presenting with retinitis or optic nerve inflammation without a retinochoroidal scar. This disease tends to relapse; thus, close follow-up is required.
Cicatrix ; Diagnosis ; Follow-Up Studies ; Humans ; Immunoglobulin M ; Inflammation ; New Zealand ; Optic Nerve ; Recurrence ; Retinitis ; Retrospective Studies ; Toxoplasmosis ; Toxoplasmosis, Ocular ; Uveitis ; Uveitis, Posterior ; Vasculitis ; Visual Acuity

A 54-year-old man presented with blurred central vision in the right eye of two weeks' duration. On presentation, visual acuity was 40 / 50 in the right eye and fundus examination showed a whitish-yellow inflammatory lesion near an atrophic, pigmented retinochoroidal scar located in the superotemporal quadrant. Serologic assessment was negative for IgM, but serum IgG to toxoplasma was elevated. Spectral domain optical coherence tomography (SD-OCT) revealed increased reflectivity from the inner retinal layer, retinal thickening, and choroidal shadowing while focal posterior hyaloid thickening and detachment were observed in the new lesion. He was treated with trimethoprim/sulfamethoxazole, clindamycin, and prednisone. SD-OCT is helpful for definitively differentiating ocular toxoplasmosis from other retinal diseases.
Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Tomography, Optical Coherence/*methods ; Toxoplasmosis, Ocular/*diagnosis/drug therapy ; Visual Acuity

Toxoplasma gondii is a zoonotic parasite resulting in human infections and one of the infectious pathogens leading to uveitis and retinochoroiditis. The present study was performed to assess T. gondii infection in 20 ocular patients with chronic irregular recurrent uveitis (20 aqueous humor and 20 peripheral blood samples) using PCR. All samples were analyzed by nested PCR targeting a specific B1 gene of T. gondii. The PCR-positive rate was 25% (5/20), including 5% (1) in blood samples, 25% (5) in aqueous humor samples, and 5% (1) in both sample types. A molecular screening test for T. gondii infection in ocular patients with common clinical findings of an unclear retinal margin and an inflammatory membrane over the retina, as seen by fundus examination, may be helpful for early diagnosis and treatment.
Aqueous Humor/parasitology ; Blood/parasitology ; Chronic Disease ; Humans ; Polymerase Chain Reaction/*methods ; Recurrence ; Toxoplasma/genetics/*isolation & purification ; Toxoplasmosis, Ocular/*diagnosis/*parasitology ; Uveitis/*parasitology