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Jose Daniel Diaz, Jorge Bustillo, David C Gritz; Ocular Toxoplasmosis: Clinical Features in 279 Patients from Central Cuba. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2869.
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Characterize ocular toxoplasmosis (OT) in patients seen at Centro Oftalmológico Provincial Hospital, Sancti Spiritus, Cuba.
This non-comparative case series utilized a prospective database for the study period from April 1, 2011 through March 31, 2013. Inclusion criteria were the clinical diagnosis of OT, characterized by focal retinochoroidal inflammation and response to therapy as expected. When indicated, serologic tests such as serum anti-Toxoplasma titers of IgM and IgG and other diagnostic modalities also helped support the diagnosis. Medical records were reviewed to confirm inclusion criteria and gather demographic and clinical data (visual acuity recorded as logMAR).
279 patients from 20 municipalities (in 5 provinces) in Central Cuba were diagnosed with OT during the study period. Seventy percent (n=195) were diagnosed with acquired OT (44.7% male, 55.3% female) with a mean age of 35.9 and 2% (n=5) were congenital (80% male, 20% female) with a mean age of 3.4. Of the acquired cases, 5.2% (n=13) acquired OT during pregnancy and 3.6% (n=9) were HIV positive. The time of onset for the T. gondii infection could not be determined in 28.3% (n=79) of patients. Unilateral disease was noted in 82% (n=229) of patients. Overall, clinical presentations were posterior uveitis (70.3%), quiescent focal retinochoroiditis (15.4%), panuveitis (11.1%), intermediate uveitis (2.5%), and anterior uveitis (0.7%). On presentation, 14% (n=39) of patients had a slight decrease (0.9-0.6) in visual acuity, 44.4% (n=124) a moderate decrease (0.5-0.2), and 41.6% (n=116) a marked decrease (< 0.1). Retinochoroidal lesions were most commonly located in Zone 1 (46.6%, n=130 patients). Recurrences occurred during the 24 month study period in 22% of patients (157 total episodes, range 1-6). Recurrences occurred most commonly in patients between the ages of 15 and 45 (72%, n=113 episodes). Patients treated with trimethoprim-sulfamethoxazole were less likely to develop a recurrence (P < 0.001).
To our knowledge, this is the first Index Medicus-listed report describing ocular toxoplasmosis in the Cuban population. Identifying and describing these patients will offer further insights into the characterization of ocular toxoplasmosis in the Caribbean and is an important first step in determining toxplasmosis and uveitis population-based rates of disease in Cuba.
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