Acquired Ocular Toxoplasmosis in Brazilian Patients

Abstract

Purpose: : To better understand the distinguishing features of ocular toxoplasmosis (OT) following two different modes of Toxoplasma gondii infection, e.g. congenital versus acquired, we evaluated the interval between documented systemic toxoplasmic infection to the first detection of OT in a subset of Brazilian patients.

Methods: : This is a retrospective review of charts of 2168 patients evaluated at the Uveitis Section of the Hospital São Geraldo at the Universidade Federal de Minas Gerais, Brazil, from April 1982 to October 2007. After a thorough evaluation, 1552 patients were given the diagnosis of presumed OT and of these, 47 were considered to have acquired toxoplasmic infection by demonstrating positive anti-T. gondii IgG and IgM antibodies. The following data was collected: clinical presentation of systemic toxoplasmosis and interval since systemic disease to the first detection of OT. Patients’ age and gender as well as clinical presentation of the ocular disease at the time of first detection were evaluated.

Results: : Patients with documented primary toxoplasmic infection presented with a range of findings at initial diagnosis: lymphadenopathy (n=21), unspecific (fever, myalgia, adynamia, headache, hepatosplenomegaly; n=6), pneumonia (n=1), ocular symptoms only (OT; n=8), and indeterminate (n=7). The remaining four patients seroconverted during pregnancy and were all followed subsequently at the same center by the first author. The interval between the first findings of acquired systemic infection to the detection of OT varied: 0 (n=8), 1-90days (n=20), 91days-36months (n=9), >36months (n=10). The mean (SD) age of the 47 patients (male, 27; female, 20) at the time of the detection of OT was 34.26±15.69 (range, 6 to 67 years). OT presented as retinochoroiditis in 44 patients, papillitis in 1 patient, and anterior granulomatous uveitis in 1. In the remaining patient, a 12-years-old child, a drop of visual acuity associated with an epiretinal membrane was the only ocular features identified at the time of systemic disease.

Conclusions: : In our series of patients with acquired OT, we demonstrate that OT can develop up to 23 years after the initial systemic infection.

Keywords: toxoplasmosis • clinical (human) or epidemiologic studies: natural history • inflammation