Abstract
Purpose: :
To analyze the proportion of acquired or congenital infections in cases of ocular toxoplasmosis, and to compare clinical manifestations in congenital and acquired cases.
Methods: :
We retrospectively analyzed the charts of consecutive patients with a diagnosis of ocular toxoplasmosis seen between November 1994 and July 2005 in a referral center for uveitis. All patients with active or inactive lesions consistent with the diagnosis of ocular toxoplasmosis were included. Data from the French program for prevention of congenital toxoplasmosis, first implemented in 1978, was used to assess the origin of infection. The data were recorded at first examination and included patients’ serological status prior to their ocular manifestations and patients’ mothers serological status before, during, and/or after pregnancy. Based on these data, the origin of infections was categorized as congenital proven or presumed, acquired proven or presumed, or unknown.
Results: :
Of 425 cases of ocular toxoplasmosis, 100 (23.5 %) were acquired (69 proved and 31 presumed), 62 (14.6 %) were congenital (51 proved and 11 presumed), and 263 (61.9 %) were of unknown origin. Median age (25th–75th percentile) at first presentation was 18 years (15–23) and 7 years (1–14) respectively for acquired and congenital group (p < 0.0001). Bilateral chorioretinitis was observed in 4 % of acquired cases and in 43.5 % of congenital cases (p < 0.0001). Active chorioretinitis without scars was seen in 87 patients (20.5 %) and active chorioretinitis with scars in 142 patients (33.4 %). Active chorioretinitis without scars were present in 29 of 87 (33.3 %) in acquired cases and in 4 of 87 (4.6 %) in congenital cases (p < 0.0001). Among 62 congenital cases, inactive chorioretinitis were present in 49 (79 %) patients. Mean decimal visual acuity was 1.0+/– 7 lines best eye and 0.4 +/– 3 lines worse eye in acquired infection, and 0.6 +/– 4 lines best eye and 0.25 +/– 2 lines worse eye in congenital cases (p < 0.05).
Conclusions: :
The French program for the prevention of congenital toxoplasmosis provided a mean to assess the origin of infection, especially in younger patients. Although the majority of cases remained of unknown origin, of those that could been classified, acquired infection was a more frequent cause of ocular toxoplasmosis than congenital infection. Patients with congenital toxoplasmosis had presented at a younger age and more often had poor vision, chorioretinal scars and bilateral involvement than patients with acquired toxoplasmosis.
Keywords: toxoplasmosis • chorioretinitis • clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology