Original article
Respective Roles of Acquired and Congenital Infections in Presumed Ocular Toxoplasmosis

https://doi.org/10.1016/j.ajo.2008.06.027Get rights and content

Purpose

To analyze the roles of acquired or congenital infections in cases of ocular toxoplasmosis, and to compare their clinical manifestations.

Design

Retrospective, observational case series.

Methods

We analyzed the charts of consecutive patients with a diagnosis of ocular toxoplasmosis. Data from the French program for the prevention of congenital toxoplasmosis were used to assess the origin of infection. The data included patients' serologic status prior to their ocular manifestations and patients' mothers' serologic status before, during, and/or after pregnancy. Infections were categorized as congenital, acquired, or unknown.

Results

Of 425 cases of ocular toxoplasmosis, 100 (23.5%) were acquired, 62 (14.6%) were congenital, and 263 (61.9%) were of unknown origin. At the time of the study, the mean age of the patients with congenital ocular toxoplasmosis was 9.1 ± 8.8 years, and was 21.7 ± 12.6 years in the patients with acquired ocular toxoplasmosis (P < .0001). Bilateral chorioretinitis was observed in 4% of acquired cases and in 43.5% of congenital cases (P < .0001). In acquired infections, mean decimal visual acuity (VA) was 1.0 (logarithm of the minimum angle of resolution [logMAR] 0.0 ± 1 line) in the best eye and 0.4 (logMAR 0.4 ± 5 lines) in the worst eye. In congenital cases, mean decimal VA was 0.8 (logMAR 0.1 ± 4 lines) in the best eye and 0.25 (logMAR 0.6 ± 7 lines) in the worst eye (P < .05).

Conclusion

In cases where the origin of the infection could be determined, acquired infections were a more frequent cause of ocular toxoplasmosis than congenital infections. Cases of congenital ocular toxoplasmosis were more severe than acquired cases.

Section snippets

Methods

We analyzed retrospectively the charts of consecutive patients with a diagnosis of presumed ocular toxoplasmosis examined between November 1994 and July 2005 in a single referral center. The diagnosis of ocular toxoplasmosis was based on the clinical characteristics of the fundus lesions, and a positive toxoplasma serology. Cases with either active or scarred lesions, or both, were included. Patients with a known cause of immunodepression were excluded from the study. Retinochoroiditis was

Results

The study included 425 patients. Results of tests available to assess the origin of infection are shown in Table 1. Infection was acquired in 100 patients (23.5%): 69 (16.2%) definite and 31 (7.3%) presumed cases. Infection was congenital in 62 patients (14.6%): 52 (12.3%) definite and 10 (2.3%) presumed cases. This population included 34 children with congenital infection, referred for a systematic ophthalmic examination. The origin of the infection remained unknown in 263 cases (61.9%). Among

Discussion

Programs for the prevention of congenital toxoplasmosis have been tested or discussed in several countries or states.7, 8, 9, 10, 11 To our knowledge, France and Austria are the only countries in which testing for toxoplasmosis is required by law in women of childbearing age. France has the most stringent program, but its epidemiologic impact on ocular toxoplasmosis has not been assessed. No national registry is available, and data were acquired by asking patients or their mothers to recollect

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