Abstract
Disseminated toxoplasmosis is a well-known complication of immunodeficiency states, including those induced by malignancies, steroid and cytotoxic drug therapy, and AIDS. In immunodeficient patients, toxoplasmic infections of the eye are less common than toxoplasmic infections of other organs for unknown reasons. When ocular toxoplasmosis does occur in the immunodeficient host, or if immunosuppressive therapy is administered to patients with active disease, widespread tissue destruction by proliferating organisms may result. Immunodeficiency alone may not be sufficient, however, to cause reactivation of encysted organisms in retinochoroidal scars.
Ocular toxoplasmosis in the immunocompromised host presents difficult problems in diagnosis and management. There may be a variety of clinical lesions, including single foci of retinochoroiditis in one or both eyes, multifocal lesions, or diffuse areas of retinal necrosis. The majority of lesions do not arise from the borders of preexisting scars, which suggests that they result from acquired infection or dissemination of organisms from nonocular sites of disease.Toxoplasma gondii may infect iris, choroid, and vitreous-tissues that are not usually infected in the immunocompetent host. Ocular lesions appear to respond to standard antiparasitic drug therapies, but continued treatment is probably necessary to prevent reactivation of disease in the most immunocompromised patients. The best treatment regimens have yet to be determined. Histopathologic studies show little retinal inflammation; therefore anti-inflammatory drugs, such as oral steroids, probably have no role in the management of infection.
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References
O'Connor GR, Frenkel JK. Dangers of steroid treatment in toxoplasmosis. Arch Ophthalmol 1976; 94: 213.
Sabates R, Pruett RC, Brockhurst RJ. Fulminant ocular toxoplasmosis. Am J Ophthalmol 1981; 92: 497–503.
Tabbara KF. Toxoplasmosis. In: Duane TD, Jaeger EA, eds. Clinical Ophthalmology, vol. 4. Philadelphia: Harper & Row, 1988: Chap. 46, pp. 1–23.
Holland GN, O'Connor GR, Diaz RF, Minasi P, Wara WM. Ocular toxoplasmosis in immunosuppressed nonhuman primates. Invest Ophthalmol Vis Sci 1988; 29: 835–841.
Cohen SN. Toxoplasmosis in patients receiving immunosuppressive therapy. JAMA 1970; 211: 657–660.
Ruskin J, Remington JS. Toxoplasmosis in the compromised host. Ann Int Med 1976; 84: 193–199.
Ryning FW, Mills J.Pneumocytis carinii, Toxoplasma gondii, cytomegalovirus and the compromised host. West J Med 1979; 130: 18–34.
Nicholson DH, Wolchek EB. Ocular toxoplasmosis in an adult receiving long-term corticosteroid therapy. Arch Ophthalmol 1976; 94: 248–254.
Hoerni B, Vallet M, Durand M, Pesme D. Ocular toxoplasmosis and Hodgkin's disease. Arch Ophthalmol 1978; 96: 62–63.
Yeo JH, Jakobiec FA, Iwamoto T, Richard G, Kreissig I. Opportunistic toxoplasmic retinochoroiditis following chemotherapy for systemic lymphoma. A light and electron microscopic study. Ophthalmology 1983; 90: 885–898.
Wong B, Gold JWM, Brown AE, Lange M, Fried R, Grieco M, Mildvan D, Giron J, Tapper ML, Lerner CW, Armstrong D. Central nervous system toxoplasmosis in homosexual men and parenteral drug abusers. Ann Int Med 1984; 100: 36–42.
Luft BJ, Brooks RG, Conley FK, McCabe RE, Remington JS. Toxoplasmic encephalitis in patients with acquired immune deficiency syndrome. JAMA 1984; 252: 913–917.
Araujo FG, Remington JS. Toxoplasmosis in immunocompromised patients. Eur J Clin Microbiol 1987; 6: 1–2.
Schuman JS, Friedman AH. Retinal manifestations of the acquired immune deficiency syndrome (AIDS): Cytomegalovirus,Candida albicans, Cryptococcus, toxoplasmosis andPneumocystis carinii. Trans Ophthalmol Soc UK 1983; 103: 177–190.
Friedman AH. The retinal lesions of the acquired immune deficiency syndrome. Trans Am Ophthalmol Soc 1984; 82: 447–491.
Weiss A, Margo CE, Ledford DK, Lockey RF, Brinsner JH. Toxoplasmic retinochoroiditis as an initial manifestation of the acquired immune deficiency syndrome. Am J Ophthalmol 1986; 101: 248–249.
Heinemann M-H, Gold JMW, Maisel J. BilateralToxoplasma retinochoroiditis in a patient with acquired immune deficiency syndrome. Retina 1986; 6: 224–227.
Parke DW, Font RL. Diffuse toxoplasmic retinochoroiditis in a patient with AIDS. Arch Ophthalmol 1986; 104: 571–575.
Holland GN, Engstrom RE, Glasgow BJ, Berger BB, Daniels SA, Sidikaro Y, Harmon JA, Fischer DH, Boyer DS, Rao NA, Eagle RC, Kreiger AE, Foos RY. Ocular toxoplasmosis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 1988; 106: 653–667.
Holland GN. Ophthalmic disorders associated with the acquired immunodeficiency syndrome. In: Insler MS, ed. AIDS and other sexually transmitted diseases and the eye. Orlando, FL, Grune & Stratton 1987: 145–172.
Rehder JR, Burnier M, Pavesio CE, Kim MK, Rigueiro M, Petrilli AMN, Belfort R. Acute unilateral toxoplasmic iridocyclitis in an AIDS patient. Am J Ophthalmol 1988; 106: 740–741.
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Holland, G.N. Ocular toxoplasmosis in the immunocompromised host. Int Ophthalmol 13, 399–402 (1989). https://doi.org/10.1007/BF02306488
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DOI: https://doi.org/10.1007/BF02306488