Eye manifestations of congenital toxoplasmosis

被引:108
作者
Mets, MB
Holfels, E
Boyer, KM
Swisher, CN
Roizen, N
Stein, L
Stein, M
Hopkins, J
Withers, S
Mack, D
Luciano, R
Patel, D
Remington, JS
Meier, P
McLeod, R
机构
[1] CHILDRENS MEM HOSP,DEPT OPHTHALMOL,CHICAGO,IL 60614
[2] CHILDRENS MEM HOSP,DEPT NEUROL,CHICAGO,IL 60614
[3] CHILDRENS MEM HOSP,DEPT AUDIOL,CHICAGO,IL 60614
[4] NORTHWESTERN UNIV,CHICAGO,IL 60611
[5] MICHAEL REESE HOSP & MED CTR,DEPT RADIOL,CHICAGO,IL 60616
[6] RUSH UNIV,SCH MED,DEPT PEDIAT,CHICAGO,IL 60612
[7] MICHAEL REESE HOSP & MED CTR,DEPT MED,CHICAGO,IL 60616
[8] RUSH PRESBYTERIAN ST LUKES MED CTR,CHICAGO,IL 60612
[9] UNIV CHICAGO COLL,DEPT PEDIAT,CHICAGO,IL
[10] UNIV CHICAGO COLL,DEPT PSYCHIAT,CHICAGO,IL
[11] UNIV CHICAGO COLL,DEPT OPHTHALMOL MED & PATHOL,CHICAGO,IL
[12] UNIV CHICAGO COLL,COMM IMMUNOL,PRITZKER SCH MED,CHICAGO,IL
[13] IIT,DEPT PSYCHOL,CHICAGO,IL 60616
[14] DOCTORS HOSP CHICAGO,DEPT NURSING,CHICAGO,IL
[15] UNIV ILLINOIS,DEPT MED,CHICAGO,IL
[16] UNIV ILLINOIS,DEPT MICROBIOL,CHICAGO,IL
[17] UNIV ILLINOIS,DEPT IMMUNOL,CHICAGO,IL
[18] UNIV ILLINOIS,DEPT GENET,CHICAGO,IL 60612
[19] STANFORD UNIV,DEPT MED,STANFORD,CA 94305
[20] PALO ALTO RES INST,STANFORD,CA
[21] COLUMBIA UNIV,DEPT MATH & STAT,NEW YORK,NY
关键词
D O I
10.1016/S0002-9394(14)72057-4
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
PURPOSE: To determine the natural history of treated and untreated congenital toxoplasmosis and impact of this infection on vision. METHODS: In this prospective, longitudinal study, 76 newborns were treated with pyrimethamine and sulfadiazine for approximately one year, and 18 individual not treated during their first year of life entered the study after age 1 year (historical patients). RESULTS: Chorioretinal scars were the most common eye finding in all patients and were most common in the periphery (58% of treated and 82% of historical patients). Macular scars were present in 54% of the treated patients; 41% were bilateral. Macular scars were present in 76% of the historical patients; 23% were bilateral. Visual acuity in the presence of macular lesions ranged from 20/20 to 20/400. Of the patients followed up from the newborn period and treated, 29% had bilateral visual impairment, with visual acuity for the best eye of less than 20/40. Causes for this visual impairment in eyes with quiescent lesions included macular scars, dragging of the macula secondary to a peripheral lesion, retinal detachment, optic atrophy, cataract, amblyopia, and phthisis. There were recurrences in both treated (13%, 7/54) and previously untreated historical patients (44%, 8/18). The total, median, and range of years of follow-up during which recurrences were observed were, for treated patients, 189 years (total), five years (median), and three to ten years (range) and, for historical, untreated patients, 160 years (total), 11 years (median), and three to 24 years (range). New lesions occurred in previously normal retinas and also contiguous to older scars. Active lesions appeared to become quiescent within ten to 14 days after beginning pyrimethamine and sulfadiazine therapy. CONCLUSION: Many children with congenital toxoplasmosis have substantial retinal damage at birth and consequent loss of vision. Nonetheless, vision may be remarkably good in the presence of large macular scars. Active lesions become quiescent with treatment.
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收藏
页码:309 / 324
页数:16
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