Ophthalmological evaluation of patients with AIDS and neurotoxoplasmosis

Introduction: To describe fundoscopic findings among patients with AIDS and active-phase neurotoxoplasmosis. Methods: A prospective study of case series type was developed, including 70 patients of both sexes and ages ranging from 20 to 63 years who were admitted to the wards of three public hospitals in the city of Recife, Pernambuco, Brazil, from January to October 2008, with diagnoses of AIDS and neurotoxoplasmosis determined according to the criteria of the Centers for Disease Control and Prevention (1992). The patients were characterized by a first episode of neurotoxoplasmosis (65; 92.9%) or recurrence (5; 7.1%), unawareness of having AIDS (23; 32.9%), mean T CD4+ count of 139.8 +/- 3.04 lymphocytes/mm(3) and mean viral load of 137,080 +/- 39,380 copies/ml. All patients underwent ophthalmological examination consisting of ocular inspection, gauging of visual acuity, investigation of ocular extrinsic muscle function and fundoscopy using a binocular indirect ophthalmoscope (model OHM 3.5 Eyetec (R)) and external lens of 20 diopters (Volk (R)). Results: The findings consisted of retinal cotton-wool spot exudates (8.6%), slight diffuse arteriolar constriction (8.6%), retinochoroiditis scars characteristic of ocular toxoplasmosis (5.7%), atrophy of retinal pigment epithelium (2.9%), retinal detachment (2.9%), increased papillary excavation (1.4%), retinal peripheral degeneration (1.4%), macroaneurysm (1.4%), bilateral papilledema (1.4%) and vitreous-retinal traction (1.4%). Conclusions: Patients with AIDS and neurotoxoplasmosis may present fundoscopic abnormalities characteristic of ocular toxoplasmosis, either in active or in scar form, related to HIV or even to other opportunist or systemic diseases, which can be of great aid for integral treatment of patients by a multiprofessional team.