Toxoplasmosis ocular reporte de caso y revisión de la literatura

Autores/as

  • Arlin Montoya Universidad Nacional Autónoma de Nicaragua, Managua
  • Mario Mayorga Universidad Nacional Autónoma de Nicaragua, Managua.
  • Clara González Moncada Universidad Nacional Autónoma de Nicaragua, Managua.

Palabras clave:

Toxoplasmosis ocular, Toxoplasma gondii, Inmunocompetente.

Resumen

La toxoplasmosis ocular es una enfermedad causada por el parasito protozoario toxoplasma gondii. Aproximadamente un tercio de la población mundial está infectada por este patógeno, siendo generalmente una afectación asintomática. La afectación ocular se ha estimado que se produce en un 1-2% de las personas infectadas y se asocia con un riesgo de recurrencia de por vida y perdida de la visión, siendo poco frecuente esta presentación en paciente inmunocompetentes, por lo que se presenta el siguiente reporte de caso descriptivo. Paciente de 19 años asiste al CENAO con motivo de consulta; visión borrosa e hiperemia conjuntival, al fondo de ojo se observa zona activa de retinitis adyacente a la placa de coriorretinitis. En estudios de laboratorio se encontró Toxotest positivo con títulos 1/256, Toxo IgM Negativo, Toxo IgG 322.6 UI/ml, PCR Negativo, RPR No reactivo, VSG 4 mm/hr, HIV No reactivo, CMV IgM negativo, CMV IgG IgG 7.8 UI/ml. Lo particular de este caso es que es un paciente inmunocompetente, diagnosticado en etapa temprana y con resolución completa de su visión, lo que es una premisa para concluir que un diagnóstico temprano conlleva a un mejor pronóstico de la enfermedad.

 

Citas

Arantes, Tiago EF, Silveira, C., Holland, G. N, Muccioli, C., Yu Fei, J. Jeffrey L., & Belfort, R. (2015). Ocular involvement following postnatally acquired Toxoplasma gondii infection in southern Brazil: a 28-year experience. American journal of ophthalmology, 159(6), 1002-1012. e1002. https://doi.org/10.1016/j.ajo.2015.02.015

Barna, F., Debache, K., Vock, C. A, Küster, T., & Hemphill, A. (2013). In vitro effects of novel ruthenium complexes in Neospora caninum and Toxoplasma gondii tachyzoites. Antimicrobial agents and chemotherapy, 57(11), 5747-5754. https://doi.org/10.1128/AAC.02446-12

Belfort, R. N, Fernandes, B.F., Romano, A., Nose, R., Cools-Lartigue, J., Navajas, E. V, . . . Jr, R. Belfort. (2009). Bilateral macular hemorrhage as a complication of drug-induced anemia: a case report. Journal of medical case reports, 3(1), 16. https://doi.org/10.1186/1752-1947-3-16

Bonametti, A.M., Passos, Jdo N, Da Silva, E.M., & Bortoliero, A.L. (1995). [Outbreak of acute toxoplasmosis transmitted thru the ingestion of ovine raw meat]. Revista da Sociedade Brasileira de Medicina Tropical, 30(1), 21-25. https://doi.org/10.1590/S0037-86821997000100005

Bosch-Driessen, E.H., & Rothova, A. (1998). Sense and nonsense of corticosteroid administration in the treatment of ocular toxoplasmosis. British journal of ophthalmology, 82(8), 858-860. https://doi.org/10.1136/bjo.82.8.858

Bosch-Driessen, L. E.H, Berendschot, Tos T.J.M., Ongkosuwito, J. V, & Rothova, A. (2002). Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology, 109(5), 869-878. https://doi.org/10.1016/S0161-6420(02)00990-9

Bosch-Driessen, L. H., Karimi, S., Stilma, J.S., & Rothova, A. (2000). Retinal detachment in ocular toxoplasmosis. Ophthalmology, 107(1), 36-40. https://doi.org/10.1016/S0161-6420(99)00013-5

Bosch-Driessen, L. H., Verbraak, F. D., Suttorp-Schulten, M.S.A., Van Ruyven, R.L.J, Klok, Anne Marie, Hoyng, Carel B, & Rothova, Aniki. (2002). A prospective, randomized trial of pyrimethamine and azithromycin vs pyrimethamine and sulfadiazine for the treatment of ocular toxoplasmosis. American journal of ophthalmology, 134(1), 34-40. https://doi.org/10.1016/S0002-9394(02)01537-4

Brézin, A.P., Egwuagu, C. E, Burnier, M., Silveira, C., Mahdi, R. M., Gazzinelli, R.T., . . . Nussenblatt, R. B. (1990). Identification of Toxoplasma gondii in paraffin-embedded sections by the polymerase chain reaction. American journal of ophthalmology, 110(6), 599-604. https://doi.org/10.1016/S0002-9394(14)77055-2

Cavalcante, GT, Aguiar, DM, Camargo, L M A, Labruna, MB, De Andrade, HF, Meireles, LR, . . . Gennari, SM. (2006). Seroprevalence of Toxoplasma gondii antibodies in humans from rural Western Amazon, Brazil. Journal of Parasitology, 92(3), 647-649. https://doi.org/10.1645/GE-774R.1

Commodaro, Alessandra G, Belfort, Rubens N, Rizzo, Luiz Vicente, Muccioli, Cristina, Silveira, Claudio, Burnier Jr, Miguel N, & Belfort Jr, Rubens. (2009). Ocular toxoplasmosis: an update and review of the literature. Memórias do Instituto Oswaldo Cruz, 104(2), 345-350. https://doi.org/10.1590/S0074-02762009000200030

Delair, Emmanuelle, Latkany, Paul, Noble, A Gwendolyn, Rabiah, Peter, McLeod, Rima, & Brézin, Antoine. (2011). Clinical manifestations of ocular toxoplasmosis. Ocular immunology and inflammation, 19(2), 91-102. https://doi.org/10.3109/09273948.2011.564068

Dodds, Emilio M. (2003). Toxoplasmosis ocular. Archivos de la Sociedad Española de Oftalmología, 78(10), 531-541. https://doi.org/10.4321/S0365-66912003001000004

Dubey, JP, Gennari, SM, Sundar, N, Vianna, M C B, Bandini, LM, Yai, L E O, . . . Su, C. (2007). Diverse and atypical genotypes identified in Toxoplasma gondii from dogs in São Paulo, Brazil. Journal of Parasitology, 93(1), 60-64. https://doi.org/10.1645/GE-972R.1

Dunn, David, Wallon, Martine, Peyron, François, Petersen, Eskild, Peckham, Catherine, & Gilbert, Ruth. (1999). Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling. The Lancet, 353(9167), 1829-1833. https://doi.org/10.1016/S0140-6736(98)08220-8

Furtado, João M, Smith, Justine R, Belfort Jr, Rubens, Gattey, Devin, & Winthrop, Kevin L. (2011). Toxoplasmosis: a global threat. Journal of global infectious diseases, 3(3), 281. https://doi.org/10.4103/0974-777X.83536

Ganesh, Sudha K, Sharma, Sumita, Narayana, Kannan M, & Biswas, Jyotirmay. (2004). Fuchs’ heterochromic iridocyclitis following bilateral ocular toxoplasmosis. Ocular immunology and inflammation, 12(1), 75-77. https://doi.org/10.1076/ocii.12.1.75.28065

Garweg, JG. (2005). Determinants of immunodiagnostic success in human ocular toxoplasmosis. Parasite immunology, 27(3), 61-68. https://doi.org/10.1111/j.1365-3024.2005.00747.x

Garweg, JG. (2005). Determinants of immunodiagnostic success in human ocular toxoplasmosis. Parasite immunology, 27(3), 61-68. https://doi.org/10.1111/j.1365-3024.2005.00747.x

Glasner, Peter D, Silveira, Claudio, Kruszon-Moran, Deanna, Martins, Maria C, Burnier, Miguel, Silveira, Silvia, . . . Belfort, Rubens. (1992). An unusually high prevalence of ocular toxoplasmosis in southern Brazil. American journal of ophthalmology, 114(2), 136-144. https://doi.org/10.1016/S0002-9394(14)73976-5

Harper, Thomas W, Miller, Darlene, Schiffman, Joyce C, & Davis, Janet L. (2009). Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis. American journal of ophthalmology, 147(1), 140-147. https://doi.org/10.1016/j.ajo.2008.07.043

Holland, Gary N. (2003). Ocular toxoplasmosis: a global reassessment. American Journal of Ophthalmology, 136(6), 973-988. https://doi.org/10.1016/j.ajo.2003.09.040

Holland, Gary N. (2004). Ocular toxoplasmosis: a global reassessment: part II: disease manifestations and management. American journal of ophthalmology, 137(1), 1-17. https://doi.org/10.1016/S0002-9394(03)01319-9

Holland, Gary N, Crespi, Catherine M, ten Dam-van Loon, Ninette, Charonis, Alexander C, Yu, Fei, Bosch-Driessen, Lotje H, & Rothova, Aniki. (2008). Analysis of recurrence patterns associated with toxoplasmic retinochoroiditis. American journal of ophthalmology, 145(6), 1007-1013. e1001. https://doi.org/10.1016/j.ajo.2008.01.023

Holland, Gary N, & Lewis, Kevan G. (2002). An update on current practices in the management of ocular toxoplasmosis 1, 2. American journal of ophthalmology, 134(1), 102-114. https://doi.org/10.1016/S0002-9394(02)01526-X

Howe, Daniel K, Honoré, Stephanie, Derouin, Francis, & Sibley, L David. (1997). Determination of genotypes of Toxoplasma gondii strains isolated from patients with toxoplasmosis. Journal of clinical microbiology, 35(6), 1411-1414.

Jasper, Smitha, Vedula, Satyanarayana S, John, Sheeja S, Horo, Saban, Sepah, Yasir J, & Nguyen, Quan Dong. (2013). Corticosteroids as adjuvant therapy for ocular toxoplasmosis. The Cochrane Library. https://doi.org/10.1002/14651858.CD007417.pub2

Jones, J. L., Dargelas, V., Roberts, J., Press, C., Remington, J. S., & Montoya, J. G. (2009). Risk factors for Toxoplasma gondii infection in the United States. Clinical Infectious Diseases, 49(6), 878-884. https://doi.org/10.1086/605433

Jones, J. L., Muccioli, C., Belfort Jr, R., Holland, G. N , Roberts, J. M, & Silveira, C. (2006). Recently acquired Toxoplasma gondii infection, Brazil. Emerging infectious diseases, 12(4), 582. https://doi.org/10.3201/eid1204.051081

Lima Guilherme, S. C., Saraiva, P. G. C., & Saraiva, F. P. (2015). Current Therapy of Acquired Ocular Toxoplasmosis: A Review. Journal of Ocular Pharmacology and Therapeutics.

London, N.J., Hovakimyan, A., Cubillan, L. D., Siverio Jr, C. D, & Cunningham Jr, E. T. (2010). Prevalence, clinical characteristics, and causes of vision loss in patients with ocular toxoplasmosis. European journal of ophthalmology, 21(6), 811-819. https://doi.org/10.5301/EJO.2011.6403

Lum, F., Jones, J. L, Holland, G. N, & Liesegang, T. J. (2005). Survey of ophthalmologists about ocular toxoplasmosis. American journal of ophthalmology, 140(4), 724. e721-724. e729. https://doi.org/10.1016/j.ajo.2005.04.048

Martinez, C. E, Zhang, D., Conway, M. D., & Peyman, G. A. (1998). Successful management of ocular toxoplasmosis during pregnancy using combined intraocular clindamycin and dexamethasone with systemic sulfadiazine. International ophthalmology, 22(2), 85-88. https://doi.org/10.1023/A:1006129422690

Montoya, J.G. & Liesenfeld, O. (2004). Toxoplasmosis Lancet 363, 1965â1976. CrossRef, PubMed, CAS, Web of Science® Times Cited, 807.

Montoya, J. G, Parmley, S., Liesenfeld, O., Jaffe, G. J. & Remington, J. S. (1999). Use of the polymerase chain reaction for diagnosis of ocular toxoplasmosis. Ophthalmology, 106(8), 1554-1563. https://doi.org/10.1016/S0161-6420(99)90453-0

Montoya, J. G, & Remington, J. S. (1996). Toxoplasmic chorioretinitis in the setting of acute acquired toxoplasmosis. Clinical infectious diseases, 23(2), 277-282. https://doi.org/10.1093/clinids/23.2.277

Nussenblatt, R. B, & Belfort, R. (1994). Ocular toxoplasmosis: an old disease revisited. Jama, 271(4), 304-307. https://doi.org/10.1001/jama.1994.03510280066035 https://doi.org/10.1001/jama.271.4.304

Ongkosuwito, J.V, Bosch-Driessen, E.H, Kijlstra, A., & Rothova, A.A. (2000). Serologic evaluation of patients with primary and recurrent ocular toxoplasmosis for evidence of recent infection. Evidence-Based Ophthalmology, 1(2), 90-91. https://doi.org/10.1097/00132578-200001000-00014

Opremcak, E M., Scales, D. K., & Sharpe, M. R. (1992). Trimethoprim-sulfamethoxazole therapy for ocular toxoplasmosis. Ophthalmology, 99(6), 920-925. https://doi.org/10.1016/S0161-6420(92)31873-1

Rao, N. A, & Font, R.L. (1977).Toxoplasmic retinochoroiditis:electron-microscopic and immunofluorescence studies of formalin-fixed tissue. Archives of ophthalmology, 95(2), 273-277. https://doi.org/10.1001/archopht.1977.04450020074012

Rey, A., Llorenç, V., Pelegrín, L., Mesquida, M., Molins, B., Rios, J., . . . & Adán, A. (2013). Clinical pattern of toxoplasmic retinochoroiditis in a spanish referral center. Ophthalmologica, 229(3), 173-178. https://doi.org/10.1159/000348740

Rothova, A, Buitenhuis, H.J, Meenken, C., Baarsma, G.S, Boen-Tan, T.N, de Jong, P.T.V.M., . . . Zaal, M.J.W. (2015). Therapy of ocular toxoplasmosis. International ophthalmology, 13(6), 415-419. https://doi.org/10.1007/BF02306491

Descargas

Publicado

24-07-2017

Número

Sección

Salud y vida sana