Toxoplasmic chorioretinitis
Last reviewed: 23.04.2024
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Toxoplasmic chorioretinitis is more often associated with intrauterine infection. Clinical manifestations of the defeat of the eye do not always reveal at the time of birth and at an early age.
Congenital toxoplasmosis, as well as for other congenital infections, is characterized by a combination of eye damage with other systemic disorders, most often with CNS damage. Infected newborns may have a rise in body temperature, lymphadenopathy, encephalitis, hepatosplenomegaly, pneumonia, intracranial calcifications.
Pathogens
Symptoms of the toxoplasmosis chorioretinitis
Symptoms of toxoplasmosis depend on the age and immune status of the patient, as well as on the activity of the eye infection. Toxoplasmosis manifests as chorioretinitis. With inactive toxoplasmosis, old large atrophic or cicatricial chorioretinal foci with hypertrophy of pigment epithelium are found, often single, located in the region of the posterior pole of the eye. The appearance of a zone of active inflammation in the form of white foci is observed in any area of the fundus, as a rule, but the edge of the old changes. In an acute period of inflammation, foci have fuzzy boundaries, their size varies and can be equal to several diameters of the optic nerve. For large lesions, it is possible to lead them to the vitreous. Vessels in the hearth can be closed. With active inflammation, exudative retinal detachment and secondary choroidal neovascularization with subretinal hemorrhage are possible, visible in ophthalmoscopy as a thickening of grayish-yellowish tissue at the level of pigment epithelium.
Changes in the vitreous humor, the infiltration of its layers with a cellular suspension and the formation of membranes are observed during the spread of the process to the inner layers of the retina and the destruction of the hyaloid membrane. In this case, damage to the optic nerve and macular edema of the macula are noted.
Diagnostics of the toxoplasmosis chorioretinitis
Diagnosis is based on the identification of the characteristic signs of congenital toxoplasmosis and the typical localization of large single foci in the region of the posterior pole with the formation of new inflammation zones along the edge of the old scars.
The serological study includes the determination of specific antibodies in toxoplasm by the complement fixation reaction and fluorescent antibodies. Most informatively and widely used in recent years is a study with an enzyme-linked immunosorbent assay that allows the detection of antibodies of different classes.
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Treatment of the toxoplasmosis chorioretinitis
Not all forms of toxoplasmosis require treatment. Small peripheral foci may be asymptomatic and self-healing for a period of 3 weeks to 6 months. With severe symptoms of inflammation in the posterior pole of the eye, and also during the reactivation of the process, treatment should be directed to the destruction of microorganisms. Local non-specific anti-inflammatory therapy (corticosteroids) in combination with systemic use of specific agents is shown.
The drugs most widely used in the treatment of toxoplasmosis include fosidor, pyrimethamine, daraprim, tindurine, chloridine and sulfadiazine. Treatment is carried out with sulfonamide preparations in combination with folic acid under the control of blood composition in connection with the possibility of developing leukopenia and thrombocytopenia. It is possible to use pyrimethamine and sulfadiazine in combination with corticosteroids under the conjunctiva. Clindamycin and dalacin as blockers of protein synthesis in the treatment of toxoplasmosis are also used in combination with the preparations described above.