Korean J Ophthalmol.  2019 Dec;33(6):514-519. 10.3341/kjo.2019.0092.

Primary Ocular Toxoplasmosis Presenting to Uveitis Services in a Non-endemic Setting

• Bhikoo R
• Damato EM
• Guest S
• Sims J

• KMID: 2465131
• DOI: http://doi.org/10.3341/kjo.2019.0092

Abstract

PURPOSE
This study sought to describe the different clinical features and presentations of primary ocular toxoplasmosis in a setting not demonstrating an outbreak of disease.
METHODS
This was a retrospective review of patients presenting to uveitis management services in Auckland and Hamilton, New Zealand between 2003 to 2018 with uveitis and positive toxoplasmosis immunoglobulin M serology.
RESULTS
We identified 16 patients with primary acquired toxoplasmosis infection and ocular involvement. The mean age was 53 years. Systemic symptoms were reported in 56% (9 / 16). Visual acuity was reduced to 20 / 30 or less in 50% of patients (8 / 16). A single focus of retinitis without a pigmented scar was the salient clinical feature in 69% (11 / 16). Optic nerve inflammation was the sole clinical finding in 19% (3 / 16). Bilateral arterial vasculitis was the sole clinical finding in 13% (2 / 16). A delay in the diagnosis of toxoplasmosis of more than two weeks occurred in 38% (6 / 16) due to an initial alternative diagnosis. Antibiotic therapy was prescribed in all cases. Vision was maintained or improved in 69% (11 / 16) at the most recent follow-up visit (15 months to 10 years). Relapse occurred in 69% (11 / 16), typically within four years from the initial presentation.
CONCLUSIONS
Primary ocular toxoplasmosis presenting in adulthood is a relatively uncommon cause of posterior uveitis in New Zealand. This condition should be considered in any patient presenting with retinitis or optic nerve inflammation without a retinochoroidal scar. This disease tends to relapse; thus, close follow-up is required.

Keyword

Ocular toxoplasmosis; Uveitis

MeSH Terms

Cicatrix
Diagnosis
Follow-Up Studies
Humans
Immunoglobulin M
Inflammation
New Zealand
Optic Nerve
Recurrence
Retinitis
Retrospective Studies
Toxoplasmosis
Toxoplasmosis, Ocular*
Uveitis*
Uveitis, Posterior
Vasculitis
Visual Acuity
Immunoglobulin M

Figure

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  Fig. 1 This wide-field image focused at the posterior pole shows a single focus of retinitis (resolving) with areas of chorioretinal atrophy in the left superior temporal retina.

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  Fig. 2 Primary ocular toxoplasmosis presenting as isolated juxtapapillary retinochoroiditis.

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  Fig. 3 Yellow segmental Kyrieleis arteriolar plaques (arrows) in a patient with presumed toxoplasmosis immune-mediated vasculitis, as other infective causes were excluded. The clinical findings improved with oral antibiotics and a tapering course of oral steroids.

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