scholarly journals The challenges of treating a patient with recurrent congenital toxoplasmic chorioretinitis

2021 ◽  
Vol 9 (2) ◽  
pp. 56-59
Author(s):  
Aleksandra Krasińska ◽  
Kamila Jaz ◽  
Joanna Mamczur ◽  
Jarosław Kocięcki
Keyword(s):  
Intraocular Pressure ◽  
Toxoplasma Gondii ◽  
Congenital Toxoplasmosis ◽  
Psychotic Symptoms ◽  
Blurred Vision ◽  
The Past ◽  
Ocular Manifestations ◽  
Pressure Lowering ◽  
The Right ◽  
Toxoplasmic Chorioretinitis

Abstract Congenital toxoplasmosis is a rare, non-curable parasite infection, that affects approximately 242 children in Europe each year. Poland has one of the highest rates of congenital toxoplasmosis in Europe. Transmission of Toxoplasma gondii to the fetus results in numerous medical conditions, such as developmental delay, intellectual disabilities, seizures, hearing loss, and blindness. Chorioretinitis is a serious manifestation of congenital toxoplasmosis that can recur even after 25 years from the primary infection, which poses a significant therapeutic challenge. A 41-year-old female reported to the Ophthalmology Emergency Room due to blurred vision and pain in the right eye, accompanied by a constant headache. The patient suffered from congenital toxoplasmosis with two relapses in the past. On examination, the best-corrected visual acuity was 1,0 in both eyes, and the intraocular pressure was significantly increased. Slit-lamp examination showed vitritis and an active retinochoroidal lesion in the right eye. In the left eye, there was a retinochoroidal scar. A relapse of toxoplasmosis was suspected. Serology for Toxoplasma gondii was positive. Pyrimethamine with sulfadiazine, clindamycin, topical corticosteroids, and intraocular pressure-lowering drugs were implemented. During the treatment, the patient developed corticonuclear cataract in both eyes and reported psychotic symptoms. Clinical condition improved after the treatment with corticosteroids at a lower dose. Treatment of ocular manifestations of congenital toxoplasmosis is challenging. The clinical benefit of treatment should be weighed against side effects for each patient. Running title: Congenital toxoplasmosis treatment

Active iris vascular tufts bleeding successfully treated with argon laser photocoagulation

2018 ◽  
Vol 28 (2) ◽  
pp. 241-242 ◽  
Author(s):  
Ambreen Sarmad ◽  
Fadi Alfaqawi ◽  
Monali Chakrabarti ◽  
Arijit Mitra ◽  
Bushra Mushtaq
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Case Report ◽  
Laser Photocoagulation ◽  
Argon Laser ◽  
Active Bleeding ◽  
Blurred Vision ◽  
Argon Laser Photocoagulation ◽  
The Right ◽  
Effective Use

Purpose: Iris vascular tufts (IVT) are rare biomicroscopic capillary outgrowths from the pupillary margins. Patients are usually asymptomatic until presenting with blurred vision due to spontaneous hyphema or with raised intraocular pressure. Case report: A 61-year-old woman presented to eye casualty with left eye (LE) blurred vision and discomfort for 1 day. Her external ocular examination was unremarkable and visual acuity was 6/6 in the right eye (RE) and 6/9 in the LE. Biomicroscopic examination revealed a 2-mm hyphema in her LE and bilateral multiple small IVT and active bleeding from IVT at the pupillary margin of the LE at the 5 o’clock position. Diagnosis of LE active bleeding from IVT was made and she underwent argon laser photocoagulation directed at the source of bleeding. The bleeding stopped immediately after the second burn. She was followed up for 3 months; her visual acuity was 6/5 and 6/6 in the RE and LE, respectively, with no further problems. Conclusions: Iris vascular tufts are benign and recurrent hemorrhages are unlikely. Therefore, definitive argon laser photocoagulation or surgical treatment are reserved to arrest further episodes of hyphema. Our case demonstrates the effective use of argon laser photocoagulation to completely arrest active bleeding from IVT and excellent recovery of hyphema with no further problems for 5 years.

scholarly journals Chorioretinal Folds in the Trabeculectomized Eye with Normal Intraocular Pressure after Phacoemulsification

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 896
Author(s):  
Yi-Fen Lai ◽  
Ching-Long Chen ◽  
Ke-Hao Huang ◽  
Yi-Hao Chen
Keyword(s):  
Intraocular Pressure ◽  
Case Report ◽  
Visual Loss ◽  
Early Recognition ◽  
Open Angle Glaucoma ◽  
Eye Drops ◽  
Fundus Examination ◽  
Blurred Vision ◽  
Foveal Thickness ◽  
The Right

Background and Objectives: This case report discusses possible causes of chorioretinal fold (CRF) formation. Materials and Methods: A case report. Results: A 48-year-old man presented with a history of high myopia and primary open-angle glaucoma in both eyes. He underwent a trabeculectomy followed by phacoemulsification in both eyes. Two months later, he complained of blurred vision in the right eye. The intraocular pressure (IOP) was 17 mmHg in the left eye and 9 mmHg in the right eye. Refraction showed a hyperopic shift in both eyes. Slit-lamp examination showed a deep anterior chamber without cells and a well-functional bleb without leakage. Fundus examination revealed CRFs in the macula of the right eye. No papilledema, choroidal lesions, or other retinal lesions were found. Wrinkling of CRFs at the macula, an increase in central foveal thickness, and a fluid cleft were demonstrated by spectral-domain optical coherence tomography. After using steroid eye drops, the IOP in the right eye and refraction in both eyes recovered to the baseline level. Visual acuity improved in both eyes. Conclusions: CRFs in trabeculectomized eyes with normal IOP after phacoemulsification have not been reported. This case demonstrated that the trabeculectomized eye remains at risk of CRF formation, even if the IOP is normal without hypotony. The importance of a detailed fundus examination in patients with unexplained blurred vision may be necessary after having undergone these procedures. The early recognition of the cause of visual loss may facilitate immediate treatment and may avoid irreversible changes with permanent visual loss.

scholarly journals Congenital toxoplasmosis the overlooked disease: a case report

2021 ◽  
Vol 8 (6) ◽  
pp. 1107
Author(s):  
Mahmoud M. Osman ◽  
Eiman S. Albadani ◽  
Suzan Abdel-Hamid ◽  
Sulafa A. Hamdoun ◽  
Naif A. Alruwaished
Keyword(s):  
Case Report ◽  
Toxoplasma Gondii ◽  
Intrauterine Growth Restriction ◽  
Congenital Toxoplasmosis ◽  
Preterm Newborn ◽  
Zoonotic Infection ◽  
Obligate Intracellular ◽  
Intrauterine Growth ◽  
Ocular Manifestations ◽  
Late Preterm Newborn

The causative agent of congenital toxoplasmosis (CT) is Toxoplasma gondii, an obligate intracellular parasitic protozoan presenting as a zoonotic infection distributed worldwide. Congenital toxoplasmosis may lead to abortion, intrauterine growth restriction, hepatosplenomegaly, jaundice and several neurological and ocular manifestations. The classic pathognomonic manifestations are the triad of intracranial calcifications, hydrocephalus and chorioretinitis. However, the majority of infected infants are asymptomatic at birth. Herein, we reported a case of severe CT in a late preterm newborn. Interestingly, the majority of the manifestations reported for CT were observed in this case. The high anti-toxoplasma antibodies (IgM and IgG) in the infant and his mother confirmed the diagnosis. 

scholarly journals Challenges in Cytomegalovirus (CMV) Retinitis Management

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Denisa Rosati ◽  
Sauli Ari Widjaja ◽  
Wimbo Sasono ◽  
Muhammad Firmansjah ◽  
Ima Yustiarini ◽  
...  
Keyword(s):  
Optic Disc ◽  
Ocular Involvement ◽  
Fundus Examination ◽  
Blurred Vision ◽  
Cmv Retinitis ◽  
Ocular Manifestations ◽  
Highly Active ◽  
Cell Counts ◽  
Lung Tuberculosis ◽  
The Right

Introduction: HIV infection can manifest in a variety of ways in and around the eyes and it is most commonly due to retinal microvasculopathy, neoplasm and also opportunistic infection. Those usually occur associated with a significantly reduced CD4 T-cell counts. In this era of Highly Active Anti Retroviral Therapy (HAART) has caused a major decreasing of the ocular involvement prevalence itself.  Case presentation : A 31 year-old-male came with blurred vision on the right eye, which has started 3 years ago and slowly worsened. Central scotoma also presented previously. Patient was an HIV-AIDS, that placed him on HAART. CD4+ T-lymphocyte count was 3 cells/mm3. The initial visual acuity was light perception and fundus examination showed Roth spots, massive exudates and hemorrhages covering the optic disc and decreased foveal reflex. Laboratory examination revealed positive Rubella and anti-CMV immunoglobulin-G (IgG). He also suffered from lung tuberculosis and took tuberculosis medication regularly. Patient was diagnosed with Cytomegalovirus (CMV) retinitis based on history of illness, fundus examination as well as laboratory testing and given oral induction valganciclovir 900 mg once daily for 3 weeks followed by maintenance dosage .  Result : After valganciclovir induction, there was significant changes with decreased peripapillary exudates, hemorrhages and vasculitis, but the optic disc appeared pale. The patient also had bicytopenia due to valganciclovir therapy that complicate his condition and passed away after 3 months follow up. Conclusion: CMV retinitis is reported to occur in patient with extreme CD4 count usually less than 50 cells/mm3. The sooner of proper treatment would likely following better outcome. Making diagnosis of immunosuppresed patient with ocular manifestations was challenging so that comprehensive eye examination in HIV-infected individuals should be conducted. Oral valganciclovir could give satisfactory response to decrease the progression of retinitis but risk of blindness may still occur.

Toxoplasma gondii: the changing paradigm of congenital toxoplasmosis

Parasitology ◽  
2011 ◽  
Vol 138 (14) ◽  
pp. 1829-1831 ◽  
Author(s):  
D. S. LINDSAY ◽  
J. P. DUBEY
Keyword(s):  
United States ◽  
Toxoplasma Gondii ◽  
Population Biology ◽  
Congenital Toxoplasmosis ◽  
The United States ◽  
Women Physicians ◽  
Type I ◽  
Type Ii ◽  
The Past ◽  
New Information

SUMMARYResearchers have learned much concerning the population biology ofToxoplasma gondiiover the past 2 decades. It is now apparent that many atypical genotypes exist besides the typical 3 genotypes (type I, type II and type III) first described from samples from Europe and the United States. These genotypes can differ in pathogenicity and transmissibility from the typical genotypes that have been used in the majority of scientific research over the past 70 years. These differences impact much of what we used to believe as facts about congenital toxoplasmosis (CT) and will be important in developing new recommendations for prevention of CT and the monitoring of women at risk for developing CT. The present review highlights new information onT. gondiigenotypes and how this information will change the way we convey information about CT to pregnant women, physicians and students.

COMMONWEALTH Forum: The Politics of Science or the Science of Politics

Commonwealth ◽  
2017 ◽  
Vol 19 (1) ◽  
Author(s):  
John Arway
Keyword(s):  
Public Policy ◽  
Natural Resource ◽  
Factual Information ◽  
The Past ◽  
Difference Of Opinion ◽  
History Of ◽  
The Right ◽  
Scientific Facts ◽  
Environmental Agency ◽  
Laws And Regulations

The challenges of including factual information in public policy and political discussions are many. The difficulties of including scientific facts in these debates can often be frustrating for scientists, politicians and policymakers alike. At times it seems that discussions involve different languages or dialects such that it becomes a challenge to even understand one another’s position. Oftentimes difference of opinion leads to laws and regulations that are tilted to the left or the right. The collaborative balancing to insure public and natural resource interests are protected ends up being accomplished through extensive litigation in the courts. In this article, the author discusses the history of environmental balancing during the past three decades from the perspective of a field biologist who has used the strength of our policies, laws and regulations to fight for the protection of our Commonwealth’s aquatic resources. For the past 7 years, the author has taken over the reins of “the most powerful environmental agency in Pennsylvania” and charted a course using science to properly represent natural resource interests in public policy and political deliberations.

Late-onset malignant glaucoma

2020 ◽  
Vol 3 ◽  
pp. 1
Author(s):  
Ramiro José Daud ◽  
Horacio Freile ◽  
Mauricio Freile ◽  
Soledad Mariano
Keyword(s):  
Intraocular Pressure ◽  
Case Report ◽  
Acute Pain ◽  
Late Onset ◽  
Slit Lamp ◽  
Normal Range ◽  
Slit Lamp Examination ◽  
Complete Occlusion ◽  
Malignant Glaucoma ◽  
The Right

A case report on a 49-year-old female with diagnoses of ocular hypertension in her left eye (LE) treated with 250 mg/day acetazolamide for 2 years. During the slit-lamp examination, complete occlusion of both iridocorneal angles was detected. Intraocular pressure (IOP) was 10 and 35 mmHg in the right eye and LE, respectively. Phacotrabeculectomy was performed in the LE. After 1 month of the procedure, the patient developed a slowly progressive miopization from −1 to −3 diopters (D) the following months. Approximately 3 months after surgery, the patient developed an episode of acute pain, athalamia, and IOP 45 mmHg in her LE. Late-onset malignant glaucoma was suspected and the patient was treated with topical hypotensive and cycloplegic agent until a prompt vitrectomy was performed. Deepening of the anterior chamber and restoration of IOP to normal range was obtained after surgery.

Accelerating Agricultural Growth—Is Irrigation Institutional Reform Necessary? (Distinguishedl Lecture)

1996 ◽  
Vol 35 (4I) ◽  
pp. 399-417 ◽  
Author(s):  
John W. Mellor
Keyword(s):  
Growth Rates ◽  
Irrigation System ◽  
Institutional Reform ◽  
Residual Effect ◽  
Agricultural Growth ◽  
The Past ◽  
Major Reform ◽  
History Of ◽  
The Right ◽  
Economic Growth Rates

The right to the flow of income from water is vigorously pursued, protected, and fought over in any arid part of the world. Pakistan is of course no exception. Reform of irrigation institutions necessarily changes the rights to water, whether it be those of farmers, government, or government functionaries. Those perceived rights may be explicit and broadly accepted, or simply takings that are not even considered legitimate. Nevertheless they will be fought over. Pakistan has a long history of proposals for irrigation reform, little or none being implemented, except as isolated pilot projects. Thus, to propose major changes in irrigation institutions must be clearly shown to have major benefits to justify the hard battles that must be fought and the goodwill of those who might win those battles for reform. Proponents of irrigation institution reform have always argued the necessity of the reforms and the large gains to be achieved. Perhaps, however, those arguments have not been convincing. This paper will briefly outline the failed attempts at irrigation reform to provide an element of reality to the discussion. It will then proceed to make the case of the urgency of reform in a somewhat different manner to the past. Finally, current major reform proposals will be presented. This paper approaches justification of irrigation reform by focusing on the agricultural growth rate. It does so because that is the critical variable influencing poverty rates and is a significant determinant of over-all economic growth rates. The paper decomposes growth rates and suggests a residual effect of deterioration of the irrigation system that is large and calls for policy and institutional reform. The data are notional, suggesting the usefulness of the approach and paves the way for more detailed empirical analysis and enquiry for the future.

Therapeutic Effects of Hab Shabyar on Open-Angle Glaucoma: A Double-Blinded, Randomized, Placebo-Controlled Trial

2019 ◽  
Vol 8 ◽  
pp. 1218
Author(s):  
Ebrahim Khalil BaniHabib ◽  
Ali Mostafai ◽  
Seyyed Mohammad Bagher Fazljou ◽  
Ghadir Mohammdi
Keyword(s):  
Placebo Group ◽  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Controlled Trial ◽  
Intervention Group ◽  
Therapeutic Effects ◽  
Open Angle ◽  
The Mean ◽  
The Right ◽  
Double Blinded

Background: Open-angle glaucoma (OAG) is one of the leading causes of blindness worldwide. This study evaluates the therapeutic effects of hab shabyar in patients with open-angle glaucoma. Materials and Methods: In this clinical randomized controlled trial, 50 patients with OAG were randomized into two groups. The intervention group was received a drop of timolol plus 500 mg of hab shabyar every 12 hours. The placebo group was received a drop of timolol every 12 hours plus 500 mg of wheat germ as a placebo. The intraocular pressure in patients with OAG was measured in each group and compared at before the intervention (t1), one month (t2), and two months (t3) after the intervention. Results: The mean decrease in intraocular pressure for the right eye at three times in the intervention group was statistically significant, but the mean decrease in the placebo group was not significant. Similar results were obtained for the left eye at t1 when compared to t3. The patients in the intervention group expressed more satisfaction than the patients in the placebo group (P≤0.001). Conclusion: Our study demonstrated that consumption of timolol plus hab shabyar instead of consuming of timolol alone was probably more effective for reducing intraocular pressure in patients with OAG.[GMJ.2019;In press:e1218]

scholarly journals A Novel Calcium-Dependent Protein Kinase 1 Inhibitor Potently Prevents Toxoplasma gondii Transmission to Foetuses in Mouse

Molecules ◽  
2021 ◽  
Vol 26 (14) ◽  
pp. 4203
Author(s):  
Héloïse Débare ◽  
Nathalie Moiré ◽  
Firmin Baron ◽  
Louis Lantier ◽  
Bruno Héraut ◽  
...  
Keyword(s):  
Protein Kinase ◽  
Toxoplasma Gondii ◽  
Intraperitoneal Administration ◽  
Congenital Toxoplasmosis ◽  
Parasite Burden ◽  
Oral Route ◽  
Dependent Protein Kinase ◽  
Calcium Dependent ◽  
Dependent Protein ◽  
Calcium Dependent Protein Kinase

Treatments currently used to prevent congenital toxoplasmosis are non-specific of Toxoplasma gondii and have grievous side effects. To develop a more specific and less toxic drug, we have designed SP230, an imidazo[1,2-b]pyridazine salt targeting the Toxoplasma gondii calcium-dependent protein kinase 1 (TgCDPK1) and active against acute toxoplasmosis in mice. Efficiency of SP230 to inhibit foetal transmission of the parasite was evaluated in a mouse model of congenital toxoplasmosis. Swiss mice were infected at mid-pregnancy with tachyzoites or cysts of the ME49 strain of T. gondii by intraperitoneal and oral route, respectively, and treated with SP230 at 50 mg/kg for 5 days by the same routes. Parasite burden in organs of dams and in foetuses was measured by quantitative PCR. Intraperitoneal administration of SP230 drastically reduced the number of parasites (more than 97% of reduction) in the brain and lungs of dams, and led to a reduction of 66% of parasite burden in foetuses. Oral administration of SP230 was particularly efficient with 97% of reduction of parasite burdens in foetuses. SP230 did not impact number and weight of offspring in our conditions. This inhibitor of TgCDPK1 is a promising candidate for the development of alternative therapeutics to treat infected pregnant women.

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