ABSTRACT
Birdshot retinochoroidopathy (BSRC) is a distinct type of posterior uveitis originally described in the 1940s. Its characteristics include minimal anterior segment inflammation and diffuse posterior choroidopathy with vitritis and retinal vasculitis. The precise etiology of this disease is yet to be elucidated. However, various treatment modalities have been employed with the ultimate goal of durable remission of this vision threatening intraocular disease. The purpose of this review is not only to emphasize the importance of recognizing BSRC, but also to discuss the new discoveries, immune mediators, current and new therapies, and techniques applied to monitor and accomplish disease remission.
Retinocoroidopatia do tipo "birdshot" é um tipo de uveíte posterior originalmente descrita na década de 1940. Achados característicos incluem inflamação mínima do segmento anterior, retinocoroidopatia difusa associada à vitreíte e vasculite retiniana. A etiologia da doença ainda não foi completamente definida, entretanto várias modalidades de tratamento têm sido utilizadas com o objetivo de atingir a remissão. O objetivo desta revisão é enfatizar não só a importância do reconhecimento da doença como também discutir novas descobertas relacionadas a mediadores imunes, formas de tratamentos e como monitorar a doença.
Subject(s)
Humans , Retinal Diseases , Choroid Diseases , Chorioretinitis , Antibodies, Monoclonal, Humanized/therapeutic use , Retinal Diseases/diagnosis , Retinal Diseases/immunology , Retinal Diseases/drug therapy , Remission Induction , Fluorescein Angiography , HLA-A Antigens/immunology , Choroid Diseases/diagnosis , Choroid Diseases/immunology , Choroid Diseases/drug therapy , Chorioretinitis/diagnosis , Chorioretinitis/immunology , Chorioretinitis/drug therapy , Diagnosis, Differential , Drug Therapy, Combination , Electroretinography , Immunosuppressive Agents/therapeutic useABSTRACT
A infecção pelo Toxoplasma gondii é uma importante causa de doença ocular, tanto em indivíduos imunocomprometidos como em imunocompetentes. A patogênese da destruição retinocoroidiana associada a essa infecção ainda não está totalmente esclarecida. Nesta revisão, discute-se o papel do sistema imune no controle da infecção pelo Toxoplasma, especialmente, no olho.
Toxoplasma gondii infection is an important cause of ocular disease in both immunocompromised and immunocompetent subjects. The pathogenesis of retinochoroidal lesion associated with this infection is not fully understood. In this review, the role of the immune system in the control of Toxoplasma infection, especially in the eye, is discussed.
Subject(s)
Humans , Chorioretinitis/immunology , Toxoplasmosis, Ocular/immunology , Cytokines/immunology , Immune System/immunologyABSTRACT
Objetivo: Apresentar um caso raro de toxoplasmose congênita de uma mãe imunocompetente com infecção crônica que teve reativação da doença ocular durante a gestação. Descrição: O recém-nascido estava assintomático no nascimento e foi identificado através de triagem neonatal (IgM anti-Toxoplasma gondii em sangue seco) entre outros 190 bebês com toxoplasmose congênita durante um período de 7 meses. Sua mãe tinha tido um episódio não tratado de reativação de retinocoroidite toxoplásmica durante a gestação, com títulos de IgG estáveis e resultados negativos para IgM. Os resultados de IgM e IgG no soro do recém-nascido e o teste de immunoblotting para IgG foram positivos, e detectou-se lesões retinocoroideanas ativas na periferia da retina. O recém-nascido foi tratado com sulfadiazina, pirimetamina e ácido folínico. Aos 14 meses de vida, a criança permanecia assintomática, com regressão das lesões retinocoroideanas e persistência de IgG. Comentários: É possível que a triagem neonatal sistemática em áreas com alta prevalência de infecção possa identificar esses casos.
Objectives: To report a rare case of congenital toxoplasmosis from an immunocompetent mother with chronic infection who had reactivation of ocular disease during pregnancy. Descriptions:The newborn was asymptomatic at birth and identified by neonatal screening (IgM anti-Toxoplasma gondii in dried blood) among other 190 infants with congenital toxoplasmosis during a 7-month period. His mother had had a non-treated episode of reactivation of toxoplasmic retinochoroiditis during pregnancy, with stable IgG titers and negative IgM results. Results of IgM and IgG in the newborns serum, as well as IgG immunoblotting were positive and active retinochoroidal lesions were detected in his peripheral retina. The neonate was treated with sulfadiazine, pyrimethamine and folinic acid. At 14 months of life, the child remained asymptomatic, with regression of retinochoroidal lesions and persistence of IgG. Comments: It is possible that systematic neonatal screening in areas with high prevalence of infection may identify these cases.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Chorioretinitis/parasitology , Infectious Disease Transmission, Vertical , Pregnancy Complications, Parasitic , Toxoplasmosis, Ocular/transmission , Chorioretinitis/congenital , Chorioretinitis/immunology , Neonatal Screening/methods , Pregnancy Complications, Parasitic/drug therapy , Pregnancy Complications, Parasitic/immunology , Recurrence , Toxoplasmosis, Ocular/congenital , Toxoplasmosis, Ocular/immunologyABSTRACT
Toxoplasmosis is a worldwide zoonosis that generally produces an asymptomatic infection. In some cases, however, toxoplasmosis infection can lead to ocular damage. The immune system has a crucial role in both the course of the infection and in the evolution of toxoplasmosis disease. In particular, IFN-γ plays an important role in resistance to toxoplasmosis. Polymorphisms in genes encoding cytokines have been shown to have an association with susceptibility to parasitic diseases. The aim of this work was to analyse the occurrence of polymorphisms in the gene encoding IFN-γ (+874T/A) among Toxoplasma gondii seropositive individuals, including those with ocular lesions caused by the parasite, from a rural population of Santa Rita de Cássia, Barra Mansa, state of Rio de Janeiro, Brazil. Further, we verified which of these polymorphisms could be related to susceptibility to the development of ocular toxoplasmosis. This study included 34 individuals with ocular toxoplasmosis (ocular group) and 134 without ocular lesions (control group). The differences between A and T allele distributions were not statistically significant between the two groups. However, we observed that a higher frequency of individuals from the ocular group possessed the A/A genotype, when compared with the control group, suggesting that homozygocity for the A allele could enhance susceptibility to ocular toxoplasmosis in T. gondii infection.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Chorioretinitis/parasitology , Genetic Predisposition to Disease/genetics , Interferon-gamma/genetics , Toxoplasmosis, Ocular/genetics , Case-Control Studies , Chorioretinitis/genetics , Chorioretinitis/immunology , Gene Frequency , Genotype , Polymorphism, Single Nucleotide , Rural Population , Toxoplasmosis, Ocular/immunology , Young AdultABSTRACT
The purpose is to report a complication after photodynamic therapy (PDT) and intravitreal triamcinolone for a presumed choroidal neovascularization in age-related macular degeneration. Photodynamic therapy and intravitreal triamcinolone were used in an 84-year-old man with choroidal neovascularization in the left eye. Forty-five days after therapy, the patient returned with a severe necrotizing uveitis in the posterior pole and vitritis. Laboratory investigation disclosed a high anti-Toxoplasma IgG titer. Therapy with pyrimethamine, sulfadiazine and folinic acid resulted in total lesion healing although central vision was lost. Intravitreal triamcinolone may have had an influence on the exacerbation of retinochoroiditis in the posterior pole of the patient. Although rare, this complication may not be disregarded in the cases that require intraocular corticosteroids for treatment of several conditions, especially in patients who had previously suffered from toxoplasmosis infection.
O objetivo é relatar complicação após terapia fotodinâmica (PDT) e triancinolona intravítrea para presumida neovascularização de coróide em degeneração macular relacionada à idade. A terapia fotodinâmica e triancinolona intravítrea foram utilizados em paciente de 84 anos, do sexo masculino, com neovascularização de coróide no olho esquerdo. Quarenta e cinco dias após o tratamento, o paciente retornou com grave retinite necrosante do pólo posterior e vitreíte. Investigação laboratorial indicou alto título de IgG anti-Toxoplasma. Tratamento com pirimetamina, sulfadiazina e ácido folínico levaram à total cicatrização da lesão embora a visão central tenha sido comprometida. Conclui-se que a triancinolona intravítrea pode ter influenciado na exacerbação da retinocoroidite no pólo posterior do paciente. Embora rara, esta complicação não pode ser descartada nos casos que necessitem corticóide intra-ocular para tratamento de várias doenças, principalmente em pacientes que tenham tido surtos prévios de toxoplasmose ocular.
Subject(s)
Humans , Male , Female , Aged, 80 and over , Chorioretinitis/immunology , Glucocorticoids/adverse effects , Immunocompromised Host , Porphyrins/administration & dosage , Toxoplasmosis, Ocular/immunology , Triamcinolone Acetonide/adverse effects , Chorioretinitis/drug therapy , Choroidal Neovascularization/etiology , Choroidal Neovascularization/therapy , Fluorescein Angiography , Glucocorticoids/administration & dosage , Macular Degeneration/complications , Photochemotherapy , Photosensitizing Agents/administration & dosage , Severity of Illness Index , Toxoplasmosis, Ocular/drug therapy , Triamcinolone Acetonide/administration & dosage , Visual AcuityABSTRACT
A retinocoroidopatia de Birdshot é uma doença rara em nosso meio, que acomete principalmente mulheres caucasianas, entre a terceira e sexta décadas de vida. Os autores apresentam um caso de paciente do sexo masculino, de 25 anos de idade, com retinocoroidopatia de Birdshot, cujo quadro clínico é bilateral e constitui-se basicamente de discreta reaçäo inflamatória do segmento anterior, vitreíte, "leakage" vascular retiniano e presença de lesöes simétricas, ovaladas e branco-amareladas, evidenciadas à fundoscopia. O objetivo deste trabalho é discutir os aspectos clínicos, eletrofisiológicos, imunológicos e angiofluoresceinográficos da doença, além de relatar o primeiro caso publicado na literatura brasileira
Subject(s)
Humans , Female , Middle Aged , Chorioretinitis/physiopathology , Chorioretinitis/diagnosis , Chorioretinitis/immunologyABSTRACT
Foram estudados soros de 40 pacientes portadores de lesöes de retinocoroidite ativa, focal, satélite, necrótica e granulomatosa, através de reaçöes imunoenzimáticas de ELISA reversa-IgM. Concluiu-se que ambas as reaçöes apresentavam a mesma sensibilidade, näo ultrapassando 12% de positividade neste grupo