Alves Jane Mary, Magalhães Vera, Matos Marcus Augusto Gomes de
Universidade Federal de Pernambuco, Recife, PE, Brasil.
Arq Bras Oftalmol. 2010 Mar-Apr;73(2):150-4. doi: 10.1590/s0004-27492010000200010.
Neurotoxoplasmosis is the most common central nervous system disorder in patients with AIDS. The occurrence of ocular toxoplasmosis in neurotoxoplasmosis is not well studied. The objective of this study was to investigate the occurrence of typical or probable toxoplasmic retinochoroiditis in patients with AIDS and neurotoxoplasmosis.
A prospective case series was performed, including 70 patients of both genders, aged from 20 to 63 years, hospitalized in three public hospitals in Recife, Pernambuco, with such diagnosis according to the CDC criteria (1992), from January to October, 2008.
Patients were characterized by first neurotoxoplasmosis episode (65, 92.9%) or relapse (5, 7.1%), ignorance of AIDS diagnosis (23, 32.9%), mean CD4 T lymphocytes count of 139.8 +/- 3.04 cells/mm(3) and mean viral load of 137,080 +/- 39,380 copies/mL. All patients underwent ophthalmologic examination, consisting of ocular inspection, visual acuity measurement, investigation of ocular extrinsic muscle function and fundoscopy, using binocular indirect ophthalmoscope (model OHN 3.5 (Eyetec) and 20 diopters external lens (Volk). Four (5.7%) patients presented retinochoroiditis scar lesions, characteristic of ocular toxoplasmosis, typical in 3 (75%) of them and bilateral in one. There was no case of typical or probable active retinochoroiditis. Active ocular lesions were rare compared to scarring, which are associated with the presence of retinal cysts.
Scarring lesions should be valued in patients with AIDS.
神经型弓形虫病是艾滋病患者中最常见的中枢神经系统疾病。神经型弓形虫病中眼部弓形虫病的发生率尚未得到充分研究。本研究的目的是调查艾滋病合并神经型弓形虫病患者中典型或可能的弓形虫性视网膜脉络膜炎的发生率。
进行了一项前瞻性病例系列研究，纳入了70例年龄在20至63岁之间的男女患者，他们于2008年1月至10月在伯南布哥州累西腓的三家公立医院住院，根据美国疾病控制与预防中心（1992年）的标准诊断为此病。
患者的特点为首次发生神经型弓形虫病发作（65例，92.9%）或复发（5例，7.1%），对艾滋病诊断不知情（23例，32.9%），平均CD4 T淋巴细胞计数为139.8±3.04个细胞/mm³，平均病毒载量为137,080±39,380拷贝/mL。所有患者均接受了眼科检查，包括眼部检查、视力测量、眼外肌功能检查和眼底镜检查，使用双目间接检眼镜（OHN 3.5型号（Eyetec）和20屈光度外置透镜（Volk））。4例（5.7%）患者出现了视网膜脉络膜炎瘢痕病变，这是眼部弓形虫病的特征，其中3例（75%）为典型病变，1例为双侧病变。没有典型或可能的活动性视网膜脉络膜炎病例。与瘢痕形成相比，活动性眼部病变较少见，瘢痕形成与视网膜囊肿的存在有关。
艾滋病患者中的瘢痕病变应受到重视。
