从非典型坏死性视网膜炎玻璃体中分离弓形虫缓殖子和速殖子
Toxoplasma gondii bradyzoites and tachyzoites isolation from vitreous of atypical necrotizing retinitis.
作者信息
Kharel Sitaula Ranju, Joshi Sagun Narayan, Sah Ranjit, Khadka Sushila, Khatri Kc Anadi, Pokharel Bharat Mani
机构信息
B.P. Koirala Lions Centre for Ophthalmic Studies, Maharajgunj Medical Campus, Department of Ophthalmology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
出版信息
J Ophthalmic Inflamm Infect. 2018 Jun 15;8(1):8. doi: 10.1186/s12348-018-0151-x.
BACKGROUND
Detection of Toxoplasma gondii cysts in vitreous of immunocompetent patient with necrotizing retinitis is extremely rare. We herein report the isolation of Toxoplasma bradyzoites and tachyzoites from the vitreous of healthy person.
RESULTS
A 19-year-old immunocompetent female presented with sudden loss of vision in left eye since 1 week. The BCVA was 6/6 and HM in right and left eye. The left eye finding was suggestive of diffuse necrotizing retinitis with retinal detachment. The IgM and IgG for TORCH infection were negative and HIV, HCV and HBsAg tests were also non reactive. The patient underwent diagnostic and therapeutic vitrectomy with silicon oil installation. The vitreous toxoplasma IgG titre was found to be significantly raised to 1:16. Bradyzoites of toxoplasma were identified in H&E staining and tachyzoites of Toxoplasma were identified in Giemsa staining of vitreous sample. She received oral clindamycin and oral corticosteroid but the vision could not be restored in left eye.
CONCLUSION
Hence, atypical toxoplasmosis with necrotizing retinitis is a fulminant condition with the diagnostic and therapeutic challenge.
背景
在免疫功能正常的坏死性视网膜炎患者的玻璃体液中检测到弓形虫囊肿极为罕见。我们在此报告从一名健康人的玻璃体液中分离出缓殖子和速殖子。
结果
一名19岁免疫功能正常的女性自1周前出现左眼突然视力丧失。右眼和左眼的最佳矫正视力分别为6/6和眼前手动。左眼检查提示弥漫性坏死性视网膜炎伴视网膜脱离。TORCH感染的IgM和IgG均为阴性，HIV、HCV和HBsAg检测也无反应。患者接受了诊断性和治疗性玻璃体切除术并植入硅油。发现玻璃体液弓形虫IgG滴度显著升高至1:16。在苏木精-伊红染色中鉴定出弓形虫缓殖子，在玻璃体液样本的吉姆萨染色中鉴定出弓形虫速殖子。她接受了口服克林霉素和口服皮质类固醇治疗，但左眼视力未能恢复。
结论
因此，伴有坏死性视网膜炎的非典型弓形虫病是一种暴发性疾病，诊断和治疗具有挑战性。
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