Couvreur J, Thulliez P
Laboratoire de la Toxoplasmose, Institut de Puériculture, Paris.
Presse Med. 1996 Mar 16;25(9):438-42.
Over a period of 13 years (1982-1995), 49 cases of acquired toxoplasmosis complicated with ocular and/or neurologic or meningeal involvement were observed in our toxoplasmosis laboratory. This series includes 43 cases of isolated ocular lesions, 3 cases of meningoencephalitis (associated with retinochoroiditis in 1 case), 1 case of meningitis with uveitis, 1 case of polyradiculoneuritis and 1 case of facial nerve palsy.
The patients were aged 1 to 62 years. None had either spontaneous or iatrogenic immunodeficiency. There were two steps in the diagnosis. First congenital infection was eliminated on one or several of the following criteria: any possibility of maternal infection during pregnancy ruled out in 26 cases, evidence of recent acquired infection (i.e. clinical and/or serological evidence of recent acquired toxoplasmosis in 17 cases, retinochoroiditis in non-twin siblings in 3 cases). The second step was to confirm the diagnosis of toxoplasma infection. Apart from serological evidence of recent infection, confirmation included specific local antibody synthesis in the aqueous humor of the eye and/or in cerebro-spinal fluid or ocular lesions characteristic of toxoplasmosis and absence of other etiology.
Ocular lesions were unilateral in 43 cases among 45. A mean follow-up of 37.9 months revealed relapses in 14 among 36 patients (39%). As routine serological examination for toxoplasmosis is compulsory in France since 1978, it was possible to document retrospectively the immune status of the mothers of many of the patients of the present series during pregnancy and to rule out congenital toxoplasmosis in a number of cases. This might explain the discrepancy between the relatively large number of cases in the present series and the fact that complicated acquired toxoplasmosis has been considered hitherto as relatively rare in immunocompetent patients.
Based on the epidemiology of ocular toxoplasmosis and the data obtained here, it is suggested that the acquired pattern of ocular toxoplasmosis might be more frequent than estimated up to now.
在13年期间（1982 - 1995年），我们的弓形虫病实验室观察到49例获得性弓形虫病合并眼部和/或神经或脑膜受累的病例。该系列包括43例单纯眼部病变、3例脑膜脑炎（其中1例伴有视网膜脉络膜炎）、1例伴有葡萄膜炎的脑膜炎、1例多发性神经根神经炎和1例面神经麻痹。
患者年龄在1至62岁之间。均无先天性或医源性免疫缺陷。诊断分两步进行。首先，根据以下一项或多项标准排除先天性感染：26例排除孕期母亲感染的任何可能性，17例有近期获得性感染的证据（即近期获得性弓形虫病的临床和/或血清学证据），3例非双胞胎兄弟姐妹中有视网膜脉络膜炎。第二步是确诊弓形虫感染。除近期感染的血清学证据外，确诊还包括眼房水和/或脑脊液中特异性局部抗体的合成，或具有弓形虫病特征的眼部病变且无其他病因。
45例中有43例眼部病变为单侧。36例患者平均随访37.9个月，其中14例（39%）复发。自1978年起法国将弓形虫病的常规血清学检查列为强制性检查，因此有可能回顾性记录本系列许多患者母亲孕期的免疫状态，并在一些病例中排除先天性弓形虫病。这可能解释了本系列病例数量相对较多与迄今认为免疫功能正常患者中获得性弓形虫病合并症相对罕见这一事实之间的差异。
基于眼部弓形虫病的流行病学及此处获得的数据，提示获得性眼部弓形虫病的发病模式可能比目前估计的更为常见。
