Johnson M W, Greven G M, Jaffe G J, Sudhalkar H, Vine A K
W.K. Kellogg Eye Center, Department of Ophthalmology, University of Michigan School of Medicine, Ann Arbor 48105, USA.
Ophthalmology. 1997 Jan;104(1):48-57. doi: 10.1016/s0161-6420(97)30362-5.
The diagnosis of toxoplasmic retinochoroiditis is based primarily on characteristic ocular findings, with supportive serologic evidence. Clinical recognition of atypical presentations is critical for timely antiparasitic drug therapy.
Case histories were reviewed for seven presumed immunocompetent elderly patients with atypically severe (multifocal or diffuse or both) toxoplasmic retinochoroiditis. Three cases initially were misdiagnosed as acute retinal necrosis syndrome. The correct diagnosis was confirmed in each case by response to antiparasitic drug therapy, polymerase chain reaction studies of intraocular specimens, or histopathologic analysis.
The patients ranged in age from 69 to 82 years (median, 74 years). Only three patients had intercurrent medical conditions that may be associated with subtle immune dysfunction (diabetes mellitus and hepatitis C). The extensive necrotizing retinochoroiditis in each patient was nonhemorrhagic and not associated with occlusive retinal arteritis. Despite prompt response to antiparasitic drug therapy, prolonged treatment usually was required, and four patients had retinitis reactivation after discontinuing treatment. Significant visual loss accompanied the infection in most eyes.
Toxoplasmosis should be considered as a cause of multifocal or diffuse necrotizing retinitis or both in elderly patients. Older patients may be more susceptible to severe ocular Toxoplasma infections because of age-related decline in cell-mediated immunity and chronic underlying diseases.
弓形虫性视网膜脉络膜炎的诊断主要基于特征性的眼部表现以及支持性的血清学证据。对非典型表现的临床识别对于及时进行抗寄生虫药物治疗至关重要。
回顾了7例推测免疫功能正常的老年患者的病历，这些患者患有非典型严重（多灶性或弥漫性或两者皆有）弓形虫性视网膜脉络膜炎。3例最初被误诊为急性视网膜坏死综合征。通过对抗寄生虫药物治疗的反应、眼内标本的聚合酶链反应研究或组织病理学分析，每例均确诊为正确诊断。
患者年龄在69至82岁之间（中位数为74岁）。只有3例患者患有可能与轻微免疫功能障碍相关的并发疾病（糖尿病和丙型肝炎）。每位患者广泛的坏死性视网膜脉络膜炎均无出血，且与闭塞性视网膜动脉炎无关。尽管对抗寄生虫药物治疗反应迅速，但通常需要延长治疗时间，4例患者在停药后出现视网膜炎复发。大多数眼睛在感染时伴有明显的视力丧失。
弓形虫病应被视为老年患者多灶性或弥漫性坏死性视网膜炎或两者兼有的病因。老年患者可能由于细胞介导免疫的年龄相关性下降和慢性基础疾病而更容易发生严重的眼部弓形虫感染。
