Clinical and Multimodal Imaging Findings and Risk Factors for Ocular Involvement in a Presumed Waterborne Toxoplasmosis Outbreak, Brazil1.

In 2015, an outbreak of presumed waterborne toxoplasmosis occurred in Gouveia, Brazil. We conducted a 3-year prospective study on a cohort of 52 patients from this outbreak, collected clinical and multimodal imaging findings, and determined risk factors for ocular involvement. At baseline examination, 12 (23%) patients had retinochoroiditis; 4 patients had bilateral and 2 had macular lesions. Multimodal imaging revealed 2 distinct retinochoroiditis patterns: necrotizing focal retinochoroiditis and punctate retinochoroiditis. Older age, worse visual acuity, self-reported recent reduction of visual acuity, and presence of floaters were associated with retinochoroiditis. Among patients, persons >40 years of age had 5 times the risk for ocular involvement. Five patients had recurrences during follow-up, a rate of 22% per person-year. Recurrences were associated with binocular involvement. Two patients had late ocular involvement that occurred >34 months after initial diagnosis. Patients with acquired toxoplasmosis should have long-term ophthalmic follow-up, regardless of initial ocular involvement.

Vision-Related Quality Of Life And Depression In Brazilian Patients With Toxoplasmic Retinochoroiditis.

PURPOSE: To investigate visual-related quality of life (VRQL) and prevalence and severity of depressive symptoms in Brazilian individuals with toxoplasmic retinochoroiditis (TRC). DESIGN: Comparative observational cross-sectional study. The National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and Beck Depression Inventory-II (BDI-II) were applied to respectively assess VRQL and depression in individuals consecutively seen at a uveitis referral center. Clinical/demographical data were collected. Descriptive/analytic statistics were employed, with P<0.05. RESULTS: Patients and controls were comparable concerning age, sex and socioeconomic level. VRQL scores for all subscales were significantly lower in TRC when compared with controls, particularly associated (P<0.05) with female sex, history of ≥2 prior TRC recurrences, concomitant use of systemic corticosteroids, monocular vision and blindness. Depressive symptoms were more prevalent in TRC (55/188; 29.2%) than in controls (34/182; 18.7%) (P=0.023), also being associated with lower VRQL scores (P<0.001). Seropositive and seronegative controls for toxoplasmosis had similar VRQL scores and comparable rates of depressive symptoms. CONCLUSION: TRC affects VRQL in Brazilian individuals, particularly women, using systemic corticosteroids, with visual impairment and presenting recurrences of TRC. One-third of patients with TRC had evidence of depression, which was also associated with lower VRQL scores. Mental health issues in subjects with TRC should not be overlooked.

Ocular Toxoplasmosis in Tropical Areas: Analysis and Outcome of 190 Patients from a Multicenter Collaborative Study.

PURPOSE: To describe clinical findings and outcomes for ocular toxoplasmosis in an international multicenter collaborative study. METHODS: Retrospective analysis of 190 patients diagnosed with ocular toxoplasmosis from three study sites (Brazil, India, and Singapore). RESULTS: There were 93 (48.9%) females with a mean age of 32.8 years. The most common symptoms were isolated blurring of vision (36.8%), followed by blurring of vision with floaters (21.1%). Treatment regimens varied largely from monotherapy to multiple combination therapies. Final visual acuity of ≥20/40 was achieved in 106 (74.2%) patients. In a median follow-up period of 31 weeks (range 12-749 weeks), 83/190 (43.7%) patients suffered a relapse. CONCLUSIONS: There appears to be geographical variation in the presentation of ocular toxoplasmosis. Compared to previous studies, we did not observe the '"dual peak" phenomenon of chronic and active disease based on age at presentation, and there was less bilateral and macular involvement (but more peripheral involvement).