Long term ocular and neurological involvement in severe congenital toxoplasmosis.

AIMS: This study was set up to determine the long term ocular and systemic sequelae in patients with severe congenital toxoplasmosis. METHODS: Cross sectional and retrospective study of 17 patients with severe congenital toxoplasmosis. RESULTS: In addition to chorioretinitis (100%), the most common abnormal ocular features were optic nerve atrophy (83%), visual acuity of less than 0.1 (85%), strabismus, and microphthalmos. In 50% of cases we observed iridic abnormalities and about 40% developed a cataract. Overt endocrinological disease, diagnosed in five of 15 patients, included panhypopituitarism (n = 2), gonadal failure with dwarfism (n = 1), precocious puberty with dwarfism and thyroid deficiency (n = 1), and diabetes mellitus and thyroid deficiency (n = 1). The observed endocrinological involvement was associated in all cases with obstructive hydrocephalus with a dilated third ventricle and optic nerve atrophy. CONCLUSION: The recognition of long term ocular, neurological, and endocrinological sequelae of congenital toxoplasmosis is important for medical management of these severely handicapped patients.

The morphological picture of developing meningo-encephalitis in central nervous system.

In this paper we are summarizing our observations collected during several years and concerning the inflammatory changes in maturing human brains. Studies of inflammatory reactions in developing central nervous system (CNS) revealed that their morphological picture changes along with the maturation of the brain and formation of fetal immune response. We have analyzed various types of inflammatory processes (meningeal infiltrations, meningoencephalitis with perivascular infiltrates and glial interstitial changes, inflammatory-necrotic lesions) occurring in different stages of brain development. In all these processes gradual maturation of cell lines belonging to the immune system was seen. Evident correlation between tissue inflammatory reaction and necrosis was confirmed. The necrotic changes mainly within hemispheric white matter may result in the cortical malformations. The morphologic manifestation of inflammation in the developing CNS is dependent on the stage of maturation of the brain structure and immunological response.

[A case of meningoencephalocele with a rare location]. / Sluchai na meningoentsefalotsele s riadka lokalizatsiia.

A case of a meningoencephalocele (MEC) with rare localisation was observed and the authors make a extensive review of the recent scientific literature. We emphasize the importance of early detection of the defects of the neural tube in order to interrupt the pregnancy. Some of the rare localisations of MEC make the prenatal and postnatal diagnosis of these malformations difficult. We report a case of MEC in a newborn infant, with localisation in the lateral colli region, protruding through a scalp base defect.

Damage of maturing brain in the course of toxoplasmic encephalitis.

The aim of the study is to present the damaging influence of toxoplasmic encephalitis on newborn brains. The material consisted of six cases of toxoplasmosis who died during the first months of life. The neuropathological picture indicated indirectly the mechanism of spread of the inflammatory-necrotic process. In the first stage of pathologic process intensive inflammatory infiltrations in the periventricular white matter were seen. In the next stage the necrotic changes involved the majority of the hemispheric white matter. Further development of the disease transformed the brain hemispheres into thin-walled sacs composed of meninges and remnants of the nervous system. Finally, the inflammatory process resulted in hydranencephaly. Proliferation of subependymal glia evident in all cases and blocking the pathways of the cerebro-spinal fluid circulation, may have played a role in this process.

An unusual CT presentation of congenital cerebral toxoplasmosis in an 8 month-old boy with AIDS.

We report on a 8-month-old boy with AIDS, born of an asymptomatic mother with positive HTLV-III serology. He was hospitalized in the Intensive Care Unit because of anemia, fever and hepatosplenomegaly. Chest X-ray showed pneumonia and subsequent blood cultures were positive for Candida albicans. After 3 days of Amphotericin B treatment, the patient was transferred to Infectious Disease Department. After 30 days of hospitalization, the patient developed a rapid neurological impairment evolving into coma. CT scan showed a round, ring-shaped low density lesion with hyperdense and enhancing haemorrhagic centre in the left basal ganglia and a smaller hypodense lesion on the right. There was also evidence of cortical atrophy and mild ventricular dilatation. Such lesions are more commonly described in children with AIDS and congenital cytomegalic inclusion virus (CMV) encephalitis. In this case toxoplasma cysts were shown microscopically reinforcing the contention that in patients with AIDS, toxoplasma gondii infection may occur with atypical manifestation.