An outbreak of toxoplasmosis linked to cats.

Clinical, serologic, and epidermiologic evidence documents an outbreak of toxoplasmosis involving ten of 30 members of an extended family. The index patient had unusual clinical manifestations including brain abscesses, progressive chorioretinitis, seizures, neurologic deficits, hepatosplenomegaly, pneumonitis, and eosinophilia. Toxoplasmosis was confirmed by demonstrating the organism in brain tissue and cerebrospinal fluids; clinical and serologic evidence also indicated infection with Toxocara (viscd children. Of the 11 such children, seven (68%) were seropositive, six of whom had high acute-phase titers (greater than or equal to 1024) to Toxoplasma and a disease consistent with acute toxoplasmosis. All six of the latter group required specific chemotherapy. Geophagia was associated statistically with acute toxoplasmosis among the children; it also increased the risk of infection with Toxocara and enteroparasites. Two school-aged children and two adults had serologic evidence of acute toxoplasmosis, but only one of the group was symptomatic. Epidemiologic evidence indicates that this outbreak was probably caused by ingesting oocysts from cat feces. We suggest that the severe and unusual clinical manifestations of the index patient resulted from simultaneous infection with Toxoplasma and Toxocara.

Auditory and visual defects resulting from symptomatic and subclinical congenital cytomegaloviral and toxoplasma infections.

Sensorineural hearing loss was present in ten of 59 (17%) patients with congenital cytomegalovirus (CMV) infection (three of eight born with symptomatic and seven of 51 born with subclinical infection). The defect was bilateral in eight, moderate to profound in eight, and of progressive nature in two. Hearing loss did not occur in 21 patients with natal CMV infection nor in seven of 12 patients with congenital toxoplasmosis. Histopathologic and immunofluorescent studies of the inner ear in two of three neonates who died with severe infection revealed that viral antigens were widely distributed in cochlear structures. Eye pathology was associated only with congenital Toxoplasma (nine of 12) and CMV (seven of 43) infections. Visual impairments were more prominent and severe in those born with symptomatic infections, exclusively so with CMV. However, ocular defects, in particular chorioretinitis, developed after birth in five of eight patients born with asymptomatic congenital toxoplasmosis. These data firmly establish clinically inapparent congenital CMV infection as a major public health problem and confirm the fact that congenital toxoplasmosis may be associated with late-appearing, debilitating chorioretinitis.

Hearing loss and congenital symptomatic cytomegalovirus infection: a case report of multidisciplinary longitudinal assessment and intervention.

More than 6000 children born annually in this country have hearing loss resulting from congenital cytomegalovirus (CMV) infection, the leading nonhereditary congenital cause of hearing loss in children. This exemplary congenital symptomatic CMV case focuses on the results of longitudinal audiologic, educational, medical, psychological, and visual evaluations and intervention. Decreased ocular motor control and visual acuity were observed as was bilateral deterioration of hearing from 3 days though 9 years of age. Treatment with dexamethasone and histamine resulted in almost complete reversal of the most recent progression of hearing loss in the left ear.

Posterior segment involvement in selected pediatric infectious diseases.

This paper reviews the ocular manifestations that may be found primarily in the posterior segment of the eye in selected infectious diseases. These diseases largely affect the pediatric population. Each disease is discussed in terms of its etiology, epidemiology, clinical course and manifestations, ocular involvement, and treatment. These diseases are important since their ocular involvement may lead to severe visual impairment.

Refractive error distribution in a profoundly retarded population.

The refractive errors distribution of 103 profoundly retarded individuals (10 of zero to 20) was determined. This distribution was skewed in the direction of myopia. Since no such data were available for any other profoundly retarded population, direct comparison with other studies was not possible. However, a significant difference in mean spherical equivalent was found between the profoundly retarded of this study and the combined severely and profoundly retarded of two earlier studies.

The ocular manifestations of congenital infections produced by toxoplasma and cytomegalovirus.

Chorioretinitis is the most common ocular manifestation of congenital toxoplasmosis occurring in both symptomatic and the more freqeunt subclinical form of the disease. Chorioretinitis also occurs in symptomatic congenital cytomegalovirus (CMV) but not in the subclinical form of this congenital congenital infection. Diagnosis cannot be made from ocular signs alone. Knowledge of the epidemiology of both congenital infections along with information about the postnatal history will assist in the differentiation.

The effect of a nitrous oxid-oxygen mixture on the lateral heterophoria.

The distance and near lateral heterophorias were investigated in 10 subjects to determine the effect of a nitrous oxide (N2O)-oxygen (O2) mixture. The heterophorias were measured by the Maddox method before and after a 3-minute induction period of nitrous oxide. It was found that the distance lateral heterophoria for all 10 subjects changed toward more esophoria, whereas the changes in the near lateral heterophoria were inconsistent in their direction.

Ocular abnormalities in congenital cytomegalovirus infection.

BACKGROUND: Congenital cytomegalovirus (CMV) infection often results in damage to the brain, auditory system and visual system that leads to debility. This report describes the frequency, severity and effect on vision function of ocular abnormalities in a large cohort of children with congenital CMV infection. METHODS: Serial eye examinations were performed on 445 infants and children with congenital CMV infection from one month to 9 years of age, assessing anatomic integrity, motor sensory function, retina and posterior pole. RESULTS: Ocular disease was manifest principally by chorioretinitis, optic atrophy, pigmentary retinopathy and strabismus; each of these findings occurred more frequently (p < 0.05) among children who were symptomatic at birth than among those who were initially asymptomatic. These same findings were also more common among patients born after a primary maternal infection than among those born after a recurrent maternal infection. More than half of the patients with symptomatic congenital CMV infection with chorioretinitis or optic atrophy had significant binocular vision impairment. CONCLUSIONS: Ocular disease is an important sequela of congenital CMV infection that can lead to impaired vision. In order to allow for early intervention, patients with congenital CMV infection should have eye examinations beginning in early infancy.