retinochoroiditis

视网膜脉络膜炎
  • 文章类型: Systematic Review
    目的:通过系统评价和荟萃分析,确定HIV感染者中眼弓形虫病的患病率。材料与方法:进行了文献检索,估计合并患病率并进行质量评估,离群值,有影响力和荟萃回归分析。结果:29项研究纳入分析,结果显示,HIV感染者的眼弓形虫病率为0.37%(95%CI:0.2-0.6).在研究中观察到显著的异质性。尽管分析了连续变量,包括出版年份,男性的比例,接受抗逆转录病毒治疗的患者的平均年龄和比例,没有发现有统计学意义的关联.结论:本研究概述了HIV感染者眼弓形虫病的患病率,强调需要进一步研究以发现促成其发展的因素。
    这项研究观察了常见的眼部弓形虫病,一种寄生虫感染,是艾滋病毒携带者中的一员。我们通过回顾其他研究来做到这一点,结合他们的结果并评估每个研究的质量。我们还寻找了可能影响眼弓形虫病患病率的任何异常发现和其他因素。在分析了29项研究后,我们发现大约0.37%的艾滋病毒感染者患有眼部弓形虫病,0.2%至0.6%不等。研究结果之间存在显着差异。我们的研究概述了HIV感染者中眼部弓形虫病的患病率,强调需要进一步研究,以确定有助于其发展的因素。
    Aim: To determine the prevalence of ocular toxoplasmosis among people living with HIV through a systematic review and meta-analysis. Materials & methods: A literature search was conducted, estimating pooled prevalence and performing quality assessment, outlier, influential and meta-regression analyses. Results: Twenty-nine studies were included in the analysis, revealing that the rate of ocular toxoplasmosis among people living with HIV was 0.37% (95% CI: 0.2-0.6). Substantial heterogeneity was observed among the studies. Despite analyzing continuous variables, including year of publication, proportion of males, mean age and proportion of patients receiving antiretroviral therapy, no statistically significant associations were found. Conclusion: This study provides an overview of the prevalence of ocular toxoplasmosis in people living with HIV, emphasizing the need for further research to uncover factors contributing to its development.
    This study looked at how common ocular toxoplasmosis, a type of parasitic infection, is among people living with HIV. We did this by reviewing other studies, combining their results and evaluating the quality of each study. We also looked for any unusual findings and other factors that might affect the prevalence of ocular toxoplasmosis. After analyzing 29 studies, we found that approximately 0.37% of people living with HIV had ocular toxoplasmosis, ranging from 0.2% to 0.6%. There was a significant variation in the results among the studies. Our study provides an overview of the prevalence of ocular toxoplasmosis in people living with HIV, highlighting the need for further research to identify the factors contributing to its development.
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  • 文章类型: Review
    目的:报道一例长期使用阿达木单抗治疗后的眼弓形虫病,并回顾抗肿瘤坏死因子-α治疗后的眼弓形虫病文献。方法:回顾性分析一名21岁男性在阿达木单抗联合口服甲氨蝶呤治疗后左眼出现视网膜脉络膜炎。结果:在过去的四年中,一名已知的青少年特发性关节炎(JIA)患者服用了阿达木单抗和口服甲氨蝶呤,在过去的15天中视力模糊。左眼眼底检查显示严重的玻璃体炎和眼底下部的两个视网膜脉络炎斑块。随后的调查证实这是一例弓形虫视网膜脉络膜炎,他对抗弓形虫治疗有反应。对类似主题的文献进行回顾发现了五个这样的案例,索引病例是JIA患者中的首例此类报告。结论:该索引案例强调了早期识别和管理接受生物制剂的患者的机会性感染的重要性。
    Purpose: To report a case of ocular toxoplasmosis following long-term treatment with adalimumab and review the literature on ocular toxoplasmosis following anti-Tumour necrosis factor-α therapy. Method: A retrospective chart review of A 21-year-old male who developed retinochoroiditis in his left eye following adalimumab therapy combined with oral methotrexate. Result: A known patient of juvenile idiopathic arthritis (JIA) on adalimumab and oral methotrexate for the last four years presented to us with a blurring of vision for the last 15 days. Fundus examination of the left eye revealed severe vitritis and two patches of retinochoroiditis in the inferior part of the fundus. Subsequent investigations confirmed it to be a case of toxoplasma retinochoroiditis, and he responded to anti-toxoplasma treatment. A review of literature on a similar topic revealed five such cases, and the index case was the first such report in patients with JIA. Conclusion: The index case highlights the importance of early recognition and management of opportunistic infections in patients receiving biologicals.
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  • 文章类型: Journal Article
    即使在出生时没有表现,患有先天性弓形虫病(CT)的儿童在以后的生活中可能会出现严重的长期后遗症。本系统综述旨在介绍当前的知识状况,以根据如何最佳管理这些怀孕和儿童做出明智的决定。为此,2022年7月28日在PubMed进行了系统的文献检索,中部,ClinicalTrials.gov,GoogleScholar和Scopus确定了所有关于先天性弓形虫病及其长期结果的前瞻性和回顾性研究。我们纳入了来自多个国家的31篇研究论文。毒力性寄生虫菌株,低社会经济地位和任何治疗延误似乎都会导致更糟糕的结果,而作为产前筛查结果的CT的早期诊断可能是有益的。随着时间的推移,接受治疗的儿童的眼部病变率在欧洲增加到30%,在南美儿童中增加到70%以上,并且在生命的第一年通过早期治疗可以大大降低。治疗后,新的神经表现没有报告,虽然超过50%的患者出现眼部复发,与受影响更严重的南美儿童的生活质量相比,欧洲队列对生活质量有轻度至中度影响。尽管与南美相比,欧洲的CT很少见,也不那么严重,产前筛查是尽早诊断和治疗受影响个体的唯一有效方法,以减轻疾病负担并取得令人满意的结果。
    Even in the absence of manifestations at birth, children with congenital toxoplasmosis (CT) may develop serious long-term sequelae later in life. This systematic review aims to present the current state of knowledge to base an informed decision on how to optimally manage these pregnancies and children. For this, a systematic literature search was performed on 28 July 2022 in PubMed, CENTRAL, ClinicalTrials.gov, Google Scholar and Scopus to identify all prospective and retrospective studies on congenital toxoplasmosis and its long-term outcomes that were evaluated by the authors. We included 31 research papers from several countries. Virulent parasite strains, low socioeconomic status and any delay of treatment seem to contribute to a worse outcome, whereas an early diagnosis of CT as a consequence of prenatal screening may be beneficial. The rate of ocular lesions in treated children increases over time to 30% in European and over 70% in South American children and can be considerably reduced by early treatment in the first year of life. After treatment, new neurological manifestations are not reported, while ocular recurrences are observed in more than 50% of patients, with a mild to moderate impact on quality of life in European cohorts when compared to a significantly reduced quality of life in the more severely affected South American children. Though CT is rare and less severe in Europe when compared with South America, antenatal screening is the only effective way to diagnose and treat affected individuals at the earliest possible time in order to reduce the burden of disease and achieve satisfying outcomes.
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  • 文章类型: Case Reports
    UNASSIGNED:本研究的目的是报告1例玻璃体切除术后眼弓形虫病(OT)复发的病例,并回顾其科学依据。
    未经证实:一名58岁男性患者,既往有OT,适当治疗,因黄斑裂孔行玻璃体切除术。随访期间,患者随OT复发而演变。一年后,患者的视力为20/200,黄斑瘢痕广泛。
    UNASSIGNED:关于使用以预防复发为目标的围手术期抗寄生虫治疗尚无共识。有必要进行更好的统计学设计的研究来评估眼部手术后的复发风险以及可能的预防建议。特别是在毒株毒性更强、复发更常见的国家。
    UNASSIGNED: The purpose of this study is to report one case of ocular toxoplasmosis (OT) recurrence after vitrectomy and review the scientific basis about it.
    UNASSIGNED: A 58-year-old male patient with previous OT, properly treated, underwent vitrectomy due to macular hole. During follow-up, patient evolved with recurrence of the OT. After 1 year, patient presents visual acuity of 20/200 and extensive macular scar.
    UNASSIGNED: There is no consensus on using perioperative antiparasitic therapy aiming recurrence prophylaxis. Studies with better statistical design are necessary to evaluate the recurrence risk after ocular surgeries and the possible recommendation of prophylaxis, especially in countries where the strains are more virulent and the recurrence more common.
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  • 文章类型: Journal Article
    目的:这篇综述旨在总结当前有关临床特征的知识,眼弓形虫病的诊断工作和治疗方法主要集中在出生后获得的疾病形式。
    方法:在PubMed数据库中进行了细致的文献检索。在GoogleScholar中进行了补充搜索,以完成收集的项目。
    结果:眼部弓形虫病是后葡萄膜炎最常见的感染性病因之一。它通常表现为视网膜脉络膜炎。设定准确的诊断在很大程度上取决于检测特征性临床特征。除了临床特征的评估,弓形虫病的诊断在很大程度上依赖于血清学检测。检测房水或玻璃体液中的寄生虫DNA可以为明确的诊断提供证据。目前治疗的支柱,如有必要,是口服抗生素与全身性皮质类固醇的使用。最近的证据表明其他治疗方法,如玻璃体内可使用抗生素。
    结论:诊断和治疗方法的最新进展有助于预防或限制眼弓形虫病患者的视力丧失。需要进一步的研究,以便更好地了解流行病学,发病机制,诊断,和治疗对这个具有挑战性的临床实体的管理有重大影响。
    OBJECTIVE: This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up and therapeutic approach of ocular toxoplasmosis focusing mainly on the postnatally acquired form of the disease.
    METHODS: A meticulous literature search was performed in the PubMed database. A supplementary search was made in Google Scholar to complete the collected items.
    RESULTS: Ocular toxoplasmosis is one of the most frequent infectious etiologies of posterior uveitis. It typically presents with retinochoroiditis. Setting an accurate diagnosis depends to a considerable degree on detecting characteristic clinical characteristics. In addition to the evaluation of clinical features, the diagnosis of toxoplasmosis relies at a large degree on serologic testing. The detection of the parasite DNA in the aqueous or vitreous humor can provide evidence for a definitive diagnosis. The current mainstay for the treatment, if necessary, is the use of oral antibiotic with systemic corticosteroids. Recent evidence suggests other therapeutic approaches, such as intravitreal antibiotics can be used.
    CONCLUSIONS: Recent developments in the diagnostic and therapeutic approach have contributed to preventing or limiting vision loss of patients suffering from ocular toxoplasmosis. Further studies are required to provide a better understanding of epidemiology, pathogenesis, diagnosis, and treatment with a significant impact on the management of this challenging clinical entity.
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  • 文章类型: Case Reports
    Toxoplasmosis gondii is ubiquitously present on earth and infection, including congenital infection, is common. Neurological, developmental, and ocular effects can be devastating in the congenital toxoplasmosis population. At present, there is no standard, nation-wide neonatal screening for this disease in the United States.
    A 17-month-old Caucasian female presented to our institution by way of referral for macular scarring. She was diagnosed with intrauterine growth retardation and born with low birth weight and microcephaly at an outside institution, but no systemic workup was conducted at that time. On ocular examination, she was found to have nystagmus and extensive multifocal chorioretinal pigmented scars involving the macula and peripheral retina in both eyes with fibrous vitreous strands extending between scars in the right eye. Toxoplasmosis immunoglobulin G was found to be highly positive. Magnetic resonance imaging of the brain showed supratentorial intracranial calcifications.
    Our patient presented with severe chorioretinal lesions, microcephaly, and nystagmus with a positive immunoglobulin G toxoplasmosis titer. She did not receive any evaluation, including TORCH infectious panel workup, on being born with low birth weight and microcephaly. There are currently no national programs in place for toxoplasmosis to be included in routine neonatal screening, despite the grave sequelae of congenital infection or that studies in other countries have shown cost-effectiveness in early screening and treatment.
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  • 文章类型: Journal Article
    目的:回顾后梅毒性葡萄膜炎的多模态成像模式。
    方法:系统评价。
    结果:梅毒的百分比再次开始增加:世界卫生组织每年报告新的梅毒病例为1200万例。此外,2002年,梅毒占全球死亡人数的0.3%。眼部表现普遍发生在梅毒的二级和三级阶段,即使眼部受累可以发生在所有阶段。梅毒有一个绰号:“伟大的模仿者”,因为它没有独特的临床表现,尽管后葡萄膜炎被认为是最常见的形式。梅毒被称为“伟大的模仿者”,“在存在后葡萄膜炎的情况下进行诊断特别具有挑战性,因为它与其他眼部疾病(如急性视网膜坏死)相似。然而,随着多模式成像的出现,视网膜前的一些特殊模式,视网膜,可以确定梅毒的视网膜脉络膜和视神经受累,以指导诊断和实验室检查。
    结论:这篇综述强调了视网膜前沉淀的各种模式,多灶性视网膜炎,视网膜脉络膜炎(融合和胎盘)和梅毒引起的视神经炎,获得适当的实验室工作和开始治疗。
    OBJECTIVE: To review the multimodal imaging patterns of posterior syphilitic uveitis.
    METHODS: A systematic review.
    RESULTS: The percentage of syphilis has started to increase again: The World Health Organization has reported 12 million new cases of syphilis each year. In addition, syphilis was responsible for 0.3% of deaths globally in 2002. Eye manifestations happen prevalently in secondary and tertiary stages of syphilis, even though ocular involvement can occur in all stages. Syphilis has the nickname: \"the great imitator\" since it has no unique clinical presentation, even though posterior uveitis is considered the most common form. Syphilis is known as \"the great imitator,\" making its diagnosis in the presence of posterior uveitis particularly challenging as it presents similarly to other ocular conditions such as acute retinal necrosis. However, with the advent of multimodal imaging some particular patterns of pre-retinal, retinal, retinochoroidal and optic nerve involvement from syphilis can be identified to guide the diagnosis and the laboratory workup.
    CONCLUSIONS: This review highlights the various patterns of pre-retinal precipitates, multifocal retinitis, retinochoroiditis (confluent and placoid) and optic neuritis caused by syphilis, the appropriate laboratory work to be obtained and the treatment to be initiated.
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  • 文章类型: Journal Article
    Toxoplasmosis is a common infection whose worldwide prevalence is estimated at 30%, with large disparities across the world. Among infected subjects, the prevalence of ocular toxoplasmosis (OT) is, however, limited to about 2% in Europe and 17% in South America. In France, it is estimated that about 1 000 000 patients present either active OT or subsequent chorioretinal scars. Toxoplasma gondii is the first cause of posterior uveitis worldwide, responsible for retinochoroiditis, at times associated with anterior uveitis. To date, there is no consensus yet on how to diagnose OT, which is often based only on clinical presentation. Nevertheless, OT-associated symptoms are often atypical and misleading. Over the last 20 years, tremendous progress has been made in biological tools, enabling parasitologists to confirm the diagnosis in most suspected cases of OT. Using anterior chamber puncture, a safe and fast procedure, ophthalmologists sample aqueous humour for analysis using multiple techniques in order to reach high specificity and sensitivity in OT diagnosis. In this article, we present the different techniques available for the biological diagnosis of OT, along with their characteristics, and propose a diagnostic algorithm designed to select the best of these techniques if clinical examination is not sufficient to ascertain the diagnosis.
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