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

Brandão-de-Resende, Camilo; Santos, Helena Hollanda; Lagos, Angel Alessio Rojas; Lara, Camila Munayert; Arruda, Jacqueline Souza Dutra; Marino, Ana Paula Maia Peixoto; Antonelli, Lis Ribeiro do Valle; Gazzinelli, Ricardo T.; Vitor, Ricardo Wagner de Almeida; Vasconcelos-Santos, Daniel Vítor

doi:10.3201/eid2612.200227

Cited by 6 publications

(11 citation statements)

References 26 publications

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“…Heparinized whole blood was collected from acutely T. gondii -infected patients ( n = 21) from an outbreak that occurred in Gouveia, Minas Gerais, Brazil, in 2015 ( 50 ). These 21 patients were reassessed 6 months later and were then determined to be chronically infected.…”

Section: Methodsmentioning

confidence: 99%

Toxoplasma gondii-Induced Neutrophil Extracellular Traps Amplify the Innate and Adaptive Response

Miranda

Rocha

Pereira

et al. 2021

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Section: Methodsmentioning

confidence: 99%

Toxoplasma gondii-Induced Neutrophil Extracellular Traps Amplify the Innate and Adaptive Response

Miranda

Rocha

Pereira

et al. 2021

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“…In addition, age over 40 years was a factor that increased the risk of recurrences with a relative risk (RR) up to 1.74, (95% CI 1.06–2.86) [ 44 ]. Other clinical factors increasing the risk of OT reactivation were bilateral lesions (RR: 8.0; 95% CI 1.3–50.0) [ 28 ], pregnancy (RR: 7.40; 95% CI 4.46–12.06) [ 33 ], the presence of a single lesion with a Hazard Ratio (HR) 1.60 (95% CI 1.07–2.40) [ 12 ], and an initial active presentation odds ratio (OR) 4.74 (95% CI 1.95–12.91) [ 27 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…Regarding recurrences in previous and no previous involved eye, they usually occur in the affected eye [ 7 , 85 ]. Finally, the mean number of reactivations was between 0.105 and 2.6 recurrences per year [ 14 , 28 , 31 , 50 ]. In addition, reported flare-ups per interval of time were one recurrence in 5 years, 1.7 recurrences in 10 years, and two recurrences in 11 years [ 42 , 44 , 50 ].…”

Section: Resultsmentioning

confidence: 99%

Risk factors for recurrences and visual impairment in patients with ocular toxoplasmosis: A systematic review and meta-analysis

et al. 2023

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Background Ocular toxoplasmosis (OT) is caused by the parasite Toxoplasma gondii. OT is the leading cause of posterior uveitis globally; it is a recurrent disease that may result in visual impairment and blindness. This systematic review and meta-analysis aim to summarize and evaluate the risk factors for recurrences, visual impairment, and blindness described in the literature worldwide. Methods and findings We performed a systematic literature search in PubMed, Embase, VHL, Cochrane Library, Scopus, and DANS EASY Archive. All studies reporting patients with clinically and serologically confirmed OT presenting any clinical or paraclinical factor influencing recurrences, visual impairment, and blindness were included. Studies presenting secondary data, case reports, and case series were excluded. An initial selection was made by title and abstract, and then the studies were reviewed by full text where the eligible studies were selected. Then, the risk of bias was assessed through validated tools. Data were extracted using a validated extraction format. Qualitative synthesis and quantitative analysis were done. This study was registered on PROSPERO (CRD42022327836). Results Seventy two studies met the inclusion criteria. Fifty-three were summarized in the qualitative synthesis in three sections: clinical and environmental factors, parasite and host factors, and treatment-related factors. Of the 72 articles, 39 were included in the meta-analysis, of which 14 were conducted in South America, 13 in Europe, four in Asia, three multinational, two in North America and Central America, respectively, and only one in Africa. A total of 4,200 patients with OT were analyzed, mean age ranged from 7.3 to 65.1 year of age, with similar distribution by sex. The frequency of recurrences in patients with OT was 49% (95% CI 40%–58%), being more frequent in the South American population than in Europeans. Additionally, visual impairment was presented in 35% (95% CI 25%–48%) and blindness in 20% (95% CI 13%–30%) of eyes, with a similar predominance in South Americans than in Europeans. On the other hand, having lesions near the macula or adjacent to the optic nerve had an OR of 4.83 (95% CI; 2.72–8.59) for blindness, similar to having more than one recurrence that had an OR of 3.18 (95% CI; 1.59–6.38). Finally, the prophylactic therapy with Trimethoprim/Sulfamethoxazole versus the placebo showed a protective factor of 83% during the first year and 87% in the second year after treatment. Conclusion Our Systematic Review showed that clinical factors such as being older than 40 years, patients with de novo OT lesions or with less than one year after the first episode, macular area involvement, lesions greater than 1 disc diameter, congenital toxoplasmosis, and bilateral compromise had more risk of recurrences. Also, environmental and parasite factors such as precipitations, geographical region where the infection is acquired, and more virulent strains confer greater risk of recurrences. Therefore, patients with the above mentioned clinical, environmental, and parasite factors could benefit from using prophylactic therapy.

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“… 25 A Brazilian population-based study 34 found that older age showed no association with the presence of ocular lesions, unlike other studies that reported this variable as a risk factor for OT. 11 34 36 …”

Section: Discussionmentioning

confidence: 99%

“…The most common clinical manifestation of toxoplasmosis involves the eye in the form of retinochoroiditis10; it is the leading cause of infectious posterior uveitis in non-immunocompromised individuals worldwide 6 11 12. Although ocular toxoplasmosis (OT) results from both congenital and acquired infections, eye disease acquired after birth is much more common than congenital infection 6 11–13. OT may occur immediately or long after the initial infection or during reactivation 3.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for ocular toxoplasmosis among uveitis patients in Kinshasa, DR Congo

et al. 2023

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ObjectiveTo identify the risk factors associated with ocular toxoplasmosis (OT) in a cohort of Congolese patients with uveitis.Methods and analysisA cross-sectional study was conducted between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa. Patients with a diagnosis of uveitis were enrolled in the study. Each patient underwent an interview, an ophthalmological examination and serology testing. Logistic regression was performed to identify risk factors for OT.Results212 patients were included in the study with a mean age at presentation of 42.1±15.9 years (limits: 8–74 years) and a sex ratio of 1.1:1. OT concerned 96 patients (45.3%). The age of the patients below 60 years (p=0.001, OR=9.75 CI 95% 2.51 to37.80)), the consumption of cat meat (p=0.01, OR=2.65 CI 95% 1.18 to 5.96)) and undercooked meat (p=0.044, OR=2.30 CI 95% 1.02 to 5.21)) and living in rural area (p=0.021, OR=11.4 (CI 95% 1.45 to 89.84])) were identified as risk factors for OT.ConclusionOT affects more young people. It is associated with dietary habits. Informing and educating the population is necessary to avoid infection.

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

Cited by 6 publications

References 26 publications

Toxoplasma gondii-Induced Neutrophil Extracellular Traps Amplify the Innate and Adaptive Response

Toxoplasma gondii-Induced Neutrophil Extracellular Traps Amplify the Innate and Adaptive Response

Risk factors for recurrences and visual impairment in patients with ocular toxoplasmosis: A systematic review and meta-analysis

Risk factors for ocular toxoplasmosis among uveitis patients in Kinshasa, DR Congo

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