|Year : 1973 | Volume
| Issue : 2 | Page : 63-65
Macular dysplasia in congenital toxoplasmosis : Report of two cases
IS Roy1, TN Ghosh2, Badal Chowdhuri3
1 Institute of Ophthalmology, Medical College Hospitals, Calcutta-12, India
2 Department of Protozoology, School of Tropical Medicine, Calcutta-12, India
3 Department of Ophthalmology, National Medical College, Calcutta-14, India
I S Roy
Institute of Ophthalmology, Medical College Hospitals, Calcutta-12
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Roy I S, Ghosh T N, Chowdhuri B. Macular dysplasia in congenital toxoplasmosis : Report of two cases. Indian J Ophthalmol 1973;21:63-5
|How to cite this URL:|
Roy I S, Ghosh T N, Chowdhuri B. Macular dysplasia in congenital toxoplasmosis : Report of two cases. Indian J Ophthalmol [serial online] 1973 [cited 2020 May 30];21:63-5. Available from: http://www.ijo.in/text.asp?1973/21/2/63/31409
Toxoplasmosis is a disease caused by the protozoan parasite, Toxo-PLASMA GONDII. Of the various clinical conditions known to be caused by this parasite, ophthalmological manifestations are probably more commonly known (PERKINS  ). In India, SANTAK SINGH  &  for the first time reported a human congenital toxoplasmosis in a boy, aged 9 years, who had been suffering primarily from loss of vision due to retino-choroiditis and convulsions. Since then, many more cases of human toxoplasmosis have been reported from India and the literature has been reviewed by one of us (GHOSH  ). Further cases of ocular toxoplasmosis have also been reported since then by CONSUL et al,  PRAKASH AND CHOWDHRY  and others.
During the period, January, 1965 to October, 1971, 352 ophthalmological cases, each with the possibility of toxoplasmosis were referred to one of us (T.N.G.) at the Department of Protozoology, School of Tropical Medicine, Calcutta, for toxoplasmin skin test. The patients were habitual resisdents of Calcutta, various parts of West Bengal and adjoining provinces. Sixty-four of these cases gave positive toxoplasmin skin reaction. Two of the positive cases had macular coloboma (dysplasia) with other ocular findings and they were suspected to be due to congenital toxoplasmosis. These two cases are reported below.
| Case Reports|| |
P. B. a Hindu girl, aged 10 years, was brought for dimness of vision and occasional convulsions since birth. On examination, the child was found to have overaction of inferior oblique muscles of both eyes and the vision was 6/60 in each of them. Ophthalmoscopic examination showed clear media but large, almost circular choroido-retinal atrophic areas were seen in the macular region of each eye; shining sclera could be seen through these areas [Figure - 1]. Systemic examination revealed no abnormality.
Investigations: General laboratory investigations including serological tests (VDRL & Kahn tests) showed no abnormality. Small areas of calcification in both parietal regions were seen in the skiagram of the skull. Toxoplasmin skin test was positive with an induration of 11 x 12 mm at 72 hours. Indirect haemagglutination test (IHA) for toxoplasmosis performed at the All-India Institute of Medical Sciences, New Delhi-16, was found positive with a very high titre of 1 : 16,384. The mother showed strongly positive toxoplasmin skin reaction.
S. B. a Hindu male aged 15 years, attended for dimness of vision since birth. There was a history of fits in the past. The mother gave a history of repeated abortions. General examination showed no abnormality. Ocular examination showed microcornea with nystagmus. The vision in the right eye was 6/60 and in the left 6/36. On ophthalmoscopic examination, a big solitary round choroidoretinal patch with punched out margin in each macula exposing the white sclera was seen [Figure - 2]. The media were clear.
Investigations: General laboratory investigations including serological tests (VDRL & Kahn tests) showed no abnormality. Small areas of calcification in occipital and parietal bones were seen in the skiagram of the skull. Toxoplasmin skin test gave positive reaction with an induration of 19 x 20 mm at 72 hours. The IHA test for toxoplasmosis could not be done.
| Discussion|| |
Macular dysplasia is a more suitable description than macular coloboma (MANN  ) because the latter implies a developmental defect. Morover, colobomas are rare in which the uveal tissues and adjoining areas of retina are either lacking or ill developed. A typical coloboma of the fundus appears as an oval or comet shaped defect with the rounded apex towards the disc which may or may not be included. Similar patches, usually symmetrical in both the eyes occur in other situations notably at the macular region. It is highly probable that this condition arises out of an intra-uterine choroiditis (MANN  loc cit). It is also probable that some of these are due to intra-uterine ocular inflammation, particularly due to toxoplasmosis (RoY  ). Examination of histological preparations documents the destruction of smaller vessels of the choroid with subsequent scar formation, occasional pigmentation round the larger ones, and formation of retina into a disorganised membrane. This view is supported by the clinical observation of this variety of macular dysplasia noted between 5-6 months of the intra-uterine life (MANN  loc cit).
The toxoplasmin skin test was positive in both the cases. Positivity of this immuno-allergic test indicates the past infection with T. gondii. A very high IHA titre (1 : 16,384) of toxoplasma antibody found in case No. 1 is very characteristic and significant., Clinical features viz., nystagmus bilateral chorio-retinal macular patches, small calcified areas in the brain, history of convulsions from childhood are highly characteristic. Further, the mother of case No. 1 was toxoplasmin positive and the mother of case No. 2 had a history of repeated abortions. These, together with the results of immunological tests confirm the diagnosis of toxoplasmosis. It appears very probable that in both the cases infection was transmitted from mother to child in utero.
| Summary|| |
Two cases of macular dysplasia with congenital ocular annomalies have been reported where congenital toxoplasmosis has been implicated.
| Acknowledgements|| |
We are grateful to Academician Prof. Otto Jirovec and Dr. J Jira of Prague, Czechoslovakia for the supply of toxoplasmin for our work. The late Prof. Om Prakash of the AllIndia Institute of Medical Sciences, New Delhi, very kindly performed the IHA test for toxoplasmosis in case No. 1.
| References|| |
Consul, B. N.. Sharma, D. P. & Chhabra, H. N.: Proc. All-India Ophthal. Soc. 26: 37-44, (1969).
Ghosh. T. N.: Bull. Calcutta School Trop. Med. 16: 91-95, (1968).
Mann, Ida.: Developmental Abnormalities of the Eye, 2nd Edition. London: British Medical Association. (1957).
Perkins, E. S.: Uveitis and Toxoplasmosis, London: J & A Churchill Ltd. (1961).
Om Prakash, and Chowdhry, Prema: Ind. J. Med. Res. 57: 13-24, (1969).
Roy, I. S.: Proc. All-India Ophthal. Soc. 22: 98-103, (1965).
Santok Singh.: Indian Physician. 11: 209-220, (1952).
J. All-India Ophthal. Soc. 1: 71-88, (1953).
[Figure - 1], [Figure - 2]