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ARTICLES
Year : 1973  |  Volume : 21  |  Issue : 2  |  Page : 63-65

Macular dysplasia in congenital toxoplasmosis : Report of two cases


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

Correspondence Address:
I S Roy
Institute of Ophthalmology, Medical College Hospitals, Calcutta-12
India
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Source of Support: None, Conflict of Interest: None


PMID: 4789113

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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 Oct 31];21:63-5. Available from: https://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 [4] ). In India, SANTAK SINGH [7] & [8] 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 [2] ). Further cases of ocular toxoplasmosis have also been reported since then by CONSUL et al, [1] PRAKASH AND CHOWDHRY [5] 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 Top


CASE-I

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.

CASE-II

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 Top


Macular dysplasia is a more suitable description than macular coloboma (MANN [3] ) 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 [3] loc cit). It is also probable that some of these are due to intra-uterine ocular inflamma­tion, particularly due to toxoplasmosis (RoY [6] ). 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 [3] 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 Top


Two cases of macular dysplasia with congenital ocular annomalies have been reported where congenital toxo­plasmosis has been implicated.


  Acknowledgements Top


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 Top

1.
Consul, B. N.. Sharma, D. P. & Chhabra, H. N.: Proc. All-India Ophthal. Soc. 26: 37-44, (1969).  Back to cited text no. 1
    
2.
Ghosh. T. N.: Bull. Calcutta School Trop. Med. 16: 91-95, (1968).  Back to cited text no. 2
    
3.
Mann, Ida.: Developmental Abnor­malities of the Eye, 2nd Edition. London: British Medical Association. (1957).  Back to cited text no. 3
    
4.
Perkins, E. S.: Uveitis and Toxo­plasmosis, London: J & A Churchill Ltd. (1961).  Back to cited text no. 4
    
5.
Om Prakash, and Chowdhry, Prema: Ind. J. Med. Res. 57: 13-24, (1969).  Back to cited text no. 5
    
6.
Roy, I. S.: Proc. All-India Ophthal. Soc. 22: 98-103, (1965).  Back to cited text no. 6
    
7.
Santok Singh.: Indian Physician. 11: 209-220, (1952).  Back to cited text no. 7
    
8.
Idem: J. All-India Ophthal. Soc. 1: 71-88, (1953).  Back to cited text no. 8
    


    Figures

  [Figure - 1], [Figure - 2]



 

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