Cílem sdělení je seznámit s formami očních projevů visceral larva migrans u dětí, jak dokresluje rozsáhlá fotodokumentace. Oční larvální toxokaróza (OLT) má i v dětském věku rozdílné klinické projevy, kdy vliv má věkové zastoupení. Nejčastěji bývá přítomen periferní granulom oka často s trakčním vitreálním pruhem táhnoucím se z periferie sítnice k papile zrakového nervu. Následuje granulom zadního pólu oka zasahující většinou od makulární krajiny do střední periferie sítnice vždy s vitritidou. U dětí se může OLT projevit i postižením optického nervu (cystický granulom hlavy zrakového nervu nebo neuropatie s vitritreální reakcí), fulminativní endoftalmitidou a vzácně i difúzní chorioretinitidou. Diagnostika se opírá o klinický oftalmologický nález a také laboratorní vyšetření hladin protilátek s případnou eosinofilií. Histologické vyšetření může prokázat kulovitou polyploidní osifikaci v cévnatce na zadním pólu oka jako následek fibrotizace a kalcifikace postupující z v okolí vstřebané larvy. Celková kombinovaná léčba anthelmetikem a kortikoidem je obtížná, a ne vždy přináší dobrý efekt ve smyslu uspokojivého zlepšení zrakové ostrosti. Projevy OLT u malých dětí jsou stále spojeny v diferenciální diagnóze s retinoblastomem a klinikou dalších nitroočních chorob.

The aim of this paper is to present an outline of forms of ocular manifestations of visceral larva migrans in children, as illustrated by the extensive photographic documentation. Ocular larval toxocariasis (OLT) has various clinical manifestations even in childhood age, in which age representation has an influence. The most common is presence of peripheral granuloma of the eye, frequently with a tractional vitreal streak leading from the retinal periphery to the optic nerve papilla. This is followed by granuloma of the posterior pole of the eye, usually reaching from the macular landscape to the central retinal periphery, always with vitritis. In children OLT may be manifested also in affliction of the optic nerve (cystic granuloma of the head of the optic nerve or neuropathy with vitreal reaction), fulminant endophthalmitis and in rare cases also diffuse chorioretinitis. The diagnosis rests upon a clinical ophthalmological finding, as well as laboratory examination of the levels of antibodies with potential eosinophilia. Histological examination may demonstrate spherical polypoid ossification in the choroid at the posterior pole of the eye as a consequence of fibrotisation and calcification, proceeding from the surrounding area of the absorbed larva. General combined treatment with antihelminthics and corticosteroids is arduous and does not always produce the desired effect in the sense of a satisfactory improvement of visual acuity. In differential diagnostics, manifestations of OLT in small children are still associated with retinoblastoma and a clinical picture of other intraocular diseases.

• MeSH
• Anthelmintics administration & dosage   pharmacokinetics   therapeutic use   MeSH
• Chorioretinitis etiology   MeSH
• Diagnosis, Differential MeSH
• Child MeSH
• Enzyme-Linked Immunosorbent Assay methods   MeSH
• Endophthalmitis etiology   MeSH
• Larva Migrans, Visceral diagnosis   etiology   MeSH
• Humans MeSH
• Eye pathology   MeSH
• Toxocariasis * diagnosis   drug therapy   prevention & control   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Choroiditis diagnosis   etiology   drug therapy   MeSH
• Endophthalmitis diagnosis   etiology   therapy   MeSH
• Conjunctivitis diagnosis   etiology   therapy   MeSH
• Humans MeSH
• Eye Infections, Bacterial MeSH
• Eye Infections, Fungal MeSH
• Eye Infections, Parasitic MeSH
• Eye Infections, Viral MeSH
• Eye Infections * diagnosis   etiology   therapy   MeSH
• Retinitis diagnosis   etiology   drug therapy   MeSH
• Uveitis diagnosis   etiology   therapy   MeSH
• Check Tag
• Humans MeSH

Cíl: Seznámit se získanými atypickými formami oční toxoplazmózy (OT) v dětství, s přihlédnutím k stoletému výročí objevu této etiologie profesorem Janků z Československa. Jmenovaný poprvé popsal klinický kongenitální obraz OT charakterizovaný makulární jizvou. Materiál: U 6tiletého děvčete se objevily příznaky nitrooční oboustranné neuritidy se zrakovou ostrostí (ZO) oboustranně 0,1. Laboratorně byla prokázaná toxoplazmová etiologie, jednalo se imunokompetentní pacientku. Po léčbě makrolidovým antibiotikem a aplikaci kortikosteroidu parabulbárně se stav trvale normalizoval na ZO 1,0 na obou očích. U 8letého chlapce byla zjištěna oboustranná vaskulitida sítnice se ZO vpravo 0,25 a vlevo 1,0 s anamnézou strabismu detekovaného po varicelle. Vyšetření na toxoplasmózu bylo negativní, byla však odhalena výrazná celková hypogamaglobulinémie tříd IgG, IgM i IgA. Imunosupresivní a imunomodulační terapie nepřinesla efekt, stav progredoval do retinochoroiditidy. Pro slepotu a dolorózní glaukom vpravo byla ve věku 15 let provedena enukleace. Histologicky byly odhaleny toxoplazmové cysty s bradozoity, následné laboratorní vyšetření prokázalo toxoplazmovou etiologii při přetrvávající ustupující hypogamaglobulinémii. Celková protitoxoplazmová i následná imunosupresivní léčba nepřinesla efekt a ve věku 22 let pacient oslepl i na levé oko. Závěr: Atypická forma OT intraokulární neuritidy u imunokompetentního pacienta měla příznivý průběh, zatímco retinální vaskulitida s retinochoroiditidou u přechodně imunokompromitovaného pacienta skončila oboustrannou slepotou.

Aim: To present an outline of acquired atypical forms of ocular toxoplasmosis (OT) in childhood, with reference to the 100th anniversary of the discovery of this etiology by Professor Janků from Czechoslovakia, who was first to describe the clinical congenital picture of OT characterised by macular scar. Material and Methods: Symptoms of intraocular bilateral neuritis appeared in a 6-year-old girl, with visual acuity (VA) bilaterally 0.1. Toxoplasmic etiology was demonstrated in laboratory tests, and the patient was immunocompetent. Following treatment with macrolide antibiotic and parabulbar application of corticosteroid, the condition was normalised stably at VA 1.0 in both eyes. Bilateral retinal vasculitis was determined in an 8-year-old boy, with VA of 0.25 in the right eye and 0.25 in the left, with a medical history of strabismus detected after suffering from varicella. The examination for toxoplasmosis was negative, but pronounced general hypogammaglobulinaemia classes IgG, IgM and IgA was detected. Immunosuppressive and immunomodulatory therapy did not produce the desired effect, and the condition progressed to retinochoroiditis. Due to blindness and dolorous glaucoma, enucleation of the right eye was performed at the age of 15 years. Histologically toxoplasmic cysts with bradyzoites were detected, a subsequent laboratory test demonstrated toxoplasmic etiology upon a background of persistent regressing hypogammaglobulinaemia. General anti-toxoplasma and subsequent immunosuppressive treatment did not produce the desired effect, and at the age of 22 years the patient lost his sight also in the left eye. Conclusion: Atypical form of OT intraocular neuritis in an immunocompetent patient had a favourable course, whereas retinal vasculitis with retinochoroiditis in a temporarily immunocompromised patient ended in bilateral blindness.

• MeSH
• Agammaglobulinemia drug therapy   MeSH
• Chorioretinitis drug therapy   MeSH
• Child MeSH
• Humans MeSH
• Neuritis drug therapy   MeSH
• Toxoplasmosis, Ocular * diagnosis   complications   physiopathology   MeSH
• Retinal Vasculitis drug therapy   MeSH
• Famous Persons MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Biography MeSH
• Case Reports MeSH

• MeSH
• Retinal Necrosis Syndrome, Acute MeSH
• Brucellosis drug therapy   blood   physiopathology   MeSH
• Chorioretinitis MeSH
• Diagnosis, Differential MeSH
• Herpesviridae Infections drug therapy   classification   blood   physiopathology   MeSH
• Histoplasmosis drug therapy   immunology   physiopathology   MeSH
• Bartonella Infections drug therapy   blood   physiopathology   MeSH
• Communicable Diseases * classification   complications   MeSH
• Candidiasis drug therapy   physiopathology   pathology   MeSH
• Cryptococcosis drug therapy   immunology   complications   MeSH
• Leptospirosis diagnosis   drug therapy   microbiology   physiopathology   MeSH
• Humans MeSH
• Lyme Disease drug therapy   blood   physiopathology   MeSH
• Myiasis diagnostic imaging   classification   transmission   MeSH
• Eye Manifestations * MeSH
• Toxoplasmosis, Ocular diagnostic imaging   drug therapy   MeSH
• Onchocerciasis, Ocular diagnostic imaging   MeSH
• Pneumocystis carinii isolation & purification   pathogenicity   drug effects   MeSH
• Schistosomiasis diagnostic imaging   classification   transmission   MeSH
• Measles complications   blood   physiopathology   MeSH
• Toxocariasis immunology   pathology   MeSH
• Toxoplasmosis MeSH
• Uveitis classification   MeSH
• Optic Neuritis MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Kongenitální toxoplasmosa je celosvětově rozšířené onemocnění způsobené transplacentárním přenosem intracelulárního parazita Toxoplasma gondii. V případě vertikálního přenosu může infekce způsobit závažné multiorgánové komplikace až úmrtí plodu v závislosti na fázi těhotenství v okamžiku nákazy a na celkovém stavu imunitního systému matky. Z příznaků je známá častá triáda chorioretinitida, hydrocefalus a intrakraniální kalcifikace. Právě toxoplasmová chorioretinitida je jejím nejčastějším očním projevem a v případě zasažení centrální oblasti sítnice může vést k závažnému postižení centrální zrakové ostrosti nebo až ke slepotě dítěte. V současné době je v České republice prenatální screening tohoto onemocnění dobrovolný. Práce dokumentuje případ chorioretinitidy toxoplasmové etiologie u novorozeného chlapce zachycené v aktivním stádiu a vývoj sítnicového nálezu v čase. Dále se věnuje celkovým multiorgánovým komplikacím popsaným u tohoto pacienta, kdy na základě diagnostikovaného hydrocefalu bylo indikováno oční vyšetření, které stanovilo závažné změny na očním pozadí. Hydrocefalus u chlapce byl následně řešen. V textu práce je popsán stručný souhrn dostupných diagnostických a terapeutických metod a možnosti screeningu onemocnění v porovnání s jinými zeměmi.

Congenital toxoplasmosis is a globally spread infectious disease caused by transplacental transmission of an intracellular parasitic protozoan Toxoplasma gondii. The infection can cause serious multi-organ complications, and in the case of vertical transmission, can lead up to fetal death - depending on the stage of pregnancy at the time of infection and the overall condition of the mother's immune system. Chorioretinitis, hydrocephalus and intracranial calcifications are a typical triad of symptoms associated with the disease. Toxoplasmic chorioretinitis in particular is the most common ocular manifestation. If the central retina is affected, it can cause a severe impairment of central visual acuity or lead up to blindness in the child. Prenatal screening of this disease is presently voluntary in the Czech Republic. This article reports on a case study of a toxoplasmic chorioretinitis in a newborn child observed from the active stage and the development of the affected retina over time. Further is also reported on the diagnostics and the treatment of multi-organ complications which occurred in this patient. Ophthalmologic examination was performed after diagnosis of hydrocephalus, which revealed severe changes of retina. Hydrocephalus was then properly treated. An overview of the diagnostic and therapeutic methods and the screening options available in the Czech Republic compare with other countries is also presented in the report.

• MeSH
• Chorioretinitis * diagnosis   etiology   drug therapy   MeSH
• Diagnostic Techniques, Ophthalmological MeSH
• Hydrocephalus diagnosis   etiology   therapy   MeSH
• Clinical Laboratory Techniques methods   MeSH
• Drug Therapy, Combination MeSH
• Toxoplasmosis, Congenital * diagnosis   drug therapy   complications   MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Neuroimaging methods   MeSH
• Infant, Newborn MeSH
• Disease Transmission, Infectious MeSH
• Pyrimethamine administration & dosage   pharmacology   therapeutic use   MeSH
• Vision Screening MeSH
• Serologic Tests methods   MeSH
• Spiramycin administration & dosage   pharmacology   therapeutic use   MeSH
• Sulfadiazine administration & dosage   pharmacology   therapeutic use   MeSH
• Toxoplasma drug effects   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Publication type
• Case Reports MeSH

Tuberkulóza (TBC) oka je v krajinách s nízkym endemickým výskytom ochorenie veľmi zriedkavé. Môže sa vyskytovať ako pri orgánovej, tak latentnej tuberkulóznej infekcii alebo úplne izolovane. Pre stanovenie diagnózy potvrdenej očnej tuberkulózy je nevyhnutné dokázať prítomnosť Mycobacterium tuberculosis priamo v očných tkanivách, čo je pri známej paucibacilarite veľmi náročné. V uvedenom článku opisujeme prípad pacienta schoroiditis serpiginosa, u ktorého v rámci diferenciálnej diagnostiky bola odobraná vzorka sklovca na PCR vyšetrenie prítomnosti mykobaktéria tuberkulózy. Po obdržaní negatívneho výsledku ako aj ostatných negatívnych sérologických vyšetreniach bol pacient 33 mesiacov liečený imunosupresívnou liečbu pre neustále recidivujúci charakter ochorenia. Až po vzostupe nešpecifických zápalových parametrov, sérokonverzii Mantoux II a pozitivite IGRA testov napriek negatívnej snímke pľúc a negatívnom mikroskopickom a kultivačnom vyšetrení na prítomnosť Mycobacterium tuberculosis, sme diagnózu konvertovali na predpokladanú tuberkulóznu, serpiginóznej choroiditíde podobnú klinickú jednotku. Pacientovi sme nasadili diagnostickú terapiu antituberkulotikmi s pozitívnou terapeutickou odozvou. Na kompletné zhojenie

Ocular tuberculosis (TB) is very rare in countries with a low endemic occurrence of this disease. It may be present in connection with organ and/or latent tuberculous infection or as an isolated form. A presence of Mycobacterium tuberculosis directly in ocular structures is essential for a diagnosis of proven ocular tuberculosis, which is very demanding due to its known paucibacillary character. A patient with choroiditis serpiginosa, who underwent PCR testing of his vitreous sample for a presence of Mycobacterium tuberculosis during a process of differential diagnosis, is presented in our paper. Based on negative results of both vitreous sample and other serology tests and due to recurrent character of the disease the patient was treated with immunosuppressive therapy for a period of 33 months. Despite negative chest X ray and negative microscopic and culture tests for a presence of Mycobacterium tuberculosis the diagnosis was converted to a suspected tuberculous serpiginous-like chorioditis after the increase of non-specific inflammatory parameters, Mantoux II seroconversion and positivity of IGRA tests. The patient received antituberculous therapy as a diagnostic treatment and had a positive therapeutic response. Complete healing of intraocular inflammation required the administration of the antituberculous therapy for a period of 24 months.

• MeSH
• Antitubercular Agents therapeutic use   MeSH
• Choroiditis * etiology   drug therapy   MeSH
• Diagnosis, Differential MeSH
• Ethambutol administration & dosage   therapeutic use   MeSH
• Immunosuppression Therapy MeSH
• Isoniazid administration & dosage   therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Moxifloxacin MeSH
• Mycobacterium tuberculosis isolation & purification   MeSH
• Prednisone administration & dosage   therapeutic use   MeSH
• Rifampin administration & dosage   therapeutic use   MeSH
• Tuberculosis, Ocular * diagnosis   drug therapy   blood   MeSH
• Uveitis drug therapy   surgery   complications   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

x

x

• MeSH
• Chorioretinitis diagnosis   etiology   MeSH
• Iridocyclitis diagnosis   etiology   MeSH
• Humans MeSH
• Uveitis * diagnosis   etiology   classification   MeSH
• Check Tag
• Humans MeSH

Congenital toxoplasmosis is a globally spread infectious disease caused by transplacental transmission of an intracellular parasitic protozoan Toxoplasma gondii. The infection can cause serious multi-organ complications, and in the case of vertical transmission, can lead up to fetal death – depending on the stage of pregnancy at the time of infection and the overall condition of the mother's immune system. Chorioretinitis, hydrocephalus and intracranial calcifications are a typical triad of symptoms associated with the disease. Toxoplasmic chorioretinitis in particular is the most common ocular manifestation. If the central retina is affected, it can cause a severe impairment of central visual acuity or lead up to blindness in the child. Prenatal screening of this disease is presently voluntary in the Czech Republic. This article reports on a case study of a toxoplasmic chorioretinitis in a newborn child observed from the active stage and the development of the affected retina over time. Further is also reported on the diagnostics and the treatment of multi-organ complications which occurred in this patient. Ophthalmologic examination was performed after diagnosis of hydrocephalus, which revealed severe changes of retina. Hydrocephalus was then properly treated. An overview of the diagnostic and therapeutic methods and the screening options available in the Czech Republic compare with other countries is also presented in the report.

• MeSH
• Central Nervous System diagnostic imaging   pathology   MeSH
• Chorioretinitis * diagnostic imaging   etiology   drug therapy   pathology   congenital   MeSH
• Diagnostic Techniques, Ophthalmological MeSH
• Head pathology   MeSH
• Hydrocephalus diagnosis   etiology   pathology   congenital   MeSH
• Hypertension diagnosis   etiology   MeSH
• Clinical Laboratory Techniques methods   MeSH
• Drug Therapy, Combination MeSH
• Toxoplasmosis, Congenital * diagnosis   drug therapy   complications   MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Cerebral Ventricles diagnostic imaging   pathology   MeSH
• Multiple Organ Failure etiology   MeSH
• Neuroimaging methods   MeSH
• Infant, Newborn MeSH
• Eye Manifestations MeSH
• Disease Transmission, Infectious MeSH
• Pyrimethamine administration & dosage   pharmacology   therapeutic use   MeSH
• Vision Screening MeSH
• Serologic Tests methods   MeSH
• Spiramycin administration & dosage   pharmacology   therapeutic use   MeSH
• Sulfadiazine administration & dosage   pharmacology   therapeutic use   MeSH
• Toxoplasma drug effects   MeSH
• Ultrasonography MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Azithromycin * administration & dosage   MeSH
• Chorioretinitis * drug therapy   parasitology   MeSH
• Adult MeSH
• Humans MeSH
• Eye Infections, Parasitic MeSH
• Eye Manifestations MeSH
• Toxoplasmosis, Ocular * diagnosis   drug therapy   blood   radiography   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Choroiditis diagnosis   drug therapy   MeSH
• Adult MeSH
• Fluorescein Angiography MeSH
• Immunosuppressive Agents administration & dosage   MeSH
• Humans MeSH
• Prednisone administration & dosage   MeSH
• Treatment Outcome MeSH
• Uveitis, Posterior drug therapy   immunology   pathology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH