Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports
Propose: To report two cases of severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia. Observations: We report two immunocompetent male patients aged 44- and 67-years-old who, despite not having visited the Amazonian regio...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2020-06-01
|
Series: | American Journal of Ophthalmology Case Reports |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993619300933 |
id |
doaj-3d0a59345b914ed5b60a046475e5119e |
---|---|
record_format |
Article |
spelling |
doaj-3d0a59345b914ed5b60a046475e5119e2020-11-25T03:00:57ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362020-06-0118Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reportsDiana Alejandra Cortés0María Camila Aguilar1Hernán Andres Ríos2Francisco José Rodríguez3Kelly Verónica Montes4Jorge Enrique Gómez- Marín5Alejandra de-la-Torre6Fundación Oftalmológica Nacional, Uveitis and Retina Services, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cl. 50 #13 – 50, Bogotá, ColombiaFundación Oftalmológica Nacional, Uveitis and Retina Services, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cl. 50 #13 – 50, Bogotá, ColombiaFundación Oftalmológica Nacional, Uveitis and Retina Services, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cl. 50 #13 – 50, Bogotá, ColombiaFundación Oftalmológica Nacional, Uveitis and Retina Services, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cl. 50 #13 – 50, Bogotá, ColombiaFundación Oftalmológica Nacional, Uveitis and Retina Services, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cl. 50 #13 – 50, Bogotá, ColombiaGEPAMOL Group, Centro de Investigaciones Biomédicas, Universidad del Quindío, Armenia, Carrera 15 calle 12 norte Armenia, Quindío, ColombiaFundación Oftalmológica Nacional, Uveitis and Retina Services, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cl. 50 #13 – 50, Bogotá, Colombia; Neuroscience Research group (NeURos), Escuela de Medicina y Ciencias de la Salud, Unidad de Inmunología, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia; Corresponding author. Uveitis Unit, NeURos research group, Carrera 24 # 63 C 69, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.Propose: To report two cases of severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia. Observations: We report two immunocompetent male patients aged 44- and 67-years-old who, despite not having visited the Amazonian region in Colombia, had severe bilateral posterior uveitis and extensive-bilateral macular lesions and multiple organ failure that required admission to an intensive care unit. Toxoplasma gondii was positive by PCR assay in vitreous humor samples. Patients were treated with intravitreal clindamycin and dexamethasone in addition to systemic treatment with trimethoprim-sulfamethoxazole. In both patients, infection by atypical strains was confirmed; in one case by serotyping and in another one by genotyping (ROP 18 virulent allele). After 2 and 4 months of treatment respectively, the patients showed improvement of the posterior uveitis and its systemic manifestations. However, there was no significant visual acuity improvement due to bilateral extensive macular involvement. Conclusions and importance: Clinicians should be aware that toxoplasmosis originating from South America could be associated with severe acute multisystemic and intraocular bilateral involvement, even in patients with no history of exposure to jungle environments.http://www.sciencedirect.com/science/article/pii/S2451993619300933Toxoplasma gondiiAtypical strainsROP18Ocular toxoplasmosisMultiple organ failure |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Diana Alejandra Cortés María Camila Aguilar Hernán Andres Ríos Francisco José Rodríguez Kelly Verónica Montes Jorge Enrique Gómez- Marín Alejandra de-la-Torre |
spellingShingle |
Diana Alejandra Cortés María Camila Aguilar Hernán Andres Ríos Francisco José Rodríguez Kelly Verónica Montes Jorge Enrique Gómez- Marín Alejandra de-la-Torre Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports American Journal of Ophthalmology Case Reports Toxoplasma gondii Atypical strains ROP18 Ocular toxoplasmosis Multiple organ failure |
author_facet |
Diana Alejandra Cortés María Camila Aguilar Hernán Andres Ríos Francisco José Rodríguez Kelly Verónica Montes Jorge Enrique Gómez- Marín Alejandra de-la-Torre |
author_sort |
Diana Alejandra Cortés |
title |
Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports |
title_short |
Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports |
title_full |
Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports |
title_fullStr |
Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports |
title_full_unstemmed |
Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports |
title_sort |
severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in colombia: case reports |
publisher |
Elsevier |
series |
American Journal of Ophthalmology Case Reports |
issn |
2451-9936 |
publishDate |
2020-06-01 |
description |
Propose: To report two cases of severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia. Observations: We report two immunocompetent male patients aged 44- and 67-years-old who, despite not having visited the Amazonian region in Colombia, had severe bilateral posterior uveitis and extensive-bilateral macular lesions and multiple organ failure that required admission to an intensive care unit. Toxoplasma gondii was positive by PCR assay in vitreous humor samples. Patients were treated with intravitreal clindamycin and dexamethasone in addition to systemic treatment with trimethoprim-sulfamethoxazole. In both patients, infection by atypical strains was confirmed; in one case by serotyping and in another one by genotyping (ROP 18 virulent allele). After 2 and 4 months of treatment respectively, the patients showed improvement of the posterior uveitis and its systemic manifestations. However, there was no significant visual acuity improvement due to bilateral extensive macular involvement. Conclusions and importance: Clinicians should be aware that toxoplasmosis originating from South America could be associated with severe acute multisystemic and intraocular bilateral involvement, even in patients with no history of exposure to jungle environments. |
topic |
Toxoplasma gondii Atypical strains ROP18 Ocular toxoplasmosis Multiple organ failure |
url |
http://www.sciencedirect.com/science/article/pii/S2451993619300933 |
work_keys_str_mv |
AT dianaalejandracortes severeacutemultisystemicfailurewithbilateraloculartoxoplasmosisinimmunocompetentpatientsfromurbansettingsincolombiacasereports AT mariacamilaaguilar severeacutemultisystemicfailurewithbilateraloculartoxoplasmosisinimmunocompetentpatientsfromurbansettingsincolombiacasereports AT hernanandresrios severeacutemultisystemicfailurewithbilateraloculartoxoplasmosisinimmunocompetentpatientsfromurbansettingsincolombiacasereports AT franciscojoserodriguez severeacutemultisystemicfailurewithbilateraloculartoxoplasmosisinimmunocompetentpatientsfromurbansettingsincolombiacasereports AT kellyveronicamontes severeacutemultisystemicfailurewithbilateraloculartoxoplasmosisinimmunocompetentpatientsfromurbansettingsincolombiacasereports AT jorgeenriquegomezmarin severeacutemultisystemicfailurewithbilateraloculartoxoplasmosisinimmunocompetentpatientsfromurbansettingsincolombiacasereports AT alejandradelatorre severeacutemultisystemicfailurewithbilateraloculartoxoplasmosisinimmunocompetentpatientsfromurbansettingsincolombiacasereports |
_version_ |
1724695773910663168 |