Toxoplasma gondii bradyzoites and tachyzoites isolation from vitreous of atypical necrotizing retinitis

• Main Authors: Ranju Kharel(Sitaula), Sagun Narayan Joshi, Ranjit Sah, Sushila Khadka, Anadi Khatri(KC), Bharat Mani Pokharel
• Format: Article
• Language: English
• Published: SpringerOpen 2018-06-01
• Series: Journal of Ophthalmic Inflammation and Infection
• Online Access: http://link.springer.com/article/10.1186/s12348-018-0151-x

Abstract Background Detection of Toxoplasma gondii cysts in vitreous of immunocompetent patient with necrotizing retinitis is extremely rare. We herein report the isolation of Toxoplasma bradyzoites and tachyzoites from the vitreous of healthy person. Results A 19-year-old immunocompetent female presented with sudden loss of vision in left eye since 1 week. The BCVA was 6/6 and HM in right and left eye. The left eye finding was suggestive of diffuse necrotizing retinitis with retinal detachment. The IgM and IgG for TORCH infection were negative and HIV, HCV and HBsAg tests were also non reactive. The patient underwent diagnostic and therapeutic vitrectomy with silicon oil installation. The vitreous toxoplasma IgG titre was found to be significantly raised to 1:16. Bradyzoites of toxoplasma were identified in H&E staining and tachyzoites of Toxoplasma were identified in Giemsa staining of vitreous sample. She received oral clindamycin and oral corticosteroid but the vision could not be restored in left eye. Conclusion Hence, atypical toxoplasmosis with necrotizing retinitis is a fulminant condition with the diagnostic and therapeutic challenge.