ACQUIRED TOXOPLASMOSIS WITH OCULAR OR NEU ROLOGIC INVOLVEMENT - 49 CASES

Objectives: Over a period of 13 years (1982-1995), 49 cases of acquire d toxoplasmosis complicated with ocular and/or neurologic or meningeal involvement were observed in our toxoplasmosis laboratory. This serie s includes 43 cases of isolated ocular lesions, 3 cases of meningoence phalitis (associated with retinochoroiditis in 1 case), 1 case of meni ngitis with uveitis, 1 case of polyradiculoneuritis and 1 case of faci al nerve palsy. Methods: The patients were aged 1 to 62 years. None ha d either spontaneous or iatrogenic immunodeficiency. There were two st eps in the diagnosis. First congenital infection was eliminated on one or several of the following criteria: any possibility of maternal inf ection during pregnancy ruled out in 26 cases, evidence of recent acqu ired infection (i.e. clinical and/or serological evidence of recent ac quired toxoplasmosis in 17 cases, retinochoroiditis in non-twin siblin gs in 3 cases). The second step was to confirm the diagnosis of toxopl asma infection. Apart from serological evidence of recent infection, c onfirmation included specific local antibody synthesis in the aqueous humor of the eye and/or in cerebro-spinal fluid or ocular lesions char acteristic of toxoplasmosis and absence of other etiology. Results: Oc ular lesions were unilateral in 43 cases among 45. A mean follow-up of 37.9 months revealed relapses in 14 among 36 patients (39%). As routi ne serological examination for toxoplasmosis is compulsory in France s ince 1978, it was possible to document retrospectively the immune stat us of the mothers of many of the patients of the present series during pregnancy and to rule out congenital toxoplasmosis in a number of cas es. This might explain the discrepancy between the relatively large nu mber of cases in the present series and the fact that complicated acqu ired toxoplasmosis has been considered hitherto as relatively rare in immunocompetent patients. Conclusion: Based on the epidemiology of ocu lar toxoplasmosis and the data obtained here, it is suggested that the acquired pattern of ocular toxoplasmosis might be more frequent than estimated up to now.