Case report of severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia

Project: Research project

Project Details

Description

Context: Severe forms of disseminated toxoplasmosis in South America have been reported in immunocompetent patients who have been in jungle areas, as well as in those who live nearby or soldiers who camp in the jungle. Patients with these clinical characteristics usually show multisystemic commitment, with an intensive care unit requirement. These forms of toxoplasmosis are associated with a concomitant infection with atypical strains and do not associate with the archetypal clonal lineages (I, II, III).

Objectives: to report two patients with acute systemic toxoplasmosis with multi-organ involvement who require an intensive care unit, accompanied by severe bilateral panuveitis with extensive macular lesions, despite not having had it anywhere. is associated

Case presentation: We reported two male patients aged 44 and 67 years, who informed us about the history of the Colombian Amazon, the bilateral network and the most important injuries related to a multi-organ failure that requires admission to an intensive care unit. . In both cases, the systemic symptoms preceded the ophthalmological findings. The PCR of Toxoplasma gondii was positive in the aqueous humor samples. Patients were treated with intravitreal clindamycin and dexamethasone with systemic treatment with trimethoprim - sulfamethoxazole, clindamycin and dexamethasone. In both patients, infection by atypical strains was confirmed; One diagnosed by sertotyping and the other by genotyping (ROP 18 virulent allele). After 2 and 4 months respectively, patients show an improvement of their panuveitis and its systemic manifestations. However, there are no significant changes in the improvement of visual visual acuity to extensive bilateral macular involvement.

Conclusions: The medical staff must take into account that toxoplasmosis originating in South America may be associated with a severe acute multi-organ involvement and bilateral intraocular compromise, even without taking into account the patients do not have a history of exposure to jungle environments.

Commitments / Obligations

Al ser reporte de caso no requiere aprobación por comité de ética. Los autores certifican que obtuvieron el consentimiento y asentimiento informado del paciente. En estos, el paciente ha dado el consentimiento para que sus imágenes y su información clínica sean reportadas en el artículo. El paciente entiende que ni su nombre, ni sus iniciales, serán publicadas y se hará un esfuerzo por mantener su identidad en privado, sin embargo, la anonimidad no puede ser garantizada.
StatusFinished
Effective start/end date3/31/163/15/20

Main Funding Source

  • Internal

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