|GRIGG, MICHAEL - National Instiute Of Allergy And Infectious Diseases (NIAID, NIH)|
|NUSSENBLATT, ROBERT - National Institutes Of Health (NIH)|
Submitted to: American Journal of Ophthalmology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/6/2015
Publication Date: 5/19/2015
Publication URL: http://dx.doi.org/10.1016/j.ajo.2015.04.005
Citation: Grigg, M., Dubey, J.P., Nussenblatt, R. 2015. Ocular Toxoplasmosis: Lessons from Brazil. American Journal of Ophthalmology. 159:999-1001.
Interpretive Summary: Toxoplasmosis continues to be a major public problem worldwide. It can cause serious illness in humans, including birth defects and abortion in livestock. If a mother previously not exposed to the parasite Toxoplasma acquires infection during pregnancy the chance is 50% that the fetus will become infected with Toxoplasma. Loss of vision is the most important consequence of congenital toxoplasmosis. Recent studies have indicated that even infections acquired after birth can result in eye disease. The burden of ocular toxoplasmosis is considered very high in Brazil. In this article the authors (2 from NIH) and 1 from ARS-who are expert on toxoplasmosis provide commentary on papers to be published in the American Journal of Ophthalmology. These papers should be of interest to public health workers , physicians, and opthalomologists.
Technical Abstract: • A new attention to post-natally acquired infections. Previously, most attention was focused on infection during pregnancy, and the risk of congenital disease, with the feeling that infection in older individuals was benign, without a substantial risk of disease morbidity, such as ocular involvement. We now understand that people with post-natally acquired infections are at risk for ocular toxoplasmosis, depending on the strain of the infecting parasite. Public health strategies to limit post-natal infections are important. • I dentifying other sources of infection. Studies in Brazil have added the important perspective that contaminated water, not just undercooked meat or unwashed vegetables, is an important source of infection.30. • Refinements of treatment. In addition to confirmation that long-term prophylaxis reduces recurrence risk, the study by Arantes and associates raises the possibility that early treatment of systemic infection may reduce the risk of ocular involvement.1 There is currently no better information regarding timed ophthalmic events during the months and years following initial systemic infection; most studies of epidemic infections have dealt only with events at the onset of the outbreak, and in studies of endemic disease, the time of the original infection is rarely known. The studies reported by Arantes, which span more than 30 years, and Silveira, which follows a point-source outbreak, give us our first real glimpse for how disease progresses across time in both a highly endemic and outbreak scenario.