Abstract
To describe fundoscopic findings among patients with AIDS and active-phase neurotoxoplasmosis. A prospective study of case series type was developed, including 70 patients of both sexes and ages ranging from 20 to 63 years who were admitted to the wards of three public hospitals in the city of Recife, Pernambuco, Brazil, from January to October 2008, with diagnoses of AIDS and neurotoxoplasmosis determined according to the criteria of the Centers for Disease Control and Prevention (1992). The patients were characterized by a first episode of neurotoxoplasmosis (65; 92.9%) or recurrence (5; 7.1%), unawareness of having AIDS (23; 32.9%), mean T CD4+ count of 139.8 + or - 3.04 lymphocytes/mm(3) and mean viral load of 137,080 + or - 39,380 copies/ml. All patients underwent ophthalmological examination consisting of ocular inspection, gauging of visual acuity, investigation of ocular extrinsic muscle function and fundoscopy using a binocular indirect ophthalmoscope (model OHM 3.5 Eyetec) and external lens of 20 diopters (Volk). The findings consisted of retinal cotton-wool spot exudates (8.6%), slight diffuse arteriolar constriction (8.6%), retinochoroiditis scars characteristic of ocular toxoplasmosis (5.7%), atrophy of retinal pigment epithelium (2.9%), retinal detachment (2.9%), increased papillary excavation (1.4%), retinal peripheral degeneration (1,4%), macroaneurysm (1.4%), bilateral papilledema (1.4%) and vitreous-retinal traction (1.4%). Patients with AIDS and neurotoxoplasmosis may present fundoscopic abnormalities characteristic of ocular toxoplasmosis, either in active or in scar form, related to HIV or even to other opportunist or systemic diseases, which can be of great aid for integral treatment of patients by a multiprofessional team.
Highlights
To describe fundoscopic findings among patients with AIDS and active-phase neurotoxoplasmosis
Classificando em categorias as lesões oculares, que acometem pacientes com AIDS14, constituíram-se manifestações decorrentes de alteração da microvasculatura os exsudatos algodonosos retinianos, o macroaneurisma e a constrição arteriolar; as alterações oculares por infecções oportunistas secundárias à AIDS incluíram a retinocoroidite cicatricial, característica da toxoplasmose e o descolamento de retina, atribuído à uveíte posterior, decorrente de infecção por Citomegalovírus
Concluiu-se que pacientes com AIDS e neurotoxoplasmose podem apresentar alterações fundoscópicas características da toxoplasmose ocular, seja na forma ativa ou cicatricial, relacionadas ao HIV ou, ainda, a outras doenças oportunistas ou sistêmicas. podendo ser de grande auxílio no tratamento do paciente
Summary
Introdução: Descrever os achados fundoscópicos em pacientes com AIDS e neurotoxoplasmose em fase ativa. Os pacientes se caracterizavam por: primeiro episódio de neurotoxoplasmose (65; 92,9%) ou recidiva (5; 7,1%); desconhecimento de ter AIDS (23; 32,9%), contagem média de linfócitos T CD4 de 139,8 ± 3,04 células/mm[3] e carga viral média igual a 137.080 ± 39.380 cópias/mL. Resultados: Os achados consistiram em: exsudatos algodonosos retinianos (8,6%), constricção arteriolar difusa leve (8,6%); lesões de retinocoroidite cicatricial, características de toxoplasmose ocular (5,7%), atrofia do epitélio pigmentar retiniano (2,9%), descolamento da retina (2,9%), aumento de escavação papilar (1,4%), degeneração periférica retiniana (1,4%), macroaneurisma (1,4%), papiledema bilateral (1,4%), tração vítreo-retiniana (1,4%). Conclusões: Pacientes com AIDS e neurotoxoplasmose podem apresentar alterações fundoscópicas características da toxoplasmose ocular, na forma ativa ou cicatricial, relacionadas ao HIV ou, ainda, a outras doenças oportunistas ou sistêmicas, podendo ser de grande auxílio num tratamento integral do paciente por uma equipe multiprofissional.
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