J Daniel Diaz1,3*, Jorge L Bustillo2, Idarmes C Pacheco2 and David C Gritz3,4
1Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
2Instituto Superior de Ciencias Medicas de Sancti Spiritus, Cuba
3Albert Einstein College of Medicine, Department of Ophthalmology, Montefiore Medical Center, Bronx, New York, USA
4King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
Received: 13 Oct, 2016; Accepted: Oct, 2016; Published: 25 Oct, 2016
Jose Daniel Diaz, MD, 221 Newbury St, STE 3F, Boston, MA, 02116, USA, Tel: 305-794-6117; E-mail:
Diaz JD, Bustillo JL, Pacheco IC, Gritz DC (2016) Cuban Ocular Toxoplasmosis Epidemiology Study (COTES): Clinical Features in 279 Patients from Central Cuba. J Clin Res Ophthalmol 3(1): 027-033. 10.17352/2455-1414.000032
© 2016 Diaz JD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Epidemiology; International ophthalmology; Ocular toxoplasmosis; Posterior uveitis
Purpose: To characterize the clinical features of ocular toxoplasmosis (OT) in Central Cuba.
Methods: A database at a large regional referral center was searched for patients who, from April 1, 2011 to May 31, 2013, had the potential diagnosis of OT. Inclusion criteria were the clinical diagnosis of OT, characterized by focal retinochoroidal inflammation. Medical records were reviewed to confirm inclusion criteria (visual acuity recorded in decimal form).
Results: 279 patients (329 total eyes) were affected with OT. Overall, 66.7% were diagnosed with acquired OT with a mean age of 35.4 years and 1.8% with congenital OT with a mean age of 3.4 years. The time of onset of OT could not be determined in 28.3% (n=79) of patients. Patient clinical presentations were posterior uveitis (72.8 %), quiescent retinochoroiditis (16.1 %), and panuveitis (11.1%). Fourteen percent of patients had a slight decrease (0.9-0.6) in visual acuity, 44.4% a moderate decrease (0.5-0.2), and 41.6% a marked decrease (< 0.1).
Conclusion: There exist large numbers of patients with active toxoplasmic uveitis in the Central Cuban region. To our knowledge, this is the first report in the English medical literature describing OT in the Cuban population.
Toxoplasma gondii, an obligate intracellular protozoan with a broad range of hosts, continues to be the most common cause of infectious posterior uveitis in humans . Cats are the definitive hosts for T. gondii, and humans and other mammals continue to act as intermediate hosts. The transmission occurs by many routes, including ingestion of raw or undercooked meat infected with tissue cysts, ingestion of food and water contaminated with oocysts, ingestion of eggs and milk contaminated with tachyzoites, blood transfusion, organ transplantation, and even transplacental transmission [1,2]. Interestingly, visual symptoms during acute toxoplasma retinochoroiditis are typically secondary to vitritis. Vision loss may become permanent due to formation of a macular scar or the presence of optic atrophy. Although the classic triple-drug therapy of pyrimethamine, sulfadiazine, and corticosteroid is an effective choice, alternative treatment regimens including single agent treatment with trimethoprim-sulfamethoxazole, intravitreal injection of clindamycin with dexamethasone, or combination of azithromycin with pyrimethamine have been shown to be effective against ocular toxoplasmosis [1-3].
Despite its worldwide prevalence, worldwide rates of ocular toxoplasmosis (OT) infection differ, with under-developed countries having higher rates of infection. The prevalence of OT has been reported to be higher in tropical regions, with seroepidemiological research examining OT in Brazil and Colombia showing that there is an increased prevalence in South America, Central America, and the Caribbean compared to North America and Europe [1-3].
Although demographics and clinical manifestations of OT have been extensively described in large parts of the world, there continues to be a lack of characterization of OT in the Caribbean. The aim of this non-comparative case series is to describe the clinical features and demographics of OT in patients evaluated at a large tertiary referral center in previously unassessed Central Cuba.
Materials and Methods
A retrospective study of the medical records of patients seen and evaluated at the Centro Oftalmológico Provincial hospital in Sancti Spiritus, Central Cuba was performed. The Centro Oftalmológico Provincial hospital, opened in 2007, is a large tertiary referral center that serves patients in a catchment area spanning over 20 municipalities (in 5 provinces) in Central Cuba. The majority of patients are seen from within the Sancti Spiritus province, which is made up of eight municipalities (Figure 1). A prospective database kept by physicians at the center was used to identify all patients coded with the diagnosis of OT during a consecutive 24-month period from April 1, 2011, through March 31, 2013. Medical records were reviewed to confirm inclusion criteria and gather demographic and clinical data.
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