TOXOPLASMOSIS

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TOXOPLASMOSIS

• Developed by
• Pam Holmes, Christy Stalcup, and Pam Yarborough

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• WHAT IS TOXOPLASMOSIS?
• Toxoplasmosis is an infection caused by a
  parasite most often found in cats and farm
  animals. Humans can catch this disease from
• coming into contact with infected cat feces
• eating raw or undercooked meat thats infected
• eating contaminated vegetables or fruits
• being born with it
• Note Once a person is infected, the infection
  remains in the body for life, usually in an
  inactive form. It can reactivate when that
  persons immune system is weak.

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• About 98 of cases of Toxoplasmosis are acquired
  through Congenital Toxoplasmosis.

One study showed that 76 of infants infected
with congenital toxoplasmosis had ocular lesions,
51 had neurological involvement, and 26 had
either hydrocephalus (increased intracranial
pressure) or michrocephaly (small brain). It is
evident that vision problems are very common with
Congenital Toxoplasmosis. Once the mother
develops immunity to the organism, all future
pregnancies are protected from transmission of
the organism.
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• Signs and Symptoms
• 1. Toxoplasmosis in an otherwise healthy person
  may have no symptoms or only a few swollen glands
  usually in the patients neck.
• 2. Toxoplasmosis in a person with a weakened
  immune system may only have symptoms of swollen
  glands, or in the case of an infection that
  attacks the brain and nervous system, the
  symptoms may include fever, seizures, headache,
  psychosis, and problems with vision, speech,
  movement, or thinking.

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• 3. Children born with Toxoplasmosis, which
  accounts for about 98 of cases, may show
  symptoms including
• Fever
• Swollen glands
• Jaundice
• An unusually large or small head
• Rash
• Bruises or bleeding under the skin
• Anemia
• Enlarged liver or spleen
• Seizures
• Limp muscle tone
• Mental retardation
• Hearing loss
• Vision problems (toxoplasmosis of the eye)

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Toxoplasmosis of the Eye

• Congenital Toxoplasmosis is the most common form.
  If the mother acquires the infection during the
  first trimester, 17 of these babies develop
  congenital toxoplasmosis and the effects are
  severe. However, if the infection occurs during
  the third trimester, 65 of the babies develop
  the disease. Yet, the infant usually has no
  symptoms.

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• DAMAGE TO THE EYE
• The parasite usually invades the retina and the
  choroid tissue. Depending upon the area and
  severity of the infection, visual acuity can be
  unaffected to severely affected. The retina is
  inflamed by the infection and sometimes when the
  inflammation settles, scars are left on the
  retina. Symptoms include floaters and blurred
  vision. If the scarring is on the central macula,
  detailed vision will be affected. Approximately
  35 of all retinachoroiditis cases can be
  attributed to toxoplasmosis.
• Active Toxoplasmosis Inactive
  Toxoplasmosis Scar

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Effects of Ocular Toxoplasmosis

• Common Effects
• Inflammation of retina
• Blurred vision
• Floaters
• Nystagmus
• Amblyopia
• Squint

• Occasional Effects
• Cataracts
• The eye can be small
• Optic atrophy
• Cerebral visual impairment

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• Functional Implications
• Functional implications vary depending on
  severity of infection and/or scaring and how
  successful the treatment. Those affected often
  describe vision as hazy with floaters. Some
  implications are more serious such as total
  blindness in one or both eyes. Those affected
  early during pregnancy often suffer other
  implications such as mild to severe mental
  retardation, cerebral palsy, seizures and other
  problems. Appropriate accommodations and
  modifications should be determined by the FVE.

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Treatment

• Treatment will not result in the elimination of
  the organism from the eye. Since new lesions can
  form if the organism reactivates, especially
  during adolescence, patients should be closely
  monitored.
• Medications
• Spiramycin during pregnancy
• Antibiotics and steroid tablets during an
  infection
• Pyrimethamine/sulphadoxine for 6-12 months as
  follow-up procedure

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Sam
History Sam is a third grader that was diagnosed
with Toxoplasmosis (visual impairment), mental
retardation, and other health impairment. He
suffered acute retino-choroidal inflammation
which produced dense scaring in both eyes. He has
suffered reactivations which caused adjacent
scars creating satellite lesions to the macula in
the right eye. His eye report states that there
is significant scar tissue stretching from the
nasal passage to the optic nerve. There is
little medical information other than eye
examination reports. It was determined in ARD
meeting that there was little (if any) pre-natal
care and treatment of the toxoplasmosis after
birth. It is a continuing problem to get consent
signed to obtain medical records from the
parents. Environment Sam is attending third
grade in an inclusive classroom environment. He
functions about 2 ½ years below grade level. It
is difficult to determine if it is visual
deficits or cognitive ability that hinders
learning. Some modifications in the classroom
are 36 pt font, one step directions, peer
tutoring, slant board, frequent breaks, well lit
environment, auditory instruction coupled with
visual input, clear/uncluttered copies, contrast,
allow positioning for materials as needed, do not
ask questions like can you see this have him
tell you what he sees, do not place him beyond
6-8 feet from board, make sure he is wearing
glasses at all times and watch for signs such at
fatigue and headaches.
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• Sources
• http//www.nlm.nih.gov/medlineplus/ency/imagepages
  /17186.htm
• http//www.eyemdlink.com/Condition.asp?ConditionID
  444
• http//www.patient.co.uk/showdoc/40000376/
• www.viscotland.org.uk
• http//www.kidshealth.org/PagManager.jsp?dnKidsHe
  althlic1ps-107cat_id20045art......
• http//www.revoptom.com/handbook/sect5i.htm
• Program in Low Vision Therapy, Region 4 Education
  Service Center, McKinney, Bill, Ph.D. Executive
  Director, 2004. Houston, Tx pg 25