Examination: Ocular Toxoplasmosis

Casebank Combined
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This view is of the optic disc and temporal retina

IMG_3688
IMG_36881218×733 80.3 KB

The main clinical features are:

  • Pigmented clumps in macular area with chorio-retinal atrophy and scarring
  • Pallor of the optic disc is noted indicating atrophy

This diagnosis is consistent with:
MACULAR SCAR (TOXOPLASMOSIS)

Comment:

  • The cat is a definitive host for Toxoplasma gondii. This is usually a quiescent lesion often discovered incidentally when a child is assessed for impaired vision. An active lesion may show an inflammatory focus with a vitreous haze adjacent to a previous scar and vasculitis.
  • There may be associated anterior uveitis.
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What’s Ocular Toxoplasmosis?

  • its a condition caused by a parasite or bug that you can catch from poo of infected cats or eating raw meat (pork/lamb), most common in immunocompromised people.

Explore Presenting complaint

  • Blurring of vision/floaters/pain in eyes
  • ODPARA
  • Associated symptoms: flu like symptoms, headache, blurred vision, lumps or bumps in body, fever, confusion

Rule out D/Ds

  • Age related macular degeneration
  • Scleritis/uveitis
  • Optic neuritis
  • Cataract

PMAFTOSA

  • Ask about medication and previous medical condition hx
  • Mostly presentation will be immunocompromised using steriods
  • Ask about: home condition? Whom they live with? Daily routine activities? Job?
  • DESA
  • Ask about concerns
  • Do they noticed any change in their routine or living condition which may triggered it

Examination

  • Observation
  • Visual acuity
  • Fundoscopy: typical ocular findings are focal retinochoroiditis, a nearby retinochoroidal scar and moderate-to-severe vitreous inflammation
  • Neurological examination (verbalise)
  • If uptil now they didnt tell you about cats thn its better to ask about them after examination that do you have any pets?explore how take care of them? How you handle them?

Management

  • explain daignosis: its a self limiting condition but sometimes can cause serious complications
  • Refer to infectious disease specialist. They will perform serology test, MRI brain & may start on medication depending on severity (Sulfadiazine, pyrimethamine, folinic acid).
  • General advices
    – Always give advices after exploring in hx and give advices accordingly
    – wear gloves while gardening, and wash your hands thoroughly afterwards
    – wash your hands before preparing food and eating wash hands, knives and chopping boards thoroughly after preparing raw meat
    – wash fruit and vegetables thoroughly to get rid of any traces of soil
    – avoid cat poo in cat litter and soil if you can, wearing gloves if you need to empty cat litter trays and washing your hands afterwards
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FY2 Gp
55yr old woman
Blurry vision for 3/52
PMR on steroids
Has multiple cats as pets
Takes care of cat poo with bare hands

Exam findings; Tendochoroniditis + dilated vessels on fundoscopy

Mgt
Send to specialist
Advise about taking care of cats poo :poop:

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48 yr old Laura Parker comes to GP surgery with complaints of blurring of vision for the past one month.

DOs
Which eye? What about the other eye
Ask for trigger
Ask for atleast 3 dds
Immunocompramised or not. In this case patient has PMR and is in steroids
ASK FOR PETS (Cats)
Be familiar with all eye slides

DONTS
Dont straight away jump to phycosocial Hx. Go with the flow Dont spend more than 3 minutes in Hx as its a combined station
Dont ever forget to ask ICE and explain the diagnosis.
Dont forget safety net, Follow up, leaflet

MANAGEMENT
Advice about hygiene while handling food.Cooking
Extra careful with cat poo and take cat to vet
Involve senior and refer to specialist if immunocompramised

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