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425
平成29年 5 月20日
3 歳児健診で視力低下を認め,先天性トキソプラズマ症と
診断した 1例
1)大森赤十字病院小児科,2)同 救急総合診療科
森内 優子1) 古川 真紀1) 大沼 健一1) 馬庭 厚2)
(平成 28 年 9 月 5 日受付)(平成 29 年 3 月 9 日受理)
Key words : congenital toxoplasmosis, serological screening test, retinochoroiditis
Fig. 1 Fundus photograph: At the age of 3 years, the macular region in the right eye showed a round scarring lesion with black and white pigmentation (indicated by white arrowhead), which sig-nificantly reduced visual acuity.
Fig. 2 Fundus photograph: At the age of 4 years and 6 months, white opacities (indicated by white arrowheads) were observed from the macula and optic disc to the inferior temporal area in the reti-na of the left eye. Opacity of the vitreous body was also noted. Visual acuity in the left eye de-creased from 1.2 to 0.6.
Fig. 3 Fundus photograph: The white opacities (indicated by white arrowheads) observed from the macula and optic disc to the inferior temporal area in the retina of the left eye showed improve-ment, leaving only slight opacities around the macula after treatment. Visual acuity in the left eye also showed recovery from 0.6 to 1.0 after treatment.
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A Case of Congenital Toxoplasmosis in an Infant Discovered Through Visual ImpairmentDuring a Health Check-up
Yuko MORIUCHI1), Maki FURUKAWA1), Kenichi OHNUMA1)& Kou MANIWA2)1)Department of Pediatrics and 2)Department of Emergency and General Medicine, Omori Red Cross Hospital
Toxoplasmosis is an infectious disease transmitted by ingestion of inadequately cooked meat, etc. If awoman is infected with Toxoplasma gondii for the first time during pregnancy, the fetus is at risk of congeni-tal toxoplasmosis (via placental infection). We herein report on a patient who was born to a mother with anegative toxoplasma antibody test at an early stage of pregnancy, and was later diagnosed as having con-genital toxoplasmosis based on decreased visual acuity at a medical check-up. A 3-year-old boy presented toour hospital with suspected low vision in the right eye. Fundus examination showed macular scarring in theright eye with accompanying reduced visual acuity. Both mother and child were positive for toxoplasma an-tibody IgG and negative for IgM, and the child was diagnosed as having congenital toxoplasmosis based oncharacteristic fundus findings. While being followed closely without treatment, retinochoroiditis of the lefteye developed at the age of 4 years and 6 months, and treatment with pyrimethamine, sulfadiazine, leuco-vorin, and steroid was then started at another institution. This treatment improved visual acuity and fundusfindings in the left eye. Congenital toxoplasmosis is an infectious disease in which early diagnosis and earlytreatment are beneficial. No therapy, however, has yet been established for children with non-apparent dis-ease at birth and whose diagnosis was made after infancy, such as the child in our present report. Takingthese factors into consideration, antibody tests during the prenatal check-up are important in order not tooverlook potentially treatable pregnant women or infants, though the usefulness of antibody screening testsin all pregnant women has not been established in Japan. A thorough review of antibody screening tests inpregnant women, given circumstances such as the recent changes in food culture and internationalization,would appear to be warranted.