تعيين فراواني و ميزان پاسخ به درمان ضايعات چشمي در كودكان مبتلا به انواع عفونت‌هاي داخل رحمي (سايتومگالويروس و توكسوپلاسموزيس): گزارش كوتاه

Determination of the frequency and response to treatment of ocular lesions in children with various types of intrauterine infections (cytomegalovirus and toxoplasmosis): brief report

زمينه و هدف: عفونت‌هاي داخل رحمي منجر به درگيري ارگان‌هاي مختلف بدن جنين از جمله چشم مي‌شود. تعيين فراواني و پاسخ باليني ضايعات چشمي به داروهاي اختصاصي در شيرخواران مبتلا به عفونت‌هاي مادرزادي توكسوپلاسما و سايتومگالوويروس هدف اين مطالعه بود. روش بررسي: اين مطالعه كوهورت تاريخي از مهر 1390 تا آبان 1396، در بخش كودكان و چشم، بيمارستان حضرت رسول اكرم (ص) تهران انجام شد. بيماران شامل 78 شيرخوار با عفونت داخل رحمي (اثبات شده) و درگيري چشمي (كاتاراكت، گلوكوم و رتينيت) بودند. شيرخواراني كه آزمايشات تكميلي و تشخيصي، معاينات چشمي نداشتند، مراجعه و پيگيري نكردند و درمان موثر دريافت نداشتند، از مطالعه حذف شدند. سه نفر فوت كردند. درنهايت 37 بيمار (25 سايتومگالوويروس و 12 توكسوپلاسما) وارد مطالعه و تا يك سال پاسخ باليني ضايعات چشمي ارزيابي شد. يافته‌ها: از 12 توكسوپلاسما، پنج بيمار درمان كامل و چهار مورد پاسخ باليني مناسب داشتند. از 25 سايتومگالوويروس، 18 بيمار درمان كامل و 9 بيمار پاسخ باليني مناسب داشتند. نتيجه‌گيري: ضايعات چشمي در 80% موارد توكسوپلاسما و 50% سايتومگالوويروس بهبود يافتند.

Background: Intrauterine infections (TORCH) lead to the involvement of various organs of the body of the fetus, including the eye. The aim of this study was to determine the frequency and clinical response of eye lesions to specific drugs, in infants with confirmed TORCH induced ocular lesions. Methods: This historical cohort study from 2011 to 2017, had done in Pediatrics and Ophthalmology Department of Rasoul Akram Hospital, Tehran, Iran. Cases included; 78 infants with confirmed intrauterine infection (TORCH) with ophthalmologic disorders (glaucoma, cataract, and retinitis), 3 cases died (without any treatment). The cases with incomplete diagnosis, no treatment or without follow-up excluded from study. Out of 74 children with confirmed TORCH induced ophthalmologic disorders, finally 37 children (25 cytomegalovirus, 12 toxoplasma) were treated with specific drugs, and clinical response to treatment was followed-up to 1 year by ophthalmologic examination. Results: From 12 cases with ophthalmologic disorders due to congenital toxoplasmosis, 5 cases had full treatment, 4 cases had complete response. One case had not any improvement. From 25 cases with congenital cytomegalovirus (CMV), 18 patients continued treatment, 9 cases with complete clinical response, 9 cases had not response to antiviral treatment, indeed most non responder cases had central nervous system involvement from birth. The best response observed in CMV infected cases accompanied with sensory hearing loss (without CNS involvement). Conclusion: Good clinical response of ophthalmic diseases in 80% of congenital toxoplasma; and 50% of congenital cytomegalovirus infected cases. Probably with initial diagnosis and rapid treatment of cases with TORCH induced ophthalmic disorders (especially cases without CNS involvement) it would lead to stopping ocular lesions.