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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "224" "paginaFinal" => "225" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Definición de la adquisición de la infección toxoplásmica, <span class="elsevierStyleBold">¿</span>cuándo es congénita o adquirida?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.A. López-Castillo, A. de-la-Torre" "autores" => array:2 [ 0 => array:2 [ "nombre" => "C.A." "apellidos" => "López-Castillo" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "de-la-Torre" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669111001870" "doi" => "10.1016/j.oftal.2011.02.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669111001870?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579411000338?idApp=UINPBA00004N" "url" => "/21735794/0000008600000007/v1_201305091027/S2173579411000338/v1_201305091027/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Author's reply" "tieneTextoCompleto" => true "saludo" => "Dear Sir," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "225" "paginaFinal" => "226" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Alvarez, A. Rey, A. Adán" "autores" => array:3 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Alvarez" "email" => array:1 [ 0 => "guifre.alvpar@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Rey" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Adán" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Institut Clínic d’Oftalmologia, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta de los autores" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We appreciate the interest in the comments related to our article by the group of de-la-Torre et al., who have a considerable experience in ocular toxoplasmosis. As they point out, the only way to determine conclusively the congenital or acquired origin of the toxoplasma infection are pre- and perinatal tests.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Our study consists in the analysis of the clinical characteristics of 22 adult patients of different countries of whom we were unable to obtain any type of previous serological analysis. Accordingly, considering both factors, a probability classification was established based on the funduscopic aspect lacking absolute certainty as pointed out in the article («according to funduscopic appearance of the lesions and the patient antecedents, the patients were classified in two groups: those with probable congenital involvement …»), following previously published criteria,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> although subsequently Holland,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> mainly through unpublished observations by Silveira, clarified that this is not an entirely reliable classification. In fact, other authors like Bosch-Driessen et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> also drew up clinical classifications in the absence of available serological tests (they defined as congenital children under 2 years of age exhibiting inactive cicatricial lesions, and in this subgroup they found a high rate of macular involvement). Consequently, and notwithstanding the classification by Holland<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> as they adequately point out, this data should not be taken as a definitive classification.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Patient number 4 in our series is clearly a very interesting case for several reasons and perhaps the summary table could give rise to some confusion. This was a 25-year-old patient from Columbia who did not refer any similar clinical episode and was in fact diagnosed by us as having ocular toxoplasmosis. For this reason and even though he exhibited chorioretinal scars demonstrating that the toxoplasmosis was recurrent, he was classified as “no previous episodes” because the column in the table refers to episodes known by the patients and recorded in the anamnesis. The only antecedent provided by the patient was amblyopia in the right eye which exhibited a large and inactive macular scar (in contrast with what you commented), and for this reason at the clinical level the primary infection had taken place in childhood at the latest. In the other eye the patient exhibited 4 peripheral scars and 2 peripheral foci non-adjacent to said scars. Therefore, in the presence of bilateral and recurring toxoplasmosis which remained inactive for many years, we were surprised by the slightly high value of IgM because, as pointed out by Gómez-Marín et al.,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> the IgM values remain high up to 2 years after the first infection. Even so, the anamnesis seemed to show that the patient had been infected many years earlier. In fact, Holland<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> indicated that it is not possible to know if reinfections may arise, even more so considering that our patient could have been in contact with 2 different strains of toxoplasma (that of his country of origin and that of his country of residence). Finally, we should point out that it could have been a false positive but unfortunately we have no serologies to confirm this and, as you aptly comment in your letter, the classification of the patient does not influence the treatment. Therefore and considering the clinical context of the patient and the absence of pre- or perinatal data, it is not possible to determine whether this is both a congenital and acquired infection and we can only describe typical clinical characteristics, which is the aim of the text.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Álvarez G, et al. Respuesta de los autores. Arch Soc Esp Oftalmol. 2011;86:222–26.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and clinical characteristics in a Colombian cohort of ocular toxoplasmosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. De-la-Torre" 1 => "C.A. López-Castillo" 2 => "J.E. Gómez-Marín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/eye.2008.219" "Revista" => array:6 [ "tituloSerie" => "Eye" "fecha" => "2009" "volumen" => "23" "paginaInicial" => "1090" "paginaFinal" => "1093" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18617902" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respective roles of acquired and congenital infections in presumed ocular toxoplasmosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Delair" 1 => "D. Monnet" 2 => "S. Grabar" 3 => "J. Dupouy-Camet" 4 => "H. Yera" 5 => "A.P. 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Castano-Osorio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Trop Med Hyg" "fecha" => "1997" "volumen" => "57" "paginaInicial" => "180" "paginaFinal" => "186" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9288813" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000008600000007/v1_201305091027/S217357941100034X/v1_201305091027/en/main.assets" "Apartado" => array:4 [ "identificador" => "8723" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000008600000007/v1_201305091027/S217357941100034X/v1_201305091027/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357941100034X?idApp=UINPBA00004N" ]
Journal Information
Vol. 86. Issue 7.
Pages 225-226 (July 2011)
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Vol. 86. Issue 7.
Pages 225-226 (July 2011)
Letter to the Editor
Author's reply
Respuesta de los autores
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Institut Clínic d’Oftalmologia, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
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