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"tieneTextoCompleto" => true "saludo" => "Dear Sir," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "224" "paginaFinal" => "225" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C.A. López-Castillo, A. de-la-Torre" "autores" => array:2 [ 0 => array:4 [ "nombre" => "C.A." "apellidos" => "López-Castillo" "email" => array:1 [ 0 => "lopezcastilloc@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." 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Traditionally, the presence of lesions at the macular level has been considered a sign of congenital toxoplasmosis. However, as described by Holland in a recent review on the influence of age in ocular toxoplasmosis,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> more recent studies show that the presence of macular lesions does not differentiate reliably between congenital infections and those acquired after birth. A study carried out by ourselves<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> describes the clinical characteristics of ocular toxoplasmosis in a Colombian cohort where the acquisition of the infection was determined in only 30% of patients (20% congenital, 10% acquired), with a large percentage (70%) remaining undetermined precisely because it is not possible to demonstrate whether the infection of a patient was acquired after birth if there is no evidence of seroconversion or serological demonstration of an acute infection (IgM+, IgG−) and subsequent positivization of the IgG antibodies, discarding natural IgM antibodies. Moreover, it is not possible to determine in an adult that the infection was congenital if there is no certainty about the infection being diagnosed at the prenatal level by means of the techniques described in literature, either immunological such as avid IgG, IgA, or through molecular biology with the PCR of gene B1 in amniotic liquid.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To illustrate the mistake of classifying the type of infection based on the morphological characteristics of the retinal choroiditis, we can observe case number 4, documented in tables 1 and 2 of the article by Álvarez et al. A 25 year-old Colombian male, with an active peripheral lesion of multiple foci without adjacent scars, IgM+ IgG+, but classified as congenital because he exhibited active macular lesions. In Columbia, IgM can be positive up to a maximum period of 2 years after the infection<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> allowing us to assume that this patient exhibited an acquired and not congenital infection as suggested by the type of the lesion. On the other hand, although this is registered as a first episode, the fact of exhibiting peripheral inactive lesions (the article does not mention how many) gives rise to the assumption that the patient exhibited several activation episodes during the period of time since his first infection.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On the basis of our experience, identifying in a patient the type of infection (congenital or acquired), if the diagnostic is postnatal in many cases it is highly valuable information for the patient even though it would not modify the therapeutic approach. For this reason, we must be very careful when classifying the toxoplasmosis infection with ocular involvement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We consider it very important to prepare guidelines to facilitate the diagnostic and treatment of patients with ocular toxoplasmosis. In the cases of patients from regions with high prevalence of this infection and with circulation of virulent parasite types such as in Colombia and Brazil, such guidelines would guarantee a reduction in impact on eyesight and on the quality of life of these patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: López-Castillo CA, De-la-Torre A. Definición de la adquisición de la infección toxoplásmica, ¿cuándo es congénita o adquirida? Arch Soc Esp Oftalmol. 2011;86:222–26.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features of ocular toxoplasmosis in an inmigrant population in the Barcelona area: study of 22 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Álvarez" 1 => "A. Rey" 2 => "A. Adán" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oftal.2010.07.001" "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2010" "volumen" => "85" "paginaInicial" => "202" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21074095" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ocular toxoplasmosis: the influence of patient age" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.N. Holland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Mem Inst Oswaldo Cruz" "fecha" => "2009" "volumen" => "104" "paginaInicial" => "351" "paginaFinal" => "357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19430663" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "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. 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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/S2173579411000338/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/S2173579411000338/v1_201305091027/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579411000338?idApp=UINPBA00004N" ]
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Vol. 86. Issue 7.
Pages 224-225 (July 2011)
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Vol. 86. Issue 7.
Pages 224-225 (July 2011)
Letter to the Editor
Definition of acquired toxoplasmosis infection: When is it congenital or acquired?
Definición de la adquisición de la infección toxoplásmica, ¿cuándo es congénita o adquirida?
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