levoleucovorin and Chorioretinitis

Topics: Chorioretinitis; Drug Administration Schedule; Female; Fluorescein Angiography; Fundus Oculi; Humans; Leucovorin; Pyrimethamine; Retinal Detachment; Sulfadiazine; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Young Adult

To investigate ocular involvement (prevalence, incidence, lesion characteristics) following postnatally acquired infection with an "atypical" genotype of Toxoplasma gondii during a well-characterized 2001 outbreak in Santa Isabel do Ivaí, Brazil, attributed to a contaminated municipal reservoir.. Prospective longitudinal cohort study.. We performed ophthalmic examinations on 290 of 454 individuals with serologic evidence of T gondii infection during the epidemic (positive IgM antibody tests). Prevalence of ophthalmic findings (intraocular inflammatory reactions [including transient, isolated retinal whitening without clinically apparent retinal necrosis] and necrotizing retinochoroiditis) at initial examination (baseline) and incidence of new findings during 10.5 months of follow-up were calculated. Cumulative risks of ophthalmic events were determined (Kaplan-Meier technique).. Ocular involvement was present in 33 of 288 IgM+ individuals (11.5%) at baseline, including 17 with focal retinal whitening only and 13 with necrotizing retinochoroiditis. Incidence of new ocular involvement was estimated to be 1.73 events per 100 person-months (PM); cumulative risk at 10.5 months was 30.1%. Incident necrotizing retinochoroiditis was more common among those with focal retinal whitening at baseline (6.7/100 PM) than among those with no ocular involvement at baseline (1.11/100 PM; hazard ratio 6.07 [1.94-19.01]; P < .0001).. Waterborne infection with an atypical genotype of T gondii is associated with substantial risk of ocular involvement. Lesions may continue to develop during the first year after infection. The increased risk of late necrotizing retinochoroiditis associated with isolated focal retinal whitening at presentation suggests the early presence of parasites in the retina, despite initial lack of observable retinal necrosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Protozoan; Antiprotozoal Agents; Brazil; Child; Child, Preschool; Chorioretinitis; Cohort Studies; Disease Outbreaks; Endemic Diseases; Enzyme-Linked Immunosorbent Assay; Female; Folic Acid Antagonists; Humans; Immunoglobulin M; Incidence; Infant; Infant, Newborn; Leucovorin; Longitudinal Studies; Male; Middle Aged; Prevalence; Prospective Studies; Pyrimethamine; Seroepidemiologic Studies; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular; Water; Water Supply

Children treated for toxoplasma retinochoroiditis may experience a range of severe adverse drug responses. Drug reaction with eosinophilia and systemic symptoms syndrome is a life-threatening idiosyncratic drug reaction with a 10% mortality. We present a case of drug reaction with eosinophilia and systemic symptoms syndrome in a child on standard combination treatment with oral sulfadiazine, pyrimethamine, folinic acid, and steroids for toxoplasma retinochoroiditis. Early clinical recognition and appropriate treatment led to a complete recovery and no longterm sequelae. The parents of children during sulfadiazine treatment should be counseled on the potential significance of nonspecific illness.

Topics: Adolescent; Antiprotozoal Agents; Chorioretinitis; Drug Eruptions; Drug Hypersensitivity; Drug Therapy, Combination; Eosinophilia; Female; Humans; Leucovorin; Pyrimethamine; Steroids; Sulfadiazine; Toxoplasmosis, Ocular

Chemokines have been implicated in the control of leucocyte infiltration in uveitis and in modulating angiogenesis in several ocular conditions. Toxoplasmic retinochoroiditis is a common cause of posterior uveitis. This study aimed to evaluate the serum concentrations of CC and CXC chemokines in patients with acute toxoplasmic retinochoroiditis.. The levels of five chemokines (CCL2, CCL11, CXCL9, CXCL8 and CXCL10) were evaluated in the serum of patients with active toxoplasmic retinochoroiditis (n = 55) and control subjects (n = 40). In a subset of patients (n = 18), a second measure of serum levels of chemokines was performed after the completion of oral treatment with pyrimethamine (25 mg/day), sulphadiazine (1 g, four times per day), folinic acid (7.5 mg/day) and prednisone (initial dose: 1 mg/kg/day) for approximately 30 days.. Patients with toxoplasmic retinochoroiditis, notably those presenting with vasculitis, had increased serum levels of CXCL8 (mean +/- standard error of the mean [SEM] 35.1 +/- 6.5 pg/ml) compared with control subjects (mean +/- SEM 16.0 +/- 2.3 pg/ml; p = 0.01). There were no differences between patients and controls in serum levels of the other chemokines measured. The size of ocular lesions correlated significantly with serum levels of CXCL8 and CXCL9. After treatment, there was a significant reduction in serum levels of CXCL8. Severity of vitreous opacities did not correlate with serum levels of these chemokines.. These data suggest a role for CXCL8 in the inflammatory process of acute toxoplasmic retinochoroiditis. Furthermore, CXCL8 may be a useful marker for patient follow-up.

Topics: Acute Disease; Adult; Anti-Inflammatory Agents; Antiprotozoal Agents; Chorioretinitis; Female; Humans; Interleukin-8; Leucovorin; Male; Optic Disk; Prednisone; Pyrimethamine; Sulfadiazine; Toxoplasmosis, Ocular; Vasculitis; Visual Acuity

To describe eight patients with active toxoplasmic retinochoroiditis (RC) who had features suggestive of acute choroidal ischemia.. A retrospective review of the clinical records of 23 consecutive patients with acute toxoplasmic RC was performed. All patients underwent detailed ophthalmic examination at presentation and throughout follow-up, including dilated biomicroscopic fundus examination, fundus photography, fluorescein angiography, and indocyanine green (ICG) angiography.. Of 23 patients, 8 (34.8%) had a large area of retinal whitening surrounding a small focus of RC. Fluorescein as well as ICG angiography showed a well demarcated geographic area of early choroidal hypofluorescence that extended beyond the clinical borders of the white retinal lesion, particularly by ICG angiography. Associated findings for these 8 patients included old retinochoroidal scars (7 [87.5%]), serous retinal detachment (3 [37.5%]), retinal hemorrhages (1 [12.5%]), and multiple satellite dark dots by ICG angiography (6 [75%]). Seven of eight patients were treated using a combination of antitoxoplasmic drugs and corticosteroids. All findings seen at the acute stage resolved in 2 weeks to 6 weeks. A small atrophic retinochoroidal scar replaced the active toxoplasmic lesion and was surrounded with mild or moderate retinal pigment epithelium changes that were associated with decreased final visual acuity in 2 patients (25%).. Patients with toxoplasmic RC may develop features suggestive of choroidal ischemia that can result in a transient or permanent decrease in vision. Choroidal ischemia can only be suspected clinically, and fluorescein angiography and ICG angiography are required to establish the definitive diagnosis.

Topics: Acute Disease; Adult; Azithromycin; Chorioretinitis; Choroid; Coloring Agents; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Indocyanine Green; Ischemia; Leucovorin; Male; Prednisone; Pyrimethamine; Retrospective Studies; Toxoplasmosis, Ocular

To describe a case of recurrent frosted branch angiitis after treatment of ocular toxoplasmosis.. In a 6-year-old boy, we found perivascular, creamy, patchy, retinal sheathing in both eyes without any focal necrotizing retinochoroiditis or scarring. IgM antibodies for toxoplasma gondii were also found. The patient was treated with antitoxoplasmosis medication and a systemic steroid.. Several years after treatment of the toxoplasmosis, frosted branch angiitis occurred twice without any retinal scarring or serological evidence of toxoplasmosis. After systemic steroid therapy, the angiitis improved without further complications.. Toxoplasmic retinal vasculitis should be considered as a cause of frosted branch angiitis.

Topics: Antiprotozoal Agents; Child; Chorioretinitis; Drug Therapy, Combination; Fluorescein Angiography; Glucocorticoids; Humans; Leucovorin; Male; Pyrimethamine; Recurrence; Retinal Vasculitis; Toxoplasmosis, Ocular

The clinical management of perinatal toxoplasmosis involves a gynaecologist during pregnancy and a neonatologist after delivery. Then, in the absence of a uniform approach, early evaluation of infected infants requires a thorough long-term follow-up also in asymptomatic children, who have to be observed for at least one year due to unpredictable sequelae in later life. We retrospectively analyzed pregnancy management of 54 women with certain infection from Toxoplasma gondii (TG) and prospectively enrolled their infants to compare prenatal management with postnatal clinical outcome. All mothers with seroconversion for TG infection were from the Palermo area and were retrospectively analyzed, whereas their newborns referred to G. Di Cristina Children Clinical Hospital between 1999-2004 were prospectively enrolled in a 48-month follow-up. Timing of infection was dated for 24 women (45%) to the first trimester, 18 (33%) to the second and 12 (22%) the third. The maternal-fetal transmission rate was 17.2%. Prenatal diagnosis from amniotic fluid was performed in 25/54 pregnant subjects and showed positive results in 6. Despite diagnosis of TG infection, 9 women were untreated and only 2 with positive amniocentesis received combined therapy. 10/55 enrolled infants were infected and half of them were preterm and/or SGA at birth. None showed peculiar signs of TG at birth but 4 had abnormalities during the follow-up. 9/10 infected children were born to mothers who had undergone neither amniocentesis nor combined therapy.. Our work confirms the difficulty of applying standardized therapeutic protocol for TG infection during pregnancy. The asymptomatic course of TG infection at birth confirms the importance of an instrumental long-term follow-up to identify typical TG lesion to prevent sequelae.

Topics: Adolescent; Adult; Amniocentesis; Animals; Antibodies, Protozoan; Antiprotozoal Agents; Chorioretinitis; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Hydrocephalus; Immunoglobulin G; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Small for Gestational Age; Infectious Disease Transmission, Vertical; Italy; Leucovorin; Male; Prednisone; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimesters; Prenatal Care; Prospective Studies; Pyrimethamine; Retrospective Studies; Spiramycin; Sulfadiazine; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Cerebral; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

Topics: Animals; Antibodies, Protozoan; Antiprotozoal Agents; Chorioretinitis; DNA, Protozoan; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Immunoglobulin G; Infant; Leucovorin; Panuveitis; Pyrimethamine; Retina; Retinal Detachment; Sulfadiazine; Toxoplasma; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

To describe a case of severe congenital toxoplasmosis because of inadequate surveillance of a seronegative pregnant woman and to evaluate the usefulness of different microbiological diagnostic methods after birth.. We applied serology, DNA amplification by one-tube semi-nested PCR, cell culture and mice inoculation analysis.. Anti. T. gondii serology was useful for the diagnosis of congenital toxoplasmosis. PCR analysis of neonate cerebrospinal fluid and peripheral blood were positive, and yielded negative results after a few days of specific treatment. Cellular culture and mice inoculation yielded negative results.. Our results suggest that serology and PCR are useful methods for the diagnosis of toxoplasmosis in newborns. Prenatal toxoplasmosis screening and suitable follow up of the seronegative pregnant women are necessary to prevent cases of severe infection in our area.

Topics: Acute Disease; Administration, Topical; Adult; Animals; Anti-Inflammatory Agents; Antibodies, Protozoan; Antiprotozoal Agents; Blood; Brain; Cerebrospinal Fluid; Chorioretinitis; Dexamethasone; Female; Glucocorticoids; Humans; Infant, Newborn; Leucovorin; Male; Methylprednisolone; Mice; Neonatal Screening; Ophthalmic Solutions; Polymerase Chain Reaction; Pregnancy; Pyrimethamine; Random Amplified Polymorphic DNA Technique; Sulfadiazine; Tomography, X-Ray Computed; Toxoplasma; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

The purpose of this study was to determine the clinical and immunological outcome of 78 children with congenital toxoplasmosis treated with the pyrimethamine-sulfadoxine combination between 1980 and 1997.. Children were divided into 3 groups according to the initial duration of treatment (always including folinic acid, 5 mg/week by mouth), as follows: pyrimethamine (1.25 mg/kg every 15 d) + sulfadoxine (25 mg/kg every 15 d) for 12 months (Group 1, 47 children), or for 24 months, with or without prenatal therapy (respectively, Group 2, 19 children, and Group 3, 12 children).. Chorioretinitis occurred in 23% of these 78 children. Four children had unilateral blindness, 1 had mild epileptic fits and 1 had psychomotor retardation. The lowest rate of sequelae were in Groups 2 and 3. Immunological rebounds, generally without clinical repercussions, occurred frequently (90% of cases on average) during, or more often after therapy, regardless of the treatment duration. Treatment was always well tolerated.. Our current treatment strategy for congenital toxoplasmosis consists of a 24-month course of pyrimethamine-sulfadoxine (Fansidar) combined with folinic acid (Lederfoline). If the prenatal diagnosis is positive, we also prescribe this treatment to the mother until delivery. This combination offers satisfactory compliance, adequate serum concentrations, and good preventive efficacy.

Topics: Adolescent; Antimalarials; Child; Child, Preschool; Chorioretinitis; Drug Administration Schedule; Drug Combinations; Follow-Up Studies; Humans; Infant; Infant, Newborn; Leucovorin; Pyrimethamine; Sulfadoxine; Toxoplasmosis, Congenital

The authors discuss a possible relationship between systematic corticosteroid use and reactivation of ocular toxoplasmosis.. Patients were identified who developed foci of recurrent toxoplasmic retinochoroiditis while being treated with systemic corticosteroids. Case histories were reviewed retrospectively.. During a 10-year interval, three patients were identified at the University of California, Los Angeles, who had been receiving systemic corticosteroid therapy (dose range, 0.27-1.23 mg/kg/day) when they developed recurrent toxoplasmic retinochoroiditis. Disease occurred at intervals of 20 days to approximately 1 year after start of corticosteroid therapy. Lesions were typical in appearance, course, and manner in which they responded to antimicrobial therapy.. Recurrent toxoplasmosis in patients receiving corticosteroid therapy probably is uncommon. These cases do not confirm a causal relationship between corticosteroid use and initiation of disease recurrence.

Topics: Adolescent; Animals; Anti-Infective Agents; Anti-Inflammatory Agents; Antibodies, Protozoan; Antidotes; Child; Chorioretinitis; Enzyme-Linked Immunosorbent Assay; Female; Humans; Leucovorin; Male; Middle Aged; Prednisolone; Pyrimethamine; Recurrence; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular

Active, recurrent, protracted toxoplasmic retinochoroiditis that had been unresponsive to intensive medical therapy with pyrimethamine, sulfamethoxypyridazine, intramuscular folicic acid, or clindamycin and corticosteroids, was treated with photocoagulation in five eyes. Four eyes healed rapidly within a few weeks. In one patient's eye, lens and vitreous opacities prevented adequate treatment with the red III intensity level of the xenon are photocoagulator. Subsequent surgical diathermy and cryocoagulation resulted in prompt healing of the lesion. Noninvasive photocoagulation of active toxoplasmosis retinochoroiditis is recommended in protracted cases if the media are clear, the macula is threatened, or there are severe complications from systemic medications.

Topics: Adolescent; Adult; Chorioretinitis; Chronic Disease; Drug Therapy, Combination; Female; Humans; Leucovorin; Light Coagulation; Male; Middle Aged; Prednisone; Pyrimethamine; Sulfadiazine; Toxoplasmosis, Ocular

Topics: Chorioretinitis; Glucocorticoids; Humans; Leucomycins; Leucovorin; Pyrimethamine; Sulfonamides; Toxoplasmosis, Ocular

Topics: Adrenal Cortex Hormones; Chorioretinitis; Humans; Leucovorin; Pyrimethamine; Sulfadiazine; Toxoplasmosis, Ocular