trimethoprim--sulfamethoxazole-drug-combination and Toxoplasmosis--Ocular

Ocular toxoplasmosis (OT) is the most frequent form of infectious posterior uveitis caused by the protozoan parasite Toxoplasma gondii. To evaluate the available evidence in peer-reviewed publications about the most effective therapy for OT in immunocompetent patients, herein a systematic literature search was conducted using Embase, PubMed, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) database from January 1987 to October 2017, with search terms "OT", "retinochoroiditis", "treatment", and "immunocompetent"; search filters "controlled clinical trial", "randomized clinical trial", and "clinical trial". The included studies were performed to evaluate the various treatment modalities of OT. Different treatment regimens were compared with regard to the improvement of visual acuity, the resolution of vitreous inflammation, recurrence, and side-effects. We independently extracted data and assessed eligibility and risk of bias using the preferred reporting items for systematic reviews and meta-analysis, and resolved any disagreement through discussion. A Bayesian network meta-analysis model was used to evaluate the interesting outcomes of all the interventions. Total 10 trials of treatments for OT were found to meet the inclusion criteria. Six trials of treatments including clindamycin, azithromycin, and trimethoprim-sulfamethoxazole (TMP-SMX) were compared with conventional therapy (the combination of pyrimethamine, sulfadiazine, and corticosteroids) for evaluation of the effect on visual acuity, vitreous inflammation, recurrence of OT, and side-effects. Two trials were compared TMP-SMX with placebo. One trial was compared azithromycin with TMP-SMX. And another trial was compared among treatments with clindamycin, P-S, TMP-SMX, and placebo. Based on our network meta-analysis, therapy with TMP-SMX seems to be an alternative treatment of OT in immunocompetent patients.

Topics: Adult; Aged; Aged, 80 and over; Bayes Theorem; Clindamycin; Female; Humans; Immunocompromised Host; Male; Middle Aged; Network Meta-Analysis; Pyrimethamine; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

Acute toxoplasma retinochoroiditis causes transient symptoms of ocular discomfort and may lead to permanent visual loss. Antibiotic treatment aims primarily to reduce the risk of permanent visual loss, recurrent retinochoroiditis, and the severity and duration of acute symptoms. There is uncertainty about the effectiveness of antibiotic treatment.. To compare the effects of antibiotic treatment versus placebo or no treatment for toxoplasma retinochoroiditis.. We searched CENTRAL (which contains the Cochrane Eyes and Vision group Trials Register) (2016, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2016), EMBASE (January 1980 to February 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to February 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 22 February 2016. We searched the reference lists of identified articles and contacted pharmaceutical companies for unpublished trials.. We included randomised controlled trials that compared any antibiotic treatment against placebo or no treatment. We excluded trials that included immunocompromised participants. We considered any antibiotic treatment known to be active against Toxoplasma gondii. Antibiotic treatment could be given in any dose orally, by intramuscular injection, by intravenous infusion, or by intravitreal injection.. The primary outcomes for this review were visual acuity at least three months after treatment and risk of recurrent retinochoroiditis. Secondary outcomes were improvement in symptoms and signs of intraocular inflammation, size of lesion, and adverse events. We used standard methodological procedures expected by Cochrane.. Four trials that randomised a total of 268 participants met the inclusion criteria. In all four studies antibiotic was administered orally.One study conducted in Brazil in both adults and children compared trimethoprim-sulfamexacocol over 20 months to no treatment and was judged to be at high risk of performance, detection, and attrition bias. The other three studies compared antibiotic treatment to placebo. We judged these three studies to be at a mixture of low or unclear risk of bias due to poor reporting. One study conducted in the US in adults studied pyrimethamine-trisulfapyrimidine for eight weeks; one study conducted in the UK in children and adults evaluated pyrimethamine for four weeks; and one study conducted in Brazil in adults investigated trimethoprim-sulfamethoxazole for 12 months. In the last study, all participants had active retinochoroiditis and were treated with antibiotics for 45 days prior to randomisation to trimethoprim-sulfamethoxazole versus placebo.Only the study in Brazil of trimethoprim-sulfamethoxazole over 12 months, in participants with healed lesions, reported the effect of treatment on visual acuity. People treated with antibiotics may have a similar change in visual acuity compared with people treated with placebo at one year (mean difference -1.00 letters, 95% confidence interval (CI) -7.93 to 5.93 letters; 93 participants; low-quality evidence).Treatment with antibiotics probably reduces the risk of recurrent retinochoroiditis compared with placebo (risk ratio (RR) 0.26, 95% CI 0.11 to 0.63; 227 participants; 3 studies; I(2) = 0%; moderate-quality evidence); similar results were seen for acute and chronic retinochoroiditis.The UK study of pyrimethamine for four weeks reported an improvement in intraocular inflammation in treated compared with control participants (RR 1.76, 95% CI 0.98 to 3.19; 29 participants; low-quality evidence). The study in Brazil of trimethoprim-sulfamethoxazole for 12 months stated that the severity of inflammation was higher in the comparator group when compared to the antibiotic-treated group but did not provide further details. In the US study of pyrimethamine-trisulfapyrimidine for eight weeks intraocular inflammation had almost completely resolved by eight weeks in all participants, however in this study all participants received steroid treatment.Two studies (UK and US studies) reported an increased risk of adverse events in treated participants. These were a fall in haemoglobin, leucocyte. Treatment with antibiotics probably reduces the risk of recurrent toxoplasma retinochoroiditis, but there is currently no good evidence that this leads to better visual outcomes. However, absence of evidence of effect is not the same as evidence of no effect. Further trials of people with acute and chronic toxoplasma retinochoroiditis affecting any part of the retina are required to determine the effects of antibiotic treatment on visual outcomes.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Child; Chorioretinitis; Drug Combinations; Humans; Pyrimethamine; Randomized Controlled Trials as Topic; Recurrence; Secondary Prevention; Sulfadiazine; Sulfamerazine; Sulfamethazine; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity; Watchful Waiting

To evaluate the available evidence in peer-reviewed publications about the outcomes and safety of interventions for toxoplasma retinochoroiditis (TRC).. Literature searches of the PubMed and the Cochrane Library databases were conducted last on July 20, 2011, with no date restrictions. The searches retrieved 275 unique citations, and 36 articles of possible clinical relevance were selected for full text review. Of these 36 articles, 11 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence.. Eight of the 11 studies reviewed were randomized controlled studies, and none of them demonstrated that routine antibiotic or corticosteroid treatment of TRC favorably affects visual outcomes or reduces lesion size. There is level II evidence from 1 study suggesting that long-term treatment with combined trimethoprim and sulfamethoxazole prevented recurrent disease in patients with chronic relapsing TRC. Adverse effects of antibiotic treatment were reported in as many as 25% of patients. There was no evidence supporting the efficacy of other nonmedical treatments such as laser photocoagulation.. There is a lack of level I evidence to support the efficacy of routine antibiotic or corticosteroid treatment for acute TRC in immunocompetent patients. There is level II evidence suggesting that long-term prophylactic treatment may reduce recurrences in chronic relapsing TRC. Adverse effects of certain antibiotic regimens are frequent, and patients require regular monitoring and timely discontinuation of the antibiotic in some cases.

Topics: Academies and Institutes; Anti-Infective Agents; Chorioretinitis; Clinical Trials as Topic; Humans; Laser Coagulation; Ophthalmology; Technology Assessment, Biomedical; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States

To review current evidence for the treatment of ocular toxoplasmosis (OT).. Narrative review and expert recommendations.. Meta-analysis and selected original articles from the medical literature were reviewed critically. Expert recommendations were analyzed.. Numerous observational studies suggest a benefit of short-term antimicrobial therapy for toxoplasmic retinochoroiditis in immunocompetent patients, although its efficacy has not been proven in randomized clinical trials. A randomized clinical trial revealed that intermittent trimethoprim/sulfamethoxazole treatment could decrease the rate of recurrence in high-risk patients. Intravitreal injection of clindamycin and dexamethasone was an acceptable alternative to the classic treatment for OT in a randomized clinical trial.. Opinions about therapy differ and controversy remains about its type, efficacy, and length. Intravitreal therapy may be promising for OT. A recent description of the presence of parasitemia in patients with active and inactive ocular toxoplasmosis raises new questions that need to be explored.

Topics: Anti-Bacterial Agents; Antiprotozoal Agents; Clindamycin; Dexamethasone; Female; Humans; Male; Ophthalmic Solutions; Secondary Prevention; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Uveitis

Retinochorioditis is the most common complication of ocular toxoplasmosis and also the most dangerous one in respect of central visual acuity. New treatment concepts are increasingly replacing the therapy that had become established since the fifties and that had been based on pyrimethamine and sulphadiazine. The new concepts entail fewer complications and are better accepted by the patients. However, prospective randomised studies that are based on severe criteria could not prove for any of the employed treatment courses that it promotes healing of retinochorioditis or prevents relapses. However, if central visual acuity is endangered, drug therapy should nevertheless be initiated. In babies and in persons with immunodeficiency treatment must be in accordance with the overall pattern of symptoms.

Topics: Child; Clindamycin; Coccidiostats; Contraindications; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Combinations; Humans; Spiramycin; Sulfadiazine; Toxoplasmosis, Ocular; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

To compare the effects of 1 year of treatment with trimethoprim-sulfamethoxazole (TMP-SMZ) vs placebo in reducing the risk of recurrence of toxoplasmic retinochoroiditis during a 6-year follow-up period.. Randomized, double-masked clinical trial.. This cohort included 141 subjects recruited in Campinas, Brazil. The inclusion criterion was unilateral active recurrent toxoplasmic retinochoroiditis. All subjects were treated with 1 dose of TMP-SMZ (160 mg/800 mg) twice daily for 45 days, and all lesions healed after this treatment. After this initial treatment, subjects were randomly assigned to group 1 (1 TMP-SMZ dose every other day for 311 days) or group 2 (1 identical placebo tablet containing starch with no active ingredients every other day for 311 days). Between the second and sixth years of follow-up appointments, none of the subjects received treatment unless a new recurrence episode had occurred. The primary outcomes were recurrent toxoplasmic retinochoroiditis within the first year of follow-up and recurrent toxoplasmic retinochoroiditis in the 6 years of follow-up.. The cumulative probability of recurrence 1, 2, 3, 4, 5, and 6 years after the initial infection was, respectively, 13.0% (9/69), 17.4% (12/69), 20.3% (14/69), 23.2% (16/69), 26.1% (18/69), and 27.5% (19/69) in the placebo group and 0%, 0%, 0%, 0%, 0%, and 1.4% (1/72) in the TMP-SMZ group (P < .001; log-rank test). There were 3 cases (3/69; 4.3%) of multiple recurrences in the same individual in the placebo group. No treatment-limiting toxicity or side effects were observed in either group. New recurrences were more frequent among female subjects.. TMP-SMZ may be used safely for prophylaxis of recurrent toxoplasmic retinochoroiditis and may provide long-term benefits.

Topics: Adult; Anti-Bacterial Agents; Chorioretinitis; Double-Blind Method; Eye Infections, Parasitic; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Secondary Prevention; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity; Young Adult

To compare the effects of 1 year of treatment with trimethoprim/sulfamethoxazole (TMP-SMZ) vs a placebo in reducing the risk of toxoplasmic retinochoroiditis recurrences during a 3-year follow-up period.. Randomized, double-masked clinical trial.. This cohort included 141 volunteers recruited in Campinas, Brazil. Inclusion criterion was unilateral active recurrent toxoplasmic retinochoroiditis. All volunteers were treated with 1 tablet of TMP-SMZ (160 mg/800 mg) twice daily for 45 days, and all lesions healed after this treatment. After this initial treatment, the volunteers were randomly assigned to Group 1 (1 TMP-SMZ tablet every 2 days for 311 days) or Group 2 (1 identical placebo tablet containing starch with no active ingredients every 2 days for 311 days). At the second- and third-year follow-up appointments, none of the volunteers received treatment unless a new recurrence episode had occurred. The primary outcomes were recurrent toxoplasmic retinochoroiditis within the first year of follow-up and recurrent toxoplasmic retinochoroiditis within the third year of follow-up.. The cumulative probability of recurrence at 1, 2, and 3 years of follow-up were, respectively, 13.0% (9/69), 17.4% (12/69), and 20.3% (14/69) in the placebo group and 0% (0/72) in the TMP-SMZ group (P < .001, log-rank test). There was no case of multiple recurrences in the same individual. No treatment-limiting toxicity or side effects were observed in either group. New recurrences were more frequent among female volunteers.. TMP-SMZ may be used safely for prophylaxis of recurrent toxoplasmic retinochoroiditis, with long-term benefits.

Topics: Adult; Anti-Bacterial Agents; Chorioretinitis; Double-Blind Method; Eye Infections, Parasitic; Female; Follow-Up Studies; Humans; Male; Middle Aged; Placebos; Prospective Studies; Recurrence; Secondary Prevention; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity; Young Adult

To compare the effects of trimethoprim-sulfamethoxazole vs placebo in reducing the risk of recurrences of Toxoplasma gondii retinochoroiditis.. Single-center, prospective randomized double-masked clinical trial.. A total of 95 patients from Campinas, Brazil, with active recurrent Toxoplasma gondii retinochoroiditis were included. The initially active toxoplasmosis lesions were successfully treated in all cases using trimethoprim-sulfamethoxazole (800 mg/160 mg) twice daily for 45 days. Subsequently, 5 patients dropped out of the study. The remaining patients were randomized to Group 1 (trimethoprim/sulfamethoxazole tablet every 2 days) or Group 2 (identical placebo tablet every 2 days). Randomization was 1:1, was stratified by sex, and used block sizes of 4. The primary outcome was recurrent toxoplasmosis retinochoroiditis within 1 year, and the secondary outcome was a 1-year change in best-corrected visual acuity (BCVA) (ETDRS chart).. The incidence of recurrent toxoplasmosis retinochoroiditis within 12 months was 0 of 46 (0%) and 6 of 47 (12.80%) in the trimethoprim-sulfamethoxazole and placebo groups, respectively (P = .026). Visual acuity improvements in the 2 groups were similar. No treatment-limiting toxicity was observed.. Trimethoprim/sulfamethoxazole therapy resulted in a 100% reduction in the recurrence of Toxoplasma gondii retinochoroiditis over 1 year of treatment.

Topics: Adult; Anti-Infective Agents; Chorioretinitis; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Prospective Studies; Secondary Prevention; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

To compare the efficacy of the classic treatment of ocular toxoplasmosis (pyrimethamine, sulfadiazine, and prednisolone) with a regimen consisting of trimethoprim/sulfamethoxazole (co-trimoxazole) plus prednisolone.. Prospective randomized single-blind clinical trial.. Fifty-nine patients with active ocular toxoplasmosis were randomly assigned to 2 treatment groups: 29 were treated with pyrimethamine/sulfadiazine, and 30 patients received trimethoprim/sulfamethoxazole.. Treatment consisted of 6 weeks' treatment with antibiotics plus steroids. Antitoxoplasmosis antibodies (immunoglobulin M [IgM] and IgG) were measured using an enzyme-linked immunosorbent assay.. Changes in retinochoroidal lesion size after 6 weeks' treatment, visual acuity (VA) before and after intervention, adverse drug reactions during follow-up, and rate of recurrence.. Active toxoplasmosis retinochoroiditis resolved in all patients over 6 weeks' treatment, with no significant difference in mean reduction of retinochoroidal lesion size between the 2 treatment groups (61% reduction in the classic treatment group and 59% in the trimethoprim/sulfamethoxazole group, P = 0.75). Similarly, no significant difference was found in VA after treatment between the 2 groups (mean VAs after treatment were 0.12 logarithm of the minimum angle of resolution [logMAR] [20/25] in the classic treatment group and 0.09 logMAR [20/25] in the trimethoprim/sulfamethoxazole group, P = 0.56). Adverse effects were similar in both groups, with one patient in each suffering from any significant drug side effects. The overall recurrence rate after 24 months' follow-up was 10.16%, with no significant difference between the treatment groups (P = 0.64).. Drug efficacies in terms of reduction in retinal lesion size and improvement in VA were similar in a regimen of trimethoprim/sulfamethoxazole and the classic treatment of ocular toxoplasmosis with pyrimethamine and sulfadiazine. Therapy with trimethoprim/sulfamethoxazole seems to be an acceptable alternative for the treatment of ocular toxoplasmosis.

Topics: Adolescent; Adult; Animals; Antibodies, Protozoan; Antiprotozoal Agents; Child; Chorioretinitis; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Prospective Studies; Pyrimethamine; Recurrence; Single-Blind Method; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

To determine the effect of long-term intermittent trimethoprim/sulfamethoxazole treatment on recurrences of toxoplasmic retinochoroiditis.. Prospective randomized open-labeled interventional clinical trial.. A total of 124 patients with a history of recurrent toxoplasmic retinochoroiditis were randomized to treatment with one tablet of trimethoprim (160 mg)/sulfamethoxazole (800 mg) (Bactrim F; Roche Pharmaceuticals, Rio de Janeiro, Brazil) every 3 days (61 patients) or to observation without treatment (63 patients) and were followed monthly for up to 20 consecutive months for clinical signs of disease recurrence. A recurrence was defined as a new focus of necrotizing retinochoroiditis with active inflammation either adjacent to or remote from preexisting retinochoroidal scars.. Recurrences developed in four (6.6%) treated patients and in 15 (23.8%) controls (P =.01). Treatment was discontinued prematurely in four patients because of mild drug reactions.. Long-term intermittent treatment with trimethoprim/sulfamethoxazole can reduce the rate of recurrent toxoplasmic retinochoroiditis.

Topics: Adolescent; Adult; Anti-Infective Agents; Child; Chorioretinitis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We conducted a prospective multicenter study of the efficacy of current therapeutic strategies for ocular toxoplasmosis in 149 patients. Treatment consisted of the following three triple-drug combinations: group 1, pyrimethamine, sulfadiazine, and corticosteroids; group 2, clindamycin, sulfadiazine, and corticosteroids; and group 3, trimethoprim, sulfamethoxazole and corticosteroids. Patients with peripheral retinal lesions were not treated systemically. No difference in the duration of inflammatory activity was observed between treated and untreated patients (P = .5). The most important factor predicting the duration of inflammatory activity was the size of the retinal lesion itself, independent of the treatment (P < .001). We found a reduction in size of the retinal inflammatory lesion for 49% of the pyrimethamine-treated patients (17 of 35) compared to 20% of the untreated patients (eight of 41) (P < .01). However, the most frequent occurrence of side effects was also associated with pyrimethamine medication (26%, nine of 35). The mean recurrence rate after three years of follow-up was 49% for all patients (60 of 122 patients), with no differences between treated and untreated patients (P = .6).

Topics: Adult; Chorioretinitis; Clindamycin; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Prospective Studies; Pyrimethamine; Recurrence; Sulfadiazine; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

We performed a prospective multicentre study to evaluate the efficacy of therapeutic strategies currently used for ocular toxoplasmosis in a large number of patients (n = 106). Treatment was given for at least four weeks and consisted of three triple drug combinations: group 1, pyrimethamine, sulphadiazine and corticosteroids (n = 29); group 2. clindamycin, sulphadiazine and corticosteroids (n = 37); and group 3. cotrimoxazole (trimethoprim and sulphamethoxazole) and corticosteroids (n = 8). Patients with peripheral retinal lesions remained without systemic therapy (group 4, n = 32). Patients from group 1 received leucovorin 5 mg twice a week. No difference in the duration of inflammatory activity was observed between the treated and untreated patients or between the separate groups of patients. The most important factor predicting the duration of inflammatory activity was the size of the retinal focus itself, independently of the therapy given (P less than 0.05). We showed a reduction in size of the retinal inflammatory focus in 52% of the pyrimethamine patients as compared to 25% of untreated cases. However the most frequent side effects were also associated with pyrimethamine medication and included hematologic complications as thrombocytopenia and leucopenia despite leucovorin medication.

Topics: Chorioretinitis; Clindamycin; Coccidiostats; Drug Therapy, Combination; Humans; Inflammation; Multicenter Studies as Topic; Prospective Studies; Pyrimethamine; Retina; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice.. 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy.. For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing-usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%.. Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists.

Topics: Anti-Bacterial Agents; Chorioretinitis; Humans; Surveys and Questionnaires; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a 14-year-old girl with ocular toxoplasmosis presenting with severe panuveitis with anterior segment involvement, moderate vitreous haze, focal retinochoroiditis, extensive retinal periphlebitis, and macular bacillary layer detachment. Toxoplasmosis treatment was complicated by Stevens-Johnson syndrome, which developed 8 days after starting trimethoprim-sulfamethoxazole.

Topics: Adolescent; Bacillus; Child; Chorioretinitis; Female; Humans; Macular Degeneration; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

Ocular toxoplasmosis (OT) is the leading cause of infectious posterior uveitis in several areas worldwide. The combination of Trimethoprim/Sulfamethoxazole (TMP/SMX) has been presented as an attractive alternative to the "classic' treatment therapy (Pyrimethamine/Sulfadiazine).. A prospective study was carried out between February 2020 and September 2021 in 2 ophthalmic centers in Kinshasa. This study aimed to describe TMP/SMX treatment outcomes for OT in a cohort of immunocompetent Congolese patients.. 54 patients were included, with a mean age at presentation of 37.5 ± 13.6 years old and a Male-Female ratio of 1.45:1. Three patients (5.6%) presented a recurrence during the follow-up period. At the end of the follow-up, improvement in VA and resolution of inflammation concerned 75.9% and 77.5% of patients, respectively. Cataracts (3.7%), macular scars (3.7%), and vitreous opacities (3.7%) were the principal causes of non-improvement in VA. Treatment-related adverse events were present in 10 patients (18.5%); gastrointestinal (14.8%) and dermatological (3.7%) adverse events were the most frequent. Dermatological adverse events led to discontinuation of treatment.. TMP/SMX regimen appears to be a safe and effective treatment for OT in Congolese patients. The low cost and the accessibility of the molecules make this regimen an option for treating OT in resource-limited countries.

Topics: Adult; Democratic Republic of the Congo; Female; Humans; Male; Middle Aged; Prospective Studies; Pyrimethamine; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

To evaluate diagnostic and therapeutic practices and then establish a consensus on the management of ocular toxoplasmosis in France through a Delphi study.. Twenty-three French experts in ocular toxoplasmosis were invited to respond to a modified Delphi study conducted online, in the form of two questionnaires, in an attempt to establish a consensus on the diagnosis and management of this pathology. The threshold for identical responses to reach consensus was set at 70 %.. The responses of 19 experts out of the 23 selected were obtained on the first questionnaire and 16 experts on the second. The main elements agreed upon by the experts were to treat patients with a decrease in visual acuity or an infectious focus within the posterior pole, to treat peripheral lesions only in the presence of significant inflammation, the prescription of first-line treatment with pyrimethamine-azithromycin, the use of corticosteroid therapy after a period of 24 to 48hours, the prophylaxis of frequent recurrences (more than 2 episodes per year) with trimethoprim-sulfamethoxazole as well as the implementation of prophylactic treatment of recurrences in immunocompromised patients. On the other hand, no consensus emerged with regard to the examinations to be carried out for the etiological diagnosis (anterior chamber paracentesis, fluorescein angiography, serology, etc.), second-line treatment (in the case of failure of first-line treatment), or treatment of peripheral foci.. This study lays the foundations for possible randomized scientific studies to be conducted to clarify the management of ocular toxoplasmosis, on the one hand to confirm consensual clinical practices and on the other hand to guide practices for which no formal consensus has been demonstrated.

Topics: Azithromycin; Delphi Technique; Humans; Recurrence; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a 69-year-old man, who presented in the UK with a short history of deteriorating vision and clinical features of bilateral atypical retinochoroiditis, after travelling to South America. Vitreous samples demonstrated

Topics: Age Factors; Aged; Anti-Bacterial Agents; Azithromycin; Fundus Oculi; Glucocorticoids; Humans; Male; South America; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Travel-Related Illness; Trimethoprim, Sulfamethoxazole Drug Combination; United Kingdom

Topics: Chorioretinitis; Humans; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Chorioretinitis; Humans; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

To report the successful treatment of ocular toxoplasmosis and present the use of multimodal imaging to describe the changes in ocular toxoplasmic lesions subsequent to treatment.. A 73-year-old female visited the clinic with decreased visual acuity in the left eye. Fundus examination showed severe vitreous haze with yellow-white infiltrates near the foveal center. Spectral-domain optical coherence tomography (SD-OCT) revealed disorganization of the retinal structure with markedly thickened choroid beneath the active lesion. Highly elevated serum titers of IgG antibodies against Toxoplasma gondii were observed. Topical and systemic steroids with oral Bactrim were administered after a diagnosis of ocular toxoplasmosis was made. After improvement in the severity of vitritis, structural en face swept-source optical coherence tomography (SS-OCT) imaging demonstrated diffuse choroidal dilation with many collateral vascular branches surrounding the active lesion. Eight intravitreal injections of clindamycin (1 mg/0.1 ml) were administered at 1- to 2-week intervals along with systemic antibiotics and steroids. After the treatment, the toxoplasmic lesion resolved to an atrophic chorioretinal scar. Dilated choroidal vessel size was normalized and collateral vascular branches were markedly constricted on structural en face SS-OCT images.. This is the first detailed report on the morphological changes in the choroidal vasculature surrounding ocular toxoplasmic lesions that were characterized using SS-OCT-A imaging. Multimodal imaging with SS-OCT-A can be valuable in clinical diagnosis as well as in clarifying the mechanism of choroidal structural changes in ocular toxoplasmosis.

Topics: Aged; Anti-Bacterial Agents; Antibodies, Protozoan; Choroid Diseases; Clindamycin; Eye Infections, Parasitic; Female; Fluorescein Angiography; Humans; Immunoglobulin G; Multimodal Imaging; Retinal Pigment Epithelium; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

To evaluate intravitreal injections of sulfamethoxazole/trimethoprim in association with dexamethasone for treating toxoplasmic retinochoroiditis.. Thirteen patients with active, recurrent ocular focal toxoplasmic retinochoroiditis and visual acuity worse than 20/63 in the affected eye were included. Ocular toxoplasmosis was diagnosed according to the classic clinical findings. The primary end point was the change in the final best-corrected visual acuity (BCVA).. The intraocular inflammation decreased within 2 weeks after injection in all eyes and resolved in 8 (62%) eyes with only one injection after 30 days; the remaining eyes received two injections. In all eyes, the retinitis was inactive and no patient had decreased early treatment diabetic retinopathy study lines of BCVA at the final examination.. The combination of intravitreal trimethoprim/sulfamethoxazole and dexamethasone might be an alternative treatment strategy in patients with toxoplasmic retinochoroiditis.

Topics: Adult; Aged; Anti-Bacterial Agents; Chorioretinitis; Complementary Therapies; Dexamethasone; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Intravitreal Injections; Male; Middle Aged; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity; Young Adult

The authors report a case of a 60-year-old Caucasian male with a background of treated Chronic Lymphocytic Leukaemia (CLL) with secondary hypogammaglobulinaemia present with toxoplasma chorioretinitis and negative serum toxoplasma serology on presentation and on subsequent reactivation.. Retrospective case notes review with fundal photographs.. In this case, on initial presentation and on recurrence, the patient's serum anti-Toxoplasma IgG remained negative. The diagnosis was made on quantitative PCR of vitreous initially and aqueous humor on reactivation.. Despite negative serology, one must still consider ocular toxoplasmosis especially in CLL patients where the clinical picture could be compatible. Hypogammaglobulinaemia, the inability to produce IgG antibodies, is a well-recognized complication of CLL. Intraocular fluid sampling is essential in these cases where the sensitivity of PCR on either aqueous or vitreous humor has been shown to be higher in immunocompromised patients.

Topics: Anti-Bacterial Agents; Antibodies, Protozoan; Antiviral Agents; Aqueous Humor; Chorioretinitis; DNA, Protozoan; Drug Combinations; Enzyme-Linked Immunosorbent Assay; False Negative Reactions; Humans; Immunocompromised Host; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Predictive Value of Tests; Real-Time Polymerase Chain Reaction; Retrospective Studies; Serology; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Valganciclovir; Vitreous Body

To describe clinical findings and outcomes for ocular toxoplasmosis in an international multicenter collaborative study.. Retrospective analysis of 190 patients diagnosed with ocular toxoplasmosis from three study sites (Brazil, India, and Singapore).. There were 93 (48.9%) females with a mean age of 32.8 years. The most common symptoms were isolated blurring of vision (36.8%), followed by blurring of vision with floaters (21.1%). Treatment regimens varied largely from monotherapy to multiple combination therapies. Final visual acuity of ≥20/40 was achieved in 106 (74.2%) patients. In a median follow-up period of 31 weeks (range 12-749 weeks), 83/190 (43.7%) patients suffered a relapse.. There appears to be geographical variation in the presentation of ocular toxoplasmosis. Compared to previous studies, we did not observe the '"dual peak" phenomenon of chronic and active disease based on age at presentation, and there was less bilateral and macular involvement (but more peripheral involvement).

Topics: Adolescent; Adult; Aged; Antibodies, Protozoan; Antiprotozoal Agents; Child; Child, Preschool; Female; Geography; Humans; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Pyrimethamine; Retrospective Studies; Sulfadiazine; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Tropical Climate; Uveitis; Vision Disorders; Visual Acuity

To describe treatment practices for ocular toxoplasmosis among members of the Brazilian Uveitis Society.. An online questionnaire sent to specialists, between October 2014 and March 2015.. Most respondents (67.9%) treat all active cases. Most specialists consider visual acuity <20/200 (88.2%), severe vitreous inflammation (94.1%), and ocular disease during acquired infection (88.2%) as absolute indications for treatment. Systemic steroids are associated with anti-toxoplasmic therapy in most cases by 50.9% of the respondents. For immunocompetent individuals, 57.4% of the respondents chose trimethoprim/sulfamethoxazole. Classical therapy (sulfadiazine/pyrimethamine) is preferred most for patients with central lesions (70.4%), immunosuppression (68.4%), acquired infection (70.4%), and atypical forms (74.1%). For patients with frequent relapses, 84.9% of the respondents preferred antibiotic prophylaxis.. Treatment patterns of ocular toxoplasmosis are not uniform among Brazilian specialists. Most specialists treat all cases of active retinochoroiditis. Typical cases are more frequently treated with trimethoprim/sulfamethoxazole. However, classical therapy is the regimen of choice when lesions are considered more severe.

Topics: Anti-Bacterial Agents; Brazil; Glucocorticoids; Health Surveys; Humans; Ophthalmology; Practice Patterns, Physicians'; Pyrimethamine; Specialization; Sulfadiazine; Surveys and Questionnaires; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

Ocular toxoplasmosis may present in atypical fashion, particularly in immunosuppressed patients, and PCR is an important diagnostic tool especially when differentiating from other infectious causes.. A descriptive case-series demonstrating the use of a novel real-time PCR protocol targeting 529 bp repeat element, a multicopy and highly conserved fragment, in Toxoplasma gondii genome. This was designed and established by our microbiology service following independent, external validation.. Three immunosuppressed patients presenting to a tertiary uveitis referral centre with unilateral, severe, sight-threatening uveitis are described. One patient presented with a large focus of sight-threatening retinitis and occlusive vasculitis while on systemic immunosuppression with azathioprine and adalimumab for Crohn's disease. One patient with chronic lymphocytic leukaemia presented with severe posterior uveitis and total retinal detachment. Finally, the third patient presented with severe retinitis adjacent to the optic nerve and vitritis causing acute vision loss. HIV infection was subsequently identified. In all three cases, the cause of inflammation was not clear from clinical examination alone and prompt treatment was required to prevent permanent vision loss. Intraocular sampling and PCR testing was performed including testing for toxoplasmosis, herpesviruses and syphilis.. The novel real-time PCR assay described is more sensitive than those targeting the Toxoplasma B1 gene owing to the higher number of repeats and highly conserved sequence level. This technique can be applied in clinical practice and provides a valuable tool for the rapid diagnosis of ocular toxoplasmosis.

Topics: Aged; Azithromycin; Base Pairing; DNA Primers; DNA Probes; DNA, Protozoan; Drug Combinations; Eye Infections, Parasitic; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Prednisolone; Real-Time Polymerase Chain Reaction; Repetitive Sequences, Nucleic Acid; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Uveitis; Vitreous Body

We report a case of toxoplasmosis with bilateral maculopathy in a 7-year-old boy diagnosed with ataxia telangiectasia (AT) at age 6. AT manifests as ataxia, apraxia, telangiectasia, and dysarthria. Common ophthalmologic findings in AT include fine conjunctival telangiectasia. Patients also suffer from recurrent sinopulmonary infections; however, serious opportunistic infection is rarely diagnosed. At 8 years of age he developed disseminated Toxoplasma gondii (toxoplasmosis) infection and meningoencephalitis. This ophthalmologic finding and the subsequent toxoplasmosis meningoencephalitis have not been previously reported in AT.

Topics: Anti-Infective Agents; Ataxia Telangiectasia; Cerebrospinal Fluid; Child; Conjunctival Diseases; Eye Infections, Parasitic; Humans; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction; Retinal Diseases; Tomography, Optical Coherence; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate outcomes and complications of pars plana vitrectomy in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis.. Retrospective evaluation of the records of 14 patients who underwent pars plana vitrectomy for epiretinal membrane secondary to toxoplasmic retinochoroiditis. The best-corrected visual acuity, intraoperative and postoperative complications, and macular optical coherence tomography were analysed. All patients received postoperative prophylactic treatment with trimethoprim/sulfamethoxazole.. Fourteen patients, 5 men and 9 women, were included. Mean follow-up period after surgery was 6.07 ± 2.64 months. Preoperative mean best-corrected visual acuity was 20/200, and postoperative mean best-corrected visual acuity was 20/60. There were no intraoperative complications. Three patients developed posterior capsule opacification, and one patient developed cataract.. Pars plana vitrectomy is a safe and effective procedure in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis, improving both visual acuity and anatomical result on macular optical coherence tomography. The most frequent postoperative complications were posterior capsule opacification and cataract. No recurrences of the disease were recorded.

Topics: Adult; Anti-Bacterial Agents; Chorioretinitis; Epiretinal Membrane; Eye Infections, Parasitic; Female; Humans; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity; Vitrectomy; Young Adult

Toxoplasmosis may be transferred by organ transplantation. The most common clinical presentation is with multisystem disease, although isolated ocular toxoplasmosis has been described. Many centers have suggested that universal use of co-trimoxazole prophylaxis obviates the need for specific Toxoplasma testing. We report a case of donor-acquired ocular toxoplasmosis after liver transplantation despite co-trimoxazole prophylaxis. The diagnosis was confirmed by Toxoplasma polymerase chain reaction assay in conjunction with seroconversion. The fact that the infection was donor acquired was confirmed by serological mismatch and the absence of sporozoite-specific antigen antibody in the recipient.

Topics: Adult; Allografts; Antibiotic Prophylaxis; Antigens, Protozoan; Antiprotozoal Agents; Chorioretinitis; Diagnosis, Differential; Female; Humans; Immunosuppression Therapy; Liver Failure, Acute; Liver Transplantation; Polymerase Chain Reaction; Seroconversion; Serologic Tests; Toxoplasma; Toxoplasmosis, Ocular; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Choroiditis; Dose-Response Relationship, Drug; Follow-Up Studies; Forecasting; Humans; Recurrence; Retinitis; Retrospective Studies; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A 20 year-old healthy patient consulted due to acute loss vision in his left eye. A fundus examination showed a macular alteration compatible with unifocal helioid choroiditis, characterized by being an atypical inflammatory yellow-white, round, single lesion of approximately an optic disc in diameter. The etiology study detected low Antitoxoplasma gondii Ig G (immunoglobulin) titers.. The non-specificity of the serology and the atypical characteristics of the lesion is a limitation in the diagnosis. The Goldmann-Witmer coefficient may be useful in the diagnosis of atypical lesions, by comparing the concentration of IgG from the serum and aqueous humor.

Topics: Algorithms; Antibodies, Protozoan; Aqueous Humor; Choroiditis; Fluorescein Angiography; Humans; Immunoglobulin G; Male; Prednisolone; Retinal Detachment; Retinal Hemorrhage; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Vision Disorders; Young Adult

The authors evaluate the role of intravitreal trimethoprim/sulfamethoxazole in the treatment of toxoplasma retinochoroiditis (TRC) in four patients. Intravitreal injection of trimethoprim/sulfamethoxazole 1.28 mg/0.08 mL with dexamethasone 400 µg/0.1 mL was injected weekly or biweekly. After the initiation of treatment, a reduction in intraocular inflammation was observed clinically and on optical coherence tomography within 1 week. Three patients regained visual acuity of 20/20, and one patient improved to 20/40 with residual macular scarring. No evidence of retinal toxicity was noted on full-field electroretinogram. Intravitreal trimethoprim/sulfamethoxazole and dexamethasone combination may be an alternative treatment strategy in patients with TRC.

Topics: Adolescent; Adult; Anti-Infective Agents; Antibodies, Protozoan; Child; Chorioretinitis; Dexamethasone; Drug Therapy, Combination; Female; Humans; Immunoglobulin G; Intravitreal Injections; Male; Retrospective Studies; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity; Young Adult

To determine if patients with inactive chorioretinitis lesions who experience chronic toxoplasmic uveitis test PCR positive for Toxoplasma in their ocular fluids.. Two patients undergoing long-term anti-toxoplasmic treatment developed chronic uveitis and vitritis. They underwent therapeutic and diagnostic pars plana vitrectomy. Patient specimens were tested for toxoplasmosis by real-time PCR and nested PCR. Patient specimens were also tested for the presence of Toxoplasma antibodies that recognise allelic peptide motifs to determine parasite serotype.. Patients tested positive for Toxoplasma by real-time PCR at the B1 gene in the vitreous and aqueous humours of patient 1, but only the vitreous of patient 2. Patients were not parasitemic by real-time PCR in plasma and blood. During surgery, only old hyperpigmented toxoplasmic scars were observed; there was no sign of active retinitis. Multilocus PCR-DNA sequence genotyping at B1, NTS2 and SAG1 loci established that two different non-archetypal Toxoplasma strains had infected patients 1 and 2. A peptide-based serotyping ELISA confirmed the molecular findings.. No active lesions were observed, but both patients possessed sufficient parasite DNA in their vitreous to permit genotyping. Several hypotheses to explain the persistence of the vitritis and anterior uveitis in the absence of active retinitis are discussed.

Topics: Anti-Infective Agents; Antibodies, Protozoan; Antiprotozoal Agents; Chronic Disease; DNA, Protozoan; Enzyme-Linked Immunosorbent Assay; Female; Genotyping Techniques; Glucocorticoids; Humans; Male; Middle Aged; Prednisone; Real-Time Polymerase Chain Reaction; Retinitis; Serotyping; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Uveitis; Vitrectomy; Vitreous Body

The purpose of this article is to report the development of Fuchs' heterochromic cyclitis (FHC) secondary to toxoplasmosis chorioretinitis. The design is based on observational case series report. We report in this article six cases of typical FHC developing secondary to ocular toxoplasmosis. Intraocular immunoglobulin G production against Toxoplasma gondii was determined in the aqueous humor of five patients by calculation of the Goldmann-Witmer coefficient (GWC). The clinical examination revealed typical FHC with no active chorioretinal scar. We report on five women and one man (aged 33-64 years old; median 44.6 years) who developed FHC over a period of time ranging from 2-13 years. A positive GWC (>3) was found in four patients; of the two remaining patients one was negative and the other did not have anterior chamber paracentesis. Four patients were treated for an active ocular toxoplasmic lesion before the development of FHC with pyrimethamine, sulfadiazine and corticosteroids. Two patients had negative anti-toxoplasmic therapy for FHC (one with trimethoprim-sulfamethoxazole for 3 weeks and the other with pyrimethamine, sulfadiazine and corticosteroids for 8 weeks). One never had any treatment. All the patients had mild anterior chamber reaction with no synechia, diffuse and characteristic white stellate keratic precipitates and vitritis; five patients had posterior subcapsular cataract and heterochromia and three had elevated intraocular pressure. The findings help us to conclude that FHC can develop over a period of time after ocular toxoplasmosis. This could be a main association to search for when a Fuchs' uveitis is found with a chorioretinal scar. Ocular inflammation does not mean reactivation of ocular toxoplasmosis. FHC could be a secondary immune reaction with a past antigenic stimulation to a previous infection, i.e., toxoplasmosis, etc.

Topics: Adrenal Cortex Hormones; Adult; Anti-Infective Agents; Female; Fuchs' Endothelial Dystrophy; Fundus Oculi; Humans; Iridocyclitis; Male; Middle Aged; Pyrimethamine; Sulfadiazine; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

Ocular toxoplasmosis after solid organ transplantation occurs usually within the first three months of primary infection or reactivation of latent infection. There are a few reports of ocular toxoplasmosis following liver transplantation in the literature, however, no reports were detected in the national data. In this report a 35-year-old female patient diagnosed as ocular toxoplasmosis following reactivation in the second year after liver transplantation, was presented. The case was successfully treated with trimethoprim/sulfamethoxazole and clindamycin. This case was presented to emphasize late presentation of toxoplasmosis in transplantation patients and to withdraw attention to the importance of serological investigations done before transplantation.

Topics: Adult; Anti-Infective Agents; Clindamycin; Female; Humans; Liver Transplantation; Recurrence; Time Factors; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

A 48-year-old man, on imatinib therapy for chronic myeloid leukemia, developed bilateral retino-choroiditis. Visual acuity was 20/100 and counting fingers at 2 m in both the right and left eye. Vitreous biopsy (left eye) revealed Toxoplasma gondii genome by polymerase chain reaction. Serum anti-toxoplasma IgG levels were significantly elevated. Blood counts were normal. Bcr-Abl/Abl transcript ratio was 0.016%. He was treated with oral co-trimoxazole, to which corticosteroids in tapering doses were added later. Imatinib therapy was continued. After 6 weeks of therapy, all retinal lesions regressed and vision improved to 20/30 and 20/40 in right and left eyes, respectively.

Topics: Antineoplastic Agents; Benzamides; Chorioretinitis; DNA; Genome; Humans; Imatinib Mesylate; Immune Tolerance; Immunoglobulin G; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Piperazines; Protein Kinase Inhibitors; Pyrimidines; Toxoplasma; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

Topics: Adolescent; Anti-Infective Agents; Child; Female; Humans; Immunoglobulin G; Male; Pigment Epithelium of Eye; Prednisone; Retinitis; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

A 36-year old female with acute myelogenous leukemia presented with a sudden decrease in vision one month following bone marrow transplantation (BMT). She had been taking multiple immunosuppressants to treat her recently-developed graft-versus-host-disease (GVHD). Visual acuity was 20/60 in her right eye and 20/25 in her left. Ophthalmic examination revealed mild inflammatory reaction in both the anterior chamber and the vitreous of both eyes, as well as densely opaque yellow-white infiltrates with well-demarcated borders in the posterior retina of both eyes. She was originally diagnosed as CMV retinitis, but treatment with ganciclovir failed to improve her ocular condition. Subsequent work-up, including serology and brain MRI, led to a diagnosis of combined ocular and cerebral toxoplasmosis. After 6 weeks of antiparasitic therapy, her retinal lesions became inactive and her cerebral lesions improved. Immunosuppressed patients with necrotizing retinochoroiditis should be suspected of having toxoplasmosis. Accurate differentiation between this condition and CMV, and early intervention with the appropriate treatment may be critical to preserve the best vision.

Topics: Adult; Anti-Bacterial Agents; Bone Marrow Transplantation; Chorioretinitis; Clindamycin; Cytomegalovirus Retinitis; Drug Therapy, Combination; Female; Functional Laterality; Humans; Leukemia, Myeloid, Acute; Magnetic Resonance Imaging; Tomography, Optical Coherence; Toxoplasmosis, Cerebral; Toxoplasmosis, Ocular; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Antiprotozoal Agents; Humans; Prospective Studies; Pyrimethamine; Randomized Controlled Trials as Topic; Sulfadiazine; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

6 cases with pathognomonic fundus pathologies are presented and discussed using multiple-choice questions.

Topics: Adult; Aged; Albinism, Oculocutaneous; Choroid; Choroid Hemorrhage; Clindamycin; Diagnosis, Differential; Drug Hypersensitivity; Eye Diseases; Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Pigment Epithelium of Eye; Retinal Necrosis Syndrome, Acute; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis

Ocular toxoplasmosis can cause a variety of retinal vascular changes including branch retinal arterial occlusion, which is a rare complication of the disease.. We report a case of toxoplasmic chorioretinitis in a pregnant woman, who developed branch retinal arterial obstruction adjacent to the active chorioretinitis lesion.. The patient received an appropriate steroid and antibiotic treatment and the retinitis lesion resolved over a six-week period. At two months after diagnosis, visual acuity in her right eye was 20/30 and there was a hyperpigmented scar at the site where active retinitis had been observed.. Especially in young patients with branch retinal vascular occlusion associated with posterior uveitis, the diagnosis of ocular toxoplasmosis should be kept in mind and serologic test results should be obtained.

Topics: Adult; Animals; Anti-Infective Agents; Antibodies, Protozoan; Chorioretinitis; Clindamycin; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Fluorescein Angiography; Glucocorticoids; Humans; Pregnancy; Retinal Vein Occlusion; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

The authors a case with uveoretinal toxoplasmosis, in a immunocompetent patient. There are some discussions about treatment and evolution in such cases.

Topics: Acute Disease; Adult; Anti-Infective Agents; Antiprotozoal Agents; Drug Therapy, Combination; Female; Humans; Pyrimethamine; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Neuroretinitis is a clinical entity usually seen in young healthy adults, that is characterized by rapid profound unilateral loss of vision and includes optic nerve head edema, splinter hemorrhages, macular exudate in a stellate pattern, and variable vitreous inflammation. There are numerous entities that can cause a picture of neuroretinitis ranging from vascular to infectious to autoimmune.. We report two patients with neuroretinitis, who presented with unilateral blurred vision and had serologic evidence of Toxoplasma gondii infection.. Both patients responded well to treatment with systemic antibiotics and corticosteroids. Visual acuity returned to 20/60 in one patient and 20/20 in the other.. Although the etiology is usually idiopathic, infectious causes of neuroretinitis, including toxoplasmosis, should be kept in mind in order to maintain visual acuity by early diagnosis and appropriate therapy.

Topics: Animals; Antibodies, Protozoan; Antiprotozoal Agents; Child; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Male; Middle Aged; Optic Neuritis; Prednisolone; Retinitis; Toxoplasma; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

Toxoplasmosis is a major and preventable cause of severe visual loss and blindness in young people. Ocular toxoplasmosis is the leading cause of posterior uveitis and in most cases it represents a late manifestation of a congenital infection. The clinical picture and anti-Toxoplasma therapy of seven patients referred to the Department of Infectious Diseases, Hvidovre Hospital is described. All patients had clinical ocular toxoplasmosis at initial examination with unilateral focal necrotizing retinitis associated with typical old, pigmented scars. All patients had anti-toxoplasmosis IgG antibodies. After anti-Toxoplasma therapy with sulfadiazine, pyrimethamine and corticosteroid the ocular lesions were healed to atrophic scars and the inflammatory activity disappeared. We conclude that when the clinical picture is compatible with toxoplasmosis, antibodies to Toxoplasma gondii are demonstrated and there is no other diagnosis, anti-Toxoplasma treatment should be considered. It is important to inform pregnant women about prophylactic measures, and to perform a serological screening of newborns, since treatment of congenital toxoplasmosis from birth improves the prognosis.

Topics: Adolescent; Adult; Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Antimalarials; Chorioretinitis; Clindamycin; Female; Humans; Male; Middle Aged; Pregnancy; Pyrimethamine; Retrospective Studies; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination

Toxoplasmosis is a leading cause of retinochoroiditis. Conventional multidrug therapy using sulfadiazine, pyrimethamine, and folinic acid is increasingly difficult to procure and administer safely.. To evaluate the efficacy of trimethoprim-sulfamethoxazole, a fixed-combination antibiotic, patients with active toxoplasmosis were treated with trimethoprim-sulfamethoxazole (Bactrim DS) with or without adjunctive clindamycin and prednisone for 4 to 6 weeks.. All patients in this study (n = 16) had resolution of active retinochoroiditis and had improved vision, with an average gain of 5.2 lines of vision. Two patients developed a drug allergy.. Trimethoprim-sulfamethoxazole appears to be a safe and effective substitute for sulfadiazine, pyrimethamine, and folinic acid (Leucovorin) in treating ocular toxoplasmosis.

Topics: Adolescent; Adult; Aged; Child; Chorioretinitis; Clindamycin; Drug Tolerance; Female; Fundus Oculi; Humans; Male; Middle Aged; Prednisone; Toxoplasmosis, Ocular; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity