trimethoprim--sulfamethoxazole-drug-combination and Uveitis--Posterior

Ocular toxoplasmosis is the leading cause of posterior uveitis worldwide. We conducted an observational study of 262 consecutive individuals (n = 344 eyes) with ocular toxoplasmosis who were followed over a 34-month period. Most subjects were T. gondii IgG + /IgM- (n = 242; 92.4%; 317 eyes), and 140 eyes (40.7%) had active lesions. For eyes in which retinal lesions were active at recruitment and best-corrected visual acuity (BCVA) could be measured (n = 133), 21.0% (n = 28) remained blind (BCVA below 20/400) after inflammation resolved. In these eyes, atypical ocular toxoplasmosis (OR 4.99; 95% CI 1.14-22.85; p = 0.0330), macular lesion (OR 9.95; 95% CI 2.45-47.15; p = 0.0019) and any complication (OR 10.26; 95% CI 3.82-30.67; p < 0.0001) were associated with BCVA below 20/200. For eyes with only inactive lesions at recruitment and BCVA measured (n = 178), 28.1% (n = 50) were blind. In these eyes, having at least one lesion larger than one disc-diameter (OR 6.30; 95% CI 2.28-22.46; p = 0.0013) and macular lesion (OR 5.69; 95% CI 2.53-13.54; p < 0.0001) were associated with BCVA below 20/200. Older age (OR 1.02; 95% CI 1.00-1.05; p = 0.0493) and active disease at presentation (OR 4.74; 95% CI 1.95-12.91; p = 0.0011) were associated with recurrences. Additional clinical attention should be directed towards patients with risk factors for poor visual outcome.

Topics: Adolescent; Adult; Age Factors; Aged; Antibodies, Protozoan; Antiprotozoal Agents; Blindness; Brazil; Female; Humans; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Pyrimethamine; Recurrence; Retina; Risk Factors; Sulfadiazine; Toxoplasma; Toxoplasmosis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Uveitis, Posterior; Vision, Ocular; Visual Acuity

To describe the clinical presentation and course of Whipple disease in an adult.. A 34-year-old man with phthisis bulbi in the right eye secondary to uveitis-induced neovascular glaucoma presented with severe acute posterior uveitis in the left eye. He underwent esophagogastroduodenoscopy and jejunal biopsy for evaluation of anemia. The posterior uveitis was treated with a subtenon injection of triamcinolone.. The diagnosis of Whipple disease was confirmed by polymerase chain reaction analysis of the jejunal biopsy that demonstrated Tropheryma whippelii rDNA.. Although Whipple disease is typically evident with malabsorption, it can also present as uveitis without prominent gastrointestinal symptoms.

Topics: Actinobacteria; Actinomycetales Infections; Adult; Anti-Bacterial Agents; DNA, Bacterial; Drug Therapy, Combination; Endoscopy, Digestive System; Glucocorticoids; Humans; Jejunum; Male; Polymerase Chain Reaction; Triamcinolone Acetonide; Trimethoprim, Sulfamethoxazole Drug Combination; Uveitis, Posterior; Whipple Disease