zithromax and Toxoplasmosis--Ocular

The purpose of this pilot study is to compare the efficacy and tolerance of azithromycin alone as opposed to standard treatment with sulfadiazine and pyrimethamine for active, non-vision-threatening toxoplasmic retinochoroiditis.. We conducted a prospective, randomized, institutional clinical study comparing azithromycin to sulfadiazine and pyrimethamine for active, non-vision-threatening toxoplasmic retinochoroiditis. Nineteen out of 75 patients fulfilled inclusion criteria and were randomized into 2 treatment regimens. Nine patients were treated with sulfadiazine and pyrimethamine and 10 patients with azithromycin at a dose of 500 mg qd. Main outcome measures assessed were time to sharpening of lesion borders, time to lesion scarring, time to disease inactivity, and treatment tolerance.. Azithromycin monotherapy achieved lesion scarring and disease inactivity in all but 1 patient. Although no statistically significant difference was found between the 2 patient groups as regards main outcome measures for treatment efficacy, all median times to endpoints (days) were longer for the azithromycin group - time to sharpening of lesion borders on clinical evaluation (25.5 vs. 24) and masked evaluation of photographs (30.5 vs. 24), time to lesion scarring on clinical evaluation (73 vs. 47) and masked evaluation of photographs (71.5 vs. 36) and time to disease inactivity (73 vs. 49). Treatment tolerance was significantly better for the azithromycin group (p=0.0005).. Azithromycin monotherapy at a dose of 500 mg per day was shown to be effective and well-tolerated for the treatment of active, non-vision-threatening toxoplasmic retinochoroiditis. Duration of treatment was clinically longer for the azithromycin group.

Topics: Adult; Antiprotozoal Agents; Azithromycin; Chorioretinitis; Female; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; Pyrimethamine; Sulfadiazine; Toxoplasmosis, Ocular

To compare the effects of two treatment regimens, one of which included azithromycin, for the treatment of sight-threatening (near optic disk or fovea) ocular toxoplasmosis.. Prospective, randomized open-labeled multicenter study, masked in part with regard to evaluation.. PARTICIPANTS TOTAL ENROLLMENT: 46 patients with sight-threatening ocular toxoplasmosis; pyrimethamine and azithromycin group: 24 patients; pyrimethamine and sulfadiazine group: 22 patients.. Patients were randomized into two treatment regimens. Group 1 was treated with pyrimethamine and azithromycin complemented with folinic acid and the addition of prednisone from day 3. Group 2 was treated with pyrimethamine and sulfadiazine complemented with folinic acid and the addition of prednisone from day 3. Patients used study medications daily for 4 weeks. Ocular and laboratory examinations were performed at least weekly during the observation period. The study was masked in part with regard to evaluation.. An assessment was made of the time to resolution of the intraocular inflammatory activity, the size of the retinochoroidal lesion, and visual acuity before and after the treatment as well as all adverse effects of treatments.. Adverse effects were more frequent in the pyrimethamine/sulfadiazine group (P <.04), and three patients in this group had to discontinue treatment. The time to resolution of inflammatory activity, decrease in size of retinochoroidal lesions, and optimal visual acuity did not differ between the two treatment groups. The number of patients who developed recurrences during the first year after treatment was similar for both groups.. The efficacy of the multidrug regimen with pyrimethamine and azithromycin was similar to the standard treatment with pyrimethamine and sulfadiazine. However, the frequency and severity of adverse effects was significantly lower with a regimen containing pyrimethamine and azithromycin. Multidrug therapy with the combination of pyrimethamine and azithromycin appears to be an acceptable alternative for treatment of sight-threatening ocular toxoplasmosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antiprotozoal Agents; Azithromycin; Drug Evaluation; Drug Therapy, Combination; Humans; Middle Aged; Prospective Studies; Pyrimethamine; Safety; Sulfadiazine; Toxoplasmosis, Ocular; Treatment Outcome; Visual Acuity

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

Azithromycin has been used as an ocular toxoplasmosis alternative treatment due to its pharmacokinetic profiles. However, sufficient concentrations to promote toxoplasmosis eradication is still unknown. This study was aimed to evaluate azithromycin levels in rabbits after three regimens equivalent to human doses for ocular toxoplasmosis.. Three groups of New Zealand albino rabbits were given one of the following: azithromycin at 26 mg/kg BW daily (Group 1), 26 mg/kg BW every two days (Group 2), and 50 mg/kg BW once weekly (Group 3) for 14 days. Plasma and ocular azithromycin concentrations were examined.. Following 14 days, median ratio of plasma maximum azithromycin concentration to the minimum inhibitory concentration for Toxoplasma gondii (C-max/MIC) for Group 1, and 2 were 51.29, 5.33, while Group 3 was undetected. The median azithromycin concentration in the retina-choroid was higher than the MIC in Group 1 (1356.0 ng/ml) and Group 2 (189.0 ng/ml), but not in Group 3.. Azithromycin administered orally at the dose of 26 mg/kg BW daily or 26 mg/kg BW every two days resulted a sufficient criteria of C-max/MIC as well as retina-choroid concentration needed for its parasiticidal activity. However, well-conducted clinical trial is warranted to support its therapeutic potential in ocular toxoplasmosis.

Topics: Administration, Oral; Animals; Azithromycin; Eye; Humans; Rabbits; Toxoplasma; Toxoplasmosis, Ocular

Previously, diagnosis of ocular toxoplasmosis is based on clinical symptoms and Toxoplasma serology. Checking serological indicators often cannot reflect the real intraocular situation, and may even mislead clinicians to make wrong judgments.. A 38-year-old male patient visited our ophthalmology clinic with a chief complaint of decreased vision for about 5 days in his right eye.. Aqueous humor sample analysis found Toxoplasma DNA detectable, and Toxoplasma immunoglobulin G (IgG) and immunoglobulin M (IgM) to be positive. His serum Toxoplasma IgG was also positive (10.04 IU/mL; reference range: 0 to 7.2 IU/mL). Therefore, the final diagnose was ocular toxoplasmosis involving his right eye.. Oral prednisone 60 mg/day and azithromycin 0.25 g/day were started. Oral antibiotic treatment for toxoplasma was continued for 4 weeks, and prednisone followed by weekly stepwise tapering in steps of 10 mg/day.. The BCVA and fundus of right eye remained stable after treatment at follow-up.. This article reported a case of ocular Toxoplasma gondii infection diagnosis by serum and aqueous humor antibody tests. We provide some additional information on the T gondii infection diagnosis.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Protozoan; Aqueous Humor; Azithromycin; Humans; Immunoglobulin G; Immunoglobulin M; Male; Prednisone; Toxoplasma; Toxoplasmosis, Ocular

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

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

Toxoplasma is a leading cause of posterior uveitis in immunocompetent patients manifesting as a focal posterior retinochoroiditis. The clinical diagnosis of ocular toxoplasmosis is usually straightforward. There is typically a fluffy white retinal lesion which may lie adjacent to a pigmented chorioretinal scar and a prominent vitreous, or additionally, anterior chamber cellular reaction. Several unusual presentations in ocular toxoplasmosis have been reported, including: papillitis, neuroretinitis, retrobulbar neuritis, retinal detachment and macular oedema. This is a case of presumed primary toxoplasma papillitis in a 14-year-old child with complete absence of vitritis at presentation that made the diagnosis challenging. This evolved into neuroretinitis that resolved upon introducing antitoxoplasma antibiotics.

Topics: Adolescent; Anti-Bacterial Agents; Antiprotozoal Agents; Azithromycin; Diagnosis, Differential; Drug Therapy, Combination; Glucocorticoids; Humans; Male; Papilledema; Prednisolone; Pyrimethamine; Toxoplasmosis, Ocular; Visual Acuity

Topics: Anti-Bacterial Agents; Azithromycin; Chorioretinitis; Female; Glucocorticoids; Humans; Prednisolone; Pregnancy; Pregnancy Complications, Parasitic; Scleritis; Toxoplasmosis, Ocular; Young Adult

To describe the clinical, optical coherence tomographic, and angiographic findings in patients with acute toxoplasmic retinochoroiditis (RC) associated with serous retinal detachment (SRD).. The study included 60 eyes with acute toxoplasmic RC.. Of 60 eyes, 14 (23.3%) were found to have SRD. The SRD was visible on fundus examination in 6 cases and detectable only by optical coherence tomography (OCT) in the 8 remaining cases. It involved the fovea in 9 eyes. There was evidence of associated choroidal ischemia on fluorescein angiography and indocyanine green angiography in 5 eyes. Findings seen at the acute stage gradually resolved over a period of 2-6 weeks in all patients.. SRD, accurately detected by OCT, is a common complication of acute toxoplasmic RC that should be considered as a potential cause of visual loss. Choroidal ischemia might contribute to the development of such complication.

Topics: Acute Disease; Adult; Antiprotozoal Agents; Azithromycin; Chorioretinitis; Female; Fluorescein Angiography; Humans; Indocyanine Green; Male; Prednisone; Pyrimethamine; Retinal Detachment; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Treatment Outcome; Young Adult

Toxoplasma gondii is a widely distributed obligatory intracellular parasite that causes severe disease to the fetus when transmitted during pregnancy. Drugs used to avoid congenital transmission have shown side effects, and their efficacy is controversial. The most widely used treatment for acute toxoplasmosis during pregnancy is pyrimethamine plus sulfadiazine, which has several side effects. In this work, we tested the efficacy of azithromycin in reducing congenital transmission of T. gondii in the large vesper mouse, Calomys callosus, a rodent. Females of C callosus were inoculated perorally with 20 cysts of ME49 strain of T. gondii on the day of fertilization, and fetuses were collected from the 15th to the 19th day of gestation. Azithromycin (300 mg/kg), in association with pyrimethamine (100 or 50 mg/kg) plus sulfadiazine (100 or 75 mg/kg) and folinic acid (15 mg/kg) (SPAf), or vehicle, were administered orally on different days after infection. Brain and ocular tissues were removed and processed for immunohistochemistry using a polyclonal antibody against T. gondii, or were processed for parasite DNA quantification. Toxoplasma gondii was detected in the brains of all females and in fetuses' eyes of C. callosus treated with SPAf. On the other hand, in females treated with azithromycin, there was a reduction of T. gondii in the brains of mothers, and no parasites were detected in eyes of fetuses, indicating that azithromycin may represent an alternative treatment for toxoplasmosis during pregnancy.

Topics: Animals; Anti-Infective Agents; Antiprotozoal Agents; Azithromycin; Brain; Disease Models, Animal; DNA, Protozoan; Drug Therapy, Combination; Eye; Female; Fetus; Immunohistochemistry; Infectious Disease Transmission, Vertical; Leucovorin; Male; Polymerase Chain Reaction; Pregnancy; Pregnancy Complications, Parasitic; Pyrimethamine; Sigmodontinae; Sulfadiazine; Toxoplasma; Toxoplasmosis, Ocular; Vitamin B Complex

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 assess the diagnostic and therapeutic management of extensive toxoplasmic retinochoroiditis.. The files of all patients referred between December 1999 and December 2001 for the management of a severe, potentially sight-threatening toxoplasmic retinochoroiditis were retrospectively analyzed. The therapeutic strategy and the progression of intraocular inflammation are reported.. Thirteen eyes of seven patients were finally included in the study. The sex ratio (F/M) and the mean age were respectively 4/3 and 44.5 years. Most of the patients were immunocompromised. Both eyes were initially affected in five cases. The diagnosis was confirmed by polymerase chain reaction (PCR) after anterior chamber paracentesis in six cases. Retinal detachment was observed in three cases, initially or during follow-up. All patients were treated with a combination of sulfadiazine and pyrimethamine, but azithromycin was necessary in two cases. Clindamycin was used in two cases of allergy to sulfadiazine. Corticosteroids were associated in five cases. For all patients, infection and inflammation were finally controlled. The visual acuity improved more than two lines in four eyes and remained stable in seven other eyes.. Clinical diagnosis is still a challenge in severe cases of extensive toxoplasmic retinochoroiditis. PCR is helpful in identifying Toxoplasma gondii DNA. A systemic immunosuppression is frequently associated with a positive PCR. Treatment is based on a standard antiparasitic association and steroids must be discussed for each case according to the intensity of inflammation and the degree of immunosuppression.. Extensive ocular toxoplasmosis is a serious condition. The final prognosis depends on the location of the necrotic lesions, rapid diagnosis, and efficient treatment.

Topics: Adolescent; Adult; Aged; Algorithms; Anti-Inflammatory Agents; Antiprotozoal Agents; Azithromycin; Chorioretinitis; Clindamycin; Decision Trees; Diagnosis, Differential; Drug Combinations; Drug Therapy, Combination; Female; Humans; Immunocompromised Host; Male; Middle Aged; Paracentesis; Polymerase Chain Reaction; Pyrimethamine; Retrospective Studies; Sulfadoxine; Toxoplasmosis, Ocular; Treatment Outcome

The paper reports three clinical cases which have in common two elements: ocular toxoplasmosis and consecutive complicative cataract, the method of treatment, the evolution and the recovery visual acuity.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cataract; Drug Therapy, Combination; Female; Folic Acid; Hematinics; Humans; Middle Aged; Toxoplasmosis, Ocular; Treatment Outcome

To investigate the efficacy of azithromycin in patients with ocular toxoplasmosis.. 11 immunocompetent patients with ocular toxoplasmosis were treated with azithromycin (500 mg the first day, followed by 250 mg/day for 5 weeks). Ocular and systemic examinations were performed during active retinitis episodes and all patients were followed for at least 1 year.. The intraocular inflammation disappeared within 4 weeks in seven patients, including two cases with progressive retinitis despite previous treatment with pyrimethamine, sulphadiazine, and folinic acid. Recurrence of retinitis occurred in three patients (27%) within the first year of follow up. No systemic side effects of azithromycin were encountered.. These results indicate that although azithromycin cannot prevent recurrent disease it may be an effective alternative for patients with ocular toxoplasmosis who cannot tolerate standard therapies.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Female; Follow-Up Studies; Humans; Male; Middle Aged; Recurrence; Retinitis; Toxoplasmosis, Ocular; Treatment Failure; Uveitis, Anterior