Current Practices in Ocular Toxoplasmosis: A Survey of Brazilian Uveitis Specialists

Morais, Fábio Barreto; Arantes, Tiago Eugênio Faria e; Muccioli, Cristina

doi:10.1080/09273948.2016.1215471

Cited by 16 publications

(7 citation statements)

References 33 publications

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“…Additionally, to reduce vitreous in ammation, periocular injection of triamcinolone was indicated in 55.6% of our patients, and none of them presented adverse reactions related to the injection. In Brazil, local treatment (periocular or intraocular) with corticosteroids is indicated for selected patients adjunctively to anti-toxoplasmic treatment by 49% of specialists, whereas in the United States, periocular corticosteroid injections are an unpopular approach (8, 19).The administration of local corticosteroids has been associated with disastrous outcomes if administered without concomitant antiparasitic therapy (8), and the administration of steroids alone can result in fulminant toxoplasmosis responsible for legal blindness in most cases (8,17,22). In our series, we used triamcinolone, a long-acting corticosteroid (24).…”

Section: Discussionmentioning

confidence: 99%

“…However, there is no agreement regarding the best drug combination, and few patient-based studies have compared the e cacy of different drugs. (19) The current therapies for OT have not shown a complete cure since the principal achievement of the treatment is to limit parasite multiplication, which relates to ameliorating retinal and optic nerve tissue damage (20). Visual impairment due to recurrences, vitritis, macular compromise, or complications such as retinal traction and retinal detachment, among others, could be expected in infection by virulent strains (20,21).…”

Section: Discussionmentioning

confidence: 99%

“…In 1991, only one Uveitis specialist in the USA reported TMP/SMX as his preferred medical treatment for patients with OT; by 2001, this number had risen to 23% (8). In Brazil, the most commonly prescribed treatment for OT was TMP/SMX, used by 57% of uveitis specialists (19). Therefore, we conducted this study to assess the evolution under treatment of Congolese patients with OT.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Trimethoprim/ Sulfamethoxazole treatment for ocular toxoplasmosis in Congolese patients

Lusambo

Kaimbo

Ngoyi

et al. 2023

Preprint

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Background 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). Methods 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. Results 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. Conclusion 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes of Trimethoprim/ Sulfamethoxazole treatment for ocular toxoplasmosis in Congolese patients

Lusambo

Kaimbo

Ngoyi

et al. 2023

Preprint

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“…This relatively low ratio highlights the fact that OT diagnosis primarily relies on ophthalmic examination in most cases. Indeed, in cases where the lesions found are typical of OT, clinicians often avoid performing an ACP (5, 16). Considering that most samples analyzed in our laboratory originated from patients presenting lesions that were compatible with though not typical of a diagnosis of OT, this ratio would indicate that biological confirmation is an essential diagnostic step in atypical OT presentations.…”

Section: Discussionmentioning

confidence: 99%

Biological Diagnosis of Ocular Toxoplasmosis: a Nine-Year Retrospective Observational Study

Greigert

Pfaff

Sauer

et al. 2019

mSphere

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Ocular toxoplasmosis (OT), i.e., the ocular manifestation of Toxoplasma gondii infection, is one of the leading causes of posterior uveitis. While ocular lesions are often typical, atypical forms often require biological confirmation of the diagnosis. Our study sought to review the biological OT diagnoses made in our laboratory to further assess the role of each test in the diagnostic procedure. All ocular samples sent to our laboratory over the last 9 years for OT diagnosis were included. These samples were analyzed using T. gondii PCR and antibody detection by means of immunoblotting and Candolfi coefficient (CC) determinations, either alone or in combination. Since serum analysis is required to interpret both the CC and immunoblotting, blood serology for T. gondii was also performed in most cases. Of the 249 samples analyzed, 80 (32.1%; 95% confidence interval [95%CI], 26.3 to 37.9) were positive for OT. Of these 80 cases, 52/80 (65.0%; 54.6 to 74.5) displayed a positive PCR, 15/80 (18.8%; 10.2 to 27.3) a positive CC, and 33/80 (41.3%; 95%CI, 30.5 to 52.0) a positive immunoblot result. Overall, 63 of the 80 OT diagnoses (78.8%; 95%CI, 69.8 to 87.7) were made on the basis of a single positive test result. Our study results remind us that current biological diagnostic tools for OT must be employed in combination to obtain an optimal diagnosis based on the precious ocular fluids sampled by ophthalmologists. Clinicobiological studies that are focused on correlating the performances of the different tests with clinical features are critically needed to improve our understanding of the pathophysiology and diagnosis of OT. IMPORTANCE Ocular toxoplasmosis (OT), a parasitic infection of the eye, is considered to be the most important infectious cause of posterior uveitis worldwide. Its prevalence is particularly high in South America, where aggressive Toxoplasma gondii strains are responsible for more-severe presentations. The particular pathophysiology of this infection leads, from recurrence to recurrence, to potentially severe vision impairment. The diagnosis of this infection is usually exclusively based on the clinical examination. However, the symptoms may be misleading and are not always sufficient to confirm a diagnosis of OT. In such cases, biological tests performed by means of several techniques on blood and ocular samples may facilitate the diagnosis. In this study, we analyzed the tests that were performed in our laboratory over a 9-year period every time OT was suspected. Our report highlights that the quality of ocular sampling by ophthalmologists and combinations of several techniques are critical for a reliable biological OT diagnosis.

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“…Em imunocompetentes a toxoplasmose ocular apresenta um quadro autolimitado, com completa resolução entre seis e oito semanas 7 . Porém, para diminuirmos as chances de possíveis complicações associadas e melhorarmos o prognóstico visual, em áreas endêmicas como o Brasil, é praticamente unânime o uso de medicação específica 10 . As medicações mais utilizadas são a combinação de pirimetamina (25-50mg/dia), sulfadiazina (1g,4x/dia) e ácido folínico (15mg/dia) ou sulfametoxazoltrimetoprima (800mg/160mg, 2x/dia), associados a prednisona via oral (0,5-1mg/kg/dia), até a cicatrização da lesão, o que normalmente ocorre por volta de seis semanas após seu início.…”

Section: Toxoplasmoseunclassified

Manifestações oculares de doenças sistêmicas: uveítes, Oftalmopatia de Graves e Síndrome de Sjögren

Furtado

Oliveira

Vieira

et al. 2022

Medicina (Ribeirão Preto)

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A oftalmologia é considerada uma área especializada dentro da medicina. As manifestações oculares de doenças sistêmicas permitem a interação com outras especialidades, como reumatologia, endocrinologia, infectologia, pediatria e neurologia. Diminuição da acuidade visual, dor e hiperemia ocular, ou sensação de olho seco podem ser a primeira manifestação de doenças sistêmicas, e por isso a anamnese pode nos dar pistas de doenças não diagnosticadas. O exame de fundo de olho, exibe os vasos sanguíneos de maneira não invasiva, e alterações detectadas também podem estar presente em outras estruturas, como rins, cérebro e coração. Neste artigo, detalhamos as principais doenças sistêmicas que acometem os olhos, e suas manifestações mais comuns.

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Current Practices in Ocular Toxoplasmosis: A Survey of Brazilian Uveitis Specialists

Cited by 16 publications

References 33 publications

Outcomes of Trimethoprim/ Sulfamethoxazole treatment for ocular toxoplasmosis in Congolese patients

Outcomes of Trimethoprim/ Sulfamethoxazole treatment for ocular toxoplasmosis in Congolese patients

Biological Diagnosis of Ocular Toxoplasmosis: a Nine-Year Retrospective Observational Study

Manifestações oculares de doenças sistêmicas: uveítes, Oftalmopatia de Graves e Síndrome de Sjögren

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