Current Therapy of Acquired Ocular Toxoplasmosis: A Review

Lima, Guilherme Sturzeneker Cerqueira; Saraiva, Patrícia Grativol Costa; Saraiva, Fábio Petersen

doi:10.1089/jop.2015.0059

Cited by 20 publications

(12 citation statements)

References 91 publications

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“…The combination of pyrimethamine and sulfadiazine is probably most effective against toxoplasmosis and therefore recommended as the standard treatment for sight-threatening ocular toxoplasmosis. However, a combination of trimethoprim/sulfamethoxazole is reported to be a good alternative to standard therapy 4, 17. Our study revealed no significant difference between treatment with azithromycin and trimethoprim/sulfamethoxazole for ocular toxoplasmosis retinochoroiditis in terms of vision improvement, vitreous inflammation, duration of treatment, sharpness of lesions, reduction of the lesion size, and satellite lesions.…”

Section: Discussionmentioning

confidence: 45%

“…In considering whether to treat, the benefits of treatment must be weighed against the potential risks associated with antibiotic therapy. Available treatments include a combination of pyrimethamine and sulfadiazine plus corticosteroids as a classic and standard treatment, clindamycin (alone or in combination with the classic treatment), trimethoprim/sulfamethoxazole, azithromycin, ubiquinone analogues (atovaquone), and intravitreal injection of clindamycin 4, 5, 6, 7, 8, 9, 10, 11…”

Section: Introductionmentioning

confidence: 99%

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A prospective randomized trial of azithromycin versus trimethoprim/sulfamethoxazole in treatment of toxoplasmic retinochoroiditis

Lashay

Mirshahi

Parandin

et al. 2017

Journal of Current Ophthalmology

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PurposeTo assess the efficacy of oral azithromycin in the treatment of toxoplasmic retinochoroiditis.MethodsA randomized interventional comparative study was conducted on 14 patients with ocular toxoplasmosis who were treated with oral azithromycin and 13 patients who were treated with oral trimethoprim/sulfamethoxazole for 6–12 weeks. The achievement of treatment criteria in the two groups and lesion size reduction were considered as primary outcome measures.ResultsThe resolution of inflammatory activity, decrease in the size of retinochoroidal lesions, and final best corrected visual acuity (BCVA) did not differ between the two treatment groups. The lesion size declined significantly in all patients (P = 0.001). There was no significant difference in the reduction of the size of retinal lesions between the two treatment groups (P = 0.17).Within each group, there was a significant improvement in BCVA after treatment; BCVA increased by 0.24 logMAR in the azithromycin group (P = 0.001) and by 0.3 logMAR in the trimethoprim/sulfamethoxazole group (P = 0.001).ConclusionsDrug efficacy in terms of reducing the size of retinal lesions and visual improvement was similar in a regimen of trimethoprim/sulfamethoxazole or azithromycin treatment. Therefore, if confirmed with further studies, therapy with azithromycin seems to be an acceptable alternative for the treatment of ocular toxoplasmosis.

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Section: Discussionmentioning

confidence: 45%

Section: Introductionmentioning

confidence: 99%

A prospective randomized trial of azithromycin versus trimethoprim/sulfamethoxazole in treatment of toxoplasmic retinochoroiditis

Lashay

Mirshahi

Parandin

et al. 2017

Journal of Current Ophthalmology

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“…Sin embargo, existe aun controversia en relación a la combinación de varias drogas, el uso de tratamiento sistémico versus intravítreo y la utilización de esteroides. De acuerdo con la última revisión Cochrane, el tratamiento de la corioretinitis por toxoplasmosis podría disminuir el (3,(16)(17)(18) riesgo de recurrencia . Especial cuidado debe tenerse en pacientes inmunocomprometidos, con l e s i o n e s a c t i va s d e l a c á m a r a p o s t e r i o r , considerando que pueden presentar formas (19) fulminantes de TO .…”

Section: Discussionunclassified

“…Típicamente afecta la cámara posterior del ojo, con lesiones únicas o múltiples. Se presenta tanto en la infección congénita como en la (3) adquirida .…”

Section: Introductionunclassified

Toxoplasmosis ocular: Frecuencia y características clínicas en un consultorio de oftalmología pediátrica.

Cardozo¹,

Mesquita²,

Godoy³

2019

Pediatr (Asunción).

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Introducción: La toxoplasmosis afecta frecuentemente la cámara posterior del ojo y puede producir pérdida de la visión. Objetivo: Describir la frecuencia y características clínicas de la Toxoplasmosis ocular en un consultorio de oftalmología pediátrica. Materiales y Métodos: Estudio observacional, descriptivo retrospectivo Se analizaron las historias clínicas de pacientes de 0 a 18 años de edad, con toxoplasmosis ocular, atendidos en el consultorio de oftalmología pediátrica, desde enero 2011 a mayo de 2014. Variables: edad, sexo, forma de toxoplasmosis, tipo de lesión ocular, localización de la lesión, compromiso unilateral o bilateral, y complicaciones oculares. Los datos se analizaron con SPSSv21 utilizando estadísticas descriptivas e inferenciales. No fue necesario el consentimiento informado porque se trata de un estudio retrospectivo. Resultados: Ingresaron 72 pacientes. La mediana de edad 48 meses, fueron neonatos el 6,9%. El 52,8% eran sexo femenino. El 80,5% presentaron toxoplasmosis adquirida y el 19, 4% congénita. Todos los pacientes tenían coriorretinitis. Y en el 7% se acompañaron de uveítis. La afectación fue bilateral en 52.8%. Las lesiones eran inactivas en 87,5 con localización central. Presentaron complicaciones en el 58,3% de los pacientes: estrabismo en 76% y en 24 % desprendimiento de retina. Conclusión: La frecuencia de TO fue del 0,8%. La mayoría de los pacientes tenían más de 2 años de edad y el 19% tenía toxoplasmosis congénita. Todos tuvieron corioretinitis, con compromiso bilateral y localización central más frecuentemente. Hubo predominio de lesiones inactivas tanto en la toxoplasmosis congénita como en la adquirida. Las complicaciones fueron estrabismo y desprendimiento de retina. Correspondencia: Mirta Mesquita Correo: mirtanmr@gmail.com Conflicto de interés: Los autores declaran no poseer conflicto de interés Recibido: 21/10/2018; Aceptado: 28/12/2018

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“…Also, severe ocular disease and multiple organ failure in immunocompetent individuals have been observed in endemic countries, due to the circulation of atypical parasite strains ( 5 , 6 ). The current therapy for toxoplasmosis is based on drug combinations such as sulfadiazine/pyrimethamine, which reduce parasite replication, controlling host damage and symptoms; however, combination therapy causes important side effects and does not eliminate the resistant T. gondii cysts ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

The P2X7 Receptor Mediates Toxoplasma gondii Control in Macrophages through Canonical NLRP3 Inflammasome Activation and Reactive Oxygen Species Production

et al. 2017

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Toxoplasma gondii (T. gondii) is the protozoan parasite that causes toxoplasmosis, a potentially fatal disease to immunocompromised patients, and which affects approximately 30% of the world’s population. Previously, we showed that purinergic signaling via the P2X7 receptor contributes to T. gondii elimination in macrophages, through reactive oxygen species (ROS) production and lysosome fusion with the parasitophorous vacuole. Moreover, we demonstrated that P2X7 receptor activation promotes the production of anti-parasitic pro-inflammatory cytokines during early T. gondii infection in vivo. However, the cascade of signaling events that leads to parasite elimination via P2X7 receptor activation remained to be elucidated. Here, we investigated the cellular pathways involved in T. gondii elimination triggered by P2X7 receptor signaling, during early infection in macrophages. We focused on the potential role of the inflammasome, a protein complex that can be co-activated by the P2X7 receptor, and which is involved in the host immune defense against T. gondii infection. Using peritoneal and bone marrow-derived macrophages from knockout mice deficient for inflammasome components (NLRP3−/−, Caspase-1/11−/−, Caspase-11−/−), we show that the control of T. gondii infection via P2X7 receptor activation by extracellular ATP (eATP) depends on the canonical inflammasome effector caspase-1, but not on caspase-11 (a non-canonical inflammasome effector). Parasite elimination via P2X7 receptor and inflammasome activation was also dependent on ROS generation and pannexin-1 channel. Treatment with eATP increased IL-1β secretion from infected macrophages, and this effect was dependent on the canonical NLRP3 inflammasome. Finally, treatment with recombinant IL-1β promoted parasite elimination via mitochondrial ROS generation (as assessed using Mito-TEMPO). Together, our results support a model where P2X7 receptor activation by eATP inhibits T. gondii growth in macrophages by triggering NADPH-oxidase-dependent ROS production, and also by activating a canonical NLRP3 inflammasome, which increases IL-1β production (via caspase-1 activity), leading to mitochondrial ROS generation.

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Current Therapy of Acquired Ocular Toxoplasmosis: A Review

Cited by 20 publications

References 91 publications

A prospective randomized trial of azithromycin versus trimethoprim/sulfamethoxazole in treatment of toxoplasmic retinochoroiditis

A prospective randomized trial of azithromycin versus trimethoprim/sulfamethoxazole in treatment of toxoplasmic retinochoroiditis

Toxoplasmosis ocular: Frecuencia y características clínicas en un consultorio de oftalmología pediátrica.

The P2X7 Receptor Mediates Toxoplasma gondii Control in Macrophages through Canonical NLRP3 Inflammasome Activation and Reactive Oxygen Species Production

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