Ocular Toxoplasmosis: An Update on Diagnosis, Multimodal Imaging and Therapy

Abstract

Ocular toxoplasmosis remains to be the most common cause of infectious uveitis in immunocompetent individuals with highly variable prognosis. The transmission mode can be either congenital or acquired. A precise diagnosis of the disease is necessary to opt effective and rapid treatment. While ocular toxoplasmosis usually presents in the classic form, it may as well present in variable clinical spectrum. The diagnosis can be suspected by the ocular inflammatory clinical presentation as well as multimodal imaging. However, serologic tests including intraocular fluid testing may be needed. Treatment includes combination of systemic antiparasitic and anti-inflammatory drugs with variable effectivity. More recently, intravitreally antimicrobials may be used. The chapter aims to layout the different clinical presentations and complications of ocular toxoplasmosis. Diagnostic techniques and different antimicrobial combinations for treatment will also be discussed.

Toxoplasma Neuroretinitis

“…Toxoplasma neuroretinitis should be distinguished from idiopathic neuroretinitis as idiopathic neuroretinitis is self-limited while the former requires timely treatment for resolution [2]. Although there is a lack of randomized control studies for treatment of toxoplasma neuroretinitis, it is suggested that oral antibiotics and corticosteroids may prevent permanent damage to the optic nerve [1,2,4,[6][7][8][9].…”

“…The patient did not initially show prompt clinical improvement despite being on the empiric regimen and was therefore provided with intravitreal clindamycin. Intravitreal injection of clindamycin is well-tolerated with high bioavailability, avoids systemic side effects, and can be given for persistent cases [8,9]. This additive treatment resulted in a positive outcome with a complete resolution of ocular pathology and return of vision.…”