An ophthalmologist survey-based study of the atypical presentations and current treatment practices of ocular toxoplasmosis in India

Abstract

The last two decades have seen a paradigm shift in the understanding of ocular toxoplasmosis. Postnatally acquired infection with its atypical presentations, has emerged as a common form of the disease. We conducted a questionnaire-based survey to investigate the characteristics of atypical presentations and current treatment practices of ocular toxoplasmosis, in India. A written questionnaire was distributed to ophthalmologists at two major uveitis meetings, held in Hyderabad, India in January, 2009. It evaluated characteristics of atypical presentations of ocular toxoplasmosis and specific treatmentrelated issues in India. Of 37 respondents who completed the questionnaire, 28 (75.6%) found atypical presentations in less than one-fourth of ocular toxoplasmosis patients. Atypical presentations were mostly seen as primary retinitis lesion, and in healthy immuno-competent individuals. Most ophthalmologists (n = 28, 75.6%) thought viral retinitis to be the most common differential diagnosis for atypical ocular toxoplasmosis and relied on serological tests (n = 19, 51.3%) for the diagnosis. Twenty-three (62.1%) respondents treated all patients with active lesions. A diverse range of treatment regimens were used, trimethoprim-sulphamethoxazole combination being most common (n = 12, 32.4%). Corticosteroids were included in all regimens. Atypical presentations of ocular toxoplasmosis were identified by all ophthalmologists, participating in the survey, though not commonly by most. Treatment practices were diverse, reflecting the lack of consensus on this issue.

Ocular Toxoplasmosis in a Tertiary Referral Center in Sydney Australia—Clinical Features, Treatment, and Prognosis

“…There is great variation in treatment approaches between uveitis specialist centers globally which may be due to differences in disease severity due to organism differences or clinical variation. 9,14 There are sound arguments for watchful waiting in an immunocompetent patient with small peripheral lesions and/ or low-grade overlying inflammatory response as OT is a self-limiting disease and there is treatment-related drug toxicity. In this study, only 1 immunocompetent patient with minimal clinical disease was observed and not treated with antimicrobial therapy, and this patient had a relapse within 1 year of presentation necessitating the use of antimicrobial therapy.…”

Rezidivprophylaxe bei okulärer Toxoplasmose

“…Eine schnellere Auflösung der intraokularen Entzündungsreaktion ließ sich nicht zeigen (geringe Evidenz), wohingegen das Risiko von Nebenwirkungen bei behandelten Patienten deutlich erhöht war, hier insbesondere ein Abfall des Hämoglobins, der Leukozyten und Thrombozyten, außerdem Übelkeit, Appetitverlust, Hautausschlag und Arthralgie [27,43]. Daher werden weltweit unterschiedliche Therapieansätze praktiziert [34,35].…”

“…In diesem Kollektiv fand sich auch ein medianes rezidivfreies Intervall von 3 Jahren, unabhängig davon, ob keine oder eine toxoplasmosespezifische Antibiotikatherapie durchgeführt wurde, wohingegen eine alleinige systemische Kortisontherapie ohne Antibiotika das rezidivfreie Intervall auf 0,9 Jahre reduzierte [41]. Eine alleinige Kortikosteroidtherapie scheint damit obsolet, wohingegen eine adjuvante Anwendung von Steroiden zusätzlich zu Antibiotika sehr variabel gehandhabt wird, da evidenzbasierte Richtlinien zur Höhe und Dauer der begleitenden Steroidtherapie nicht existieren [34,35,41,44]. [15,16].…”

Water related ocular diseases

“…In pregnant patients Spiramycin 3 g per day can be used in the first trimester and triple therapy thereafter. Intravitreal Clindamycin (1.0/0.1 ml–1.5 mg/0.1 ml) is also favored currently 39, 40, 41, 42, 43…”