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| ocular_toxoplasmosis [2025/01/27 22:41] – Scott Larson | ocular_toxoplasmosis [2025/04/18 20:40] (current) – external edit 127.0.0.1 | ||
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| ====== Ocular Toxoplasmosis ====== | ====== Ocular Toxoplasmosis ====== | ||
| - | + | * Caused by Toxoplasma gondii | |
| - | ===== Toxoplasma gondii | + | |
| * Obligate intracellular protozoan | * Obligate intracellular protozoan | ||
| * 500 million have antibodies worldwide | * 500 million have antibodies worldwide | ||
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| * Propensity for cardiac and skeletal muscle and neural tissue (brain & eye) | * Propensity for cardiac and skeletal muscle and neural tissue (brain & eye) | ||
| - | ===== Clinical Manifestations | + | ==== Clinical Manifestations ==== |
| - | ==== Acquired vs. Congenital | + | === Acquired vs. Congenital === |
| * Most cases are presumed reactivation of congenital infection | * Most cases are presumed reactivation of congenital infection | ||
| * 2 to 6/1000 women acquire infection while pregnant, 40% risk of transmission to fetus. | * 2 to 6/1000 women acquire infection while pregnant, 40% risk of transmission to fetus. | ||
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| * Northern Brazil has high rate of acquired disease | * Northern Brazil has high rate of acquired disease | ||
| - | ==== Systemic | + | === Systemic === |
| * 90% lympadenopathy | * 90% lympadenopathy | ||
| * fever, malaise, occasional sore throat | * fever, malaise, occasional sore throat | ||
| * immunocompromised- fulminant CNS disease | * immunocompromised- fulminant CNS disease | ||
| - | ==== Ocular | + | === Ocular === |
| * Keratic Precipitates, | * Keratic Precipitates, | ||
| * Retinochoroiditis | * Retinochoroiditis | ||
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| * FFA of active lesion- early blockage and subsequent leakage | * FFA of active lesion- early blockage and subsequent leakage | ||
| - | ==== Atypical Presentations | + | === Atypical Presentations === |
| * In early infection: gray-white fine punctate lesions in deep retina and RPE, progress to more classic lesions | * In early infection: gray-white fine punctate lesions in deep retina and RPE, progress to more classic lesions | ||
| * Papillitis, vitreal inflammation, | * Papillitis, vitreal inflammation, | ||
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| * Wide ring-like lesion near extreme periphery resembling pars planitis | * Wide ring-like lesion near extreme periphery resembling pars planitis | ||
| * Scleritis | * Scleritis | ||
| - | ==== Reasons for Vision Loss ==== | + | === Reasons for Vision Loss === |
| * Vitreal inflammation causing clouding | * Vitreal inflammation causing clouding | ||
| * Lesion in posterior pole with edema affecting fovea | * Lesion in posterior pole with edema affecting fovea | ||
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| * Subsequent CNVM | * Subsequent CNVM | ||
| - | ===== Diagnosis | + | ==== Diagnosis ==== |
| * Typical lesions | * Typical lesions | ||
| * Toxoplasmosis titers are supportive | * Toxoplasmosis titers are supportive | ||
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| * Angiography: | * Angiography: | ||
| - | ===== Therapy | + | ==== Therapy ==== |
| * Should you treat it at all? | * Should you treat it at all? | ||
| * Lesion within temporal arcade | * Lesion within temporal arcade | ||
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| * Generally 4-6 weeks, multi-drug regimens | * Generally 4-6 weeks, multi-drug regimens | ||
| - | ===== Medications | + | ==== Medications ==== |
| * Sulfadiazine 1g PO QID | * Sulfadiazine 1g PO QID | ||
| * Pyrimethamine 75-100mg load and 25-50mg PO BID (bone marrow suppression, | * Pyrimethamine 75-100mg load and 25-50mg PO BID (bone marrow suppression, | ||
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| * recurrence rate at 3 years (42%) | * recurrence rate at 3 years (42%) | ||
| - | ==== Treatment Regimen #2 ==== | + | == Treatment Regimen #2 == |
| * Clindamycin, | * Clindamycin, | ||
| * Reducing size of lesions >1/2 DD (28%) | * Reducing size of lesions >1/2 DD (28%) | ||
| * med side effects (17%) | * med side effects (17%) | ||
| * recurrence rate at 3 years (67%) | * recurrence rate at 3 years (67%) | ||
| - | ==== Treatment Regimen #3 ==== | + | == Treatment Regimen #3 == |
| * Co-trimoxazole, | * Co-trimoxazole, | ||
| * Reducing size of lesions >1/2 DD (11%) | * Reducing size of lesions >1/2 DD (11%) | ||
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| * recurrence rate at 3 years (40%) | * recurrence rate at 3 years (40%) | ||
| - | ==== Treatment Regimen #4 ==== | + | == Treatment Regimen #4 == |
| * No treatment (peripheral lesions) | * No treatment (peripheral lesions) | ||
| * Reducing size of lesions >1/2 DD (20%) | * Reducing size of lesions >1/2 DD (20%) | ||
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| * recurrence rate at 3 years (53%) | * recurrence rate at 3 years (53%) | ||
| - | ==== Comments | + | == Comments == |
| * Recurrence rates not statistically significant | * Recurrence rates not statistically significant | ||
| * Size of retinal lesion correlated with duration of inflammation | * Size of retinal lesion correlated with duration of inflammation | ||