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Approach to ocular toxoplasmosis including pregnant women

Cortés, Jorge A.a; Roncancio, Álvaroa; Uribe, Luis Guillermoc; Cortés-Luna, Carlos Fernandob,*; Montoya, José G.d

Current Opinion in Infectious Diseases: July 15, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QCO.0000000000000577
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Purpose of review To discuss available information on the effectiveness of anti-toxoplasma therapy for ocular toxoplasmosis and to provide clinicians with a practical approach to the disease.

Recent findings Only eleven randomized studies were identified. In the three studies for acute retinitis, there was a clear trend in favor of treatment. In the two studies for the prevention of recurrences, trimethoprim–sulfamethoxazole prophylaxis was superior to placebo. In the six studies comparing different regimens, there was no statistically significant difference between the regimens. In the setting of acute posterior uveitis suspected to be caused by toxoplasma, serological testing should always be obtained, and anti-toxoplasma drug treatment, and corticosteroids should be instituted for at least 6 weeks. Toxoplasmic chorioretinitis during pregnancy represents a particular challenge.

Summary Treatment with at least two drugs and corticosteroids should be offered to patients with active toxoplasmic chorioretinitis. Pregnant women with confirmed acute infection and concomitant acute retinitis should be treated for the ocular lesion(s) and to prevent vertical transmission. Pregnant women with chronic Toxoplasma infection acquired prior to gestation and concomitant retinitis by reactivation should be treated for the retinitis and monitored for vertical transmission.

aDepartment of Internal Medicine

bOphthalmology Program, Department of Surgery, School of Medicine, National University of Colombia, Bogotá

cDivision of Infectious Diseases, Fundación Cardiovascular de Colombia, Floridablanca, Colombia

dDivision of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA

*In memoriam.

Correspondence to Jorge A. Cortés, MD, Street address: Oficina 510, Edificio Facultad de Medicina, Ciudad Universitaria, Cra 30 no 45 03, Bogotá, Colombia. Tel.: +57 1 3165000x15011;. e-mail: jacortesl@unal.edu.co

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