Department of Internal Medicine.
Division of Infectious Diseases, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.
Curr Opin Infect Dis. 2019 Oct;32(5):426-434. doi: 10.1097/QCO.0000000000000577.
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.
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.
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.
讨论抗弓形虫治疗眼弓形虫病的有效性的现有信息，并为临床医生提供一种治疗该病的实用方法。
仅确定了十一项随机研究。在三项急性视网膜炎研究中，治疗有明显的优势趋势。在两项预防复发的研究中，甲氧苄啶-磺胺甲噁唑预防优于安慰剂。在比较不同方案的六项研究中，方案之间无统计学差异。在疑似由弓形虫引起的急性后葡萄膜炎的情况下，应始终进行血清学检测，并应进行抗弓形虫药物治疗和皮质类固醇治疗至少 6 周。妊娠期间的弓形虫脉络膜炎是一个特殊的挑战。
对于活动性弓形虫脉络膜炎患者，应提供至少两种药物联合皮质类固醇治疗。对于确诊的急性感染并伴有急性视网膜炎的孕妇，应治疗眼部病变并预防垂直传播。对于妊娠前获得的慢性弓形虫感染并伴有活动性视网膜炎的孕妇，应治疗视网膜炎并监测垂直传播。
