Abstract
PurposeTo assess the impact of intensive antifolate treatment, followed by secondary antifolate prophylaxis (A-SP) on the recurrence rate of toxoplasmic retinochoroiditis (TRC). To investigate whether there are any other factors potentially predisposing for recurrence.Material and MethodsA total of 637 medical records of TRC patients, who had been treated in the years 1994–2013 were reviewed. All patients were treated with pyrimethamine /sulfadoxine one 25mg/500mg tablet daily (P/S 25/500mg) for 21 days with a double loading dose for the first two days. From Day 2 the patients also received prednisone at a starting dose of 40mg and spiramycine 3 million IU three times daily, given for 10 days followed by azithromycin 500mg once daily for another 6 days. The analysis of the recurrence rate involved 352 patients who had completed 6-month secondary prophylaxis (P/S one 25 mg/500mg tablet twice a week).ResultsWhen secondary antifolate prophylaxis (A-SP) was instituted immediately after the treatment for TRC, the probability of 3-year recurrence–free survival after the first course of A-SP was 90.9%. A recurrence was most likely approximately 3.5 years after the first treatment. A univariate Cox regression model demonstrated that a risk for recurrence was 2.82 times higher (p = 0.02) in patients with retinal scars. In the multivariate analysis, the risk for recurrence was 2.41 higher (p = 0.06). In patients with haemorrhagic lesions the risk for recurrence was lower, aRR = 0.17 (approaching borderline statistical significance p = 0.08).ConclusionsWith the institution of A-SP of immediately after the intensive treatment for TRC, i.e. when a reactivation was most likely, there was no recurrence during A-SP. Following A-SP the recurrence rates were low and recurrence-free periods tended to be longer. The treatment regimen employed had a beneficial effect on the recurrence interval as it reduced and delayed the highest probability of recurrence.
Highlights
A case of ocular toxoplasmosis was first described in 1923 by the Czech ophthalmologist Josef Janku [1]
With the institution of A-SP of immediately after the intensive treatment for toxoplasmic retinochoroiditis (TRC), i.e. when a reactivation was most likely, there was no recurrence during A-SP
The purpose of this study was to evaluate the impact of the treatment regimen developed at approved at the Department of Zoonoses and Tropical Diseases, Medical University of Warsaw on the recurrence TRC rates as well as to investigate whether other factors such as gender, age, immediate institution of intensive treatment, presence of old retinal scars and the course of inflammation including haemorrhagic lesions, retinal vascular sheathing or involvement of the optic nerve had any effect on the frequency of ocular toxoplasmosis recurrence in our material
Summary
A case of ocular toxoplasmosis was first described in 1923 by the Czech ophthalmologist Josef Janku [1]. The disease results from infection with the protozoan parasite Toxoplasma gondii, discovered by Nicole and Manceux in 1908 It was only in 1952 that the American ophthalmic pathologist Helenor Campbell Wilder-Foerster confirmed that T. gondii was a cause of retinochoroiditis. Since her pioneering publication there has been much research into ocular toxoplasmosis but in spite of considerable advances, the pathophysiology and optimal treatment of the disease have not been definitively established. When the eye is affected, toxoplasmosis follows a remitting-relapsing course It is the most common infectious disease of the posterior eye segment as up to 50% of cases of inflammation in this region of the eye are due to T. gondii infection [7, 11]. There are considerable differences in the epidemiology and course of TRC depending on the geographical region and the parasite type [7, 12, 13]
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