Approach to ocular toxoplasmosis including pregnant women.

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.

Presentación del síndrome de Wernicke-Korsakoff secundario a encefalitis por citomegalovirus, a propósito de un caso / Wernicke-Korsakoff syndrome secondary to cytomegalovirus encephalitis: A case report

Resumen El citomegalovirus (CMV) es uno de los microorganismos oportunistas con mayor prevalencia en pacientes inmunocomprometidos, aunque su reactivación ha descendido después de la introducción de la terapia antirretroviral altamente activa (Highly Active Antiretroviral Therapy, HAART). En las coinfecciones, la encefalitis se ha reportado como una de las condiciones más frecuentes. Se presenta el caso de un paciente adulto joven con infección por virus de la inmunodeficiencia humana (HIV) que tuvo un rápido deterioro neurológico evidenciado en síntomas y signos clínicos clásicos del síndrome de Wernicke-Korsakoff y que no presentaba factores de riesgo para deficiencia de tiamina. En las imágenes de la resonancia magnética cerebral, se detectaron hallazgos típicos del síndrome, y se identificó citomegalovirus (CMV) en el líquido cefalorraquídeo. Con el tratamiento específico para el CMV, se logró el control de los síntomas, aunque hubo secuelas neurológicas que mejoraron. Este es uno de los pocos casos reportados a nivel mundial de síndrome de Wernicke secundario a encefalitis por citomegalovirus.

Abstract Cytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations. We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement. This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis.

[Wernicke-Korsakoff syndrome secondary to cytomegalovirus encephalitis: A case report].

Cytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations.We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement.This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis.

Consenso Colombiano para la estratificación, diagnostico, Tratamiento y Prevención de la Infección por citomegalovirus en Pacientes Adultos con trasplante renal / Colombian consensus for stratification, diagnosis, treatment and prevention of cytomegalovirus infection in adults patients with renal transplant

El citomegalovirus es una de las principales causas de infección y enfermedad en receptores de trasplante renal, con un notorio impacto en términos de morbilidad, mortalidad y costos. Sin embargo, no existe en Colombia una práctica clínica estandarizada entre los centros de trasplante, por lo cual, es de suma importancia disponer de guías con el fin de orientar la estratificación, el diagnóstico de laboratorio, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal. A través de la metodología ADAPTE para la evaluación de calidad y transculturización de guías de práctica clínica a nuestro medio, un grupo multidisciplinario realizó una revisión sistemática de la literatura: se seleccionaron las guías internacionales, las cuales fueron evaluadas con el instrumento AGREE II en términos de calidad. Con la guía base seleccionada se buscó la evidencia existente para contestar a las preguntas, de acuerdo con el método de desarrollo de recomendaciones GRADE. Se realizaron recomendaciones para la estratificación, el diagnóstico, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal en Colombia.

Cytomegalovirus is a primary cause of infection and illness in patients who have had renal transplantation, with a significant impact on morbidity, mortality and economic costs. However, there is no standardized clinical practice in transplant centers in Colombia, and it is important to have guidelines to stratify, diagnose, treat and prevent cytomegalovirus infection and disease. Through ADAPTE's methodology for the quality evaluation and adaptation of clinical practice guidelines in our setting, a multidisciplinary group carried out a systematic review of the medical literature, selecting international guidelines that were evaluated with the AGREE-II instrument in terms of quality. With each selected guideline, an evidence table was constructed and the GRADE strategy was performed to develop recommendations. Recommendations related to stratification, laboratory diagnosis, treatment and prevention of infections and disease caused by cytomegalovirus in adult transplant patients were developed.