Long-Term Low-Dose Pyrimethamine Use for the Prevention of Ocular Toxoplasmosis Recurrences: A Cohort Study.

PURPOSE: To describe the effect of long-term, low-dose pyrimethamine for the prevention of ocular toxoplasmosis (OT) recurrences. METHODS: Sixty-three consecutive patients with inactive ocular toxoplasmosis and positive toxoplasma IgG serology were included. Pyrimethamine (25 mg) + folinic acid (15 mg) were administered every other day (three times weekly) for 12 months. Eighteen patients received the treatment for an additional six months as part of an extension study. RESULTS: Thirty-eight patients (60.3%, n = 63) were female; 38 (60.3%) had a previous history of recurrence and 37 (58.7%) had active OT within the preceding 12 months. Three (4.8%) patients had unilateral recurrences at 8, 12 and 18 months after starting intermittent pyrimethamine treatment. Five patients (7.9%) were discontinued due to hematological, renal and hepatic changes. Treatment was considered successful in 42 patients (84%). CONCLUSION: Long-term, low-dose pyrimethamine can be considered as a treatment option for the prevention of ocular toxoplasmosis recurrence in selected patients, with only a few, mild and reversible systemic adverse events.

Role of Interferon-Gamma Release Assay for the Diagnosis and Clinical Follow up in Ocular Tuberculosis.

PURPOSE: To assess the performance of interferon-gamma release assay (IGRA) associated with tuberculosis skin test (TST) for ocular tuberculosis (OTB) diagnosis and therapeutic decision making. METHOD: One hundred and ninety-one patients with ocular inflammation were prospectively followed-up. Patients with clinical signs highly suspected of OTB, TST≥10 mm, and/or IGRA≥0.35 IU/mL received antitubercular therapy (ATT). Sensitivity (Se), specificity (Sp), and area under the curve (AUC) were assessed. RESULTS: Seventy-two (37.7%) patients received ATT for presumed OTB. Combining TST and IGRA had Se=89.6%, Sp=99.2%, and AUC (0.98) significantly higher compared to TST (0.85, Z=6.3, p<.001) or IGRA (0.95, Z=2.5, p=.01). Prior history of corticosteroids or immunosuppressant with concomitantly oral prednisone and baseline IGRA> 2.0 IU/mL was associated significantly with more recurrences in ATT patients (p=.01)      . CONCLUSION: Considering TST and IGRA together was more effective in assessing OTB diagnosis. The real value of the IGRA test to predict recurrences needs further studies.

Serum Vitamin D Levels as Biomarkers in Patients with Autoimmune Uveitis and their Possible Correlation with Disease Activity.

This study investigated the correlation between serum vitamin D levels and intraocular inflammation in patients with autoimmune uveitis (AIU). We evaluated 67 patients with active and inactive AIU and measured their serum 25-hydroxyvitamin D [25(OH)D] concentration, sun exposure habits, number of relapses, and complications. Of the patients evaluated, 85% had significantly lower vitamin D levels, and patients with active uveitis had lower 25(OH)D levels than those with inactive uveitis. The odds of developing active uveitis decreased by 6% with each 1-unit increase in 25(OH)D. Patients with recurrent active AIU had significantly lower 25(OH)D serum levels than inactive forms, indicating that low vitamin D levels may alter the clinical course of intraocular inflammation in AIU. Additionally, the study found that a higher mean BMI increased the chances of an individual having active uveitis by 14%. These results suggest that serum vitamin D concentration could be a prognostic clinical biomarker in AIU.

Clinical features and management of presumed ocular tuberculosis: A long-term follow-up cohort study in a tertiary referral center in Brazil.

PURPOSE: To evaluate the clinical features and management of presumed ocular tuberculosis (OTB). METHOD: A prospective 3-year follow-up study of patients with ocular inflammation that performed Interferon-gamma release assay (IGRA) and tuberculin skin test (TST) was conducted in a tertiary referral center in Brazil. Patients with clinical signs highly suspect of OTB with a positive TST and/or IGRA with other causes ruled out were prescribed anti-tuberculosis therapy (ATT) during 9 months. Clinical features and treatment outcomes were recorded. RESULTS: Seventy-two patients (mean age 48.3 ± 15.7 years) were included in the study, and most were female (65.3%, n = 47). Posterior uveitis (43.1%, n = 31) was the main clinical feature. Multifocal choroiditis (25%, n = 18) was the most common choroidal involvement. Concomitant oral prednisone (45.8%, n = 33) during ATT was associated with more recurrences (p = 0.04). A significant difference (p < 0.001) between initial and final best-corrected visual acuity after ATT conclusion was observed. Cure or remission was observed in 58 (85.3%) patients that completed follow-up (n = 68). CONCLUSION: In our cohort some variation in demographics and ocular phenotypes of presumed OTB was observed. The high rates of cure or remission of our patients strongly support the ATT in presumed OTB. Oral corticosteroids during ATT were associated with higher recurrences rates.

Current Practices in Ocular Tuberculosis: A Survey of Brazilian Specialists.

Purpose: To describe the approach of Brazilian specialists in the diagnosis and treatment of tuberculosis-associated uveitis (TBU).Methods: Members of the Brazilian Uveitis Society received an electronic invitation to participate in an online questionnaire.Results: Of the 169 invited specialists, 78 answered the questionnaire. Specialists evaluated 5.6 patients with TBU annually. Tuberculin skin test (TST, 81%) was primarily used for diagnosis. Patients with presumed TBU should always be tested for syphilis and HIV according to 51 (88%) and 47 (81%) of respondents, respectively. Chest computed tomography (CT, 72%) was preferable to chest radiography (CXR) for diagnosis. A positive TST (81%) and CXR (60%) were the main indicators of anti-tuberculous therapy, with 34%, 39%, and 14% of specialists treating for 6, 9, and 12 months, respectively.Conclusions: TST remains the preferred method for TBU diagnosis and prompt treatment by Brazilian specialists, though there is no consensus regarding disease treatment and management.

Effectiveness of Treatments for Ocular Toxoplasmosis.

Purpose: To evaluate the effectiveness of treatments for ocular toxoplasmosis (OT).Methods: A review of charts was conducted from patients who experienced an active episode of OT treated at the Federal University of São Paulo and associated sites. OT charts were reviewed to determine treatment effectiveness based on clinical judgment, taking clinical course and outcome into consideration in addition to change in best-corrected visual acuity. Treatment emergent adverse events (TEAEs) were used to assess safety.Results: Overall, 451/1200 patient charts met the inclusion criteria. The most commonly prescribed treatment was trimethoprim + sulfamethoxazole (52.3%) followed by pyrimethamine + sulfadiazine (28%). Treatment was successful in 96.9% of patients. Irrespective of the treatment, active lesions were resolved in 63.9% of patients within 6 weeks. Vision improved in 56.3% of patients. The incidence of TEAEs was low (10%).Conclusions: All treatments were effective for active episodes of OT, with few side effects.

Caracterización clínica y serológica de la toxoplasmosis ocular activa / Clinical and serological characterization of active ocular toxoplasmosis

Objetivo: Describir las características clínicas y serológicas de un grupo de pacientes afectados de toxoplasmosis ocular activa. Método: Estudio observacional, descriptivo, de corte transversal realizado en 54 ojos de igual número de pacientes con diagnóstico de toxoplasmosis ocular. Se les realizó un examen oftalmológico completo y se determinó los niveles de anticuerpos Ig G anti-toxoplasma en suero por inmunofluorescencia indirecta. Resultados: Las edades de 16 a 45 años y el sexo masculino predominaron en los pacientes estudiados. El 100 % presentó retinocoroiditis acompañada de vitritis de variable intensidad. Predominaron en 51,9 % las lesiones recurrentes. La afectación visual moderada fue más frecuente (46,3 %), constituyó la zona I de retina el área mayormente afectada (53,7 %). La Ig G fue positiva en el 88,9 % de los pacientes, hubo un predominio de la dilución 1/32 (38,9 %). Las complicaciones más frecuentes fueron: membrana epirretinal (7,41 %), opacidades vítreas (5,56 %) y glaucoma secundario (5,56 %). Conclusiones: Las características epidemiológicas de los pacientes coincidieron con lo descrito en la literatura. El grado de afectación visual estuvo relacionado con la localización de las lesiones. Prevaleció la serpositividad a la Ig G para toxoplasma a diluciones bajas.

Objective: To report the clinical and serological features of active ocular toxoplasmosis in a group of patients. Methods: A cross-sectional observational and descriptive study was conducted in 54 eyes from an equal number of patients, with a diagnosis of active ocular toxoplasmosis. A complete ophthalmologic exam was performed; and indirect immunofluorescence was applied to estimate the anti-toxoplasma IgG antibodies levels in peripheral serum. Results: Male patients and 16-45 y age group prevailed. All of the patients presented with retinochoroiditis along with vitreous haze of variable density. Recurrent lesions prevailed in 51.9% of cases. Mild visual impairment was more common (46.3%,), being the retinal zone I the most compromised(53.7 %). Ig G was positive in 88.9% of patients; 1/32 dilution prevailed (38.9 %). The most frequent ocular complications were epiretinal membrane (7. 41 %), vitreous opacities (5.56 %) and secondary glaucoma (5.56 %). Conclusion: In this study, the epidemiological characteristics of patients were similar to those described in literature. The level of visual impairment was related with the location of lesions, whereas IgG positivity to toxoplasma at low dilutions predominated.