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Lyons MR, Arantes T, Vieira BR, Furtado JM, Smith JR. Impact of gender on clinical features and outcomes of ocular toxoplasmosis. Br J Ophthalmol 2024; 108:710-714. [PMID: 37225390 DOI: 10.1136/bjo-2023-323227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
AIM To investigate the effect of gender on the clinical features and outcomes of ocular toxoplasmosis. METHODS 262 patients (139 women and 123 men) presenting to a tertiary referral uveitis service in Ribeirão Preto, Brazil, with serological and clinical evidence of ocular toxoplasmosis were prospectively enrolled in an observational study. Predefined data items including demographics, descriptors of uveitis and ocular toxoplasmosis, best-corrected visual acuity and ocular complications were disaggregated by gender and compared statistically. RESULTS Approximately equal numbers of women and men had active versus inactive ocular toxoplasmosis. In both women and men, most infections were remotely acquired. Men were significantly more likely to present with primary active disease than women (24.4% vs 12.9%); conversely, women were significantly more likely to present with recurrent active disease than men (36.0% vs 28.5%). One toxoplasmic retinal lesion was observed in more eyes of men than eyes of women (50.4% vs 35.3%), while women's eyes were more likely to have multiple lesions than men's eyes (54.7% vs 39.8%). Lesions in women's eyes were significantly more likely to occur at the posterior pole compared with those in men's eyes (56.1% vs 39.8%). Measures of vision were similar for women and men. There were no significant differences in measures of visual acuity, ocular complications, and occurrence and timing of reactivations between the genders. CONCLUSION Ocular toxoplasmosis has equivalent outcomes in women and men, with clinical differences in the form and type of disease, as well as characteristics of the retinal lesion.
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Affiliation(s)
- Matilda R Lyons
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tiago Arantes
- Sadalla Amin Ghanem Eye Hospital, Joinville, Santa Catarina, Brazil
| | - Barbara R Vieira
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Joao M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Artiaga JCM, Azarcon CP, Levina FD, Bromeo AJ, Mesina BVQ, Arcinue CA. Considerations in the management of ocular toxoplasmosis in pregnancy: a review of literature. Eye (Lond) 2024; 38:1262-1268. [PMID: 38191658 PMCID: PMC11076467 DOI: 10.1038/s41433-023-02916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/27/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
Ocular toxoplasmosis is the most common cause of infectious posterior uveitis. Available literature is still conflicting regarding the incidence of recurrence during pregnancy as various calculations were employed in the different published studies. Although earlier reports have suggested a difference in presentation and an increase in severity during pregnancy, newer studies appear to show otherwise. Further diagnostic testing, including serologic and intraocular fluid sampling, may be indicated to increase the diagnostic accuracy in this special population of patients. The management of ocular toxoplasmosis during pregnancy is challenging as the foetus is additionally considered in the choice of treatment. Traditionally preferred anti-toxoplasmosis regimens containing antifolate drugs, such as pyrimethamine and trimethoprim-sulfamethoxazole, cannot be used routinely in pregnant patients, especially during the first trimester. This review includes literature on alternative treatments for ocular toxoplasmosis during pregnancy, including spiramycin and intravitreal treatment options.
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Affiliation(s)
- Jose Carlo M Artiaga
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Corrina P Azarcon
- Section of Ophthalmology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Faye D Levina
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | - Bryan Vincent Q Mesina
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Cheryl A Arcinue
- Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Asian Eye Institute, Makati City, Philippines
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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Cifuentes-González C, Rojas-Carabali W, Pérez ÁO, Carvalho É, Valenzuela F, Miguel-Escuder L, Ormaechea MS, Heredia M, Baquero-Ospina P, Adan A, Curi A, Schlaen A, Urzua CA, Couto C, Arellanes L, de-la-Torre A. Risk factors for recurrences and visual impairment in patients with ocular toxoplasmosis: A systematic review and meta-analysis. PLoS One 2023; 18:e0283845. [PMID: 37011101 PMCID: PMC10069780 DOI: 10.1371/journal.pone.0283845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/19/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Ocular toxoplasmosis (OT) is caused by the parasite Toxoplasma gondii. OT is the leading cause of posterior uveitis globally; it is a recurrent disease that may result in visual impairment and blindness. This systematic review and meta-analysis aim to summarize and evaluate the risk factors for recurrences, visual impairment, and blindness described in the literature worldwide. METHODS AND FINDINGS We performed a systematic literature search in PubMed, Embase, VHL, Cochrane Library, Scopus, and DANS EASY Archive. All studies reporting patients with clinically and serologically confirmed OT presenting any clinical or paraclinical factor influencing recurrences, visual impairment, and blindness were included. Studies presenting secondary data, case reports, and case series were excluded. An initial selection was made by title and abstract, and then the studies were reviewed by full text where the eligible studies were selected. Then, the risk of bias was assessed through validated tools. Data were extracted using a validated extraction format. Qualitative synthesis and quantitative analysis were done. This study was registered on PROSPERO (CRD42022327836). RESULTS Seventy two studies met the inclusion criteria. Fifty-three were summarized in the qualitative synthesis in three sections: clinical and environmental factors, parasite and host factors, and treatment-related factors. Of the 72 articles, 39 were included in the meta-analysis, of which 14 were conducted in South America, 13 in Europe, four in Asia, three multinational, two in North America and Central America, respectively, and only one in Africa. A total of 4,200 patients with OT were analyzed, mean age ranged from 7.3 to 65.1 year of age, with similar distribution by sex. The frequency of recurrences in patients with OT was 49% (95% CI 40%-58%), being more frequent in the South American population than in Europeans. Additionally, visual impairment was presented in 35% (95% CI 25%-48%) and blindness in 20% (95% CI 13%-30%) of eyes, with a similar predominance in South Americans than in Europeans. On the other hand, having lesions near the macula or adjacent to the optic nerve had an OR of 4.83 (95% CI; 2.72-8.59) for blindness, similar to having more than one recurrence that had an OR of 3.18 (95% CI; 1.59-6.38). Finally, the prophylactic therapy with Trimethoprim/Sulfamethoxazole versus the placebo showed a protective factor of 83% during the first year and 87% in the second year after treatment. CONCLUSION Our Systematic Review showed that clinical factors such as being older than 40 years, patients with de novo OT lesions or with less than one year after the first episode, macular area involvement, lesions greater than 1 disc diameter, congenital toxoplasmosis, and bilateral compromise had more risk of recurrences. Also, environmental and parasite factors such as precipitations, geographical region where the infection is acquired, and more virulent strains confer greater risk of recurrences. Therefore, patients with the above mentioned clinical, environmental, and parasite factors could benefit from using prophylactic therapy.
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Affiliation(s)
- Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Álvaro Olate Pérez
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Érika Carvalho
- Clinical Research Laboratory of Infectious Diseases in Ophthalmogy, National Institute of Infectious Disease, INI-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Felipe Valenzuela
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lucía Miguel-Escuder
- Hospital Clinic of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | - María Soledad Ormaechea
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Milagros Heredia
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Pablo Baquero-Ospina
- Inflammatory Eye Disease Clinic, Dr. Luis Sanchez Bulnes" Hospital, Asociación para Evitar la Ceguera en México (APEC), Mexico City, CDMX, Mexico
| | - Alfredo Adan
- Hospital Clinic of Barcelona, Clinic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Andre Curi
- Clinical Research Laboratory of Infectious Diseases in Ophthalmogy, National Institute of Infectious Disease, INI-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Cristhian Alejandro Urzua
- Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
- Faculty of Medicine, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Cristóbal Couto
- Department of Ophthalmology, Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires, Buenos Aires City, Argentina
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Lourdes Arellanes
- Inflammatory Eye Disease Clinic, Dr. Luis Sanchez Bulnes" Hospital, Asociación para Evitar la Ceguera en México (APEC), Mexico City, CDMX, Mexico
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Red de Investigación en Inmunología Ocular de Latinoamérica (RIOLAT)
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Velasco-Velásquez S, Celis-Giraldo D, Botero Hincapié A, Alejandro Hincapie Erira D, Sofia Cordero López S, Marulanda Orozco N, Enrique Gómez-Marín J. Clinical, Socio-economic and Environmental Factors Related with Recurrences in Ocular Toxoplasmosis in Quindío, Colombia. Ophthalmic Epidemiol 2020; 28:258-264. [PMID: 33115293 DOI: 10.1080/09286586.2020.1839509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To identify the sociodemographic, clinical, and environmental factors associated with recurrences in ocular toxoplasmosis (OT). METHODS Retrospective analysis of clinical records of patients who consulted in the Health Centre at Universidad del Quindío between 2004 and 2017. Patients with retinochoroiditis due to Toxoplasma gondii infection and follow up >12 months were included. Comparisons were made with a recurrence index adjusted for months of follow up. For the statistical analysis, the Kruskal-Wallis test and analysis of variance (ANOVA) tests were performed in Epi Info 7.2 and SPSS 14.0. A statistical significance is shown if p ≤ 0.05. RESULTS A total of 58 patients were included, with median age of 28 years (range 1-61) and 55.1% were women. The median of recurrences was 1.4 (range 0.6-16.6). High recurrence index was present in 43.1% of the patients. A higher size of lesions was observed in low socioeconomic groups (p = .016) and patients with congenital infection had more bilateral compromise (p = .002). Intake of boiled water was related to a lower recurrence index (p = .04). CONCLUSIONS Low socioeconomic level was associated with bigger lesions and congenital infection was related with higher frequency of bilateral OT. Finally, intake of boiled water is related to a lower recurrence index of OT.
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Affiliation(s)
- Stefany Velasco-Velásquez
- Group of Studies on Molecular Parasitology (GEPAMOL), Center of Biomedical Research, Faculty of Health Sciences, Universidad Del Quindío, Armenia, Colombia
| | - Daniel Celis-Giraldo
- Group of Studies on Molecular Parasitology (GEPAMOL), Center of Biomedical Research, Faculty of Health Sciences, Universidad Del Quindío, Armenia, Colombia
| | - Andrea Botero Hincapié
- Group of Studies on Molecular Parasitology (GEPAMOL), Center of Biomedical Research, Faculty of Health Sciences, Universidad Del Quindío, Armenia, Colombia
| | - Diego Alejandro Hincapie Erira
- Group of Studies on Molecular Parasitology (GEPAMOL), Center of Biomedical Research, Faculty of Health Sciences, Universidad Del Quindío, Armenia, Colombia
| | - Sara Sofia Cordero López
- Group of Studies on Molecular Parasitology (GEPAMOL), Center of Biomedical Research, Faculty of Health Sciences, Universidad Del Quindío, Armenia, Colombia
| | - Nathalia Marulanda Orozco
- Group of Studies on Molecular Parasitology (GEPAMOL), Center of Biomedical Research, Faculty of Health Sciences, Universidad Del Quindío, Armenia, Colombia
| | - Jorge Enrique Gómez-Marín
- Group of Studies on Molecular Parasitology (GEPAMOL), Center of Biomedical Research, Faculty of Health Sciences, Universidad Del Quindío, Armenia, Colombia
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