1
|
Amato VS, Ribeiro VST, Silva AG, Gomes AMV, Tuon FF. Recurrent acquired ocular toxoplasmosis associated with Kyrieleis plaques and documented allergy to sulfonamide-A treatment proposal for two rare conditions. Diagn Microbiol Infect Dis 2024; 109:116266. [PMID: 38643677 DOI: 10.1016/j.diagmicrobio.2024.116266] [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: 06/26/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/23/2024]
Abstract
The aim of this study was to describe a case of a patient with ocular toxoplasmosis, which has resulted in Kyrieleis plaques formation (segmental periarteritis associated with severe inflammation) and later follow-up and alternative treatment due to documented allergy to sulfonamide. A 33-year-old Brazilian woman diagnosed with acute toxoplasmosis, initially treated with sulfonamide, developed a critical cutaneous rash. Cotrimoxazole was changed to clindamycin and pyrimethamine, and prednisone was started. The medication was maintained for 45 days. Four months later, she developed retinal lesions suggestive of toxoplasmosis with Kyrieleis plaques in the upper temporal vessels. Pyrimethamine, clindamycin, and prednisone were initiated until healing. She presented reactivation months later, and a suppressive treatment with pyrimethamine was instituted for one year. This is the first report to use the combination of clindamycin with pyrimethamine in the treatment and recurrence prophylaxis for OT in a documented allergy to sulfonamide.
Collapse
Affiliation(s)
- Valdir Sabbaga Amato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças e Moléstias Infecciosas, São Paulo, São Paulo, 05403-000, Brazil
| | - Victoria Stadler Tasca Ribeiro
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, 80215-901, Brazil.
| | - Allan Gomes Silva
- Instituto Suel Abujamra, setor de Retina e Vítreo, São Paulo, São Paulo, 01525-001, Brazil
| | | | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, 80215-901, Brazil
| |
Collapse
|
2
|
Leong E, Cifuentes-González C, Hu Y W J, Perumal Samy R, Khairallah M, Rojas-Carabali W, Putera I, de-la-Torre A, Agrawal R. Clinical Insights: Antimicrobial Therapy for Infectious Uveitis. Ocul Immunol Inflamm 2024:1-21. [PMID: 38759216 DOI: 10.1080/09273948.2024.2345848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Abstract
Infectious uveitis is a major global cause of vision impairment. Despite the eye's immune privilege, afforded by the blood-ocular barrier that restricts microbial entry, several pathogens such as bacteria, viruses, fungi, and parasites can still infiltrate and cause ocular infections and complications. Clinicians often encounter significant challenges in treating infectious uveitis due to limited or ineffective treatment options. Modern molecular techniques and imaging can aid in diagnosing and assessing intraocular infections. Various antimicrobial therapies exist, spanning topical and systemic treatments, but these are constrained by issues like drug concentration, penetration, effective duration, toxicity, and side effects. Treatment approaches also differ based on the infection's etiology. This review provides recent updates on antimicrobial therapies from a clinical perspective, covering topical, systemic, and regional treatments for infectious uveitis.
Collapse
Affiliation(s)
- Evangeline Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeremy Hu Y W
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ramar Perumal Samy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alejandra de-la-Torre
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
| |
Collapse
|
3
|
Karakavuk M, Can H, Çeltik A, Karakavuk T, Gül C, Erdem HA, Pullukçu H, Taşbakan M, Taşbakan MS, Gürüz AY, Döşkaya M, Değirmenci Döşkaya A. Genetic characterization of Toxoplasma gondii strains isolated from humans living in İzmir, Türkiye. Indian J Med Microbiol 2024; 49:100571. [PMID: 38554777 DOI: 10.1016/j.ijmmb.2024.100571] [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: 11/17/2023] [Revised: 02/22/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Toxoplasma gondii is an obligate intracellular zoonotic parasite that can infect all warm-blooded animals, including humans. Currently, clinical findings of toxoplasmosis are being related to T. gondii strains such as Type I genotype may cause high pathogenicity and Type II genotype causes a milder clinical presentation. We have showed in our previous that Type II genotype is the most frequent strain detected in stray cats and wild birds living in natural life of İzmir. The aim of this study was to assess toxoplasmosis seroprevalence in immunocompromised patients, investigate the presence of T. gondii DNA in their blood samples, and genotype the PCR positive ones. METHODS The 42 buffy-coat and serum samples were collected from immunocompromised patients who were from various clinics. Thereafter, Real-Time PCR targeting RE gene of T. gondii was performed with DNA samples obtained from buffy-coat samples. Genotyping was performed by sequencing of GRA6 and GRA7 gene regions of positive DNA samples obtained from tissues of bioassay and PCR positive samples. RESULTS According to Real-Time PCR results, T. gondii DNA was detected in 23.8% (10/42) samples. Among these 10 samples, two samples were determined as T. gondii Type II genotype. Anti-Toxoplasma IgG antibodies were detected in 28.57% (12/42) samples. CONCLUSIONS Overall, the detection of Type II genotype in humans in İzmir province suggested that T. gondii infection in humans, stray cats, and wild animals may be associated to each other in terms of transmission.
Collapse
Affiliation(s)
- Muhammet Karakavuk
- Ege University, Odemis Vocational School, Ödemiş, İzmir, Türkiye; Ege University, Vaccine Development Application and Research Center, Bornova, İzmir, Türkiye
| | - Hüseyin Can
- Ege University, Vaccine Development Application and Research Center, Bornova, İzmir, Türkiye; Ege University, Faculty of Science, Department of Biology, Molecular Biology Section, Bornova, İzmir, Türkiye
| | - Aygül Çeltik
- Ege University, Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Bornova, İzmir, Türkiye
| | - Tuğba Karakavuk
- Ege University, Vaccine Development Application and Research Center, Bornova, İzmir, Türkiye
| | - Ceren Gül
- Ege University, Vaccine Development Application and Research Center, Bornova, İzmir, Türkiye
| | - Hüseyin Aytaç Erdem
- Ege University, Faculty of Medicine, Department of Infectious Diseases, Bornova, İzmir, Türkiye
| | - Hüsnü Pullukçu
- Ege University, Faculty of Medicine, Department of Infectious Diseases, Bornova, İzmir, Türkiye
| | - Meltem Taşbakan
- Ege University, Faculty of Medicine, Department of Infectious Diseases, Bornova, İzmir, Türkiye
| | - Mehmet Sezai Taşbakan
- Ege University, Faculty of Medicine, Department of Chest Diseases, Bornova, İzmir, Türkiye
| | - Adnan Yüksel Gürüz
- Ege University, Vaccine Development Application and Research Center, Bornova, İzmir, Türkiye; Ege University, Faculty of Medicine, Department of Parasitology, Bornova, İzmir, Türkiye
| | - Mert Döşkaya
- Ege University, Vaccine Development Application and Research Center, Bornova, İzmir, Türkiye; Ege University, Faculty of Medicine, Department of Parasitology, Bornova, İzmir, Türkiye
| | - Aysu Değirmenci Döşkaya
- Ege University, Vaccine Development Application and Research Center, Bornova, İzmir, Türkiye; Ege University, Faculty of Medicine, Department of Parasitology, Bornova, İzmir, Türkiye.
| |
Collapse
|
4
|
Fernández Zamora Y, Marinho PM, Dias JRO, Cabral T, Casoy J, Muccioli C, Nascimento H, Belfort R. Long-Term Low-Dose Pyrimethamine Use for the Prevention of Ocular Toxoplasmosis Recurrences: A Cohort Study. Ocul Immunol Inflamm 2024:1-6. [PMID: 38441575 DOI: 10.1080/09273948.2024.2321270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Abstract
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.
Collapse
Affiliation(s)
- Yuslay Fernández Zamora
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Paula M Marinho
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
| | - João Rafael Oliveira Dias
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Thiago Cabral
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
- Department of Ophthalmology, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Cristina Muccioli
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Heloisa Nascimento
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, IPEPO - Vision Institute, São Paulo, Brazil
| |
Collapse
|
5
|
Nsiangani Lusambo N, Kaimbo Wa Kaimbo D, Ngoyi Mumba DM, de-la-Torre A. Outcomes of trimethoprim/ sulfamethoxazole treatment for ocular toxoplasmosis in Congolese patients. BMC Ophthalmol 2023; 23:440. [PMID: 37907920 PMCID: PMC10617208 DOI: 10.1186/s12886-023-03183-x] [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: 03/21/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Ocular toxoplasmosis (OT) is the leading cause of infectious posterior uveitis in several areas worldwide. The combination of Trimethoprim/Sulfamethoxazole (TMP/SMX) has been presented as an attractive alternative to the "classic' treatment therapy (Pyrimethamine/Sulfadiazine). METHODS A prospective study was carried out between February 2020 and September 2021 in 2 ophthalmic centers in Kinshasa. This study aimed to describe TMP/SMX treatment outcomes for OT in a cohort of immunocompetent Congolese patients. RESULTS 54 patients were included, with a mean age at presentation of 37.5 ± 13.6 years old and a Male-Female ratio of 1.45:1. Three patients (5.6%) presented a recurrence during the follow-up period. At the end of the follow-up, improvement in VA and resolution of inflammation concerned 75.9% and 77.5% of patients, respectively. Cataracts (3.7%), macular scars (3.7%), and vitreous opacities (3.7%) were the principal causes of non-improvement in VA. Treatment-related adverse events were present in 10 patients (18.5%); gastrointestinal (14.8%) and dermatological (3.7%) adverse events were the most frequent. Dermatological adverse events led to discontinuation of treatment. CONCLUSION TMP/SMX regimen appears to be a safe and effective treatment for OT in Congolese patients. The low cost and the accessibility of the molecules make this regimen an option for treating OT in resource-limited countries.
Collapse
Affiliation(s)
- Nadine Nsiangani Lusambo
- Eye Department, Teaching Hospital, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Dieudonné Kaimbo Wa Kaimbo
- Eye Department, Teaching Hospital, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dieudonné Mumba Ngoyi Mumba
- Parasitology Department, Teaching Hospital, Medical school, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| |
Collapse
|
6
|
[Diagnostics and treatment of ocular toxoplasmosis : Results of a survey]. DIE OPHTHALMOLOGIE 2023; 120:191-199. [PMID: 35925359 DOI: 10.1007/s00347-022-01691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ocular toxoplasmosis (OT) is the most common infectious cause of posterior uveitis. This survey aimed to evaluate the current diagnostic and therapeutic approach to OT in Germany. MATERIAL AND METHODS A detailed questionnaire with specific patient examples was sent in July 2021 to the members of the Uveitis Section of the German Ophthalmological Society (DOG) and the Retinological Society (RG). RESULTS The questionnaire was answered by 53 (29 RG and 24 DOG) ophthalmologists. Of the respondents 16 (30%) work in private practice, 18 (34%) in a clinical facility and 19 (36%) in university hospital, 9 (17%) colleagues see < 50, 28 (53%) 50-200 and 16 (30%) more than 200 uveitis patients per year. The clinical results are still the gold standard (87%) for the diagnosis of OT and in cases of first manifestation 60% are supported by serological antibody investigations, while 10 out of 53 (19%) ophthalmologists rely on the clinical presentation only. An IgM test is requested by 25 (47%) respondents, 6 expected an increase in IgG titer (11%) and 1 the detection of specific IgA antibodies (2%). The majority (n = 28, 53%) of ophthalmologists would aim at confirming the diagnosis by an anterior chamber puncture, from which 20 (38%) prefer PCR, 3 (6%) determination of Goldmann-Witmer coefficients (GW) and 5 (9%) a combination of both methods. Clindamycin was most frequently used for treatment (n = 21, 40%), followed by pyrimethamine/sulfadiazine (n = 17, 32%) and trimethoprime + sulfamethoxazole (TMP/SMX) (n = 10, 19%); the latter was also used (n = 40, 75%) for secondary prophylaxis. CONCLUSION The results show that apart from the clinical results as the gold standard for the diagnosis, there is no uniform approach to diagnosis and treatment of OT. The high request rate for serum IgM antibodies indicates a widespread uncertainty about the importance of serological findings. This should be viewed critically, given the continued high seroprevalence in Germany.
Collapse
|
7
|
Zhang Y, Zhang Q, Li H, Cong H, Qu Y. In vitro and in vivo anti−Toxoplasma activities of HDAC inhibitor Panobinostat on experimental acute ocular toxoplasmosis. Front Cell Infect Microbiol 2022; 12:1002817. [PMID: 36171756 PMCID: PMC9510647 DOI: 10.3389/fcimb.2022.1002817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/24/2022] [Indexed: 11/21/2022] Open
Abstract
Ocular toxoplasmosis (OT) is retinochoroiditis caused by Toxoplasma gondii infection, which poses a huge threat to vision. However, most traditional oral drugs for this disease have multiple side effects and have difficulty crossing the blood-retinal barrier, so the new alternative strategy is required to be developed urgently. Histone deacetylases (HDAC) inhibitors, initially applied to cancer, have attracted considerable attention as potential anti-Toxoplasma gondii drugs. Here, the efficacy of a novel HDAC inhibitor, Panobinostat (LBH589), against T. gondii has been investigated. In vitro, LBH589 inhibited the proliferation and activity of T. gondii in a dose-dependent manner with low toxicity to retinal pigment epithelial (RPE) cells. In vivo, optical coherence tomography (OCT) examination and histopathological studies showed that the inflammatory cell infiltration and the damage to retinal architecture were drastically reduced in C57BL/6 mice upon treatment with intravitreal injection of LBH589. Furthermore, we have found the mRNA expression levels of inflammatory cytokines were significantly decreased in LBH589–treated group. Collectively, our study demonstrates that LBH589 holds great promise as a preclinical candidate for control and cure of ocular toxoplasmosis.
Collapse
Affiliation(s)
- Yu Zhang
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Qingqing Zhang
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Haiming Li
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Hua Cong
- Department of Pathogen Biology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Hua Cong, ; Yi Qu,
| | - Yi Qu
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Hua Cong, ; Yi Qu,
| |
Collapse
|
8
|
Neß T, Winterhalter S, Stübiger N. Infectious Posterior Uveitis - Toxoplasmosis, Treponema, Tuberculosis (TTT). Klin Monbl Augenheilkd 2022; 239:666-675. [PMID: 35320874 DOI: 10.1055/a-1727-1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Toxoplasma gondii, Treponema pallidum and Mycobacterium tuberculosis are the most important infectious causes of posterior uveitis. The epidemiology, clinical picture, diagnostic and treatment strategies of these diseases are presented.
Collapse
Affiliation(s)
- Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Deutschland.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | | | - Nicole Stübiger
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| |
Collapse
|
9
|
Kodjikian L, Bandello F, de Smet M, Dot C, Zarranz-Ventura J, Loewenstein A, Sudhalkar A, Bilgic A, Cunha-Vaz J, Dirven W, Behar-Cohen F, Mathis T. Fluocinolone acetonide implant in diabetic macular edema: International experts' panel consensus guidelines and treatment algorithm. Eur J Ophthalmol 2022; 32:1890-1899. [PMID: 35139688 DOI: 10.1177/11206721221080288] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Center-involving diabetic macular edema (DME) is a leading cause of vision impairment in working-age adults. While its management is particularly challenging in a poorly compliant population, continuous innovation and the advent of new molecules have improved its outcome. The control of glycemia and of systemic aggravating factors remain essential to slow down progression of disease complications including DME. The indications for macular laser photocoagulation has progressively been phased out as a standard of care and replaced by local intraocular anti-VEGFs biologics and glucocorticoids (GCs). Intravitreal GCs in controlled-release drug delivery systems have allowed to reduce injection frequency and treatment burden. The non biodegradable Fluocinolone Acetonide (FAc) implant allows a long-lasting stabilization of both functional and anatomic improvements. However, adequate patient selection and monitoring through regular follow-up are essential for optimal results. Based on their experience and the latest literature, the aim of the present review is to provide international expert panel consensus on the place of the FAc implant in the treatment algorithm of DME, as well as its safety profile and how to manage it.
Collapse
Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, 386696Croix-Rousse University Hospital, Hospices Civils de Lyon, University Lyon 1, Lyon, France.,UMR-CNRS 5510 Matéis, University Lyon 1, Villeurbane, France
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University Milan, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marc de Smet
- Department of Ophthalmology, 4496University of Leiden, Leiden, the Netherlands.,MicroInvasive Ocular Surgery Center, Lausanne, Switzerland
| | - Corrine Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.,French Military Health Service Academy, Val de Grâce, Paris, France
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), 16493Hospital Clínic de Barcelona, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Alper Bilgic
- Sudhalkar Eye Hospital and Retina Centre, Baroda, India
| | - José Cunha-Vaz
- Faculty of Medicine, AIBILI - Association for Innovation and Biomedical Research on Light and Image, University of Coimbra, Coimbra, Portugal
| | - Werner Dirven
- Department of Ophthalmology, AZ Turnhout Hospital, Turnhout, Belgium
| | - Francine Behar-Cohen
- Department of Ophthalmology, 26935Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Inserm, From physiopathology of retinal diseases to clinical advances, Paris, France
| | - Thibaud Mathis
- Department of Ophthalmology, 386696Croix-Rousse University Hospital, Hospices Civils de Lyon, University Lyon 1, Lyon, France.,UMR-CNRS 5510 Matéis, University Lyon 1, Villeurbane, France
| |
Collapse
|
10
|
Fabiani S, Caroselli C, Menchini M, Gabbriellini G, Falcone M, Bruschi F. Ocular toxoplasmosis, an overview focusing on clinical aspects. Acta Trop 2022; 225:106180. [PMID: 34699742 DOI: 10.1016/j.actatropica.2021.106180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022]
Abstract
Toxoplasma gondii is a widespread protozoan parasite infecting approximately one third of the world population. After proliferation of tachyzoites during the acute stage, the parasite forms tissue cysts in various anatomical sites and establishes chronic infection. Nowadays the nature of the interplay between the protozoan and its human host remains elusive. This is clearly evident in ocular toxoplasmosis, in which the parasite establishes an ambivalent relationship with the eye, manipulating the immune response and inducing variable initial lesions and further relapses. This review will focus on epidemiology and environmental, parasite and host related risk factors, clinical manifestations and laboratory findings, treatment and prophylaxis approaches in ocular toxoplasmosis. An image collection of patients referred to the Unit of Ophthalmology of Pisa's Hospital will be presented, too.
Collapse
|
11
|
Flegr J. Toxoplasmosis is a risk factor for acquiring SARS-CoV-2 infection and a severe course of COVID-19 in the Czech and Slovak population: a preregistered exploratory internet cross-sectional study. Parasit Vectors 2021; 14:508. [PMID: 34583758 PMCID: PMC8477627 DOI: 10.1186/s13071-021-05021-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Latent toxoplasmosis, i.e. a lifelong infection with the protozoan parasite Toxoplasma gondii, affects about a third of the human population worldwide. In the past 10 years, numerous studies have shown that infected individuals have a significantly higher incidence of mental and physical health problems and are more prone to exhibiting the adverse effects of various diseases. Methods A cross-sectional internet study was performed on a population of 4499 (786 Toxoplasma-infected) participants and looked for factors which positively or negatively affect the risk of SARS-CoV-2 infection and likelihood of a severe course of COVID-19. Results Logistic regression and partial Kendall correlation controlling for sex, age, and size of the place of residence showed that latent toxoplasmosis had the strongest effect on the risk of infection (OR = 1.50) before sport (OR = 1.30) and borreliosis (1.27). It also had the strongest effect on the risk of severe course of infection (Tau = 0.146), before autoimmunity, immunodeficiency, male sex, keeping a cat, being overweight, borreliosis, higher age, or chronic obstructive pulmonary disease. Toxoplasmosis augmented the adverse effects of other risk factors but was not the proximal cause of the effect of cat-keeping on higher likelihood of COVID infection and higher severity of the course of infection because the effect of cat-keeping was also observed (and in particular) in a subset of Toxoplasma-infected respondents (Tau = 0.153). Effects of keeping a cat were detected only in respondents from multi-member families, suggesting that a cat could be a vector for the transmission of SARS-CoV-2 within a family. Conclusions Toxoplasmosis is currently not considered a risk factor for COVID-19, and Toxoplasma-infected individuals are neither informed about their higher risk nor prioritised in vaccination programs. Because toxoplasmosis affects a large segment of the human population, its impact on COVID-19-associated effects on public health could be considerable. Graphical abstract ![]()
Collapse
Affiliation(s)
- Jaroslav Flegr
- Laboratory of Evolutionary Biology, Division of Biology, Department of Philosophy and History of Sciences, Faculty of Science, Charles University, Viničná 7, Prague 2, 128 00, Czech Republic. .,National Institute of Mental Health, Klecany, 250 67, Czech Republic.
| |
Collapse
|