Toxoplasma retinochoroiditis in pregnancy: Using current evidence to inform management

Figures & data

Figure 1 Recurrent toxoplasma retinochoroiditis. A ‘satellite lesion’ associated with pre-existing retinochoroidal scars is present at the right macula. The lesion became inactive over a period of several weeks. The acute retinochoroiditis extended temporally from the fovea.

Figure 2 Inactive chorioretinal scar in temporal periphery of left eye.

Table 1 Therapeutic regimens of choice for typical cases of ocular toxoplasmosisa,b

Regimenc	Respondents in 2001 survey
Pyrimethamine/folinic acid,d sulfadiazine, prednisonee	23/78 (29%)
Pyrimethamine/folinic acid,d sulfadiazine, clindamycin, prednisonef	10/78 (13%)
Sulfadiazine, clindamycin, prednisone	1/78 (1%)
Clindamycin, prednisone	8/78 (10%)
Pyrimethamine/folinic acid, TMP/SMX, prednisone	5/78 (6%)
Pyrimethamine,g TMP/SMX, clindamycin, prednisone	4/78 (5%)
Pyrimethamine/folinic acid,d sulfadiazine	3/78 (4%)
TMP/SMX, clindamycin, prednisone	3/78 (4%)
TMP/SMX, clindamycin	3/78 (4%)
TMP/SMX, prednisone	3/78 (4%)
Spiramycin, prednisone	2/78 (3%)

Notes:

a Copyright © 2002. Modified with permission from Holland GN, Lewis KG. An update on current practices in the management of ocular toxoplasmosis. Am J Ophthalmol. 2002;134:102–114. A written questionnaire was distributed to all physician members (n = 147) of the American Uveitis Society in 2001 about treatment practices for ocular toxoplasmosis.

b A typical case was defined as an immunocompetent male or nonpregnant female patient with a lesion threatening the macula or optic nerve head, who has decreased vision but potential for full recovery of central vision.

c All drug combinations cited by more than one respondent in 2001 survey.

d Use of folinic acid was mentioned by some, but not all, respondents for these regimens in the 2001 survey.

e Referred to by some clinicians as ‘classic therapy.’

f Referred to by some clinicians as ‘quadruple therapy.’

g The use of folinic acid was not specifically mentioned by respondents for this regimen.

Abbreviation: TMP/SMX, trimethoprim-sulfamethoxazole.