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Klin Monbl Augenheilkd 2016; 233(04): 534-539
DOI: 10.1055/s-0041-111821
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Ocular Toxoplasmosis: an Update

Aktuelles zur okulären Toxoplasmose
J. G. Garweg
Clinic for Vitreoretinal Diseases and Uveitis, Berner Augenklinik am Lindenhofspital, Swiss Eye Institute, Bern and Rotkreuz, and University of Bern, Switzerland
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Publication History

Publication Date:
26 April 2016 (online)

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Abstract

Introduction: Although the seroprevalence of toxoplasmosis has undergone a progressive 50 % decline during the past 20 years, the disease remains an economically important health hazard in many countries. Ocular toxoplasmosis (OT) is the most frequent cause of infectious posterior uveitis, and new insights into its pathophysiology have paved the way for new therapeutic strategies. Methods: This review summarises recent insights into the disease, its clinical manifestations and therapeutic options. The data have been gleaned from a PubMed search, which was conducted in August 2015 using the key term “ocular toxoplasmosis”. Results: A laboratory confirmation of the diagnosis serves as the basis for estimating the clinical burden of OT. This is more severe in South America than in Europe, due to the higher incidence of the more virulent New World parasitic strains. It is not yet possible to differentiate between acquired and congenital cases in most patients. However, in elderly individuals, clinical manifestations of acquired OT are more frequently encountered and in atypical forms. Although inflammation may initially be more pronounced in acquired than in congenital cases of OT, the final visual acuity is usually better and the risk of recurrence lower. Amongst the numerous therapeutic options, none is clearly superior. In immunocompromised individuals and in those with frequent recurrences, prophylactic measures should be considered. Conclusion: OT is still a potentially vision-threatening affection, namely in elderly individuals with acquired disease and in those patients harbouring the more aggressive New World strains of the parasite. Owing to the limitations in diagnostic sensitivity and therapeutic efficacy, treatment strategies have to be tailored to the individual needs.

Zusammenfassung

Hintergrund: Die Seroprävalenz der Toxoplasmose ist in den letzten zwanzig Jahren in Europa und den USA um 50 % zurückgegangen. Wegen der oft erheblichen organischen Folgeschäden stellt die Infektion in vielen Ländern aber weiterhin ein relevantes gesundheitsökonomisches Problem dar. Die okuläre Toxoplasmose (OT) ist die häufigste Ursache der infektiösen posterioren Uveitis, weshalb hier Neues zu Pathophysiologie und therapeutischen Optionen berichtet wird. Methoden: Diese Übersicht basiert auf den in den letzten drei Jahren gewonnenen Erkenntnissen zu den klinischen Manifestationen und therapeutischen Optionen der OT anhand einer Literatursuche in PubMed mit den Schlüsselwörtern „ocular“ und „toxoplasmosis“. Ergebnisse: Die Bestätigung der klinischen Diagnose mittels Laboruntersuchungen bietet die Basis für die Einschätzung der Infektions-bedingten gesundheitlichen Schäden. Diese sind in Europa deutlich weniger schwerwiegend als in Südamerika infolge der höheren Virulenz der Stämme aus der Neuen Welt. Eine Differenzierung zwischen angeborener und erworbener Infektion anhand von Laboranalysen ist weiterhin nicht möglich. Die erworbene OT zeigt schwerere Verläufe als die kongenitale, insbesondere bei älteren oder immunkompromittierten Personen. Obwohl die Entzündungsreaktion bei erworbener OT anfangs schwerer ist, ist eine bleibende Visusminderung seltener. Keine der verfügbaren Antibiotika-Therapien ist den Alternativen eindeutig überlegen, eine Monotherapie mit Steroiden ohne antibiotische Abdeckung ist jedoch kontraindiziert. Eine Rezidivprophylaxe sollte bei immunkompromittierten Patienten und häufigen Rezidiven erwogen werden. Schlussfolgerung: Die OT sollte als Differenzialdiagnose bei atypischer Präsentation einer posterioren Uveitis bedacht werden, insbesondere bei älteren Individuen mit möglicherweise kürzlich erworbener Toxoplasmose und bei lateinamerikanischer Herkunft. Bei nicht optimaler diagnostischer Sensitivität und begrenzten therapeutischen Möglichkeiten sollte sich die diagnostische und therapeutische Strategie an der individuellen Situation orientieren.

Key words

ocular toxoplasmosis - pathophysiology - burden of disease - diagnostics - therapy - prophylaxis - review

Schlüsselwörter

okuläre Toxoplasmose - Parasiten-Virulenz - Epidemiologie - Pathophysiologie - Krankheits-Manifestationen - krankheitsbedingter Schaden - Diagnostik - Therapie - Prophylaxe - Review
 

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