Overview
Toxoplasma choroiditis is an ocular manifestation of toxoplasmosis, an infection caused by the parasite Toxoplasma gondii. It typically presents as focal necrotizing retinochoroiditis, often with associated vitritis and anterior uveitis 1.Diagnosis
Diagnosis is primarily clinical, based on characteristic funduscopic findings of focal necrotizing retinochoroiditis 1.
Anterior chamber and vitreous inflammation may be present 1.
Serological testing for Toxoplasma gondii* antibodies can support the diagnosis but may not differentiate between active and past infection 1.
PCR of aqueous or vitreous fluid can be used to detect Toxoplasma gondii* DNA in cases with diagnostic uncertainty 1.Management
Systemic treatment typically involves a combination of an antibiotic (e.g., trimethoprim-sulfamethoxazole) and an anti-inflammatory agent (e.g., corticosteroids) 1.
Clindamycin or azithromycin may be used as alternatives to trimethoprim-sulfamethoxazole 1.
Pyrimethamine is another antibiotic option, often used in conjunction with sulfadiazine and leucovorin 1.
Corticosteroids are used to reduce inflammation and prevent scarring 1.
Treatment duration is typically several weeks to months 1.Special Populations
No information on special populations was provided in the abstracts.Key Recommendations
Systemic treatment for active toxoplasma choroiditis should include an antibiotic regimen (e.g., trimethoprim-sulfamethoxazole) and corticosteroids 1. (Evidence: Moderate)
Consider alternative antibiotic agents such as clindamycin, azithromycin, or pyrimethamine with sulfadiazine and leucovorin if trimethoprim-sulfamethoxazole is not tolerated or effective 1. (Evidence: Moderate)
Diagnostic uncertainty may warrant PCR testing of ocular fluids for Toxoplasma gondii DNA 1. (Evidence: Weak)References
1 MacLaren RE, Fischer MD, Gow JA, Lam BL, Sankila EK, Girach A et al.. Subretinal timrepigene emparvovec in adult men with choroideremia: a randomized phase 3 trial. Nature medicine 2023. link