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Azithromycin Monotherapy in Pediatric Patients with Primary Toxoplasma Retinochoroiditis: A Report from Egypt
Alaa Radwan, MD
Alaa E. Radwan, Amin RM
President of Egyptian Uveitis Society, Egypt
Cortoba Eye Centre, Cairo, Egypt
Department of Ophthalmology, Alexandria University, Egypt
Barts and the London NHS Trust, London, UK
Purpose: Toxoplasma gondii is an intracellular protozoan endemic throughout the world. Its prevalence will vary in different regions, but it is considered to be the most common cause of infectious posterior uveitis in humans. Most cases of toxoplasma retinitis are believed to be secondary to postnatal acquired infections. It appears that there is no consensus on standard therapy for ocular disease despite a number of case series and a few randomized trials. This study was conducted to evaluate the efficacy and safety of azithromycin for the treatment of acquired ocular toxoplasmosis in pediatric patients.
Methods: This is a prospective study where patients with sight-threatening primary acquired ocular toxoplasmosis under 18 years of age were treated with azithromycin 250 mg/day for 6 weeks and followed up for a minimum of one year. Demographic data, clinical findings on ophthalmic examination, recurrence rates, and systemic side effects were recorded.
Results: 11 patients were recruited for the study. In the absence of facilities for molecular analysis, the diagnosis was presumed based on the characteristic fundus findings of focal necrotizing retinitis or retinochoroiditis and positive serology for toxoplasma using quantitative ELISA or hemagglutination tests. The disease was considered as primary ocular toxoplasmosis in the absence of associated retinochoroidal scars in either eye.
All eyes were treated for inflammatory lesions along the vascular arcades, retinitis in proximity to the macula or optic disc, or severe intraocular inflammation. Mean duration to resolution of the inflammation and scarring of the lesions was 5.3 weeks. None of the patients had a recurrence over the follow up period, and none showed treatment related side effects. A 14 year old girl had declined treatment and was lost to follow up, but returned at 5 months with enlargement of the macular lesion and irreversible loss of vision to extensive scarring.
Conclusion: Azithromycin appears to be a safe and effective treatment option for primary acquired ocular toxoplasma in children. Large randomized clinical studies are still needed to compare the efficacy of one treatment option over the other.