Rezidivprophylaxe bei okulärer Toxoplasmose

Zusammenfassung

Hintergrund Die okulare Toxoplasmose (OT) führt bei einem hohen Anteil der Patienten zu bleibenden Sehstörungen. Eine Kombination von Antibiotika und Kortikosteroiden verringert möglicherweise das Risiko einer dauerhaften Sehbehinderung und kann ein erneutes Auftreten verzögern. In dieser Übersicht fassen wir den aktuellen Kenntnisstand zur Rezidivprophylaxe der OT zusammen.

Methode Grundlage dieser auf Expertenbewertung basierten Übersichtsarbeit bildet eine Literatursuche in PubMed mit den Schlüsselwörtern (MeSH terms) „human ocular toxoplasmosis“ oder „retinochoroiditis“ und „recurrence“ und „prophylaxis“ oder „prevention“. Unter den resultierenden Publikationen wurden Fallserien mit mehr als 20 Patienten, prospektive klinische Studien sowie Metaanalysen berücksichtigt, die innerhalb der letzten 25 Jahre publiziert wurden, außerdem darin erwähnte weitere Publikationen, und basierend auf der Erfahrung der Autoren bewertet.

Ergebnisse Die Häufigkeit von Rezidiven unterscheidet sich nicht zwischen Lateinamerika, Nordamerika und Europa, liegt in den ersten beiden Jahren bei etwa 12 – 15% und nimmt danach ab, wobei Rezidive bis 49 Jahre nach einer aktiven Affektion beobachtet wurden. Nach 2 placebokontrollierten Doppelblindstudien aus Brasilien, wo besonders schwerwiegende Rezidive auftreten, kann eine Antibiotikaprophylaxe mit Trimethoprim 160 mg kombiniert mit Sulfamethoxazol 800 mg (Cotrim forte) 3-mal pro Woche über 12 Monate das Auftreten von Rezidiven über bis zu 3 Jahre von 22 auf 3% senken. Danach ist die Rezidivwahrscheinlichkeit so hoch wie bei Patienten, die keine Prophylaxe erhalten haben.

Schlussfolgerung Rezidive können wirkungsvoll unterdrückt werden, wenn dies medizinisch indiziert ist, insbesondere bei zentraler Lage der Läsionen, unzureichender Immunkompetenz und häufigen Rezidiven. Die Prophylaxe sollte für mindestens 12 Monate durchgeführt werden, da das Rezidivrisiko in den ersten beiden Jahren am höchsten ist.

Abstract

Background Ocular toxoplasmosis (OT) leads to permanent visual disturbances in a high proportion of patients. A combination of antibiotics and corticosteroids may reduce the risk of permanent visual impairment and may delay recurrence. In this overview, we summarise the current state of knowledge regarding the recurrence prophylaxis of OT.

Method The basis of this review is a literature search in PubMed with the key words (MeSH terms) “human ocular toxoplasmosis” or “retinochoroiditis” and “recurrence” and “prophylaxis” or “prevention”. The resulting publications included case series with more than 20 patients, prospective clinical studies and meta-analyses published within the last 25 years, as well as other publications mentioned therein, and was evaluated on the basis of the experience of the authors.

Results The frequency of recurrences does not differ between Latin America, North America and Europe, and is around 12 – 15% in the first two years and then decreases, with recurrences observed up to 49 years after an active infection. According to two placebo-controlled double-blind studies from Brazil, where particularly serious relapses occur, antibiotic prophylaxis with 160 mg trimethoprim combined with 800 mg sulfamethoxazole three times a week for 12 months can reduce the occurrence of relapses from 22 to 3% for up to three years. After that, the likelihood of recurrence is as high as in patients who have never received prophylaxis.

Conclusion Relapses can be effectively prevented, if this is medically indicated. Among other considerations are central location of the lesion, insufficient immune competence and frequent relapses. Prophylaxis should be carried out for at least 12 months, since the risk of recurrence is highest in the first two years.

Schlüsselwörter

okulare Toxoplasmose - Prävention - Therapie - Uveitis

Key words

ocular toxoplasmosis - prevention - therapy - uveitis

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