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Toxoplasmose ocular : série de casos de um centro terciário
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Introdução: A toxoplasmose ocular é a manifestação oftalmológica da infeção sistémica pelo parasita Toxoplasma Gondii. Caracteriza-se por uma inflamação local acentuada, principalmente da retina e da coroide e, apesar de não ser uma doença comum, é a principal causa de uveíte posterior a nível mundial. Em Portugal, não existem dados oficiais sobre a prevalência ou apresentação clínica desta patologia. Objetivo: Este estudo teve como objetivo analisar dados clínicos e epidemiológicos de doentes com toxoplasmose ocular, seguidos em Portugal. Métodos: Análise restrospetiva de uma série de casos. A amostra foi composta por 26 doentes, seguidos em consulta oftalmológica especializada, de inflamação ocular, num centro de referência terciário, entre janeiro de 2018 e janeiro de 2021. Resultados: Estudaram-se 28 olhos com lesões causadas pelo Toxoplasma Gondii, 24 com lesões em fase ativa. Nestes últimos, o tempo de seguimento foi, em média, de 224 dias. O diagnóstico foi clínico em 81% dos casos. O tratamento de eleição foi a combinação de sulfametoxazol e trimetoprim com corticoide sistémico, em que 14 doentes completaram o esquema terapêutico (grupo A). Os restantes 9 doentes não tinham completado o esquema terapêutico à data da colheita dos dados (Grupo B). No exame objetivo registado, observou-se melhoria das acuidades visuais, da inflamação da câmara anterior e do vítreo. Conclusão: O seguimento nas consultas e a terapêutica com a combinação de sulfametoxazol e trimetoprim com corticoide sistémico, durante pelo menos 3 semanas, mostrou ter eficácia no tratamento da toxoplasmose ocular. A eficácia foi superior nos doentes do grupo A, com tempos de tratamento superiores. A diferença foi estatisticamente significativa na acuidade visual (grupo A, p<0.001), na presença de células da câmara anterior (grupo A, p <0.001; grupo B, p=0.008) e na presença de células no vítreo (grupo A, p<0.001; grupo B, p=0.006).
Introduction: Ocular toxoplasmosis is the ophthalmological manifestation of the systemic infection caused by the parasite Toxoplasma Gondii. It is characterized by a severe local inflammation, mostly of the retina and choroid. Although it isn’t a common disease, it is the main cause of posterior uveitis worldwide. In Portugal, official data about the prevalence and clinical presentation of this disease does not exist. Objective: This study has the objective of analyzing clinical and epidemiological data of patients with ocular toxoplasmosis, with follow-up in Portugal. Methods: Retrospective analysis of a series of cases. The sample had 26 patients, followed by ophthalmologists specialized in ocular inflammation, in a tertiary referral center, between January 2018 and January 2021. Results: 28 eyes with lesions caused by Toxoplasma Gondii were studied, 24 of those lesions were active. In these 24, the mean time of follow-up was 224 days. The diagnosis was clinical in 81% of the cases. The chosen treatment was the combination of sulfamethoxazole and trimethoprim with systemic corticoid. Fourteen of the patients completed the therapeutic plan (group A). The other 9 still hadn’t completed the therapeutic plan when the data was collected (group B). In the registered clinical exam, there was seen an improvement in visual acuity, inflammation of the anterior chamber and of the vitreous. Conclusion: The follow-up and treatment with the combination of sulfamethoxazole and trimethoprim with systemic corticoid, for at least 3 weeks, showed to be effective in the treatment of ocular toxoplasmosis. This effect was superior for the patients of group A, who had longer treatment times. The difference was statistically significant in the visual acuity (group A, p <0.001), in the presence of cells in the anterior chamber (group A, p <0.001; group B, p=0.008) and in the presence of cells in the vitreous (group A, p<0.001; group B, p=0.006).
Introduction: Ocular toxoplasmosis is the ophthalmological manifestation of the systemic infection caused by the parasite Toxoplasma Gondii. It is characterized by a severe local inflammation, mostly of the retina and choroid. Although it isn’t a common disease, it is the main cause of posterior uveitis worldwide. In Portugal, official data about the prevalence and clinical presentation of this disease does not exist. Objective: This study has the objective of analyzing clinical and epidemiological data of patients with ocular toxoplasmosis, with follow-up in Portugal. Methods: Retrospective analysis of a series of cases. The sample had 26 patients, followed by ophthalmologists specialized in ocular inflammation, in a tertiary referral center, between January 2018 and January 2021. Results: 28 eyes with lesions caused by Toxoplasma Gondii were studied, 24 of those lesions were active. In these 24, the mean time of follow-up was 224 days. The diagnosis was clinical in 81% of the cases. The chosen treatment was the combination of sulfamethoxazole and trimethoprim with systemic corticoid. Fourteen of the patients completed the therapeutic plan (group A). The other 9 still hadn’t completed the therapeutic plan when the data was collected (group B). In the registered clinical exam, there was seen an improvement in visual acuity, inflammation of the anterior chamber and of the vitreous. Conclusion: The follow-up and treatment with the combination of sulfamethoxazole and trimethoprim with systemic corticoid, for at least 3 weeks, showed to be effective in the treatment of ocular toxoplasmosis. This effect was superior for the patients of group A, who had longer treatment times. The difference was statistically significant in the visual acuity (group A, p <0.001), in the presence of cells in the anterior chamber (group A, p <0.001; group B, p=0.008) and in the presence of cells in the vitreous (group A, p<0.001; group B, p=0.006).
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Toxoplasmose ocular Uveíte Retinocoroidite Diagnóstico Tratamento Acuidade visual Câmara Anterior Vítreo Oftalmologia