Profilaxia de Toxo Taiwan

belcardoso@hotmail.com

Toxoplasmosis Profilaxis

www.iohc.com.br

Average Interval Between Acute Episose

and Recurrence: 263 days

(around 9 months)

Isabel Habeyche Cardoso

Trimethoprim-Sulfamethoxazole Versus Placebo in Reducing the Risk of Toxoplasmic Retinochoroiditis Recurrences: A Three-Year Follow-up. Felix, JP et al. Am J Ophthalmol , 2016.

Porto Alegre, RS

Brazil

METHANALYSIS

Toxoplamosis: endemic in Brazil

Toxoplasmosis Profilaxis:

3 years follow-up

Zhang Y, Lin X, Lu F. Current treatment of ocular toxoplasmosis in immunocompetent patients: a network meta-analysis. Acta tropica. 2018;185,52-62.

Trimethoprim Sulfamethoxazole Versus Placebo in Reducing the Risk of Toxoplasmic Retinochoroiditis Recurrences: A Three-Year Follow-up. Felix, et al. Am J Ophthalmol , 2016.

METHANALYSIS

SMT+TMT > PYRIMETHAMINE/SULFADIAZINE > CLINDAMYCIN > AZITHROMYCIN > PLACEBO

Zhang Y, Lin X, Lu F. Current treatment of ocular toxoplasmosis in immunocompetent patients: a network meta-analysis. Acta tropica. 2018;185,52-62.

Special thanks to

Dr João Paulo Felix

Silveira C, Belfort R Jr, Muccioli C, Holland GN, Victora CG, Horta BL, Yu F, Nussenblatt RB. The effect of long-term intermittent trimethoprim/sulfamethoxazole treatment on recurrences of toxoplasmic retinochoroiditis. Am. J. Ophthalmol. 2002;134,41-46.

Felix JP, Lira RP, Zacchia RS, Toribio JM, Nascimento MA, Arieta CE. Trimethoprim-Sulfametoxazole versus Placebo to reduce the risk of recurrences of Toxoplasma gondii retinochoroiditis: Randomized Controlled Clinical trial. Am. J. Ophthalmol. 2014;157,762-766.

Toxoplasmosis Macular Scar

3%: Side Effects

Sulfamethoxazole/Trimethoprim

* Low cost

* Good tolerance

Holland GN, Lewis KG. An update on current practices in the management of ocular toxoplasmosis. Am. J. Ophthalmol. 2002;134,102-14.

* SMX-TMP

* To be used for 1 year >>> long term effect

* Reduces recurrence of toxoplasmic chorioretinitis

* Imunocompetent patients

Toxoplasmosis Profilaxis

Indications?

Lenght of treatment??

Toxoplasmosis Profilaxis

Soheilian M, et al. Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis. Ophthalmology. 2005;112,1876-1882.

Posology??

Drug??

Toxoplasmosis Profilaxis:

1 year follow-up

Outbreaks

X

SMT+TMP 800/160

every other day

Placebo

every other day

SANTA ISABEL

BRAZIL

ATLANTA

USA

SANTA MARIA

BRAZIL

VICTORIA

CANADA

2018

2001

1995

1977

Year

>900

>100

>450

37

Infected

Ocular

lesions

10%

21%

12%

4%

water

Source

water

dust

water

0 (0%) recurrence

in 46 patients

6 (12,80%) recurrence

in 47 patients

p=0,03

AVOID CONGENITAL TOXOPLASMOSIS!!

Monthly, if IgG -

* Supresses cysts occasional proliferation

* Host control

* Treats before having a clinical lesion

* Long term effect: decreases cyst viability

When the second eye is affected...

Felix JP, Lira RP, Cosimo AB, Costa RL, Nascimento MA, Arieta CE. Trimethoprim-Sulfametoxazole versus Placebo to reduce the risk of toxoplasmic retinochoroiditis recurrences: A three-year follow-up. Am. J. Ophthalmol. 2016;157,762-766.

Erechim:

Rio Grande do Sul

IgG + 85%