Objective:

To review the clinical presentation, diagnosis, and management of ocular toxoplasmosis in people with systemic immunocompromise.

Approach:

• Literature review: Elke Kreps and colleagues identified 133 relevant articles, including 109 reports with clinical data on 276 immunocompromised patients and 345 affected eyes.
• Population: HIV was the most common cause of immunocompromise, accounting for 60.9% of cases.

Key Findings:

• Visual disturbance was reported in 91.8% of eyes with symptom data. Among eyes with presenting acuity reported, 76.4% had acuity of 6/15 or worse and 55.7% had acuity of 6/60 or worse; eight had no light perception.
• Presentations were variable and often lacked pre-existing retinochoroidal scars. Macular or peripapillary involvement was reported in 77.4% of eyes with lesion-location data.
• Multifocal lesions occurred in 41.3% of eyes and could be large or diffuse, mimicking acute retinal necrosis or cytomegalovirus retinitis.
• The initial diagnosis was missed in more than half of published cases with sufficient clinical information.
• Treatment regimens varied; pyrimethamine plus sulfadiazine was the most commonly reported combination.

Interpretation:

The review describes ocular toxoplasmosis in immunocompromised patients as potentially atypical and aggressive. The authors highlight ocular-fluid molecular analysis in atypical cases and consider any active toxoplasmic retinal lesion an indication for systemic antiparasitic therapy.

Limitations:

• The evidence was drawn from published literature, including clinical reports, rather than a single prospective study.
• Data were not available for every outcome; denominators varied across reported findings.

Conclusion:

The authors suggest routine immune-status stratification in clinical studies to improve understanding of how different forms of immunodeficiency affect presentation, diagnosis, and treatment.

Sources:

• Article context provided by the user; review published in Progress in Retinal and Eye Research