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Okuläre Toxoplasmose

Ocular toxoplasmosis

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Zusammenfassung

Die Toxoplasmose ist eine weltweit auftretende parasitäre Zoonose und ein bedeutendes Problem weltweiter Erblindung. Die Infektion wird durch orale Aufnahme von Oozysten, die durch infizierte Katzen ausgeschieden werden, oder durch Gewebezysten in ungenügend gekochtem und rohem Fleisch erworben. Die primäre Infektion während der Schwangerschaft kann zur kongenitalen Infektion führen. Die okuläre Toxoplasmose ist bei immunkompetenten Patienten die häufigste Ursache einer posterioren Uveitis. Abhängig vom Alter des Patienten variieren die okulären Symptome mit reduzierter Sehschärfe, Strabismus und Nystagmus bei Kleinkindern, während im Erwachsenenalter Visusminderung und Glaskörpertrübungen im Vordergrund stehen. Die aktive toxoplasmotische Retinochorioiditis präsentiert sich typischerweise als grau-weiße Retinitis mit Aderhautbeteiligung, Vaskulitis und Glaskörperinfiltration. Allerdings sind atypische Präsentationen als Neuroretinitis, Papillitis, Fuchs-Heterochromie-Zyklitis, Skleritis und akute Netzhautnekrose möglich. Die Diagnose wird meist aufgrund typischer klinischer Befunde gestellt und kann ggf. durch den Nachweis von Antikörpern oder Toxoplasma-gondii-DNA unterstützt werden. Zur Therapie der Toxoplasmose werden antimikrobielle Substanzen und Kortikosteroide herangezogen. Es werden verschiedene Behandlungsregime mit Kombinationen von v. a. Pyrimethamin, Sulfadiazin, Clindamycin, und Trimethoprim-Sulfamethoxazol verwendet. Die Prognose der okulären Toxoplasmose ist bei immunkompetenten Patienten günstig, sofern nicht die Makula betroffen ist. Die vorliegende Arbeit fasst Epidemiologie, Pathogenese, klinische Präsentation und Behandlung der Toxoplasma-Retinochorioiditis zusammen.

Abstract

Toxoplasmosis is a parasitic zoonosis which occurs worldwide and is an important cause of blindness. The infection is naturally acquired by the ingestion of oocysts excreted by infected cats or by ingestion of tissue cysts in undercooked or raw meat. Primary infection during pregnancy may result in a congenital infection. Toxoplasmic retinochoroiditis is the most common cause of posterior uveitis in immunocompetent patients. Depending on the patient’s age, ocular symptoms vary presenting with reduced visual acuity, strabismus, and nystagmus in young children – in adults decreased vision and floaters are most frequently reported. Active toxoplasmic retinochoroiditis typically presents as grey-white retinal necrosis with choroiditis, vasculitis and vitritis. However, atypical presentations including neuroretinitis, papillitis, Fuchs-like anterior uveitis, scleritis and acute retinal necrosis have been described. The diagnosis is based on clinical findings and can be supported by the detection of antibodies and Toxoplasma gondii DNA. Toxoplasmosis therapy includes antimicrobial drugs and corticosteroids. There are several regimens with different drug combinations including, among others, pyrimethamine, sulfadiazine, clindamycin, and trimethoprim-sulfamethoxazol. The prognosis for ocular toxoplasmosis is favorable in immunocompetent individuals, as long as the central macula is not directly involved. The present article reviews the epidemiology, pathogenesis, clinical presentation and management of toxoplasmic retinochoroiditis.

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  1. Augenklinik, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    U. Pleyer & N. Torun

  2. Toxoplasmose-Beratungslabor für den Bereich Ost-Deutschland, Institut für Mikrobiologie und Hygiene, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland

    O. Liesenfeld

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Pleyer, U., Torun, N. & Liesenfeld, O. Okuläre Toxoplasmose. Ophthalmologe 104, 603–616 (2007). https://doi.org/10.1007/s00347-007-1535-8

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