Clinical profile of ocular toxoplasmosis in the Universiti Sains Malaysia Hospital – 7-year review

Background
Toxoplasmosis is caused by infection from a ubiquitous obligate intracellular parasite known as Toxoplasma gondii, which can infect both human and warm-blooded animals. This infection is commonly prevalent in developing country.

Objectives
The purpose of this study is to report on a 7-year review of ocular toxoplasmosis patients that presented to the Universiti Sains Malaysia Hospital.

Material and methods
This is a retrospective review of cases. The demographic data, ocular manifestations, clinical and laboratory profiles, treatment and disease outcome were collected from the patients’ medical records from January 2010 to December 2016.

Results
A total of 16 patients with a diagnosis of ocular toxoplasmosis were identified. The mean age was 43.2, with standard deviation ± 15.4 years old. The percentage was 62.5% (10 patients) females and 37.5% (6 patients) male. The majority of patients were Malay (93.4%, 15 patients). The most common classification of uveitis was panuveitis (56.3%, 9 patients), followed by posterior uveitis (25%, 4 patients), anterior uveitis (12.5%, 2 patients) and intermediate uveitis (6.2%, 1 patient). Keratic precipitate (75%, 12 patients) and vitritis (75%, 12 patients) were the most common ocular manifestation of ocular toxoplasmosis. A serological test for toxoplasmosis found only 1 patient with positive serum immunoglobulin M, while all patients displayed non-reactive serum immunoglobulin G (except 1 missing data). All ocular toxoplasmosis patients were treated with oral Azithromycin 500 mg daily for 6 weeks, 81.3% (13 patients) were given an instillation of a steroid eye drop, while 25% (4 patients) required administration of an oral steroid. All of the patients responded well to treatment, but 25% (4 patients) suffered from recurrence, which required a second course of treatment.

Conclusions
Ocular toxoplasmosis is a serious and depilating disease that can cause serious ocular morbidities. This review shows a diverse presentation of ocular toxoplasmosis as a result of toxoplasmosis infection.