TREATMENT OF OCULAR TOXAPHSMOSIS WITH ATO VAQUONE IN IMMUNOCOMPETENT PATIENTS

Background In Central Europe ocular toxoplasmosis is the leading cause of posterior uveitis. It is a major cause of severe visual loss and b lindness in young people. Drugs for treatment of active lesions (tachy zoites) have been available for decades but are seen controversial esp ecially because of sometimes serious side effects. These drugs don't s eem to shorten the active inflammation nor the recurrence rate, in par ticular because of the poor effect on the cystic form (bradyzoites). A tovaquone (hydroxynaphthsquinone) is well tolerated systemically and i s effective against tachyzoites and bradyzoites of Toxoplasma gondii s o that we hope to reduce the recurrence rate. Patient history and clin ical findings Two immunocompetent patients with the first and respecti ve second symptomatic recurrence of unilateral active toxoplasmic reti nochorioiditis located within the major temporal vascular arcades were treated with Atovaquone and Fluorocortolone because of an impending l oss of central visual function. Therapy and clinical course Under the treatment with Atovaquone (3 x 750 mg/day) for three weeks and taperin g of the Fluorocortolone the active lesions healed quickly. After a fe w weeks, atrophic and remarkably little pigmented scars remained. No s ide effects were observed. After a period of 7 and respective 11 month s no recurrence occured. Conclusions Atovaquone is an effective and we ll tolerated drug for the treatment of active ocular toxoplasmosis in immunocompetent patients. Its efficacy against tachyzoites and cysts o f Toxoplasma gondii relative to other drugs remains to be determined b y further clinical trials.