• Iskren Kaftandjiev National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria, Department of Parasitology and Tropical Medicine
  • Rumen Harizanov National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria, Department of Parasitology and Tropical Medicine




ocular toxoplasmosis, diagnosis, treatment


Toxoplasmosis in humans is a zoonotic parasitic disease caused by a ubiquitous protozoan, Toxoplasma gondii. Toxoplasmosis is an opportunistic infection that can cause serious damage in immunocompromised patients. While in the non-immunocompromised individuals it is most often latent and asymptomatic, about one-third of the world’s population is estimated to be infected. Toxoplasmosis is the most common cause of posterior uveitis in non-immunocompromised individuals and the second most common cause of chorioretinitis after cytomegalovirus infection in people with HIV / AIDS. The infection can be acquired congenitally or postnatally and ocular lesions may present during or years after the occurance of the acute infection. Molecular biology techniques to diagnose ocular toxoplasmosis have been available for many years and are now accessible as standard laboratory tests in many countries. Aqueous humor or vitreous evaluation to detect parasite DNA by polymerase chain reaction or specific antibodies may provide evidence for diagnosis. Oral pyrimethamine and sulfadiazine plus corticosteroids are an effective therapy for ocular toxoplasmosis. Recent data supports the use of other treatment options, including intravitreal antibiotics. The aim of the present review is to discuss briefly the new diagnostic and treatment approaches for ocular toxoplasmosis.


Holland GN. Ocular toxoplasmosis: a global reassessment. Part I: Epidemiology and course of disease. Am J Ophthalmol 2003; 136: 973-988.

Subauste CS, Ajzenberg D, Kijlstra A. Review of the series ‘Disease of the year 2011: toxoplasmosis’ pathophysiology of toxoplasmosis. Ocul Immunol Inflamm 2011; 19: 297-306.

Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: from animals to humans. Int J Parasitol 2000; 30: 1217-1258.

McCannel CA, Holland GN, Helm CJ, et al: Causes of uveitis in the general practice of ophthalmology. UCLA Community-Based Uveitis Study Group. Am J Ophthalmol 1996; 121: 35–46.

Balasundaram MB, Andavar R, Palaniswamy M, Venkatapathy N: Outbreak of acquired ocular toxoplasmosis involving 248 patients. Arch Ophthalmol 2010; 128: 28–32.

Perkins ES: Ocular toxoplasmosis. Br J Ophthalmol 1973; 57: 1–17.

Atmaca LS, Simsek T, Batioglu F: Clinical features and prognosis in ocular toxoplasmosis. Jpn J Ophthalmol 2004; 48: 386–391.

Bosch-Driessen LE, Berendschot TT, Ongkosuwito JV, Rothova A: Ocular toxoplasmosis: clinical features and prognosis of 154 patients. Ophthalmology 2002; 109: 869–878.

Kim SJ, Scott IU, Brown GC, et al: Interventions or toxoplasma retinochoroiditis: a report by the American Academy of Ophthalmology. Ophthalmology 2013; 120: 371–378.

Harrell M, Carvounis PE: Current treatment of toxoplasma retinochoroiditis: an evidencebased review. J Ophthalmol 2014; 2014: 273506.

Montoya JG, Liesenfeld O: Toxoplasmosis. Lancet 2004; 363: 1965–1976.

Cem Ozgonul, Cagri Giray Besirli: Recent Developments in the Diagnosis and Treatment of Ocular Toxoplasmosis. Review. Ophthalmic Res 2017;57:1–12, DOI: 10.1159/000449169.

Maenz M, Schluter D, Liesenfeld O, et al: Ocular toxoplasmosis past, present and new aspects of an old disease. Prog Retin Eye Res 2014; 39: 77–106.

Dubey JP, Jones JL: Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 2008; 38: 1257–1278.

Robert-Gangneux F, Dardé ML: Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev 2012; 25: 264–296.

Howe DK, Sibley DL 1995. Toxoplasma gondii comprises three clonal lineages: correlation of parasite genotype with human disease. J Infect Dis 172: 1561-1566.

Belfort-Neto R, Nussenblatt V, Rizzo L, Muccioli C, Silveira C, Nussenblatt R, Khan A, Sibley LD, Belfort R Jr 2007. High prevalence of unusual genotypes of Toxoplasma gondii infection in pork meat samples from Erechim, Southern Brazil. An Acad Bras Cienc 79: 111-114.

Nowakowska D, Colón I, Remington JS, Grigg M, Golab E, Wilczynski J, Sibley LD 2006. Genotyping of Toxoplasma gondii by multiplex PCR and peptide-based serological testing of samples from infants in Poland diagnosed with congenital toxoplasmosis. J Clin Microbiol 44: 1382-1389.

Howe DK, Honoré S, Derouin F, Sibley LD 1997. Determination of genotypes of Toxoplasma gondii strains isolated from patients with toxoplasmosis. J Clin Microbiol 35: 1411-1414.

Holland GN: Ocular toxoplasmosis: the influence of patient age. Mem Inst Oswaldo Cruz 2009; 104: 351–357.

Dodds EM, Holland GN, Stanford MR, et al. Intraocular inflammation associated with ocular toxoplasmosis: relationships at initial examination. Am J Ophthalmol 2008; 146: 856 865. e2.

Nguyen AM, Seve P, Le Scanff J, et al: Clinical and etiological aspects of uveitis: a retrospective study of 121 patients referred to a tertiary centre of ophthalmology (in French). Rev Méd Interne 2011; 32: 9–16.

Jakob E, Reuland MS, Mackensen F, et al: Uveitis subtypes in a German interdisciplinary uveitis center – analysis of 1,916 patients. J Rheumatol 2009; 36: 127–136.

Furtado JM, Winthrop KL, Butler NJ, Smith JR: Ocular toxoplasmosis. I. Parasitology, epidemiology and public health. Clin Exp Ophthalmol 2013; 41: 82–94.

Guerina NG, Hsu HW, Meissner HC, et al: Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection. The New England Regional Toxoplasma Working Group. N Engl J Med 1994; 330: 1858–1863.

Webster JP, Lamberton PH, Donnelly CA, Torrey EF: Parasites as causative agents of human affective disorders? The impact of antipsychotic, mood-stabilizer and anti-parasite medication on Toxoplasma gondii ’s ability to alter host behaviour. Proc Biol Sci 2006; 273: 1023–1030.

Vasconcelos-Santos DV, Machado Azevedo DO, Campos WR, et al: Congenital toxoplasmosis in southeastern Brazil: results of early ophthalmologic examination of a large cohort of neonates. Ophthalmology 2009; 116: 2199–2205. e1.

Safadi MA, Berezin EN, Farhat CK, Carvalho ES: Clinical presentation and follow-up ofchildren with congenital toxoplasmosis in Brazil. Braz J Infect Dis 2003; 7: 325–331.

Berrebi A, Assouline C, Bessieres MH, et al: Long-term outcome of children with congenital toxoplasmosis. Am J Obstet Gynecol 2010; 203: 552. e1–6.

Barbara A. Butcher, Barbara A. Fox, Leah M. Rommereim, Sung Guk Kim, Kirk J. Maurer, Felix Yarovinsky, De’Broski R. Herbert, David J. Bzik, Eric Y. Denkers. Toxoplasma gondii Rhoptry Kinase ROP16 Activates STAT3 and STAT6 Resulting in Cytokine Inhibition and Arginase-1-Dependent Growth Control. PLoS Pathog, 2011 Sep;7(9):e1002236. doi: 10.1371/journal.ppat.1002236.

Shimada K, O'Connor GR, Yoneda C. Cyst formation by Toxoplasma gondii (RH strain) in vitro. The role of immunologic mechanisms. Arch Ophthalmol 1974; 92: 496-500.

Brézin AP, Kasner L, Thulliez P, Li Q, Daffos F, Nussenblatt RB, Chan CC. Ocular toxoplasmosis in the fetus. Immunohistochemistry analysis and DNA amplification. Retina 1993; 14: 19-26.

Ryan SJ. Retina. 3rd ed. St. Louis, USA, Mosby. 2001, p 1531-1544.

Dodds EM: Toxoplasmosis. Curr Opin Ophthalmol 2006; 17: 557–561.

Mets MB, Holfels E, Boyer KM, et al: Eye manifestations of congenital toxoplasmosis. Am J Ophthalmol 1996; 122: 309–324.

Delair E, Latkany P, Noble AG, et al: Clinical manifestations of ocular toxoplasmosis. Ocul Immunol Inflamm 2011; 19: 91–102.

Park YH, Nam HW: Clinical features and treatment of ocular toxoplasmosis. Korean J Parasitol 2013; 51: 393–399.

Wakefield D, Cunningham ET Jr, Pavesio C, et al: Controversies in ocular toxoplasmosis. Ocul Immunol Inflamm 2011; 19: 2–9.

Alwassia AA, Cho H, Adhi M, et al: Sequential optical coherence tomography images of retinal necrosis in acute ocular toxoplasmosis. Retin Cases Brief Rep 2013; 7: 98–101.

Goldenberg D, Goldstein M, Loewenstein A, Habot-Wilner Z: Vitreal, retinal, and choroidal findings in active and scarred toxoplasmosis lesions: a prospective study by spectral-domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2013; 251: 2037– 2045.

Oréfice JL, Costa RA, Scott IU, et al: Spectral optical coherence tomography findings in patients with ocular toxoplasmosis and active satellite lesions (MINAS Report 1). Acta Ophthalmol 2013; 91:e41–e47.

Noble A. Cataracts in congenital toxoplasmosis. J AAPOS 2007; 11:551-554.

Alessandra G Commodaro, Rubens N Belfort, Luiz Vicente Rizzo, Cristina Muccioli, Claudio Silveira, Miguel N Burnier Jr, Rubens Belfort Jr. Ocular toxoplasmosis - an update and review of the literature. Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 104(2): 345-350, March 2009.

Harper TW, Miller D, Schiffman JC, Davis JL: Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis. Am J Ophthalmol 2009; 147: 140–147.

Rothova A, de Boer JH, Ten Dam-van Loon NH, et al: Usefulness of aqueous humor analysis for the diagnosis of posterior uveitis. Ophthalmology 2008; 115: 306–31.

Suzuki LA, Rocha RJ, Rossi CL: Evaluation of serological markers for the immunodiagnosis of acute acquired toxoplasmosis. J Med Microbiol 2001; 50: 62–70.

Marcolino PT, Silva DA, Leser PG, et al: Molecular markers in acute and chronic phases of human toxoplasmosis: determination of immunoglobulin G avidity by Western blotting. Clin Diagn Lab Immunol 2000; 7: 384–389.

Montoya JG, Remington JS: Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2008; 47: 554–566.

Montoya JG, Huffman HB, Remington JS: Evaluation of the immunoglobulin G avidity test for diagnosis of toxoplasmic lymphadenopathy. J Clin Microbiol 2004; 42: 4627– 463.

Goldmann H, Witmer R: Antibodies in the aqueous humor (in German). Ophthalmologica 1954; 127: 323–330.

De Groot-Mijnes JD, Rothova A, Van Loon AM, et al: Polymerase chain reaction and Goldmann-Witmer coefficient analysis are complimentary for the diagnosis of infectious uveitis. Am J Ophthalmol 2006; 141: 313–318.

Fekkar A, Bodaghi B, Touafek F, et al: Comparison of immunoblotting, calculation of the Goldmann-Witmer coefficient, and real-time PCR using aqueous humor samples for diagnosis of ocular toxoplasmosis. J Clin Microbiol 2008; 46: 1965–1967.

Garweg JG, de Groot-Mijnes JD, Montoya JG: Diagnostic approach to ocular toxoplasmosis. Ocul Immunol Inflamm 2011; 19: 255–261.

Montoya JG, Parmley S, Liesenfeld O, et al: Use of the polymerase chain reaction for diagnosis of ocular toxoplasmosis. Ophthalmology 1999; 106: 1554–1563.

Fardeau C, Romand S, Rao NA, et al: Diagnosis of toxoplasmic retinochoroiditis with atypical clinical features. Am J Ophthalmol 2002; 134: 196–203.

Villard O, Filisetti D, Roch-Deries F, et al: Comparison of enzyme-linked immunosorbent assay, immunoblotting, and PCR for diagnosis of toxoplasmic chorioretinitis. J Clin Microbiol 2003; 41: 3537–3541.

Sugita S, Ogawa M, Inoue S, et al: Diagnosis of ocular toxoplasmosis by two polymerase chain reaction (PCR) examinations: qualitative multiplex and quantitative real-time. Jpn J Ophthalmol 2011; 55: 495–501.

Butler NJ, Furtado JM, Winthrop KL, Smith JR: Ocular toxoplasmosis. II. Clinical features, pathology and management. Clin Exp Ophthalmol 2013; 41: 95–108.

de-la-Torre A, Stanford M, Curi A et al: Therapy for ocular toxoplasmosis. Ocul Immunol Inflamm. 2011, 19(5): 314–20.

Pradhan E, Bhandari S, Gilbert RE, Stanford M. Antibiotics versus no treatment for toxoplasma retinochoroiditis. Cochrane Database Syst Rev. 2016;5:CD002218.

Rajapakse S, Chrishan Shivanthan M, Samaranayake N, Rodrigo C, Deepika Fernando S. Antibiotics for human toxoplasmosis: a systematic review of randomized trials. Pathog Glob Health. 2013;107(4):162–9.

Wakefield D, Cunningham ET, Pavesio C, Garweg JG, Zierhut M. Controversies in ocular toxoplasmosis. Ocul Immunol Inflamm. 2011;19(1):2– 9.

Engstrom RE, Holland GN, Nussenblatt RB, Jabs DA. Current practices in the management of ocular toxoplasmosis. Am J Ophthalmol. 1991;111:601–10.

Gilbert RE, Harden M, Stanford M. Antibiotics versus control for toxoplasma retinochoroiditis. Cochrane Database Syst Rev. 2002(1). Art. No.: CD002218.

Holland GN, Lewis K. An update on current practices in the management of ocular toxoplasmosis. Am J Ophthalmol. 2002;134(1):102–14.

Holland GN. Prospective, randomized trial of trimethoprim/sulfamethoxazole vs. pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis: discussion. Ophthalmology 2005; 112: 1882-1884.

Soheilian M, Sadoughi MM, Ghajarnia M, Dehghan MH, Yazdani S, Behboudi H, Anisian A, Peyman G A. Prospective randomized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis. Ophthalmology 2005; 112: 1876-1882.

Soheilian M, Ramezani A, Azimzadeh A, Sadoughi MM, Dehghan MH, Shahghadami R, Yaseri M, Peyman GA. Randomized trial of intravitreal clindamycin and dexamethasone versus pyrimethamine, sulfadiazine, and prednisolone in treatment of ocular toxoplasmosis. Ophthalmology 2011; 118: 134-141.

Kishore K, Conway MD, Peyman G A. Intravitreal clindamycin and dexamethasone for toxoplasmic retinochoroiditis. Ophthalmic Surg Lasers 2001; 32: 183-192.

Fichera ME, Bhopale MK, Roos DS. In vitro assays elucidate peculiar kinetics of clindamycin action against Toxoplasma gondii. Antimicrob Agents Chemother 1995; 39: 1530-1537.

Peters DH, Friedel HA, McTavish D: Azithromycin. A review of its antimicrobial activity, pharmacokinetic properties and clinical efficacy. Drugs, 1992; 44: 750–99.

Konstantinos Balaskas, Jean Vaudaux, Noémie Boillat-Blanco, Yan Guex-Crosier. Azithromycin versus Sulfadiazine and Pyrimethamine for non-vision-threatening toxoplasmic retinochoroiditis: A pilot study. Med Sci Monit, 2012; 18(5): CR296-302.

Alireza Lashay, Ahmad Mirshahi, Najaf Parandin, Hamid Riazi Esfahani, Mehdi Mazloumi, Mohammad Reza Lashay, Mohammad Karim Johari, Elham Ashrafi. A prospective randomized trial of azithromycin versus trimethoprim/ sulfamethoxazole in treatment of toxoplasmic retinochoroiditis. Journal of Current Ophthalmology 29 (2017) 120-125.

Rothova A, Bosch-Driessen LE, van Loon NH, Treffers WF: Azithromycin for ocular toxoplasmosis. Br J Ophthalmol, 1998; 82: 1306–8

Bosch-Driessen LH, Verbraak FD, Suttorp-Schulten MS et al: A prospective, randomized trial of pyrimethamine and azithromycin vs pyrimethamine and sulfadiazine for the treatment of ocular toxoplasmosis. Am J Ophthalmol, 2002; 134: 34–40

Yazici A, Ozdal PC, Taskintuna I et al: Trimethoprim/Sulfamethoxazole and azithromycin combination therapy for ocular toxoplasmosis. Ocul Immunol Inflamm, 2009; 17: 289–91.

Bosch-Driessen LH, Verbraak FD, Suttorp- Schulten MS, et al: A prospective, randomized trial of pyrimethamine and azithromycin vs pyrimethamine and sulfadiazine for the treatment of ocular toxoplasmosis. Am J Ophthalmol 2002; 134: 34–40.

Oray M, Ozdal PC, Cebeci Z, et al: Fulminant ocular toxoplasmosis: the hazards of corticosteroid monotherapy. Ocul Immunol Inflamm 2015, Epub ahead of print.

Garweg JG, Stanford MR: Therapy for ocular toxoplasmosis – the future. Ocul Immunol Inflamm 2013; 21: 300–305.

Holland GN, Engstrom RE Jr, Glasgow BJ, et al: Ocular toxoplasmosis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 1988; 106: 653–667.

Dunn D, Wallon M, Peyron F, et al: Motherto- child transmission of toxoplasmosis: risk estimates for clinical counselling. Lancet 1999; 353: 1829–1833.




How to Cite

Kaftandjiev, I., & Harizanov, R. (2021). OCULAR TOXOPLASMOSIS: BRIEF LITERATURE REVIEW . PROBLEMS of Infectious and Parasitic Diseases, 49(1), 41–50. https://doi.org/10.58395/pipd.v49i1.51