Outcomes of trimethoprim/ sulfamethoxazole treatment for ocular toxoplasmosis in Congolese patients.

BACKGROUND: Ocular toxoplasmosis (OT) is the leading cause of infectious posterior uveitis in several areas worldwide. The combination of Trimethoprim/Sulfamethoxazole (TMP/SMX) has been presented as an attractive alternative to the "classic' treatment therapy (Pyrimethamine/Sulfadiazine). METHODS: A prospective study was carried out between February 2020 and September 2021 in 2 ophthalmic centers in Kinshasa. This study aimed to describe TMP/SMX treatment outcomes for OT in a cohort of immunocompetent Congolese patients. RESULTS: 54 patients were included, with a mean age at presentation of 37.5 ± 13.6 years old and a Male-Female ratio of 1.45:1. Three patients (5.6%) presented a recurrence during the follow-up period. At the end of the follow-up, improvement in VA and resolution of inflammation concerned 75.9% and 77.5% of patients, respectively. Cataracts (3.7%), macular scars (3.7%), and vitreous opacities (3.7%) were the principal causes of non-improvement in VA. Treatment-related adverse events were present in 10 patients (18.5%); gastrointestinal (14.8%) and dermatological (3.7%) adverse events were the most frequent. Dermatological adverse events led to discontinuation of treatment. CONCLUSION: TMP/SMX regimen appears to be a safe and effective treatment for OT in Congolese patients. The low cost and the accessibility of the molecules make this regimen an option for treating OT in resource-limited countries.

Risk factors for ocular toxoplasmosis among uveitis patients in Kinshasa, DR Congo.

OBJECTIVE: To identify the risk factors associated with ocular toxoplasmosis (OT) in a cohort of Congolese patients with uveitis. METHODS AND ANALYSIS: A cross-sectional study was conducted between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa. Patients with a diagnosis of uveitis were enrolled in the study. Each patient underwent an interview, an ophthalmological examination and serology testing. Logistic regression was performed to identify risk factors for OT. RESULTS: 212 patients were included in the study with a mean age at presentation of 42.1±15.9 years (limits: 8-74 years) and a sex ratio of 1.1:1. OT concerned 96 patients (45.3%). The age of the patients below 60 years (p=0.001, OR=9.75 CI 95% 2.51 to37.80)), the consumption of cat meat (p=0.01, OR=2.65 CI 95% 1.18 to 5.96)) and undercooked meat (p=0.044, OR=2.30 CI 95% 1.02 to 5.21)) and living in rural area (p=0.021, OR=11.4 (CI 95% 1.45 to 89.84])) were identified as risk factors for OT. CONCLUSION: OT affects more young people. It is associated with dietary habits. Informing and educating the population is necessary to avoid infection.

Clinical and Serological Characteristics of Ocular Toxoplasmosis in the Democratic Republic of Congo.

PURPOSE: To describe demographic data, clinical features, and serological profiles in a cohort of Congolese patients with ocular toxoplasmosis (OT). METHOD: Cross-sectional study, carried out between March 2020 and July 2021 in two ophthalmic clinics in Kinshasa. RESULTS: The study comprised 95 participants with OT. Fifty-three patients were male (55.8%). The mean age at presentation was 35.6 ± 14.1 years (range 8-69 years); 71 had active OT (74.7%), among them, 33 had primary OT (46.5%), and 38 had recurrences (53.5%). At presentation, 51 patients (53.7%) had visual impairment (VA < 6/18). Retinochoroidal lesions were located in the central retina in 60 patients (63.1%). Patients with primary OT tend to have higher IgG levels than those with recurrent OT (P = .01). CONCLUSION: We report the largest cohort of patients with OT in sub-Saharan Africa. In our setting, most patients had recurrent OT with multiple, extensive, and central retinochoroidal lesions.

Ocular Toxoplasmosis in Africa: A Narrative Review of the Literature.

PURPOSE: To present a narrative review about ocular toxoplasmosis epidemiology, disease burden and prevalent African parasitic strains. METHODS: An initial search for MeSH terms was conducted with a posterior advanced search in two electronic databases. Full text reading was performed. RESULTS: Animal African studies have identified Toxoplasma gondii type II, type III, Africa 1, and Africa 3 strains. Seroprevalence varies from 6.4% to 74.5%. Nevertheless, there is a scarcity of epidemiology and serotyping information about ocular toxoplasmosis. African studies have demonstrated that uveitis patients present high frequencies of ocular toxoplasmosis. There is a lack of studies describing specific clinical characteristics, which can be related, to environmental and socioeconomic factors, parasite serotype and genotype, and genetic susceptibility of the host. CONCLUSION: As Toxoplasma gondii has more virulent strains in the Southern hemisphere, it is relevant to determine African strain types and the correlation between the infecting strains and the clinical manifestations.

Prevalence and patterns of childhood ocular morbidity in Kinshasa. A population-based study.

Context: Childhood ocular disorders can seriously impact on development and education, future employment opportunities and quality of life, their consequences are especially severe in low resource settings. There is a lack of data on pattern and prevalence of ocular morbidities among children in Democratic Republic of the Congo (DRC). Objective: The aim of this study was to determine the pattern and magnitude of childhood ocular disorders in children in Kinshasa, the capital city of DRC. Methods: A population-based cross-sectional study was conducted from July to August 2017. Children aged less than 16 years old were screened by volunteers in households and those with ocular pathologies were examined by two ophthalmologists. Prevalence and pattern of ocular diseases were determined. Results: A total of 4307 households were visited by the surveyors and 13,197 children were screened. Ocular pathologies were diagnosed among 399 children. Girls represented 50.7% of the children and the mean age ± SD was 9.2 ± 4.1 years. The overall prevalence of ocular morbidity in our population was 3.6% [95% CI 3.3-3.9]. Allergic conjunctivitis was the most frequent pathology (56.2%) followed by refractive errors (27.4%) and strabismus (5%). Age of children was the only risk factor with a significant impact on the frequency of ocular pathology. Forty-five percent of children had never benefited from any treatment, self-medication, and recourse to traditional treatments concerned respectively 18.%, and 2.3% of children. Conclusion: Childhood ocular morbidity in Kinshasa city was dominated by allergic conjunctivitis and refractive errors. The frequency of these conditions varies depending on the age of the children. Very few parents consult medical staff when their children have ocular problems, ignorance and limited financial resources are the principal barriers to consult.

Epidemiology of Childhood Blindness and Low Vision in Kinshasa-democratic Republic of the Congo.

Purpose: To determine the magnitude and causes of blindness and low vision in children in Kinshasa.Methods: A study was conducted to carry out a survey in 96 health areas in Kinshasa city. Children aged less than 16 years old with supposed visual problems (Visual acuity < 6/18) were identified by volunteers and surveyors in households and were thereafter examined by two ophthalmologists. Prevalence and causes of blindness and low vision were determined. For each child, anatomic sites of abnormality, etiologic factors and avoidable causes responsible for visual impairment were considered.Results: Thirty-six children with bilateral visual impairment were identified, including 10 cases of blindness and 26 cases of low vision. The prevalence of blindness and low vision was, respectively, 0.08% [95% CI 0.04-0.14] and 0.19% [95% CI 0.13-0.28].Optic nerve and whole globe were the main anatomical sites responsible for blindness in, respectively, in 30% and 20%. Optic nerve atrophy and glaucoma were the leading causes of childhood blindness. The globe apparently normal (50%), uvea (12%) and cornea (12%) were the most common anatomic site responsible for low vision with refractive errors (42%) and uveitis (12%) as the main causes. Childhood and hereditary factors accounted for, respectively, 16.7% and 13.9% of low vision cases. Visual impairment was due to avoidable causes in 69.4% of children.Conclusion: Damage to the optic nerve and refractive errors were respectively the maincauses of blindness and low vision among children in Kinshasa.