Étude des poussées cliniques évolutives et des rebonds sérologiques d'enfants atteints de toxoplasmose congénitale et suivis durant les 2 premières années de vie

Serological rebound in congenital toxoplasmosis: long-term follow-up of 133 children

“…However, given the rarity of this event, this ®nding needs to be con®rmed on a larger scale before it can be used as a reliable predictive factor in a clinical setting. Our ®nding that administration of pyrimethamine/sulphadoxine between 2±12 months of age decreased the short-term risk of rebound was consistent with previously reported ®ndings [1,7]. Interestingly, unlike these studies, we did not observe a preventive eect of maternal treatment.…”

“…Our ®nding, over a mean period of 7 years, that children with rebound had no increased risk for later development of ocular lesions than those with no rebound was consistent with several other studies [1,5,7,12]. Because we had data on treated as well as untreated children, we could go further and show that additional treatment did not aect rebound duration or ophthalmological outcome.…”

“…Comparison with published estimates (ranging from 58% to 97%) should take into account several factors. First, the definition used for rebounds varies widely, with the highest frequencies (87%, 90%) found, not surprisingly, in studies in which the de®nition was based on IgG as well as on IgM and IgA [7,12]. Our de®nition was based on IgG alone because detection of speci®c anti-toxoplasma IgG is standard procedure in all centres that use serological testing to monitor children with congenital toxoplasmosis, and because this is the ®rst isotype to alter when a secondary immune response occurs.…”

“…In congenitally-infected children, a sudden rise in antibodies, termed serological rebound, is a wellknown phenomenon and may occur irrespective of the clinical status of the infected child and the type of treatment regimen prescribed. Although several studies of serological rebound have been reported, comparison of ®ndings is dicult due to wide variations in the number of children studied (63 to 320), severity of infection (5% to 100% of children with clinical signs), treatment protocols, mean duration of follow-up (18 months to 7 years), techniques used to detect antibodies, de®nition of the rebound (based on IgG alone and/or IgM or IgA), and the frequency of rebounds (58% to 97%) [1,2,4,5,7,10,12]. Also, the underlying mechanism of serological rebound, which has been alternatively attributed to reactivation of the parasite [7,10,12], re-expression of the Toxoplasma antigen [5], and to a delay in the speci®c immune response [2,4,5], remains uncertain.…”

“…Consequently, current clinical recommendations for the management of serological rebound vary. More frequent monitoring [12], prescribing an additional 3- [7] or 6-month [2] course of treatment, and refraining from any change in the routine protocol [5] have been proposed. However, to our knowledge, there are no published reports comparing outcomes among children who have been managed in accordance with each of these recommendations to determine the optimal management strategy in patients with serological rebound.…”