Longitudinal Study of New Eye Lesions in Children with Toxoplasmosis Who Were Not Treated During the First Year of Life

Abstract

PURPOSE-To determine the incidence of new chorioretinal lesions in children with toxoplasmosis diagnosed after, and therefore not treated during, their first year. RESULTS-Twenty-eight of 38 children had one of the following: diagnosis with serum antibody to T. gondii indicative of chronic infection at age 24 months, central nervous system calcifications, hydrocephalus, illness compatible with congenital toxoplasmosis perinatally but not diagnosed at that time. Twenty-five returned for follow-up during 1981 to 2005. Their mean (range) age at last exam was 10.9 ± 5.7 (range, 3.5 to 27.2) years and mean follow-up was 5.7 ± 2.9 years. Eighteen (72%) children developed at least one new lesion. Thirteen (52%) had new central lesions, 11 (44%) had new peripheral lesions, and six (24%) had both. Thirteen (52%) had new lesions diagnosed at age ≥ 10 years. New lesions were found at more than one visit in four (22%), and bilateral new lesions developed in seven (39%) of 18 children who developed new lesions. Of 10 additional children with eye findings and serologic tests indicative of chronic infection, six returned for follow-up, four (67%) developing new lesions at ≥ 10 years of age. CONGENITAL TOXOPLASMOSIS THAT WAS UNTREATED or treated only for one month has been described in small series of patients as a relapsing, recrudescent disease causing significant visual impairment. 1,2 However, the prospective follow-up into adolescence of chorioretinal lesions in children with congenital toxoplasmosis, other than a small group of those with congenital toxoplasmosis diagnosed at birth and treated during the first year of life, has not been rigorously defined. Herein we describe a cohort of 38 children with toxoplasmosis presenting after one year of age, who were followed prospectively in a single center according to a standardized protocol. DESIGN-Prospective longitudinal cohort study. METHODS-Thirty-eight CONCLUSIONS-More METHODS DESIGN OF STUDYThe children in this study and their mothers were referred by their physicians and evaluated at the University of Chicago by a group of specialists at the onset of enrollment into the study and later at prespecified times: 1, 3.5, 5, 7.5, 10, 15, 20, 25, 30, 35, 40, and 45 years of age. 3, 4 Written informed consent was obtained from all parents or legal guardians of participating minor-age children and/or directly from the patient (if of legal adult age). PATIENT COHORTThis cohort consists of 38 persons who were children at the time of diagnosis of their ocular toxoplasmosis, who, with their mothers, had nonacute serologic tests for Toxoplasma gondii infection at the time their contact with the Chicago Toxoplasmosis Center was initiated. They were not diagnosed until after their first year of life. Patients in this cohort were not treated during their first year of life. All children with active chorioretinitis were treated when this occurred and was detected. It appears that children in the present cohort seem to have much more frequent new lesions than we report in a co...

Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States

“…Alternative approach to anti-Toxoplasma prophylaxis: home/self-monitoring for any signs and symptoms of decreased visual acuity, daily monitoring of visual acuity using home vision test methods (eg, Allen card pictures, print-outs of newspapers, etc), and prompt referral to an ophthalmologist if new symptoms occur are suggested so that treatment can be promptly initiated for any recurrence. 107 As previously discussed, the risk of recurrence of eye disease in the United States: Where the majority of the infants with CT had mothers who were not treated during pregnancy, recurrent eye disease developed in 72% of children with CT who were diagnosed after their fi rst year of life and thus were not postnatally treated (18 of 25; 95% CI: 51%-89%). 107 For comparison, recurrent eye disease developed in only 31% (34 of 108; 95% CI: 23%-41%) of US infants with CT who had received 12 months of postnatal treatment during their fi rst year of life.…”

“…194 Some experts in the United States, as an alternative to the classic treatment option of P/S, have also tried short-term antimicrobial therapy in children with toxoplasmic chorioretinal lesions that are not in a vision-threatening area, alternative combinations such as pyrimethamine plus clindamycin or azithromycin, and then continuation with clindamycin or azithromycin alone. 107 However, there is no systematic published experience with those alternative treatment options. g Duration of anti-Toxoplasma therapy for acute toxoplasmic chorioretinitis: There are no comparative trials in children or in adults for the relative effi cacy of different treatment durations for ocular toxoplasmosis.…”

“…108 However, in another report, 72% (18 of 25 CT cases; 95% CI: 51%-89%) of US children with CT who were diagnosed after infancy (and did not receive any postnatal treatment during infancy) developed new chorioretinal lesions during follow-up. 107 When postnatal treatment was started at ≤2.5 months of age and continued for 12 months, recurrent eye disease developed in 9% of children without substantial neurologic disease at birth and in 36% of children with moderate to severe neurologic disease at birth. 110 …”

Modern Aspects of Diagnostics, Treatment and Prevention of Congenital Toxoplasmosis

“… Глазные признаки: амблиопия, катаракта, хорио-ретинит (двусторонние или односторонние, поражения макулы заднего полюса или периферические поражения; желтовато-белые ватоподобные пятна на глазном дне; хориоретинальные рубцы, хориоретинальный отек, ирит, отслойка задней гиалоидной мембраны, лекокория, ма-кулярный отек, микрофтальмия, нистагм, некротический ретинит, атрофия зрительного нерва, косоглазие (сходя-щееся или расходящееся), зрительные нарушения [16][17][18][19].…”

When are we going to celebrate the centenary of the discovery of efficient treatment for congenital toxoplasmosis?

“…The rate of eye lesions was higher than that in another cohort of children treated during the first year of life. A possible explanation for this difference is that rapid onset of treatment after birth reduces the occurrence of eye lesions (Phan et al 2008).…”