Risk Factors for Retinochoroiditis During the First 2 Years of Life in Infants With Treated Congenital Toxoplasmosis

Kieffer, François; Wallon, Martine; Garcia, Patricia; Thulliez, P.; Peyron, François; Franck, Jacqueline

doi:10.1097/inf.0b013e318134286d

Cited by 114 publications

(101 citation statements)

References 26 publications

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“…25 In the current study, the longer followup times allowed us to assess the longterm impact of several prognostic factors that were identified in the same cohort of patients at an earlier stage 26 and that have been likewise recognized by other investigators. 4,23 Gender had no significant impact. The decreasing risk of developing retinochoroiditis with increasing gestational age at the time of maternal infection and with each additional month until CT postnatal diagnosis in children was confirmed.…”

Section: Discussionmentioning

confidence: 94%

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Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: In children with congenital toxoplasmosis, ocular lesions can be detected and may relapse after birth despite pre-and postnatal treatment. Long-term ocular outcome beyond puberty and associated prognostic factors are unknown due to limited follow-up.WHAT THIS STUDY ADDS: Our study in 477 patients with treated congenital toxoplasmosis who were followed up to 22 years indicated that new ocular lesions can be detected well into adolescence (with a cumulative probability at 18 years of almost 50%), but they rarely cause severe visual impairment. abstract BACKGROUND: Congenital toxoplasmosis (CT) can elicit severe damage to several organs, especially the eye, and may be manifested at birth or later. We assessed the long-term ocular prognosis in a cohort of congenitally infected children treated according to a standardized protocol and monitored for up to 22 years. METHODS:This prospective study included confirmed cases of CT, which were identified by obligatory antenatal screening at the Lyon (France) reference center between 1987 and 2008. Data obtained through ocular examinations were recorded on a standardized form and confirmed by an independent external committee. Risk factors for retinochoroiditis were identified by using a multivariable Cox model and a flexible model that accounted for changes in the factor effects during follow-up. RESULTS:A total of 477 of 485 infected live-born children were followed for a median of 10.5 years (75th percentile: 15.0 years). During the follow-up, 142 patients (29.8%) manifested at least 1 ocular lesion. Lesions were unilateral in 98 individuals (69.0%) and caused no vision loss in 80.6%. Lesions were first manifested at a median age of 3.1 (0.0-20.7) years. In 48 (33.8%) of the children, recurrences or new ocular lesions occurred up to 12 years after the appearance of the first lesion. Early maternal infection and confirmation of CT in children, prematurity, and nonocular CT lesions at baseline were associated with a higher risk of retinochoroiditis. CONCLUSIONS:Although the consequences of CT are rarely severe in treated children, regular postnatal monitoring is nevertheless justified because of the lifelong persisting risk of new ocular manifestations.

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Section: Discussionmentioning

confidence: 94%

“…Indirect evidence indicates that this measure can reduce the short-term severity of toxoplasmosis. [2][3][4][5] Whether the long-term outcome is thereby affected is unknown because no prospective data on the evolution beyond the sixth year of age in treated children are available. Such data would be invaluable in making follow-up and treatment decisions.…”

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Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

et al. 2014

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“…In case of congenital origin, the risk of ocular disease depends on the trimester of pregnancy when infection occurred, and on whether or not treatment was administered to the mother during pregnancy. In one study, a period exceeding 8 weeks between maternal infection and the beginning of treatment, female gender, and especially cerebral calcifications were risk factors for retinochoroiditis [10]. No significant association was found in other cohort studies between gestational age at maternal infection, prenatal treatment and the risk of developing OT [11,12].…”

Section: A Complication Of Acquired and Congenital Infectionsmentioning

confidence: 98%

“…Peyron et al [84] stated that "treating CT has little effect on the quality of life and visual function of the affected individuals". However, Kieffer et al [10] showed that a period exceeding 8 weeks between maternal infection and the beginning of treatment was a risk factor for retinochoroiditis; therefore emphasizing the need to prevent and treat CT. Evidence for the effectiveness of prenatal or postnatal treatment for CT is still needed.…”

Section: Efficient Treatments Are Available But There Is No Real Meanmentioning

confidence: 99%

Risk Factors, Pathogenesis and Diagnosis of Ocular Toxoplasmosis

Dupouy‐Camet¹,

Talabani²,

Delair³

et al. 2012

Toxoplasmosis - Recent Advances

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“…In a 19-month follow-up, Holfeld found that pyrimethamine plus sulfonamide was effective in reducing the severity of the disease in comparison with a group of historical controls (Holfeld et al 1989). We demonstrated that a delay of more than eight weeks between maternal seroconversion and treatment onset was associated with an increased risk of retinochorioditis during the first two years of life in infected infants (Kieffer et al 2008).…”

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confidence: 99%