title: Clinical presentation and follow up of children with congenital toxoplasmosis in Brazil.
abstract: We evaluated the clinical presentation and determined the ocular and neurologic sequelae in children with congenital toxoplasmosis in Brazil, taking into consideration the shortage of national publications on this disease. Follow-up evaluations were made of 43 children with congenital toxoplasmosis referred to Santa Casa de São Paulo, during a period of at least five years. Selection of the cases was based in clinical and laboratory criteria. A clear predominance of children with subclinical presentation of the disease at birth (88%) was found. Of the 43 children, 22 (51%) developed neurological manifestations. Using skull radiography, we detected neuroradiologic alterations in seven children (16%) and with tomography in 33 children (77%). Neurological sequelae were identified in 15 children (54%) in the group with cerebral calcifications and in 7 (47%) in the group without cerebral calcifications. We observed chorioretinitis in 95% of the cases. Reactivation of cicatricial lesions and the emergence of new ocular lesions were observed in five cases. The most frequent neurological manifestation was a delay in neuropsychomotor development. Most remarkable was the finding that cerebral calcifications were not associated with a higher incidence of neurological sequelae among the children. Chorioretinitis was the main ocular sequel of the infection, found in nearly all children; it can manifest years from birth, even in children submitted to specific therapy druing the first year of life, highlighting the importance of a follow-up of these children.
authors.affiliation: Division of Pediatric Infectious Diseases, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil. masafadi@sanet.com.br
authors.forename: Marco A P
authors.initials: MA
authors.lastname: Sáfadi
authors.forename: Eitan N
authors.initials: EN
authors.lastname: Berezin
authors.forename: Calil K
authors.initials: CK
authors.lastname: Farhat
authors.forename: Eduardo S
authors.initials: ES
authors.lastname: Carvalho
mesh_terms: D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology*; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005128:Eye Diseases / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014125:Toxoplasmosis, Congenital / Q000150:complications* / Q000175:diagnosis