Long-term ocular prognosis in 327 children with congenital toxoplasmosis.
OBJECTIVE
Retinochoroiditis is the most frequent consequence of congenital toxoplasmosis. Early diagnosis and treatment are believed to reduce the risk of visual impairment. We report on the clinical evolution of ocular lesions and final visual function in a prospective cohort of congenitally infected children who were identified during monthly maternal prenatal screening.


METHODS
The study included 327 congenitally infected children who were monitored for up to 14 years at the Croix Rousse Hospital in Lyon, France. Data on date of maternal infection; time and type of therapy; antenatal, neonatal, and postnatal work-ups; and ocular status were analyzed.


RESULTS
All mothers but 52 had been treated. Pyrimethamine and sulfadiazine was given in utero to 38% of children and after birth to 72% of newborns. Fansidar was given for an average duration of 337 days in all but 2 children. After a median follow-up of 6 years, 79 (24%) children had at least 1 retinochoroidal lesion. In 23 (29%) of them, at least 1 new event had been diagnosed up to 10 years after detection of the first lesions: reactivation of an existing lesion (1 case), new lesion in a previously healthy location (19 cases), or both (3 cases). Fifty-five children had lesions in 1 eye; of the 45 children for whom final visual acuity data were available, 31 (69%) had normal vision. Twenty-four children had lesions in both eyes; of the 21 for whom final visual acuity data were available, 11 had normal vision in both eyes. None had bilateral visual impairment.


CONCLUSIONS
Clinicians, parents, and elder children with congenital infection should be informed that late-onset retinal lesions and relapse can occur many years after birth but that the overall ocular prognosis of congenital toxoplasmosis is satisfactory when infection is identified early and treated accordingly.
Wallon
Martine
M
Department of Parasitology, Hôpital de la Croix-Rousse, Lyon, France. martine.wallon@chu-lyon.fr
Kodjikian
Laurent
L
Binquet
Christine
C
Garweg
Justus
J
Fleury
Jacques
J
Quantin
Catherine
C
Peyron
François
F
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D002825:Chorioretinitis / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011247:Pregnancy; D014125:Toxoplasmosis, Congenital / Q000150:complications*; D014126:Toxoplasmosis, Ocular / Q000151:congenital* / Q000453:epidemiology