Predictors of retinochoroiditis in children with congenital toxoplasmosis: European, prospective cohort study.
OBJECTIVE
By school age, 20% of children infected with congenital toxoplasmosis will have > or = 1 retinochoroidal lesion. We determined which children are most at risk and whether prenatal treatment reduces the risk of retinochoroiditis to help clinicians decide about treatment and follow-up.


METHODS
We prospectively studied a cohort of children with congenital toxoplasmosis identified by prenatal or neonatal screening in 6 European countries. We determined the effects of prenatal treatment and prognostic markers soon after birth on the age at first detection of retinochoroiditis.


RESULTS
Of 281 children with congenital toxoplasmosis, 50 developed ocular disease, and 17 had recurrent retinochoroiditis during a median follow-up of 4.1 years. Prenatal treatment had no significant effect on the age at first or subsequent lesions. Delayed start of postnatal treatment did not increase retinochoroiditis, but the analysis lacked power. Older gestational age at maternal seroconversion was weakly associated with a reduced risk of retinochoroiditis. The presence of nonocular clinical manifestations of congenital toxoplasmosis at birth strongly predicted retinochoroiditis. For 92% (230 of 249) of children with no retinochoroiditis detected before 4 months of age, the probability of retinochoroiditis by 4 years was low, whether clinical manifestations were present or not 8.0%.


CONCLUSIONS
Prenatal treatment did not significantly reduce the risk of retinochoroiditis in this European cohort. If children have no retinochoroiditis in early infancy, the low risk of subsequent ocular disease may not justify postnatal treatment and repeated ophthalmic assessments during childhood. Controlled trials are needed to address the lack of evidence for the effectiveness of postnatal treatment.
Freeman
Katherine
K
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Tan
Hooi Kuan
HK
Prusa
Andrea
A
Petersen
Eskild
E
Buffolano
Wilma
W
Malm
Gunilla
G
Cortina-Borja
Mario
M
Gilbert
Ruth
R
D002648:Child; D002675:Child, Preschool; D002825:Chorioretinitis / Q000175:diagnosis* / Q000517:prevention & control; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015997:Neonatal Screening; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis / Q000188:drug therapy; D011296:Prenatal Diagnosis; D011379:Prognosis; D012307:Risk Factors; D014123:Toxoplasmosis / Q000175:diagnosis / Q000188:drug therapy; D014125:Toxoplasmosis, Congenital / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014126:Toxoplasmosis, Ocular / Q000175:diagnosis*