title: Congenital toxoplasmosis in southeastern Brazil: results of early ophthalmologic examination of a large cohort of neonates.
abstract: OBJECTIVE
  To report results of early ophthalmologic examinations in a large cohort of newborns with congenital toxoplasmosis (CT) after neonatal screening.
  
  
  METHODS
  Cross-sectional analysis of a cohort.
  
  
  METHODS
  A total of 178 newborns with confirmed CT from 146,307 screened babies (95% of live births) from Minas Gerais state, southeastern Brazil.
  
  
  METHODS
  From November 2006 to May 2007, newborns underwent neonatal screening by immunoglobulin (Ig)M capture of dried blood samples. On all positive or suspected cases, confirmative serology was performed on babies and their mothers. Congenital toxoplasmosis was confirmed in newborns who had IgM and/or IgA and IgG, or IgG associated with suggestive ocular lesions (with IgM and IgG in the mother). Ophthalmologic evaluation consisted of indirect ophthalmoscopy with a lid speculum. Pediatric examination and radiologic studies of the central nervous system were also performed. In selected cases, biomicroscopy of the anterior segment, fundus photographs, or ultrasonography (B-scan) was performed.
  
  
  METHODS
  Prevalence of retinochoroidal lesions, either cicatricial or active, and their location and associated findings, such as vascular sheathing, hemorrhage, vitreous opacities, and retinal detachment, were evaluated. The occurrence of cataract, microphthalmia, microcephaly, intracranial calcification, and hydrocephalus was also recorded.
  
  
  RESULTS
  Of 146,307 neonates screened, 190 had CT, yielding a prevalence of 1 in 770 live births, of whom 178 (93.7%) underwent standardized ophthalmologic examination at an average age of 55.6+/-16.6 days. Of these 178 infants, 142 (79.8%) had retinochoroidal lesions consistent with CT in at least 1 eye. Bilateral involvement was noted in 113 patients (63.5%). Macular involvement was seen in 165 eyes (46.3%) of 111 patients (62.4%). Active lesions were observed in 142 eyes (39.9%) of 85 patients (47.8%). These lesions were located in the macula of 75 eyes (21.1%) and were associated with retinal vascular sheathing in 44 eyes (12.4%).
  
  
  CONCLUSIONS
  A high prevalence of CT was encountered (1/770) with high rates of early retinochoroidal involvement ( approximately 80%) and many active lesions (in approximately 50%), indicating a possibly more severe ocular involvement by CT in Brazil than in other parts of the world. The hypotheses of higher parasite virulence and increased individual susceptibility are being currently investigated.
authors.affiliation: Uveitis Unit, Hospital São Geraldo/HC-Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. dvitor@ufmg.br
authors.forename: Daniel Vitor
authors.initials: DV
authors.lastname: Vasconcelos-Santos
authors.forename: Danuza O
authors.initials: DO
authors.lastname: Machado Azevedo
authors.forename: Wesley R
authors.initials: WR
authors.lastname: Campos
authors.forename: Fernando
authors.initials: F
authors.lastname: Oréfice
authors.forename: Gláucia M
authors.initials: GM
authors.lastname: Queiroz-Andrade
authors.forename: Ericka V Machado
authors.initials: EV
authors.lastname: Carellos
authors.forename: Roberta M
authors.initials: RM
authors.lastname: Castro Romanelli
authors.forename: José Nelio
authors.initials: JN
authors.lastname: Januário
authors.forename: Luciana Macedo
authors.initials: LM
authors.lastname: Resende
authors.forename: Olindo Assis
authors.initials: OA
authors.lastname: Martins-Filho
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: de Aguiar Vasconcelos Carneiro
authors.forename: Ricardo W
authors.initials: RW
authors.lastname: Almeida Vitor
authors.forename: Waleska Teixeira
authors.initials: WT
authors.lastname: Caiaffa
mesh_terms: D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D015862:Choroid Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening; D009887:Ophthalmoscopy; D015995:Prevalence; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D014122:Toxoplasma / Q000276:immunology; D014125:Toxoplasmosis, Congenital / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D014126:Toxoplasmosis, Ocular / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology
chemical_list: D000913:Antibodies, Protozoan; D007074:Immunoglobulin G; D007075:Immunoglobulin M