title: Ophthalmic outcomes of congenital toxoplasmosis followed until adolescence.
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.
authors.affiliation: Hospices Civils de Lyon, Institut de Parasitologie et de Mycologie Médicale, Hôpital de la Croix-Rousse, Lyon, France;
authors.forename: Martine
authors.initials: M
authors.lastname: Wallon
authors.forename: Justus G
authors.initials: JG
authors.lastname: Garweg
authors.forename: Michal
authors.initials: M
authors.lastname: Abrahamowicz
authors.forename: Catherine
authors.initials: C
authors.lastname: Cornu
authors.forename: Sandrine
authors.initials: S
authors.lastname: Vinault
authors.forename: Catherine
authors.initials: C
authors.lastname: Quantin
authors.forename: Claire
authors.initials: C
authors.lastname: Bonithon-Kopp
authors.forename: Stéphane
authors.initials: S
authors.lastname: Picot
authors.forename: François
authors.initials: F
authors.lastname: Peyron
authors.forename: Christine
authors.initials: C
authors.lastname: Binquet
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005128:Eye Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D011446:Prospective Studies; D014125:Toxoplasmosis, Congenital / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
keywords: burden of disease; congenital toxoplasmosis; long-term prognosis; ocular lesions; retinochoroiditis