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Published on: February 15, 2022
Long-term ocular prognosis in 327 children with congenital toxoplasmosis
Martine Wallon1, Laurent Kodjikian, Christine Binquet
1Department of Parasitology, Hôpital de la Croix-Rousse, Lyon, France. martine.wallon@chu-lyon.fr
Insights
Early diagnosis and treatment of congenital toxoplasmosis significantly improve ocular prognosis. Despite potential late-onset retinal lesions, most children achieve normal vision with timely intervention.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Congenital toxoplasmosis frequently leads to retinochoroiditis, a major cause of visual impairment.
- Early detection and treatment are crucial for mitigating visual deficits.
Purpose of the Study:
- To evaluate the clinical course of ocular lesions and final visual function in children with congenital toxoplasmosis.
- To assess the impact of early diagnosis and treatment on long-term visual outcomes.
Main Methods:
- Prospective cohort study of 327 congenitally infected children monitored for up to 14 years.
- Analysis of maternal infection timing, treatment regimens (in utero and postnatal), and ocular status over time.
Main Results:
- 79 (24%) children developed retinochoroidal lesions; 23 (29%) experienced new events up to 10 years later.
- Of those with available data, 69% with unilateral lesions and 52% with bilateral lesions achieved normal vision.
- No cases of bilateral visual impairment were reported.
Conclusions:
- Late-onset retinal lesions and relapses are possible in congenital toxoplasmosis, even years after birth.
- Early identification and appropriate treatment lead to a satisfactory ocular prognosis.
- Informed vigilance by clinicians and families is essential for managing potential long-term ocular complications.
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.
