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3-D Imaging and Analysis of Neurons Infected In Vivo with Toxoplasma gondii
Published on: December 9, 2014
Longitudinal study of new eye lesions in treated congenital toxoplasmosis
Laura Phan1, Kristen Kasza, Jessica Jalbrzikowski
1University of Chicago School of Medicine, Chicago, Illinois 60637, USA.
Insights
Congenital toxoplasmosis treatment in infancy is linked to a lower incidence of new chorioretinal lesions. However, long-term follow-up is crucial as some lesions appear later in childhood.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Congenital toxoplasmosis can lead to ocular complications, including chorioretinal lesions.
- Previous studies suggest high rates of new lesions in untreated or briefly treated infants.
Purpose of the Study:
- To determine the incidence of new chorioretinal lesions in infants with congenital toxoplasmosis treated throughout their first year of life.
Main Methods:
- Prospective longitudinal observation of 132 children with congenital toxoplasmosis.
- Treatment with pyrimethamine, sulfadiazine, and leucovorin during the first year of life.
- Regular fundus examinations and fundus photography for lesion detection.
Main Results:
- 31% of 108 evaluated children developed new, previously undetected chorioretinal lesions.
- New lesions occurred at various times; 14% were central and 25% were peripheral.
- 41% of those with new lesions developed them at age 10 or later.
Conclusions:
- New central chorioretinal lesions are uncommon with first-year treatment for congenital toxoplasmosis.
- Late-onset lesions (age 10+) highlight the need for extended follow-up into adolescence.
- Treatment during infancy appears to reduce lesion prevalence compared to historical untreated cohorts.
Objective:
To determine the incidence of new chorioretinal lesions in patients with congenital toxoplasmosis who were treated throughout their first year of life.
Design:
Prospective longitudinal observation of a cohort.
Participants:
One hundred thirty-two children were studied as part of the longitudinal observation.
Methods:
One hundred thirty-two children were treated during their first year of life with pyrimethamine, sulfadiazine, and leucovorin. They had eye examinations at prespecified intervals.
Main Outcome Measures:
New chorioretinal lesions on fundus examination and fundus photographs.
Results:
The mean age (+/- standard deviation) is 10.8+/-5.1 years (range, 0.2-23). One hundred eight children have been evaluated for new chorioretinal lesions. Thirty-four (31%; 95% confidence interval, 23%-41%) of 108 children developed at least one chorioretinal lesion that was previously undetected. These occurred at varying times during their follow-up course. Fifteen children (14%) developed new central lesions, and 27 (25%) had newly detected lesions peripherally. Ten (9%) had more than one occurrence of new lesions developing, and 13 (12%) had new lesions in both eyes. Of those who developed new lesions, 14 children (41%) did so at age 10 or later.
Conclusion:
New central chorioretinal lesions are uncommon in children with congenital toxoplasmosis who are treated during their first year of life. This finding contrasts markedly with earlier reports in the literature for untreated children or those treated for only 1 month near birth, in whom new lesions were much more prevalent (>/=82%). Our observation that 14 (41%) of the 34 children with new chorioretinal lesions had occurrences when they were 10 years or older indicates that long-term follow-up into the second decade of life is important in assessing the efficacy of treating toxoplasmosis during infancy.
