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Eye manifestations of congenital toxoplasmosis
M B Mets1, E Holfels, K M Boyer
1Department of Ophthalmology, Children's Memorial Hospital, Chicago, Illinois, USA.
Insights
Congenital toxoplasmosis can cause significant vision loss due to retinal damage, even with treatment. Early treatment with pyrimethamine and sulfadiazine helps quiescent active lesions, but long-term monitoring is crucial for congenital toxoplasmosis patients.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Congenital toxoplasmosis, a parasitic infection, can lead to ocular manifestations.
- Retinal damage from congenital toxoplasmosis can impact vision throughout life.
Purpose of the Study:
- To investigate the long-term visual outcomes in individuals with congenital toxoplasmosis.
- To compare the natural history of treated versus untreated congenital toxoplasmosis.
- To assess the impact of treatment on ocular findings and vision.
Main Methods:
- A prospective, longitudinal study involving 76 newborns treated with pyrimethamine and sulfadiazine.
- Inclusion of 18 historical patients with congenital toxoplasmosis not treated in their first year.
- Long-term follow-up to monitor ocular findings, recurrences, and visual acuity.
Main Results:
- Chorioretinal scars, particularly peripheral, were common in both treated (58%) and untreated (82%) patients.
- Macular scars were prevalent, affecting 54% of treated and 76% of untreated patients, with bilateral involvement in 41% and 23%, respectively.
- Twenty-nine percent of treated patients experienced bilateral visual impairment (<20/40), with causes including macular scars, retinal detachment, and optic atrophy. Recurrences were observed in 13% of treated and 44% of untreated patients.
Conclusions:
- Congenital toxoplasmosis often results in significant retinal damage and vision loss at birth.
- While vision can be surprisingly good despite large macular scars, long-term visual impairment is a concern.
- Treatment with pyrimethamine and sulfadiazine effectively quiets active lesions, but ongoing monitoring is necessary due to potential recurrences and new lesion development.
Purpose:
To determine the natural history of treated and untreated congenital toxoplasmosis and impact of this infection on vision.
Methods:
In this prospective, longitudinal study, 76 newborns were treated with pyrimethamine and sulfadiazine for approximately one year, and 18 individuals not treated during their first year of life entered the study after age 1 year (historical patients).
Results:
Chorioretinal scars were the most common eye finding in all patients and were most common in the periphery (58% of treated and 82% of historical patients). Macular scars were present in 54% of the treated patients; 41% were bilateral. Macular scars were present in 76% of the historical patients; 23% were bilateral. Visual acuity in the presence of macular lesions ranged from 20/20 to 20/400. Of the patients followed up from the newborn period and treated, 29% had bilateral visual impairment, with visual acuity for the best eye of less than 20/40. Causes for this visual impairment in eyes with quiescent lesions included macular scars, dragging of the macula secondary to a peripheral lesion, retinal detachment, optic atrophy, cataract, amblyopia, and phthisis. There were recurrences in both treated (13%, 7/54) and previously untreated historical patients (44%, 8/18). The total, median, and range of years of follow-up during which recurrences were observed were, for treated patients, 189 years (total), five years (median), and three to ten years (range) and, for historical, untreated patients, 160 years (total), 11 years (median), and three to 24 years (range). New lesions occurred in previously normal retinas and also contiguous to older scars. Active lesions appeared to become quiescent within ten to 14 days after beginning pyrimethamine and sulfadiazine therapy.
Conclusion:
Many children with congenital toxoplasmosis have substantial retinal damage at birth and consequent loss of vision. Nonetheless, vision may be remarkably good in the presence of large macular scars. Active lesions become quiescent with treatment.