Long-Term Outcomes in Children with Congenital Toxoplasmosis—A Systematic Review

Abstract

Even in the absence of manifestations at birth, children with congenital toxoplasmosis (CT) may develop serious long-term sequelae later in life. This systematic review aims to present the current state of knowledge to base an informed decision on how to optimally manage these pregnancies and children. For this, a systematic literature search was performed on 28th July 2022 in PubMed, CENTRAL, ClinicalTrials.gov, Google Scholar and Scopus to identify all prospective and retrospective studies on congenital toxoplasmosis and its long-term outcomes that were evaluated by the authors. We included 31 research papers from several countries. Virulent parasite strains, low socioeconomic status and any delay of treatment seem to contribute to a worse outcome, whereas an early diagnosis of CT as a consequence of prenatal screening may be beneficial. The rate of ocular lesions in treated children increases over time to 30% in European and over 70% in South American children and can be considerably reduced by early treatment in the first year of life. After treatment, new neurological manifestations are not reported, while ocular recurrences are observed in more than 50% of patients, with a mild to moderate impact on quality of life in European cohorts when compared to a significantly reduced quality of life in the more severely affected South American children. Though CT is rare and less severe in Europe when compared with South America, antenatal screening is the only effective way to diagnose and treat affected individuals at the earliest possible time in order to reduce the burden of disease and achieve satisfying outcomes.

Antenatal Screening for Toxoplasmosis and Rubella in Saudi Arabia: Assessing the Need for Screening

“…Previous studies have shown that most asymptomatic infected children develop clinical symptoms. 31 , 32 Neonatal tests can frequently reveal lesions; however, standard well-child examinations frequently miss congenital toxoplasmosis. Congenital toxoplasmosis monitoring requirements and clinical toxoplasmosis management strategies are still debatable, largely because of the lack of comprehensive information on the nature of the disease.…”

Guías Latinoamericanas de Infecciones Congénitas y Perinatales de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE). Parte II

“…Las infecciones fetales del primer trimestre tienen mayor probabilidad de terminar en aborto; así, las infecciones entre las semanas 12-24, pueden llevar a hidrocefalia grave. En cambio, las que ocurren en las semanas 30-39, llevan a infecciones asintomáticas al nacer, con riesgo de desarrollar lesiones oculares más adelante 26 . La historia natural de niños que se examinaron luego del nacimiento en Colombia y que no tuvieron tratamiento prenatal, muestra que 41% nacieron con hepato-esplenomeglia, 30% con compromiso ocular y 36% con compromiso neurológico 27 .…”

Toxoplasma gondii infection and testosterone alteration: A systematic review and meta-analyses

“…In immunocompromised individuals, the infection could have life-threatening sequels, such as toxoplasmic encephalitis, myocarditis, or disseminated infections [7,8]. Congenital toxoplasmosis is also a life-threatening condition which may lead to abortion, stillbirth, and preterm birth [9][10][11][12]. The intensity of T. gondii infection depends on several factors, including genetic background [13], immunity status [14], and the parasite virulence [15,16].…”