Outcome for children infected with congenital toxoplasmosis in the first trimester and with normal ultrasound findings: A study of 36 cases

Berrébi, Alain; Bardou, Magali; Bessières, Marie-Hélène; Nowakowska, Dorota; Castagno, R.; Rolland, M; Wallon, Martine; Franck, Jacqueline; Bongain, A.; Monnier‐Barbarino, Patricia; Assouline, Corinne; Cassaing, Sophie

doi:10.1016/j.ejogrb.2006.11.002

Cited by 55 publications

(32 citation statements)

References 11 publications

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“…Half (50%) of the initial lesions were detected after 3 years of age and as late as 20 years. Similar findings have been reported by Berrebi et al 20 : 28 of the 107 children followed for .1 year manifested at least 1 ocular lesion after a median follow-up of 7.8 years.…”

Section: Discussionsupporting

confidence: 78%

Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: In children with congenital toxoplasmosis, ocular lesions can be detected and may relapse after birth despite pre-and postnatal treatment. Long-term ocular outcome beyond puberty and associated prognostic factors are unknown due to limited follow-up.WHAT THIS STUDY ADDS: Our study in 477 patients with treated congenital toxoplasmosis who were followed up to 22 years indicated that new ocular lesions can be detected well into adolescence (with a cumulative probability at 18 years of almost 50%), but they rarely cause severe visual impairment. 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.

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Section: Discussionsupporting

confidence: 78%

Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

et al. 2014

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“…As reported by Berrebi, our follow-up confirms that their outcome does not differ significantly from that of children infected during the second and third trimester [17] . As regards the prenatal phase, we observed a lower motherto-child transmission rate than in other reports, and concur with a recent meta analysis by the SYROCOT group which found weak evidence that treatment initiated within 3 weeks of seroconversion could reduce the risk of transmission [18] .…”

Section: Discussionsupporting

confidence: 74%

Investigation and management of Toxoplasma gondii infection in pregnancy and infancy: a prospective study

et al. 2011

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Aim: Toxoplasma gondii infection during pregnancy poses a serious risk to the fetus, therefore timely and accurate diagnosis is essential. The aim of this study was to estimate the frequency of congenital infection via evaluating mother's immunological status and the possibility to improving the diagnostic and therapeutic approaches. Methods: Eighty five mothers with Toxoplasma seroconversion and their offspring were enrolled (among them, 2 spontaneous abortions were documented in the first trimester). Prenatal PCR diagnosis was carried out on 50 patients (60%), with 7 positive cases (14%). Morphological ultrasound scanning revealed anomalies in one fetus. Long-term follow-up included general physical examinations, serological status tested using Western blot, neuro-radiological, ophthalmologic and neurologic examinations, psychological and developmental tests, visual evoked potential tests and audiology tests, as well as anti-Toxoplasma treatment regimes. Results: Fourteen (17%) of the infants were infected at one-year serological follow-up. Chi-square for linear trend of vertical transmission from the first to the third trimester was significant (P=0.009). Western blot analysis showed IgM and IgA in half of the infected infants. In 69 uninfected infants, anti-Toxoplasma IgG immunoblot analysis excluded infection within the 3 months in 18 infants (26%) and in the others within 6 months of life. The most relevant instrumental findings are described. Conclusion: Western blot analysis may help to evaluate infection within the 6 months of life. The accuracy of ultrasound imaging to determine the brain damage in the fetus and newborns is doubtful, and should be combined with MR imaging. Multistep approaches can improve the timing of postnatal follow-up.

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“…En este contexto se han efectuado diferentes análisis de la efectividad del estudio ecosonográfico prenatal en fetos con toxoplasmosis congénita; sus resultados han sido poco alentadores 62 . En Francia, una investigación retrospectiva analizó el ultrasonido prenatal en 36 niños infectados con T. gondii durante el primer trimestre de gestación, mostrando estudios imagenológicos normales.…”

Section: Diagnóstico De Infección Por Toxoplasma Gondiiunclassified

“…En Francia, una investigación retrospectiva analizó el ultrasonido prenatal en 36 niños infectados con T. gondii durante el primer trimestre de gestación, mostrando estudios imagenológicos normales. De ellos, 78% presentó toxoplasmosis subclínica, en 19% se diagnosticó corio-retinitis, sin mayor pérdida de la visión a los 12 meses de edad y 3% presentó una toxoplasmosis congénita grave 62 . Diferentes países han iniciados programas de tamizaje en el embarazo por medio de la determinación de inmunoglobulina M (IgM) y seroconversión de inmunoglobulina G (IgG).…”

Section: Diagnóstico De Infección Por Toxoplasma Gondiiunclassified