Prevention of Retinochoroiditis in Congenital Toxoplasmosis

Sauer, Arnaud; de-la-Torre, Alejandra; Gómez-Marín, Jorge Enrique; Bourcier, Tristan; Garweg, Justus G.; Speeg-Schatz, C.; Candolfi, Ermanno

doi:10.1097/inf.0b013e3182129e70

Cited by 31 publications

(15 citation statements)

References 21 publications

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“…It should also encourage an extension of the follow-up time beyond the traditionally recommended age limit of 5 to 12 years, 23,24 because our data provide evidence that the risk of ocular affection persists throughout life, even in treated children. In our experience, this extended follow-up is perceived by adult patients as reassuring and beneficial.…”

Section: Discussionmentioning

confidence: 80%

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: Discussionmentioning

confidence: 80%

Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

et al. 2014

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“…En Europa se aisló con más frecuencia el genotipo clonal II en los casos de enfermedad congénita y la mayoría de los RN fueron asintomáticos, los aislamientos con genotipos I y III sólo fueron obtenidos en 10 y 9% de los pacientes, respectivamente. En Sudamérica (Brasil, Colombia, Guyana y Argentina) es frecuente el aislamiento de los genotipos III y atípicos, y hay evidencia que la frecuencia y gravedad es mayor, con compromiso ocular en particular 20,21 . El riesgo de lesiones oculares en RNs infectados en Europa es de 10%, mientras que en Brasil es de 50% con una frecuencia de reactivaciones cuatro veces mayor 22 .…”

Section: Artículo Originalunclassified

Toxoplasmosis congénita: Diagnóstico serológico, RPC, aislamiento y caracterización molecular de Toxoplasma gondii

Carral

Kaufer

Pardini

et al. 2018

Rev. chil. infectol.

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Congenital toxoplasmosis diagnosis in the newborn is a very important issue due to the need for early treatment to prevent future sequels. Aim To compare available methods at the institution for the diagnosis of congenital toxoplasmosis. Material and Methods In this study we have evaluated the different diagnostic tests used in 67 congenital exposed newborns, including serological tests, PCR, parasite isolation and molecular characterization. Results The ISAGA IgM and IgA tests showed sensitivity (Se) of 87 and 91%, respectively, and specificity (Sp) of 100%. When ISAGA IgM and IgA were performed simultaneously, the Se increased to 98% and the Sp was 100%. The presence of IgE contributed to the diagnosis when it was detected in the child's serum but not in maternal blood. In four congenital infected children the parasite was isolated and genotyped: one was genotype II and the other three were "atypical" genotypes. No parasite was isolated in children without congenital toxoplasmosis. Discussion Overall, serological tests showed a good diagnostic performance although in one case they were all negative and isolation was the only tool to identify the infection. We conclude that it is essential to use all diagnostic tests in every single exposed child, including if possible, molecular characterization due to its epidemiological implication.

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“…Conversely, children with ocular lesions at birth or otherwise at high risk for developing retinochoroiditis, i.e. with foetal ultrasound abnormalities or neurologic impairment, should receive full course treatment along with repeated ocular examination [72]. However, it must be underlined that these adapted recommendations should be validated in a randomized clinical trial.…”

Section: The European Cohortsmentioning

confidence: 99%

It is not only the cat that did it: How to prevent and treat congenital toxoplasmosis

Robert‐Gangneux

2014

Journal of Infection

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The apicomplexan parasite Toxoplasma gondii was discovered a little over one hundred years ago and was soon recognized as a pathogen responsible for congenital infection. But detailed understanding of its epidemiology emerged only after 1970 with the discovery of its life cycle. In the last ten years, high resolution molecular tools have allowed the characterization of various strain types with different virulence patterns, and current studies are exploring the distribution of these different genotypes. In parallel, sophisticated diagnostic tools have been developed and awareness of disease burden has led some European countries with high prevalence rates to implement screening of pregnant women. In this article, the screening options and therapies used to prevent congenital toxoplasmosis are dissected in the light of recent data from cohort studies and other epidemiological data.

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Prevention of Retinochoroiditis in Congenital Toxoplasmosis

Cited by 31 publications

References 21 publications

Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

Toxoplasmosis congénita: Diagnóstico serológico, RPC, aislamiento y caracterización molecular de Toxoplasma gondii

It is not only the cat that did it: How to prevent and treat congenital toxoplasmosis

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