Published online April 21, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. e1215-e1222 (doi:10.1542/peds.2007-2169)
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ARTICLE

Predictors of Retinochoroiditis in Children With Congenital Toxoplasmosis: European, Prospective Cohort Study

Katherine Freeman, DrPHa, Hooi Kuan Tan, MScb, Andrea Prusa, MDc, Eskild Petersen, DScd, Wilma Buffolano, MDe, Gunilla Malm, PhDf, Mario Cortina-Borja, PhDb, Ruth Gilbert, MDb for the European Multicentre Study on Congenital Toxoplasmosis

a Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
b Centre for Paediatric Epidemiology and Biostatistics, University College London Institute of Child Health, London, United Kingdom
c Division of Neonatology and Intensive Care, Department of Pediatrics, University of Vienna, Vienna, Austria
d Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
e Perinatal Infection Unit, Department of Pediatrics, University of Naples Federico II, Naples, Italy
f Karolinska University Hospital, Huddinge, Stockholm, Sweden

OBJECTIVE. By school age, 20% of children infected with congenital toxoplasmosis will have ≥1 retinochoroidal lesion. We determined which children are most at risk and whether prenatal treatment reduces the risk of retinochoroiditis to help clinicians decide about treatment and follow-up.

PATIENTS AND METHODS. We prospectively studied a cohort of children with congenital toxoplasmosis identified by prenatal or neonatal screening in 6 European countries. We determined the effects of prenatal treatment and prognostic markers soon after birth on the age at first detection of retinochoroiditis.

RESULTS. Of 281 children with congenital toxoplasmosis, 50 developed ocular disease, and 17 had recurrent retinochoroiditis during a median follow-up of 4.1 years. Prenatal treatment had no significant effect on the age at first or subsequent lesions. Delayed start of postnatal treatment did not increase retinochoroiditis, but the analysis lacked power. Older gestational age at maternal seroconversion was weakly associated with a reduced risk of retinochoroiditis. The presence of nonocular clinical manifestations of congenital toxoplasmosis at birth strongly predicted retinochoroiditis. For 92% (230 of 249) of children with no retinochoroiditis detected before 4 months of age, the probability of retinochoroiditis by 4 years was low, whether clinical manifestations were present or not 8.0%.

CONCLUSIONS. Prenatal treatment did not significantly reduce the risk of retinochoroiditis in this European cohort. If children have no retinochoroiditis in early infancy, the low risk of subsequent ocular disease may not justify postnatal treatment and repeated ophthalmic assessments during childhood. Controlled trials are needed to address the lack of evidence for the effectiveness of postnatal treatment.

Key Words: congenital toxoplasmosis • retinochoroiditis • prospective cohort • treatment effectiveness

Abbreviations: Ig—immunoglobulin • OR—odds ratio • CI—confidence interval • IQR—interquartile range

Accepted Oct 8, 2007.