TABLE 12

Proposed Postnatal Monitoring Protocols for Infants With CT in the United States and Different European Centers, According to the PAMF-TSL and European Toxoplasmosis Centers

PAMF-TSL
 Infants with confirmed CT:
  • See Table 9
 Infants unlikely to be infected:
  • Complete clinical, radiologic, and laboratory evaluation (as discussed in Table 9) is needed at birth even for those infants (head ultrasonography may be used)
  • Decision to defer postnatal treatment should be cautiously made (for reasons previously discussed in the text)
  • Serologic follow-up is needed every 4–6 weeks until Toxoplasma IgG antibodies are undetectable
   o If the IgG assay result becomes negative, confirmation of this negative result, with another testing in the following 4–6 weeks, may be considered
   o However, if subsequent serologic testing indicates CT, then the child should be treated
Kieffer and Wallon184 (expert opinion from Paris and Lyon cohorts)
 Infants with confirmed CT:
  After completion of treatment of 1 year, the following monitoring is suggested:
   • Clinical + serologic follow-up every 3 months for the second year of life
   • Clinical + serologic follow-up every 6 months for the third year of life
   • Clinical + serologic follow-up yearly thereafter, indefinitely
   • If recurrence of eye disease is documented (beyond the neonatal period), treatment should be resumed for 3 months with pyrimethamine/sulfadoxine (with documentation of scarring of the lesions at the end of therapy)a
   • If serologic rebound is documented, but without associated symptoms of recurrence (eg, without recurrence of eye disease), treatment is not indicated
 Infants unlikely to be infected:
  • There is no need for treatment of these infants
  • However, serologic follow-up is needed every 2 months until Toxoplasma IgG antibodies are undetectable
  • If subsequent serologic testing indicates CT, then the child should be treated
Wallon et al2 (Lyon cohort)
 Evaluation at birth includes:
  • Head ultrasonography
  • Ophthalmologic examination
  • Neonatal blood testing for Toxoplasma IgM, IgA, and IgG
 Individuals with proven infection were treated for 12 months (pyrimethamine plus sulfadiazine for 2 months, and then pyrimethamine plus sulfadoxine for 10 months)
  • All children underwent a pediatric check-up and an assessment of neurologic development, every 3 months for at least 1 year
  • All children underwent serologic testing for Toxoplasma IgG and IgM, every 3 months for at least 1 year
  • Neurologic, ophthalmologic, and serologic testing were repeated every 3 months for the first 2 years of life
  • Neurologic, ophthalmologic, and serologic testing were repeated every 6 months during the third year of life
  • Neurologic, ophthalmologic, and serologic testing were repeated every year thereafter (without age limit)
Berrebi et al129 (Toulouse cohort)
 Evaluation at birth includes:
  • Clinical evaluation
  • Head ultrasonography
  • Ophthalmologic examination
  • Placenta/cord blood for parasitologic studies
 Infants likely to be infected:
  • Clinical and ophthalmologic follow-up every 1 month for the first year
  • Clinical and ophthalmologic follow-up every 2 months in the second year
  • Clinical and ophthalmologic follow-up every 3 months in the third year
  • Clinical and ophthalmologic follow-up every 3–6 months afterward
 Infants unlikely to be infected:
  • Clinical plus ophthalmologic plus serologic follow-up every 3 months, until disappearance of Toxoplasma IgG antibodies; up to 12–18 months of age
  • a Timing of diagnosis of first chorioretinal lesion in infants/children with CT: In 75% of cases, the initial chorioretinal lesions were detected for the first time after the first 7 months of age, in 50% of cases after the first 3 years of age, in 25% of cases after 8 years of age, in 20% of cases after 10 years of age, and in 10% of cases after 12.5 years of age.137 (Of note, the majority of these infants were treated once their mothers were diagnosed with acute T gondii infection during routine antepartum screening.)