Long-term Longitudinal Analysis of Retinochoroiditis in Children with Congenital Toxoplasmosis Identified through Neonatal Screening in Brazil
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Purpose
To analyze prevalence and emergence of new retinochoroiditis (RC) lesions, and their visual impact during the first 10 years of life in children with congenital toxoplasmosis (CT) identified in a population-based neonatal screening program (NS) in Minas Gerais (MG), Brazil.
Methods
A prospective study including neonates confirmed with CT after NS covering 95% of live-births in the state of MG during 6 months. Annual pediatric/ophthalmic assessment was accomplished, with data analyzed in the first 10 years of life, and statistical analyses including Kaplan-Meier survival curves.
Results
NS identified CT in 178 neonates, correponding to 1:770 live births between a six-month period. Of these, 169 (95.0%) were born to untreated mothers prenatally. On first examination at a mean of 55 days of birth, 79.8% displayed RC, predominantly in the posterior pole, with bilateral lesions in 63.5% and active ones in 39.9%. All children received classic therapy with sulfadiazine, pyrimethamine, and folinic acid in the first year of life. During follow-up, new lesions were most frequently observed at the ages of 4-5 years (asymptomatic) and 9-10 years (symptomatic and asymptomatic), being promptly treated with classic therapy, as active recurrences were detected. After 10 years of age, only 3.4% of children were free of RC.
Conclusion
RC is a hallmark of CT, with prevalence in Brazil significantly higher than in international studies. RC prevalence slowly increased during follow-up, particularly at 4-5 years, when most recurrences occurred in asymptomatic children. This highlights the need for close monitoring to allow prompt treatment and prevent irreversible visual loss.
Conflict of interest
No
1
Last name
BENETI
Initials of first name(s)
GC
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais ( UFMG)
City
Belo Horizonte
Country
Brazil
2
Last name
LAGOS
Initials of first name(s)
AAR
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais ( UFMG)
City
Belo Horizonte
Country
Brazil
3
Last name
ARRUDA
Initials of first name(s)
JSD
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais ( UFMG)
City
Belo Horizonte
Country
Brazil
4
Last name
CARDOZO
Initials of first name(s)
SEM
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais ( UFMG)
City
Belo Horizonte
Country
Brazil
5
Last name
AZEVEDO
Initials of first name(s)
DOM
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais ( UFMG)
City
Belo Horizonte
Country
Brazil
6
Last name
ROMANELLI
Initials of first name(s)
RM
Department
Hospital das Clínicas da Universidade Federal de Minas Gerais ( UFMG)
City
Belo Horizonte
Country
Brazil
7
Last name
CARELLOS
Initials of first name(s)
EVM
Department
Hospital das clínicas da Universidade Federal de Minas Gerais ( UFMG)
City
Belo Horizonte
Country
Brazil
8
Last name
JANUARIO
Initials of first name(s)
JN
Department
Hospital das Clínicas da Universidade Federal de Minas Gerais ( UFMG)
City
Belo Horizonte
Country
Brazil
9
Last name
VASCONCELOS-SANTOS
Initials of first name(s)
DV
Department
Hospital São Geraldo/HC da Universidade Federal de Minas Gerais ( UFMG)
City
Belo Horizonte
Country
Brazil
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