Article
Prognostic factors for the long-term development of ocular lesions in 327 children with congenital toxoplasmosis
Search Medline for
Authors
Published: | September 22, 2004 |
---|
Outline
Text
Objective
To identify the high-risk factors associated with the development of ocular lesions in a cohort of children with congenital toxoplasmosis (CT), irrespective of their gestational age at the time of maternal infection.
Methods
Children were managed according to a standardized protocol and monitored for up to 14 years at the Croix-Rousse Hospital, Lyon, France. Cox model and a flexible regression, spline-based method were used for the analysis of influencing factors.
Results
During a median follow-up time of 6 years, 79 of the 327 children (24%) had at least one retinochoroideal lesion. No bilateral impairment of visual acuity was observed. The risk of a child developing ocular disease was higher when mothers were infected early during pregnancy. CT diagnosis prior to or at birth, the presence of non-ocular manifestations at baseline and premature birth were additionally associated with ocular manifestation.
Conclusions
The time of fetal contamination is one factor for a more severe course of congenital toxoplasmosis. Early diagnosis, non-ocular organ manifestations and premature birth all indicate a more severe prenatal course of infection, which may be associated with a higher maternal parasite blood load resulting in a higher fetal inoculum. The latter may then be an independent risk factor for the further course. If this interpretation gains support using quantitative measures to define the parasite load in placenta and amnion fluid, it will provide a rational basis for an earliest possible aggressive antiparasitic therapy for the mother and her unborn child.