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Ocular Findings in Infants with Congenital Toxoplasmosis after a Toxoplasmosis Outbreak.
- Source :
-
Ophthalmology [Ophthalmology] 2021 Sep; Vol. 128 (9), pp. 1346-1355. Date of Electronic Publication: 2021 Mar 10. - Publication Year :
- 2021
-
Abstract
- Purpose: We investigated the prevalence of ocular abnormalities in infants vertically exposed to Toxoplasma gondii infection during an outbreak in Santa Maria City, Brazil.<br />Design: Consecutive case series.<br />Participants: A total of 187 infants were included.<br />Methods: The infants were recruited from January 2018 to November 2019. All mothers were screened for syphilis and human immunodeficiency virus before delivery. Toxoplasmosis infection was confirmed in all mothers and infants based on the presence of serum anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies. All infants underwent an ophthalmologic examination; ocular abnormalities were documented using a wide-field digital imaging system. Neonatal cranial sonography or head computed tomography was performed in 181 infants, and the cerebrospinal fluid (CSF) was screened for anti-T. gondii IgG and IgM antibodies in 159 infants. Peripheral blood samples from 9 infants and their mothers were analyzed for the presence of T. gondii DNA by real-time polymerase chain reaction.<br />Main Outcome Measures: Ocular abnormalities associated with congenital toxoplasmosis.<br />Results: A total of 187 infants were examined. Twenty-nine infants (15.5%) had congenital toxoplasmosis, of whom 19 (10.2%) had ocular abnormalities, including retinochoroiditis in 29 of 38 eyes (76.3%), optic nerve abnormalities in 5 eyes (13.2%), microphthalmia in 1 eye (2.6%), and cataract in 2 eyes (5.3%). Bilateral retinal choroidal lesions were found in 10 of 19 infants (52.6%). Nine eyes of 6 infants had active lesions, with retinal choroidal cellular infiltrates at the first examination. Thirteen (7.2%) of 181 infants screened presented with cerebral calcifications. Eighty-three percent of the screened infants were positive for anti-T. gondii IgG and negative for IgM antibodies in the CSF. Congenital toxoplasmosis was higher in mothers infected during the third pregnancy trimester, and maternal treatment during pregnancy was not associated with a lower rate of congenital toxoplasmosis.<br />Conclusions: High prevalence rates of clinical manifestations were observed in infants with congenital toxoplasmosis after a waterborne toxoplasmosis outbreak, the largest yet described. Cerebral calcifications were higher in infants with ocular abnormalities, and maternal infection during the third pregnancy trimester was associated with a higher rate of congenital toxoplasmosis independent of maternal treatment.<br /> (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Antibodies, Protozoan blood
Antibodies, Protozoan cerebrospinal fluid
Antiprotozoal Agents therapeutic use
DNA, Protozoan genetics
Drug Therapy, Combination
Female
Follow-Up Studies
Humans
Immunoglobulin G blood
Immunoglobulin G cerebrospinal fluid
Immunoglobulin M blood
Immunoglobulin M cerebrospinal fluid
Infant, Newborn
Leucovorin therapeutic use
Male
Pregnancy
Prevalence
Pyrimethamine therapeutic use
Real-Time Polymerase Chain Reaction
Retrospective Studies
Sulfadiazine therapeutic use
Tomography, X-Ray Computed
Toxoplasma genetics
Toxoplasma immunology
Toxoplasmosis, Congenital diagnosis
Toxoplasmosis, Congenital drug therapy
Toxoplasmosis, Ocular drug therapy
Ultrasonography
Disease Outbreaks statistics & numerical data
Toxoplasmosis, Congenital epidemiology
Toxoplasmosis, Ocular diagnosis
Toxoplasmosis, Ocular epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1549-4713
- Volume :
- 128
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Ophthalmology
- Publication Type :
- Academic Journal
- Accession number :
- 33711379
- Full Text :
- https://doi.org/10.1016/j.ophtha.2021.03.009