Infants With Congenital Toxoplasmosis Should Be Treated for 1 Year
A longitudinal study published in the May 15 issue of Clinical Infectious Diseases supports current guidelines for treating infants with congenital toxoplasmosis for one year to avoid adverse outcomes. Based on these findings, the investigators and the editorialist also recommend more vigilant screening.
“We now know that we can improve longer-term outcomes if we treat the acute infection early,” lead author Rima McLeod, MD, from the Toxoplasmosis Center at the University of Chicago, said in a news release. “But to treat it early we have to detect it early, and we know we are missing many infants who would benefit.”
Between 1981 and 2004, 120 infants with congenital toxoplasmosis were treated with 1 of 2 doses of pyrimethamine plus sulfadiazine, beginning shortly after birth and continuing for 12 months. They were also evaluated at birth and at predetermined intervals for motor abnormalities, cognitive outcome, vision impairment, formation of new eye lesions, and hearing loss. All children without substantial neurologic disease at birth who received treatment had normal cognitive, neurologic, and auditory outcomes. Among treated infants who had moderate or severe neurologic disease at birth, greater than 72% had normal neurologic and/or cognitive outcomes, and none had sensorineural hearing loss. New eye lesions developed in 9% of children without substantial neurologic disease and in 36% of those with moderate or severe neurologic disease at birth. Nearly all of these outcomes were dramatically better than outcomes reported in earlier decades for children who were untreated or treated for 1 month (P < .01 to P < .001). Both treatment groups were similar in sex distribution, severity of disease, and efficacy and toxicity of treatment.
“Although not all children did well with treatment, the favorable outcomes we noted indicate the importance of diagnosis and treatment of infants with congenital toxoplasmosis,” the authors write. “The majority of the children in our cohort are entering adolescence without experiencing recurrent eye lesions or seizures and with normal cognitive and motor function…. Continued, longitudinal follow-up of our sentinel cohort is of particular importance, because it will provide new information regarding outcomes — potentially lifelong — following treatment during infancy of persons with congenitall toxoplasmosis.”
This study was funded by the National Institute of Allergy and Infectious Disease; the Research to Prevent Blindness Foundation; the Hyatt Hotels Foundation (complimentary accommodations); and United Airlines, American Airlines, Southwest Airlines, Air Canada, Braniff, and Angel Flight (complimentary transportation). The authors have disclosed no relevant financial relationships.
In an accompanying editorial, Kami Kim, MD, from Albert Einstein College of Medicine in New York, notes that treated children with severe disease had remarkably better outcomes than were previously reported for untreated children with severe disease.
“Although treatment of fetal toxoplasmosis is standard clinical practice, prenatal surveillance is still controversial,” Dr Kim writes. “It may be time to consider a more comprehensive plan for neonatal screening for congenital toxoplasmosis…. Thus, a more concerted effort should be made to evaluate the cost effectiveness of identification and treatment of all cases of congenital toxoplasmosis.” Dr Kim has disclosed no relevant financial relationships.
Clinical Infectious Disease. 2006;42:1383-1397
