Longitudinal study of new eye lesions in children with toxoplasmosis who were not treated during the first year of life

Abstract

Purpose: To determine the incidence of new chorioretinal lesions in children with toxoplasmosis diagnosed after, and therefore not treated during, their first year.

Design: Prospective longitudinal cohort study.

Methods: Thirty-eight children were evaluated in Chicago between 1981 and 2005 for new chorioretinal lesions. Thirty-eight children and mothers had serum IgG antibody to Toxoplasma gondii.

Results: Twenty-eight of 38 children had one of the following: diagnosis with serum antibody to T. gondii indicative of chronic infection at age 24 months, central nervous system calcifications, hydrocephalus, illness compatible with congenital toxoplasmosis perinatally but not diagnosed at that time. Twenty-five returned for follow-up during 1981 to 2005. Their mean (range) age at last exam was 10.9 +/- 5.7 (range, 3.5 to 27.2) years and mean follow-up was 5.7 +/- 2.9 years. Eighteen (72%) children developed at least one new lesion. Thirteen (52%) had new central lesions, 11 (44%) had new peripheral lesions, and six (24%) had both. Thirteen (52%) had new lesions diagnosed at age > or =10 years. New lesions were found at more than one visit in four (22%), and bilateral new lesions developed in seven (39%) of 18 children who developed new lesions. Of 10 additional children with eye findings and serologic tests indicative of chronic infection, six returned for follow-up, four (67%) developing new lesions at > or =10 years of age.

Conclusions: More than 70% developed new chorioretinal lesions. New lesions were commonly diagnosed after the first decade of life.

FIGURE 1

Data form for ophthalmology examination for toxoplasmosis study.

FIGURE 2

Representative example of new toxoplasmic chorioretinal lesions in patients no. 159 (top), 118 (middle), and 89 (bottom). (Top left) Patient at age 4½ years before new lesion. (Top right) Patient pictured at top left at age 7 years with active disease. (Middle left) Patient at age 8 years before new lesion. (Middle right) Patient pictured at middle left with active disease at age 10 years. (Bottom left) Twelve-year-old patient before new lesion. (Bottom right) Patient pictured at bottom left at age 20 with active disease.

FIGURE 3

Representative example of new toxoplasmic chorioretinal lesions in patient no. 42. Right eye of patient at age 4 years (Top left), age 11 years (Middle left), and age 19 years (Bottom left). Left eye of patient at age 4 (Top right), at age 11 years (Middle right), and at age 19 years (Bottom right).

FIGURE 4

Representative example of new toxoplasmic chorioretinal lesions in patient no. 25. Left eye of patient at age 23 years two months (Left) and at age 23 years three months (Right).

FIGURE 5

Representative example of new toxoplasmic chorioretinal lesions in patient no. 84. Left eye of patient from two different angles at age 12 years (Top) and at age 13 years (Bottom).

FIGURE 6

Representative example of new toxoplasmic chorioretinal lesions in patient no. 27. Right eye of patient at age 15 years (Top) and at age 18 years (Middle). (Bottom) Cataract in eye of same patient at age 18 years.

FIGURE 7

Incidence of new toxoplasmic chorioretinal lesions by age of visit. Incidence rates of new lesions were calculated at each visit by dividing the number of patients seen with new lesions by the total number of person-years at risk. The dashed line is for peripheral lesions, the dotted line for central lesions, and the solid line is for all lesions (peripheral and central). The shaded region indicates the 95% confidence bounds for all lesions incidence rates.