Severe ocular abnormalities noted in children with congenital toxoplasmosis

Following a Toxoplasma gondii infection outbreak in Santa Maria City, Brazil, the authors investigated the prevalence of ocular abnormalities in a consecutive case series of 187 vertically exposed infants.

Study design

Toxoplasmosis infection was confirmed in mothers and infants via serum anti–T. gondii immunoglobulin G (IgG) and immunoglobulin M antibodies in the cerebrospinal fluid (CSF). The infants underwent an ophthalmologic examination, and a wide-field digital imaging system was used to identify ocular abnormalities.

Outcomes

Of 187 exposed infants, 29 had congenital toxoplasmosis, of whom 19 had ocular abnormalities. The most widely reported abnormality was retinochoroiditis. Bilateral retinal choroidal lesions were seen in 10 of 19 infants, and 9 eyes of 6 infants had active lesions, with retinal choroidal cellular infiltrates at the first examination. Eighty-three percent of the screened infants were positive for anti–T. gondii IgG antibodies in the CSF. Congenital toxoplasmosis was highest in mothers infected during the third pregnancy trimester.

Limitations

Given the constraints of a large outbreak, some infants born with congenital toxoplasmosis may have been missed, including those born at home from mothers without prenatal screening and those whose mothers had a recent infection and tested negative.

Clinical significance

A high prevalence of ocular clinical manifestations was observed in infants with congenital toxoplasmosis following a large waterborne toxoplasmosis outbreak. The ophthalmologic consequences of toxoplasmosis outbreaks may be dramatic; therefore, the need for surveillance and early treatment is necessary during any outbreak context, particularly for susceptible pregnant women in high-risk regions.