Serological rebound in congenital toxoplasmosis: long-term follow-up of 133 children

Citation
M. Wallon et al., Serological rebound in congenital toxoplasmosis: long-term follow-up of 133 children, EUR J PED, 160(9), 2001, pp. 534-540
Citations number
14
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Pediatrics,"Medical Research General Topics
Journal title
EUROPEAN JOURNAL OF PEDIATRICS
ISSN journal
0340-6199 → ACNP
Volume
160
Issue
9
Year of publication
2001
Pages
534 - 540
Database
ISI
SICI code
0340-6199(200109)160:9<534:SRICTL>2.0.ZU;2-N
Abstract
Although serological rebound is common in infants with congenital toxoplasm osis, clinical recommendations for management, in particular the need for a dditional treatment, vary. The goals of our retrospective cohort study in 1 33 consecutive children with congenital toxoplasmosis were to estimate the incidence and duration of the rebounds, identify predictive factors, assess the long-term risk of eye lesions and the need for treatment. We first est imated the incidence and duration of rebounds and identified predictive fac tors using an univariate analysis and a Cox model modified to include time- dependent variables. Two cohort studies were then conducted to compare the incidence density of secondary eye lesions in children who had a rebound ve rsus no rebound, and among children who had a rebound after initial therapy , in those who received an additional course of treatment and in those who did not. Of the 133 children, 93 (70%) had at least one rebound during a me an follow-up of 95 months. Of those with one rebound diagnosed after initia l treatment, 33 received an additional 3-month course of pyrimethamine/sulp hadoxine and 48 were not treated. Intracranial calcification at birth was a ssociated with an increased relative risk (RR) of rebound (RR=2.601; P=0.03 ), and treatment with pyrimethamine/sulphadoxine between 2 and 12 months of age with a decreased risk (RR=0.3; P=0.0845), whereas age of pregnancy at maternal infection, type of treatment during pregnancy and sex were not fou nd to be predictive factors. There was no difference in incidence densities of secondary eye lesions in children without rebound (7/3,367 child-months ) compared to those with at least one rebound (22/9,609 child-months) (RR=1 .10; 95% CI: 0.47-2.58), and, among the 81 children who had one rebound dia gnosed after initial treatment, in those who received an additional course of treatment and in those who did not (RR=0.72; 95% CI: 0.30-1.72). Conclus ion: serological rebound is common in children with congenital toxoplasmosi s but, due to the risk and constraints, an additional course of treatment a nd more ophthalmological surveillance than currently practiced do not seem warranted.