Symptomatic toxoplasma infection due to congenital and postnatally acquired infection

Ruth Gilbert ^1*, Hooi Kuan Tan ², Susan Cliffe ², Miles Stanford ³ and Edward Guy ⁴

¹ UCL, United Kingdom
² Institute of Child Health, United Kingdom
³ St. Thomas' Hospital, United Kingdom
⁴ Toxoplasma Reference Laboratory, United Kingdom

^* To whom correspondence should be addressed. E-mail: r.gilbert{at}ich.ucl.ac.uk.

Accepted 1 March 2006

Abstract

Objective: We determined the incidence and severity of symptomatic toxoplasma infection presenting during childhood due to congenital or postnatally acquired infection.

Design: Between 2002 and 2004, newly diagnosed children (< 16 years) with signs or symptoms of congenital or ocular toxoplasmosis were reported by clinicians to the British Paediatric and Ophthalmic surveillance units or by toxoplasma referral laboratories. Confirmed cases were estimated to have a greater than 50% probability of congenital and/or ocular toxoplasmosis, based on clinical and serological findings.

Setting: Secondary level paediatric and ophthalmic services and toxoplasma referral laboratories in the UK and Ireland.

Main outcome measures: Incidence and severity of symptomatic congenital toxoplasma infection and postnatally acquired ocular toxoplasmosis.

Results: 38 children had confirmed toxoplasma infection. 22 (58%) were classified with congenital infection (cumulative incidence for England and Wales 3.4/100,000 live births; 95%CI: 2.4, 4.8) of whom 2 (9%) were stillborn, 7 (32%) live births had intracranial abnormalities and/or developmental delay (5 of whom had retinochoroiditis), and 10 (45%) had retinochoroiditis with no other abnormalities reported. A further 16 (42%) children were classified as infected after birth, all had retinochoroiditis.

Conclusions: The low burden of symptomatic congenital toxoplasmosis combined with the lack of evidence of an effective treatment support current policy not to offer prenatal or neonatal screening for toxoplasma infection. Primary prevention strategies need to address acquisition of infection in childhood which accounts for half the ocular disease due to toxoplasma infection in children in the UK and Ireland.

Keywords: congenital toxoplasmosis, retinochoroiditis, surveillance study

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