Background Ocular lesions represent the most frequently encountered clinical manifestation of congenital toxoplasmosis (CT). Thus they may be correlated with disease activity, functional damage and impact on quality of life (QoL).
Patients The Department of Parasitology, Hôpital de la Croix-Rousse, Lyon, France, represents a national reference centre for patients with CT. Beyond a European cohort of 430 children with treated CT, 130 presented retinochoroiditis (OT) during a median follow up period of more 10 years.
Results In our European cohort, OT was present at birth in only 10% of instances, but late manifestation beyond ten years of age has to be expected. After 6 years, 24% will manifest OT, increasing to 30% after ten years. Lesions in both eyes have to be expected in 30% of instances, but no child in our cohort had bilateral visual impairment. Not surprisingly, QoL assessment revealed that treated CT has little effect on the vision related QoL and general well being of the affected individuals. This strongly contrasts to outcomes reported from Southern American cohorts with CT where 80% of the merely untreated neonates show ocular manifestations early in life, 65% present bilateral lesions, and foveal involvement is present in 50%, resulting in significantly lower QoL scores.
Conclusions People with OT in Europe show less severe clinical courses and functional damage resulting in better vision-related QoL than individuals living in Southern America, especially since these frequently have bilateral lesions and more recurrences. Close clinical follow up is warranted in any case with ocular involvement.