Evolução ocular na toxoplasmose congênita

Abstract

Objectives: To describe the ocular evolution and to investigate antecedents and clinical aspects that may influence the visual prognosis in congenital toxoplasmosis. Methodology: Retrospective cohort including patients seen between 1996 and 2017 in the public and private outpatient sectors of the São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil, with confirmed diagnosis of congenital toxoplasmosis and follow-up to at least one year old. Results: Among the 77 patients included, congenital toxoplasmosis was suspected by routine screening in 65 (84.5%). Seventy-three patients (94.8%) received treatment in the first year of life with pyrimethamine, sulfadiazine and folinic acid. The median age at the end of follow-up was 10 years (minimum 2, maximum 25). The number of patients with retinochoroiditis was 39 (70.9%) in the first year of life and 55 (71.4%) at the end of follow-up. There was a peak incidence of new retinochoroiditis lesions between 4 and 5 years and another between 9 and 14 years, the latter only in girls. New retinochoroiditis lesions appeared after the first year of life in 77.8% of patients who started treatment after the fourth month of life, vs. 35.2% of those who started it within the first four months (RR=0.45, 95%CI 0.27-0.75, p=0.02) and 33.3% of those who started it within the first two months (RR=0.42, 95%CI 0.25-0.72, p=0.01). In eight eyes with macular lesion the visual acuity was between 10% and 40% and in 10 eyes with paramacular lesion the acuity was between 5% and 100%. Thirty-four patients with retinochoroiditis were followed for 10 years or more, among which school performance was considered adequate in 28 (82.4%). Conclusions: The high incidence of new retinochoroiditis lesions during follow-up indicates the importance of long-term follow-up of patients with congenital toxoplasmosis. Starting the treatment within the first four months of life, specially within the first two months, was a protective factor for later onset of retinochoroiditis. Eyes with macular and paramacular retinochoroiditis lesions had a better than expected outcome in terms of visual function. Despite the general favorable prognosis, the marked morbidity of congenital toxoplasmosis in Brazil was confirmed.