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Toxoplasmosis and eye disease in children
Last reviewed: 04.07.2025
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The incidence of toxoplasmosis varies widely among geographic regions. In some countries, toxoplasmosis is extremely common, while in others it is rare. After birth, toxoplasmosis causes fever and lymphadenopathy, which are of little clinical significance. However, when a pregnant woman is infected, toxoplasmosis often causes significant damage to the developing fetus. The occurrence of infection, especially severe, in the first trimester of pregnancy can lead to the death of the embryo. The later the infection develops and the easier it is for the mother, the less significant the consequences. Relatively few infected mothers have affected children.
Congenital toxoplasmosis syndrome includes:
- intracranial calcification;
- hydrocephalus;
- microcephaly;
- convulsions;
- hepatitis;
- fever;
- anemia;
- hearing loss;
- mental retardation.
Manifestations of congenital toxoplasmosis syndrome from the organ of vision include:
- chorioretinitis;
- uveitis;
- cortical blindness;
- cataract (secondary to uveitis).
Chorioretinitis
Chorioretinitis is the most common manifestation of congenital toxoplasmosis syndrome, manifested by the occurrence of limited foci of chorioretinal atrophy and hyperpigmentation. The process is usually bilateral, with predominant localization at the posterior pole of the eye. Exacerbations of uveitis are possible at any time throughout subsequent life.
Other pathology of the organ of vision
In severe clinical manifestations of congenital toxoplasmosis syndrome, microphthalmos, cataracts, and panuveitis may occur. Cataracts are usually a nonspecific consequence of the intraocular inflammatory process and are almost always associated with severe retinal pathology. Optic atrophy may be due to hydrocephalus or other brain lesions.
Diagnosis of toxoplasmosis
Diagnosis is usually made by serologic testing. Dye test results depend on the degree of suppression of live Toxoplasma gondii by antibodies in the patient's serum. In acute cases, Dye test titers increase. Since infant serum may contain passively acquired antibodies, high antibody titers or positive results occur when specific IgM immunoglobulin is determined by enzyme-linked immunosorbent assay.
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Treatment of toxoplasmosis
Positive results of serological testing in neonates suffering from toxoplasmosis, in the presence of specific immunoglobulin IgM, are an indication for the administration of pyrimethamine at a daily dose of 1 mg/kg of weight and sulfadiazine at a daily dose of 100 mg/kg of weight in combination with folic acid, for 2-3 weeks. Primarily infected pregnant women are prescribed spiramycin, but the use of pyrimethamine and sulfadiazine is not recommended.
The advisability of screening for toxoplasmosis is still debatable. Screening for this pathology is more relevant in countries where the disease is endemic.
Patients with cataracts undergo ultrasound examination, visual evoked potentials and electroretinography to determine the functional prognosis of surgical intervention. In case of exacerbations of chorioretinitis, general use of steroid drugs and pyrimethamine or spiramycin is prescribed. For children with congenital toxoplasmosis syndrome, treatment is developed jointly with a pediatric infectious disease specialist.