Neuropsychological Profile of Treated Children with Congenital Toxoplasmosis

Kimberly A Kerns,Jillian Roberts,Sandra J Mish,Frank Jagdis

doi:10.4236/psych.2014.59120

Abstract

Background: Very little is known about the long-term neuropsychological outcomes of infants who were treated with pyrimethamine and sulfadiazine for congenital Toxoplasma infection. This study investigated the neurocognitive functioning and behavior of a cohort of treated infants exposed to Toxoplasma gondii in the 1994-1995 outbreak in Victoria, British Columbia. Methods: Ten infants from the original cohort, treated with pyrimethamine and sulfadiazine starting during first year of life and continuing for 12 months, were evaluated at 7 to 8.5 years of age. Neuropsychological evaluations focused on the cognitive, academic, adaptive, and behavioral functioning of these children. Results: The cohort demonstrated generally average neurocognitive abilities and academic achievement. According to parental ratings, the children’s executive functions, behavior and adaptive functioning did not differ significantly from the normative population. However, subtle difficulties were seen on more demanding sustained attention and impulse control tasks. Conclusions: These results suggest favorable outcomes in infants who were treated for one year with pyrimethamine and sulfadiazine. Nonetheless, congenital toxoplasmosis might contribute to some difficulties with higher-order cognitive abilities or tasks demanding greater self-monitoring. These difficulties could become more pronounced as higher demands for these abilities and brain areas come online during late childhood and adolescence. These findings highlight the importance of effective treatment and longitudinal follow-up of children with congenital toxoplasmosis.

Highlights

Very little is known about the long-term neuropsychological outcomes of infants who were treated with pyrimethamine and sulfadiazine for congenital Toxoplasma infection
Congenital toxoplasmosis is a disease caused by the protozoan parasite, Toxoplasma gondii (T. gondii). *Toxoplasma infections occur worldwide, widely disparate prevalence rates exist throughout the world depending on geographic region and sanitation practices
The purpose of the present study was to extend our knowledge about the long-term outcome of treatment for congenital toxoplasmosis, and to provide a comprehensive evaluation of the neuropsychological functioning, academic achievement and behavior of this unique cohort of treated children

Summary

Introduction

Very little is known about the long-term neuropsychological outcomes of infants who were treated with pyrimethamine and sulfadiazine for congenital Toxoplasma infection. Congenital toxoplasmosis might contribute to some difficulties with higher-order cognitive abilities or tasks demanding greater self-monitoring. These difficulties could become more pronounced as higher demands for these abilities and brain areas come online during late childhood and adolescence. These findings highlight the importance of effective treatment and longitudinal follow-up of children with congenital toxoplasmosis. Maternal infection is less frequently transmitted to the fetus early in pregnancy, early transmission is often associated with fetal death or severe congenital disease (Desmonts & Couvreur, 1974). Current medications do not impact maternal-fetal transmission rates (Foulon et al, 1999; Gilbert, Gras, Wallon, Peyron, Ades, & Dunn, 2001)

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