Time to Screen for Congenital Toxoplasmosis?

Abstract

Although the devastating consequences of congenital toxoplasmosis are well known as part of the TORCH syndrome (i.e., toxoplasmosis, syphilis, rubella, cytomegalovirus, and herpes infections), many aspects of surveillance and treatment of congenital toxoplasmosis have remained controversial because of incomplete data regarding the prevalence of disease and the impact of treatment. McLeod et al. [1] now report the results of a longitudinal study that shows the significant impact of treatment on 120 congenitally infected children who were treated for 1 year with pyrimethamine and sulfadiazine. The National Collaborative Chicago-Based, Congenital Toxoplasmosis Study has been observing affected children prospectively since 1981 [2]. Currently, the 1-year treatment regimen is the standard of care in the United States for congenital toxoplasmosis, but the long-term impact of treatment was unknown. Interim reports about this cohort of children have been previously published [2]. A prospective, doubleblind study including an arm of untreated patients was deemed ethically contraindicated because of unexpectedly favorable results of pilot treatment studies. As a result, outcomes were compiled for children treated with 2 regimens of pyrimethamine and sulfadiazine for 1 year and compared with outcomes of children in previously published studies. Prior studies had shown that untreated children or children who received a short course of therapy (1 month) did poorly [3, 4]. Children in the study by McLeod et al. [1] were examined for specific end points that included motor abnormalities,