Outcome of treatment for congenital toxoplasmosis, 1981-2004: The national collaborative Chicago-based, congenital toxoplasmosis study
Outcome of treatment for congenital toxoplasmosis, 1981-2004: The national collaborative Chicago-based, congenital toxoplasmosis study
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DOI：
10.1086/501360
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发表时间：
2006-05-15
影响因子：
11.8
通讯作者：
Meier, P
中科院分区：
文献类型：
--
作者：
McLeod, R;Boyer, K;Meier, P
背景。未经治疗，先天性弓形虫病有复发，复发，不良后果。对先天性弓形虫病患儿在一周岁期间接受乙胺嘧啶和磺胺嘧啶治疗的长期随访尚未见报道。1981年至2004年间，120名患有先天性弓形虫病的婴儿（当前平均年龄±标准差10.5±4.8岁）接受了乙胺嘧啶加磺胺嘧啶两剂中的一剂的治疗；治疗在出生后不久开始并持续了12个月。接受治疗的儿童在出生时和在预定的时间间隔内接受评估；评估的重点是预先设定的终点：运动异常、认知结果、视力损害、新眼损的形成和听力损失。对出生时没有严重神经系统疾病的婴儿使用乙胺嘧啶和磺胺嘧啶治疗1年，所有患者的认知、神经和听觉结果均正常。对出生时患有中度或重度神经系统疾病（如本文方法的“治疗”小节所定义）的婴儿进行治疗，可使约72%的患者获得正常的神经系统和/或认知结果，没有患者出现感音神经性听力损失。91%没有严重神经系统疾病的儿童和64%出生时患有中度或重度神经系统疾病的儿童没有出现新的眼部病变。几乎所有这些结果都明显优于前几十年未治疗或治疗1个月的儿童报告的结果（P < 0.01至P < 0.001）。两组患者的性别和疾病严重程度具有可比性，两组患者在疗效和毒性方面无显著差异（P < 0.05）。虽然不是所有的儿童治疗效果都很好，但我们注意到的良好结果表明先天性弓形虫病婴儿的诊断和治疗的重要性。
Background. Without treatment, congenital toxoplasmosis has recurrent, recrudescent, adverse outcomes. Long-term follow-up of infants with congenital toxoplasmosis treated throughout their first year of life with pyrimethamine and sulfadiazine has not been reported.Methods. Between 1981 and 2004, one hundred twenty infants (current mean age +/- standard deviation, 10.5 +/- 4.8 years) with congenital toxoplasmosis were treated with 1 of 2 doses of pyrimethamine plus sulfadiazine; therapy was initiated shortly after birth and continued for 12 months. Children who received treatment were evaluated at birth and at predetermined intervals; the focus of the evaluations was on prespecified end points: motor abnormalities, cognitive outcome, vision impairment, formation of new eye lesions, and hearing loss.Results. Treatment of infants without substantial neurologic disease at birth with pyrimethamine and sulfadiazine for 1 year resulted in normal cognitive, neurologic, and auditory outcomes for all patients. Treatment of infants who had moderate or severe neurologic disease (as defined in this article in the Treatments subsection of Methods) at birth resulted in normal neurologic and/or cognitive outcomes for > 72% of the patients, and none had sensorineural hearing loss. Ninety-one percent of children without substantial neurologic disease and 64% of those with moderate or severe neurologic disease at birth did not develop new eye lesions. Almost all of these outcomes are markedly better than outcomes reported for children who were untreated or treated for 1 month in earlier decades (P < 0.01 to P < .001). Sex and severity of disease were comparable in our 2 treatment groups, and no significant differences in efficacy or toxicity were noted between the 2 treatment groups (P > .05).Conclusions. Although not all children did well with treatment, the favorable outcomes we noted indicate the importance of diagnosis and treatment of infants with congenital toxoplasmosis.