Produção Nacional
Revisado por pares
Geographic Difference in Outcomes of Congenital Toxoplasmosis
2011; Lippincott Williams & Wilkins; Volume: 30; Issue: 9 Linguagem: Inglês
10.1097/inf.0b013e31822426a6
ISSN1532-0987
AutoresDaniel V. Vasconcelos-Santos, Gláucia Manzan Queiroz de Andrade,
Tópico(s)Parasitic Infections and Diagnostics
ResumoTo the Editors: We have read with interest the enlightening article by Peyron et al, assessing the long-term quality of life as well as visual performance in a large cohort of young adults with treated congenital toxoplasmosis (TCT) in Europe.1 The authors showed that at least in that specific population, the burden of TCT may be limited in the long term.1 This might indirectly affect public health policies on prevention of congenital toxoplasmosis in several countries. However, we believe that those findings should be interpreted and extrapolated with caution, given the variable burden of the disease in different parts of the world. It has been suggested indeed, as stressed by the authors,1 that the outcomes of children with congenital toxoplasmosis in Europe are different than those of children from South America.2 This has been hypothesized to be related at least in part to highly virulent atypical strains of Toxoplasma gondii that have been isolated in the New World.3 Moreover, the lack of prenatal treatment for the majority of these newborns diagnosed in the American continent may also contribute to these differences.4,5 In the report by Peyron et al,1 it should be noted that only one fourth of the patients with TCT had bilateral retinochoroidal involvement and less than one-sixth had foveal lesions, which probably explains their good performance on quality of life and visual function assessments. This dramatically contrasts at least to our anatomic results on early examination of a large cohort of neonates in southeastern Brazil.4 After neonatal screening, 80% of our neonates showed retinochoroidal lesions early after birth; 65% harbored bilateral lesions; and 50% had involvement of the foveal center.4 Even though data on quality of life and visual function of our cohort are not yet available, it is likely that the performance of our patients will be somewhat inferior to theirs, particularly considering the more prevalent and severe retinochoroidal changes in our cohort. Illustratively, in the Chicago cohort, researchers have previously found that the ophthalmologic involvement does account for certain specific limitations in cognitive function, even though the assessment of the quality of life in those children was not reported.6 Finally, the exact impact of recurrences in the quality of life of patients from the American continent is also not clear, although recurrence rates may be similar. We congratulate Peyron et al for their elegant and comprehensive work, hoping that current and future studies from other parts of the world are able to delineate better the problem regionally, allowing a more individualized and adequate approach for this potentially blinding disorder. ACKNOWLEDGMENT UFMG Congenital Toxoplasmosis Brazilian Group—UFMG-CTBG (members in alphabetic order): Ana Carolina A. Vasconcelos Carneiro, MSc; Daniel Vitor Vasconcelos-Santos, MD, PhD; Danuza O. Machado Azevedo, MD, PhD; Ericka V. Machado Carellos, MD, MSc; Fernando Oréfice, MD, PhD; Gláucia M. Queiroz-Andrade, MD, PhD (chair); José Nélio Januário, MD, MSc; Luciana Macedo Resende, MSc; Olindo Assis Martins-Filho, MSc, PhD; Ricardo W. Almeida Vitor, MSc, PhD; Roberta M. Castro Romanelli, MD, PhD; Waleska Teixeira Caiaffa, MPH, PhD; Wesley R. Campos, MD, PhD. Daniel Vitor Vasconcelos-Santos, MD, PhD Uveitis Unit Hospital São Geraldo/HC Universidade Federal de Minas Gerais Núcleo de Ações e Pesquisa em Apoio Diagnóstico Universidade Federal de Minas Gerais Gláucia M. Queiroz Andrade, MD, PhD Núcleo de Ações e Pesquisa em Apoio Diagnóstico Universidade Federal de Minas Gerais; Department of Paediatrics Universidade Federal de Minas Gerais Belo Horizonte, Brazil
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