209 Management of Children with Suspected or Proven Congenital Toxoplasmosis From Day 10 to the End of their First Year

Management from Day 10 to Day 365 has two goals according to the results of the work-up performed at birth, and eventually in utero . The first is to start treatment and surveillance in infected newborns and, the second, applying to settings where prenatal screening is performed, is to confirm the absence of infection in newborns who are born from a mother who seroconverted during pregnancy but who show no signs of infection at birth. When congenital infection is proven the standard attitude in France is to start treatment without delay even newborns with no clinical signs. Treatment relies on a combination of pyrimethamine and sulfonamides but there is no consensus on the type of sulfonamides, on the dosages and rhythm of administration and on the length of treatment, ranging from 3 to 24 months. Children under treatment should be monitored regularly for side effects. The decrease of IgG under treatment is a normal evolution and should not be interpreted as a sign of non-infection. Regular neurological and ophthalmological examinations in the first year of life are also important to detect any signs that would deserve special attention. In the second case, the absence of clinical and biological signs in utero or at birth significantly decreases the probability of infection. Repeated serological tests remain however necessary to fully exclude infection by monitoring the decrease of IgG to undetectable levels. Any neosynthesis of IgG would indicate that the child is infected and warrant starting the same treatment as in infected infants.