Abstract
<jats:p>Background. Toxoplasmosis is a neglected tropical disease that is common but often underrecognized in immunocompetent children, largely due to the assumption of an asymptomatic or self-limiting course. Increasing reports of severe manifestations over the past decade necessitate a re-evaluation of potential morbidity in this population. This study aimed to describe the clinical and epidemiological characteristics, treatment patterns, and short-term clinical outcomes of toxoplasmosis in immunocompetent children aged ≤ 18 years at the Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, in 2020–2024. Materials and methods. A retrospective descriptive study, using medical records of immunocompetent patients (≤ 18 years) diagnosed with toxoplasmosis. Demographic data, clinical manifestations, organ involvement, diagnostic findings, treatment regimens, and short-term outcomes were analyzed. Results. Forty patients were included, most of them were infants aged 0–1 year (n = 20, 50 % [95% confidence interval (CI): 35–65 %]), predominantly males (n = 23, 57.5 % [95% CI: 42–71 %]), and had normal nutritional status (n = 21, 52.5 % [95% CI: 37–67 %]). Eyes was the most frequent organ system affected (n = 25, 62.5 % [95% CI: 47–76 %]), primarily presenting as visual impairment. Serological patterns demonstrated positive IgM with high IgG titers in 24 patients (60 % [95% CI: 45–74 %]), based on conventional IgM/IgG profiles without IgG avidity testing. Co-infection with other TORCH pathogens was notable, particularly triple co-infection with cytomegalovirus and rubella (n = 18, 45 % [95% CI: 31–60 %]). In this tertiary referral cohort, most symptomatic cases occurred in children with multiple TORCH co-infections (72.5 %), while only a small subgroup had isolated or minimal toxoplasmosis (27.5 %). The most common antiparasitic regimen was pyrimethamine-sulfadiazine (n = 15, 37.5 % [95% CI: 24–53 %]) for a duration of one year (n = 18, 45 % [95% CI: 31–60 %]). Short-term clinical improvement was observed in 97.5 % of cases (n = 39 [95% CI: 87–100 %]), irrespective of whether specific antiparasitic therapy was administered. Conclusions. Toxoplasmosis in immunocompetent children in this setting predominantly presents in infancy, with significant ocular involvement and frequent TORCH co-infections, limiting attribution of manifestations solely to Toxoplasma gondii. Short-term clinical improvement was observed in 97.5 % of cases, irrespective of whether specific antiparasitic therapy was administered, which complicates causal interpretation of treatment effects.</jats:p>