Toxoplasma Gondii

DIAGNOSIS

Toxoplasmosis typically causes multiple CNS mass lesions and presents with encephalopathy and focal neurologic findings.

Diagnostic Testing

LABORATORIES

Disease represents reactivation of a previous infection, and the serologic workup is usually positive.

IMAGING

• MRI of the brain is the best radiographic technique for diagnosis.

• Often the diagnosis relies on response to empiric treatment, as seen by a reduction in the size of the mass lesions.

TREATMENT

• Sulfadiazine, 25 mg/kg PO q6h, plus pyrimethamine, 200 mg PO on day 1, followed by 50-75 mg PO daily (based on body weight), is the therapy of choice.

• Leucovorin, 10-25 mg PO daily, should be added to prevent hematologic toxicity.

• For patients who are allergic to sulfonamides, clindamycin, 600 mg IV or PO q8h, can be used instead of sulfadiazine.

• Doses are reduced after 6 weeks of therapy.

• Secondary prophylaxis can be discontinued among patients with a sustained increase in CD4 count gt;200 cells#8725;#956;L for more than 6 months as a result of response to ART and if the initial therapy is complete and there are no symptoms or signs attributable to toxoplasmosis.