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      Drugs & Diseases > Infectious Diseases

      Toxoplasmosis Treatment & Management

      Updated: Dec 20, 2022
      • Author: Murat Hökelek, MD, PhD; Chief Editor: Michael Stuart Bronze, MD  more...
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      Treatment

      Approach Considerations

      Treatment usually is unnecessary in asymptomatic hosts, except in children younger than 5 years. Symptomatic patients should be treated until immunity is ensured.

      Outpatient care is sufficient for acquired toxoplasmosis in immunocompetent hosts and for persons with ocular toxoplasmosis. Inpatient care is appropriate initially for persons with CNS toxoplasmosis and for acute toxoplasmosis in immunocompromised hosts.

      Patients with AIDS who have a CD4 count of less than 100 cells/μL should be commenced on suppressive therapy for T gondii until they undergo immune reconstitution.

      Consultations

      Subspecialty consultation is required for the seriously ill patient, according to organ-specific involvement. Moreover, in the setting of immunocompromise, involvement of one organ system (ie, retina) mandates analysis of further organ system involvement (ie, CNS). In addition to an infectious diseases specialist, the following are recommended consultations:

      • Parasitologist

      • Ophthalmologist

      • Neurologist

      • Radiologist

      • Gynecologist

      • Pediatrician

      Follow-up

      Follow-up visits should be scheduled every 2 weeks until the patient is stable, and then monthly during therapy. A CBC should be performed weekly for the first month, and then every 2 weeks. Renal and liver function tests should be performed monthly.

      Infants with confirmed congenital toxoplasmosis should be followed for evidence of developmental delay and should receive ophthalmologic consultation and follow-up.

      Activity

      The level of activity in patients with toxoplasmosis depends on the severity of disease and the organ systems involved.

      Next:

      Emergency Department Care

      Care of the patient in the emergency department should be specific to the presenting manifestations of the disease. Adequate airway, breathing, and circulation must be assessed and treated accordingly. Adequate fluid resuscitation, pain control, and fever control must be ensured.

      Neuroimaging should be considered for any immunocompromised patient with a new neurologic deficit, cranial nerve abnormality, severe headache, or altered mental status.

      Because the symptoms associated with acute toxoplasmosis are nonspecific and dependent on the tissues involved, emergency providers must be vigilant and include other infectious and noninfectious etiologies in their differential diagnoses. As such, broad-spectrum antimicrobial therapy is often necessary early in the course of illness, prior to the performance of definitive testing and while the diagnosis still may be uncertain. Emergency consultation with relevant subspecialties may be required for assistance in empiric treatment and the diagnostic workup.

      Previous
      Next:

      Deterrence and Prevention

      Everyone, including immunocompetent patients, should be educated about toxoplasmosis risk factors and ways to minimize the risks. Preventing toxoplasmosis is particularly important in seronegative immunocompromised patients and in pregnant women. Precautions against the disease include the following:

      • Avoid eating raw meat, unpasteurized milk, and uncooked eggs, oysters, clams, and mussels.
      • Wash hands after touching raw meat.
      • Wear gloves when gardening or handling soil and wash hands afterwards.
      • Wash fruits and vegetables.
      • Avoid contact with cat feces; however, pregnant women and persons with HIV infection who have cats are at no increased risk for toxoplasmosis compared with persons who do not have cats. [63]

      Moreover, travel to areas of high endemicity (Western Europe, South America) may increase the risk for exposure.

      Avoiding transfusions of blood products from a donor who is seropositive to a patient who is seronegative and immunocompromised is prudent, when feasible. If possible, organ recipients who are seronegative should receive transplanted organs from donors who are seronegative.

      Laboratory workers can become infected via ingestion of sporulated T gondii oocysts from feline fecal specimens or via skin or mucosal contact with either tachyzoites or bradyzoites in human or animal tissue or culture. Laboratories should have established protocols for handling specimens that contain viable T gondii and for responding to laboratory accidents.

      Currently, the only effective vaccine against toxoplasmosis is Toxovax, which contains a live attenuated S48 strain and controls congenital infection in sheep. Toxovax decreases the abortion rate but does not eradicate T gondii completely. Nevertheless, it is expensive and may be changed into a pathogenic form; for this reason, it is not appropriate for human use. Unfortunately, no licensed vaccine is yet available for humans. [64]

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