AM Report 2/15/17: Toxoplasmosis

 

Infection CD4 Count Prophylaxis
PCP pneumonia < 200 TMP-SMX
Toxoplasmosis < 100 TMP-SMX
MAC < 50 Azithromycin

Toxoplasmosis:

Presumptive Diagnosis: *usually made to avoid brain biopsy

  1. CD4 < 100
  2. Lack of effective prophylaxis
  3. Clinical syndrome (headache, neuro symptoms, fever, etc.)
  4. + T. gondii IgG antibody
  5. Imaging consistent with disease (multiple ring-enhancing lesions)

* If present >90% probably of TE.

Definitive Diagnosis:

  1. Clinical syndrome (headache, neuro symptoms, fever, etc.)
  2. Identification of ≥ 1 mass lesion by brain imaging
  3. Detection of organism in biopsy specimen

1

Treatment:

  1. Sulfadiazine
  2. Pyrimethamine
  3. Leucovorin – to prevent pyrimethamine induced hematologic toxicity
  • Measure response to treatment with daily neurological exams and repeat neuroimaging after 2-3 weeks
  • 75-80% of patients with TE will show radiographic and/or neurologic improvement
  • Treat for 6 weeks followed by maintenance therapy

ART:

  • 3 drugs from 2 different classes
  • Usually 2 nucleoside RTIs “backbone” and 3rd agent – either  a protease inhibitor or an integrase inhibitor

Post-Exposure Prophylaxis:

  • Started immediately after exposure => continued for 4 weeks
  • Test immediately, 6 weeks, 12 weeks, and 6 months
  • 3 Drug Regimen: Tenofovir-Emtricitabine + Raltegravir

Pre-Exposure Prophylaxis:

  • Recommended for certain high-risk populations: heterosexual partners of infected patients, MSM, IVDU
  • 2 Drug Regimen: Tenofovir-Emtricitabine

 

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