Toxoplasmosis Treatment & Management

  • Author: Murat Hökelek, MD, PhD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 15, 2011
 

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 may still be uncertain. Emergency consultation with relevant subspecialties may be required for assistance in empiric treatment and the diagnostic workup.

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Approach Considerations

Treatment is usually 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.

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Deterrence and Prevention

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
  • 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 who have cats are at no increased risk for toxoplasmosis compared with persons who do not have cats

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

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Contributor Information and Disclosures
Author

Murat Hökelek, MD, PhD  Technical Consultant of Parasitology Laboratory, Professor, Department of Clinical Microbiology, Ondokuz Mayis University Medical School, Turkey

Murat Hökelek, MD, PhD is a member of the following medical societies: Turkish Society for Parasitology

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Joseph U Becker, MD Fellow, Global Health and International Emergency Medicine, Stanford University School of Medicine

Joseph U Becker, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Mark L Plaster, MD, JD Executive Editor, Emergency Physicians Monthly

Mark L Plaster, MD, JD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: M L Plaster Publishing Co LLC Ownership interest Management position

Amar Safdar, MD, FACP, FIDSA Associate Professor of Medicine, Consulting Staff, Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, University of Texas

Amar Safdar, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International Immunocompromised Host Society, New York Academy of Sciences, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Joseph Sciammarella, MD, FACP, FACEP Major, Medical Corps, US Army Reserve; Attending Physician, Emergency Medicine, Weatherby Locums; President and Director of Education, Health Training/Consulting, Inc

Joseph Sciammarella, MD, FACP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Richard H Sinert, DO Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Deepika Singh, MD Staff Physician, Department of Emergency Medicine, Lawrence and Memorial Hospital, New London, CT

Deepika Singh, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Nurses Association, Emergency Medicine Residents Association, and Sigma Theta Tau International

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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Toxoplasmosis. Toxoplasma gondii tachyzoites (Giemsa stain).
Toxoplasmosis. Toxoplasma gondii tachyzoites in cell line.
Toxoplasma gondii in infected monolayers of HeLa cells (Giemsa stain).
Ophthalmic toxoplasmosis. Used with permission of Anton Drew, ophthalmic photographer, Adelaide, South Australia.
Macular scar secondary to congenital toxoplasmosis. Visual acuity of the patient is 20/400
Papillitis secondary to toxoplasmosis, necessitating immediate systemic therapy.
Acute macular retinitis associated with primary acquired toxoplasmosis, requiring immediate systemic therapy
Peripapillary scars secondary to toxoplasmosis
Perimacular scars secondary to toxoplasmosis
Inactive retinochoroidal scar secondary to toxoplasmosis
 
 
 
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