Toxoplasmosis Treatment & Management
- Author: Murat Hökelek, MD, PhD; Chief Editor: Michael Stuart Bronze, MD more...
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.
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:
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.
The level of activity in patients with toxoplasmosis depends on the severity of disease and the organ systems involved.
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.
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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