Toxoplasmosis in Emergency Medicine Follow-up

  • Author: Joseph U Becker, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 10, 2010
 

Further Outpatient Care

AIDS patients with CD4 counts less than 100 cells/μ L should be commenced on suppressive therapy for T gondii until they undergo immune reconstitution.

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

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Deterrence/Prevention

Prevention of T gondii infection includes the following:

  • All meat should be thoroughly cooked.
  • Careful handwashing should be done after handling raw meat.
  • Fruits and vegetables should be washed before eating them.
  • Pregnant women should wear gloves while gardening, thoroughly wash their hands afterwards, and avoid contact with cat feces.
  • Pregnant women and HIV patients with cats are at no increased risk of toxoplasmosis compared with those without cats.
  • Travel to areas of high endemicity (Western Europe, South America) may increase the risk of exposure.
  • Primary and secondary prevention should be completed for AIDS patients.
  • As discussed in Treatment, controversy exists regarding whether or not treatment of maternal infection prevents either fetal infection or the adverse outcomes rarely associated with congenitally acquired infection.
  • Currently, no systematic screening program exists for T gondii in the United States for either AIDS patients or pregnant women. France, with a much higher seroprevalence of T gondii exposure, does mandate monthly screening during pregnancy, although the results of this effort are difficult to measure given the infrequency of fetal infection and the generally good long-term prognosis of disease.

Development of vaccines for use in nonimmune women of childbearing age and household cats is being investigated.

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Complications

  • CNS deficits dependent on the territory effected. Basal ganglia seem to be preferentially involved.
  • Partial or complete blindness
  • Congenital complications
    • Mental retardation
    • Seizures
    • Deafness
    • Blindness
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Prognosis

Relapse is frequent with patients who are immunocompromised. Suppressive therapy and immune reconstitution significantly reduce the risk of recurrent infection.

Infants with congenitally acquired toxoplasmosis generally have a good prognosis and are on average developmentally identical to noninfected infants by the fourth year of life.

Immunocompetent patients have an excellent prognosis, and lymphadenopathy and other symptoms generally resolve within weeks of infection.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

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.

Specialty Editor Board

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.

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

Disclosure: Medscape 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

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

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

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Joseph Sciammarella, MD, to the development and writing of this article.

References

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Ophthalmic toxoplasmosis. Used with permission of Anton Drew, ophthalmic photographer, Adelaide, South Australia.
 
 
 
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