Management of Toxoplasmosis

Screening and Diagnosis

The Centers for Disease Control and Prevention recommends that all HIV-infected patients should be tested for prior exposure to T. gondii by measuring anti-Toxoplasma IgG upon initiation of care (strong recommendation, moderate quality evidence) 1, 3
A presumptive diagnosis of CNS toxoplasmosis is based on clinical symptoms, serologic evidence of infection, and the presence of space-occupying lesions on brain imaging 2, 4

The American Academy of Pediatrics recommends the preferred treatment for congenital toxoplasmosis is pyrimethamine (loading dose of 2 mg/kg body weight/day for 2 days, then 1 mg/kg/day for 2-6 months, followed by 1 mg/kg three times weekly) combined with sulfadiazine (50 mg/kg/dose twice daily) and supplementary leucovorin 2, 5
The Centers for Disease Control and Prevention recommends treatment duration should be 12 months for congenital toxoplasmosis 2, 5
For children with moderate to severe disease and HIV infection, the full 12-month regimen of pyrimethamine/sulfadiazine should be administered 2

The Centers for Disease Control and Prevention recommends Toxoplasma-seropositive patients with CD4+ T-lymphocyte count <100/µL should receive prophylaxis against toxoplasmic encephalitis 6, 7
The preferred regimen is TMP-SMZ (co-trimoxazole) double-strength tablet daily, which is also effective against PCP 6, 7

The Centers for Disease Control and Prevention recommends toxoplasma-seronegative adults should be counseled on avoiding new infection 1, 3
Preventive measures include not eating raw or undercooked meat, particularly pork, lamb, or venison 6, 7

The Centers for Disease Control and Prevention recommends complete blood count should be performed at least weekly while on daily pyrimethamine and at least monthly while on less than daily dosing to monitor for bone marrow suppression 2, 5

The American College of Obstetricians and Gynecologists recommends pregnant women with suspected or confirmed primary toxoplasmosis and newborns with possible or documented congenital toxoplasmosis should be managed in consultation with an appropriate specialist 2, 4
The Centers for Disease Control and Prevention recommends HIV-infected pregnant women with positive Toxoplasma serology have an increased likelihood of maternal reactivation and congenital transmission 1, 3