Most cases of acquired Toxoplasma infection are subclinical. When
symptomatic infection does occur, the only clinical findings may be
focal lymphadenopathy, most often involving a single site about the
head and neck. Less commonly,
acute infection is accompanied by a mononucleosis-like syndrome characterized
by fever, malaise, sore throat, headache, myalgia, and an atypical
lymphocytosis. Nearly all cases of symptomatic acquired toxoplasmosis
in immunocompetent individuals are self-limiting, although adenopathy
may persist for months.
Acute Toxoplasma infection in pregnancy also is usually subclinical,
and most cases remain undiagnosed unless antenatal antibody screening
is performed.
Immunocompromised patients are at risk for developing severe central
nervous system (CNS) disease from T gondii. Headache is common and
may be associated with focal brain lesions or diffuse encephalitis. Seizures,
altered mental status, visual disturbances, and focal neurologic
deficits can occur. Disseminated disease with multiple organ (heart,
lung, liver, retina) involvement also can occur. Most cases result
from the reactivation of latent infection, with local and distant
spread of organisms from tissue cysts. There have been cases reports
of severe acquired toxoplasmosis in immunosuppressed patients
following transplantation of infected solid organs.
Drugs Used in the Treatment of Acute Infection in Adults and Children
Adults:
? Pyrimethamine 100 mg twice a day for the first day, then 50 to 75 mg once daily
? Sulfadiazine 2 to 4 g twice a day
? Clindamycin 600 mg four times a day
? Folinic acid (leucovorin) 10?20 mg once a day
Children
? Pyrimethamine 2 mg/kg once a day for 2 days (maximum, 50 mg), then 1
mg/kg once a day (maximum, 25 mg)
? Sulfadiazine 50 mg/kg twice a day
? Clindamycin 20?30 mg/kg per day divided into 4 doses
? Folinic acid (leucovorin) 10 mg three times a week
Hope that helps.
-d |
