CNS INFECTIONS-TOXOPLASMOSIS MANAGEMENT

SUMMARY

1. If ring-enhancing lesions are present, think toxoplasmosis (CNS lymphoma, TB, and bacterial infections less likely).

2. Because toxo is a reactivation infection, patients typically have IgG (but not IgM) antibody to T. Gondii. But this is only supportive as many have the IgG antibodies. Absence of antibodies does not exclude infection.

3. Treat with sulfadiazine, pyrimethamine, and leucovorin. Add dexamethasone if there is significant swelling.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].