Diferencia entre revisiones de «Toxoplasmosis»
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==Clinical Features== | ==Clinical Features== | ||
*[[Headache]] | |||
*[[Fever]] | |||
*[[Focal neurologic deficits]] | |||
*[[AMS]] | |||
*[[Seizures]] | |||
==Differential Diagnosis== | |||
*Lymphoma | |||
**More commonly single lesion in the periventricular white matter or corpus callosum | |||
*Cerebral TB | |||
**Characteristic inflammatory appearance with isodense exudate filling basal cisterns | |||
*[[Fungal infection]] | |||
==Diagnosis== | ==Diagnosis== | ||
*Head CT | *[[Head]] CT without contrast | ||
**Shows multiple subcortical lesions w/ predilection for basal ganglia | **Shows multiple subcortical lesions w/ predilection for basal ganglia | ||
**Contrast usually not needed; if obtained, will show ring enhancing lesions | **Contrast usually not needed; if obtained, will show ring enhancing lesions | ||
*CSF | *[[CSF]] | ||
**Helpful but high rate of false negatives | **Helpful but high rate of false negatives | ||
==Treatment== | ==Treatment== | ||
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===Steroids=== | ===Steroids=== | ||
*Consider dexamethasone 4mg IV q6hr for significant edema or mass effect | *Consider [[dexamethasone]] 4mg IV q6hr for significant edema or mass effect | ||
===Folinic Acid=== | ===Folinic Acid=== | ||
''Administer if the treatment regimen includes Leucovorin'' | ''Administer if the treatment regimen includes Leucovorin'' | ||
*Folinic acid 10mg PO QD x6–8wk | *[[Folinic acid]] 10mg PO QD x6–8wk | ||
==Disposition== | ==Disposition== | ||
Revisión del 15:42 20 may 2015
Background
- Most common cause of focal encephalitis in patients with AIDS
Clinical Features
Differential Diagnosis
- Lymphoma
- More commonly single lesion in the periventricular white matter or corpus callosum
- Cerebral TB
- Characteristic inflammatory appearance with isodense exudate filling basal cisterns
- Fungal infection
Diagnosis
- Head CT without contrast
- Shows multiple subcortical lesions w/ predilection for basal ganglia
- Contrast usually not needed; if obtained, will show ring enhancing lesions
- CSF
- Helpful but high rate of false negatives
Treatment
Antibiotics
Immunocompetent
Antibiotics only needed if patient has severe symptoms
- Pyrimethamine 200mg PO load then 50mg PO q24hrs x 4 weeks AND
- Leucovorin 10mg PO q24hrs AND
- Sulfadiazine 1g PO q6hrs
Immunosprepressed
- Pyrimethamine 200mg PO load then 75mg PO q24hrs x 4-8 weeks AND Leucovorin 25mg PO q24hrs PLUS
- Sulfadiazine 1500mg PO q6hrs OR
- Clindamycin 600mg PO or IV q6hrs OR
- Azithromycin 1200mg PO q24hrs OR
- Atovaquone 1500mg PO q12hrs
OR
- TMP/SMX 5mg/kg IV q12hrs
Pregnant
- Spiramycin 1g PO q8hrs[1]
- If amniotic fluid is positive treat with 3 weeks of pyrimethamine (50 mg/day orally) + sulfadiazine (3 g/day orally in 2-3 divided doses)
- Alternate with a 3-week course of Spiramycin 1 g 3 times daily OR
- Pyrimethamine (25 mg/day orally) and sulfadiazine (4 g/day orally) divided 2 or 4 times daily until delivery AND
- Leucovorin 10-25 mg/day orally to prevent bone marrow suppression
- Dapsone 50mg PO QD; Off label use
Congenital/Pediatric
- Pyrimethamine 2mg/kg/day PO x 2 days then 1mg/kg/day x 2-6 months, then 1mg/kg MWF AND
- Sulfadiazine 50mg/kg PO BID AND
- Leucovorin 10mg PO 3x/week
- Duration: 12 months for congenital toxoplasmosis
- Alternative: TMP/SMX 5mg/kg (TMP) PO/IV q12hrs
- Clindamycin 20-30mg/kg/day PO/IV divided q6hrs (max 2.4g/day) if sulfa allergic
- Spiramycin 50-100mg/kg/day PO divided q8hrs
Steroids
- Consider dexamethasone 4mg IV q6hr for significant edema or mass effect
Folinic Acid
Administer if the treatment regimen includes Leucovorin
- Folinic acid 10mg PO QD x6–8wk
Disposition
- Admit
Source
- ↑ Paquet C, Yudin MH. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can. Jan 2013;35(1):78-9.