PRESUS

Dr.Muttaqien Sp.S

Toxoplasmosis
The most common in the west of the CNS space
occupying lesions in a person with a CD4 count
<200 (usually < 100)
Prevalence of toxoplasma CNS disease is unknown in
Botswana
Seroprevalence is low

Reactivation disease
Cat feces
Meat

Presentation is typically sub acute and focal

May be seizures

Multiple ring enhancing lesions

1/3 single lesion

CSF is normal or non-specific

Toxoplasmosis
Other than a biopsy there is no good
diagnostic test
Antibody testing is very non-specific and
occasionally insensitive
Usual diagnostic test is response to Rx

Expect response to treatment in 2

weeks

Toxoplasmosis
Things that make toxo unlikely

Negative toxo serology

Patient taking Co-trimoxazole prophylaxis
CD4 count > 100

Treatment

Pyrimethamine (50-100 mg QD) plus leucovorin and

Sulfadiazine (1 gm QID)
Alternatives

Fansidar 2-3 daily

Atovoquone 750 mg QID
Azithromycin 1200 mg QD
Clindamycin 600 QID
Co-trimoxazole 10mg/kg/day of trimethoprim
Dapsone 100 mg QD