B20.8
DESCRIPTION
Intracranial space-occupying lesions, with contrast enhancement on imaging, due to Toxoplasma gondii. AIDS-defining illness (WHO clinical stage 4).
The diagnosis of toxoplasmosis is very unlikely if either the serum toxoplasma IgG is negative or the CD4 count is > 200 cells/mm3.
Diagnosis is confirmed by a clinical response to therapy, which occurs in 7–14 days. CT scan improvement usually occurs within 14–21 days. Interpreting the response to therapy may be difficult if steroids have been given concomitantly. Steroid therapy should only be given for life-threatening peri-lesionaloedema.
MEDICINE TREATMENT
- Cotrimoxazole 160/800, oral, 2 tablets 12 hourly for 28 days, followed by 1 tablet 12 hourly for 3 months.
Secondary prophylaxis
Continue for at least 6 months and until CD4 count increases to > 200 cells/mm3 on ART.
- Cotrimoxazole 160/800 mg, oral, 2 tablets daily.
See cotrimoxazole desensitisation
REFERRAL/CONSULTATION
Specialist or tertiary
Intolerance to cotrimoxazole.
Note: Attempt desensitisation first (see Pneumocystis pneumonia).