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Toxoplasmosis
dr. Rizky Perdana,SpPD,KPTI,FINASIM
Case
Plans to married
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Case
PCR TB (-)
Serology test for toxoplasma :
IgM (+) and IgG (+)
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Case
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Case
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Toxoplasma: Human
Transmission
Raw/undercooked meat
Estimated to occur in of T. gondii infections in U.S.
Parasite isolated from 32% pork chops, 4% lamb
chops (1960s)
Toxoplasma Transmission
Toxoplasmosis
Toxoplasmosis: Clinical
Signs
Clinical Signs
Toxoplasmosis encephalitis
Congenital Toxoplasmosis
Ocular Toxoplasmosis
Lymphadenopathy
Differential Diagnosis of
Lymphadenopathy
Toxoplasmosi
s
Inf. Mono
Lymphoma
+++
+++
+++
+++
+++
Atypical Lymphocytes
++++
Anemia
+++
Positive Heterophil
++++
++++
++
Hilar
Lymphadenopathy
+++
Reticulum
Germinal
Bizarre
Lymphadenopathy
Without Other
Symptoms
Pharyngitis
Monocytosis,
Eosinophilia
Lymph Node
Toxoplasma infection
Ring-enhancing lesion
Toxoplasmosis ocular
lesions
Hematologic malignancies
Bone marrow and solid organ transplants
AIDS, e.g. leading to toxoplasmic encephalitis
Toxoplasmosis in
Pregnancy
Primary infection in
first semester
pregnant women
abortus, still birth, or
congenital
toxoplasmosis
Congenital
Toxoplasmosis
Congenital
Toxoplasmosis
H I V
Immunity
80.8%
40.1%
28.8%
17.3%
13.4%
* Djauzi S, Djoerban Z (Ed). Penatalaksanaan infeksi HIV di pelayanan kesehatan dasar. Edisi
kedua.
Jakarta: Balai Penerbit FKUI; 2003
+
Tanpa konfirmasi laboratorium
Toxoplasma: Diagnosis
Serologic testing.
Observation of parasites in patient
specimens.
Isolation of parasites from blood or
other body fluids, by intraperitoneal
inoculation into mice or tissue culture.
PCR (for congenital infections in
utero).
Test 1
(before 2
months of
pregnancy)
IgG +ve (any
titer);
IgM -ve
Serologic Detection of
Toxoplasma During
Pregnancy
Test 2
(in second trimester)
Test 3
(in third
trimester)
No test;
No test;
No treatment
No treatment
Group
I infection before
pregnancy;
No risk (Note 1)
IgG +ve
IgM +ve
IgG -ve
IgM -ve
IgG Positive :
Not infected
Infected
355 (-)
After
Four Years
Acute Toxoplasmosis
Yes 13 %*
30 % IgG rise
3 6 % IgM
18 % IgA
No 3 %
Yes 0.3 %*
No
NPV = 99.7 %
Zufferrey J, et al. Eur J Clin Microb Infect Dis 1993 ;12:590-5
Toxoplasmosis: Treatment
Drugs Of Choice :
and
Pyrimethamin
e
Sulfadoxine
NH2
H3CO
NH2
Cl
N
C2H5
H2N
Mode of action:
1. Pyrimethamine inhibits DNA synthesis by
interfering with folate synthesis.
2. Sulfadoxine prevents PABA synthesis by
inhibiting the enzyme dihydropteroate
synthetase.
OCH3
SO2NH
N
Alternate Drugs :
Spiramycin
and
Mode of action:
Sulfadiazine
Immunologically Normal
Patients
Toxoplasma
infection
Regimen suggested
Acquired via
transfusion (lab.
accident)
Active
Chorioretinitis;
meningitis, lowered
resistance due to
steroids or cytotoxic
drugs
Acute in pregnant
women
Primary
prophylaxis
AIDS pts-IgG toxo
antibody + CD4
count < 100/mcl
Suppresive
treatment
Primary treatment
Alternative treatment
[Pyrimetamine 200mg x 1 po
then 75 mg/day po] +
[Sulfadiazine 1-1.5 mg po
q6h] + [Leucovorine (folinic
acid) 10-20 mg/day po] treat
4-6 week after resolution of
signs/symptoms and then
suppresive tx
OR
Pyrimetamine + folinic
acid (as in primary regimen)
+ 1 of the following =
Clinda 600 mg po/iv q6h
Clarithro 1 gm po bid
Azithro 1.2-1.5 gm po q24h
Atovaquone 750 mg po q6h
Dapsone 50 mg po q24h +
Pyrimetamine 50 mg po q
wk
OR
Atovaquone 1500 mg po
q24h
Sulfadiazine 500-1000 mg po 4
x/day + (folinic acid) 10-25 mg
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