Summary
Toxoplasma gondii, an intracellular coccidian protozoan, is the causative agent of toxoplasmosis, a widespread infection affecting various birds and mammals including humans. In immunocompetent hosts, the infection is usually asymptomatic and benign. Toxoplasmosis is either congenital or acquired.
In general, prenatal therapy of congenital toxoplasmosis is beneficial in reducing the frequency of infant infection. Therapies are based primarily on spiramycin because of the relative lack of toxicity and high concentrations achieved in the placenta. Clindamycin is the standard drug for chemoprophylaxis in newborn infants, and is directed at preventing the occurrence of retinochoroiditis as a late sequel to congenital infection.
The standard treatment for acquired toxoplasmosis in both immunocompetent and immunodeficient patients is the synergistic combination of pyrimethamine and sulphonamides. Toxoplasmic encephalitis is the most common manifestation of acquired toxoplasmosis in immunocompromised patients and if not treated is fatal. However, because of toxicity, the therapeutic efficacy of pyrimethamine-sulphonamide combinations may be seriously limited in immunodeficient patients.
A number of novel and less toxic agents are being currently studied in clinical settings, including macrolide antibiotics (clindamycin, clarithromycin and azithromycin) and atovaquone, as well as some older anti-infective drugs such as cotrimoxazole (trimethoprim/sulfamethoxazole).
Maintenance or prophylactic therapy is essential in many patients with acquired immunodeficiency syndrome (AIDS) where toxoplasmosis is most often the result of a pre-existent latent infection.
Similar content being viewed by others
References
Georgiev VSt. Opportunistic/nosocomial infections. Treatment and developmental therapeutics. Toxoplasmosis. Med Res Rev 1993; 13: 529–68
Wong SY, Remington JS. Biology of Toxoplasma gondii. AIDS 1993; 7: 299–316
Russo M, Galanti B. Prevenzione della toxoplasmosi congenita. Clin Ter 1990; 134: 383–92
Wilson CB, Remington JS, Stagno S, et al. Development of adverse sequelae in childrent born with subclinical congenital toxoplasma infection. Pediatrics 1980; 66: 767–74
Bricaire F, Pangon B, Bouvet A. Sulfamides et associations. Sem Hop 1987; 63: 1783–98
Harpey JP, Veron P. Traitement de la toxoplasmose par le trimethoprime-sulfamethoxazole. Press Méd 1983; 12: 1492
Piens MA, Garin JP. New perspectives in the chemoprophylaxis of toxoplamosis. J Chemother 1989; 1: 46–51
Daffos F, Forestier F, Capella-Pavlovsky M, et al. Prenatal man agement of 746 pregnancies at risk for congenital toxoplasmosis. N Engl J Med 1988; 318: 271–5
Desmonts G, Couvreur J. Congenital toxoplasmosis. A prospective study of 378 pregnancies. N Engl J Med 1974; 290: 1110–6
Dutton GN. Recent development in the prevention and treat ment of congenital toxoplasmosis. Int Ophtalmol 1989; 13: 407–13
Garin JP, Mojon M, Piens MA, et al. Surveillance et traitement de la toxoplasmose chez la femme enceinte, le foetus et le nouveau-né. Pediatrie 1989; 44: 705–12
Jeannel D, Costagliola D, Niel G, et al. What is known about the prevention of congenital toxoplasmosis?. Lancet 1990; 336: 359–61
Garin JP, Pellerat J, Maillard M. Bases théoriques de la prévention par la spiramycine de la toxoplasmose congénitale chez la femme enceinte. Presse Med 1968; 76: 2266
McCabe RE, Oster S. Current recommendations and future prospects in the treatment of toxoplasmosis. Drugs 1989; 38: 973–87
Lambotte R. Toxoplasmose congénitale: évaluation du bénéfice thérapeutique prénatal. J Gynecol Obstet Biol Reprod (Paris) 1976; 5: 265–9
Thorp JM, Seeds JW, Herbert WNP, et al. Prenatal management and congenital toxoplasmosis. N Engl J Med 1988; 319: 372–3
Fuith LC, Reibnegger G, Hönlinger M, et al. Screening for toxoplasmosis in pregnancy. Lancet 1988; 2: 1196
Niyongabo T, Leport C, Vildé JL. Usefulness of folinic acid in cytopenia by antiparasitic drugs in AIDS patients. Presse Med 1991; 20: 1677–81
Holliman RE. Folate supplements and the treatment of cerebral toxoplasmosis. Scand J Infect Dis 1989; 21: 475–6
Excler JL, Piens MA, Maisonneuve H, et al. Dépistage de la toxoplasmose acquise chez la femme enceinte et de la toxoplasmose congénitale chez le nouveau-né. Enquete menée dans les maternités des Hospices Civils de Lyon pour les années 1980–1981–1982. Lyon Méd 1985; 253: 33–8
Maisonneuve H, Faber C, Piens MA, et al. Toxoplasmose congénitale: tolérance de l’association sulfadoxine-pyriméth- amine. 24 observations. Presse Med 1984; 13: 859–62
Desmonts G, Couvreur J. Toxoplasmose congénitale. Etude prospective de l’issue de la grossesse chez 542 femmes atteintes de toxoplasmose acquise en cours de gestation. Sem Hop Paris 1986; 62: 1418–22
Couvreur J, Desmonts G, Aron-Rosa D. Le pronostic oculaire de la toxoplasmose congénitale: rôle du traitement. Ann Pediatr 1984; 31: 855–8
Timsit JC, Bloch-Michel E. Efficacité de la chimiothérapie spécifique dans la prévention des récidives des chorioretinites toxoplasmique dans les 4 années qui suivent le traitement. J Fr Ophthalmol 1987; 10: 15–23
Lakhanpal V, Schocket SS, Nirankari V. Clindamycin in the treatment of toxoplasmic retinochoroiditis. Am J Ophthalmol 1983; 95: 605–13
Guldsten H. Clindamycin and sulphonamides in the treatment of ocular toxoplasmosis. Acta Ophthalmol 1983; 61: 51–7
Dutton GN. The causes of tissue damage in toxoplasmic retinochoroiditis. Trans Ophthal Soc UK 1986; 105: 404–12
Perkins ES, Smith CH, Schofield PB. Treatment of uveitis with pyrimethamine (daraprim). Br J Ophthalmol 1956; 40: 577–86
Acers TE. Toxoplasmic retinochoroiditis: A double blind ther apeutic study. Arch Ophthalmol 1964; 71: 58–62
Jones TC, Kean BH, Kimball AC. Acquired toxoplasmosis. NY State J Med 1969; 69: 2237–42
Luft BJ, Remington JS. Toxoplasmic encephalitis in AIDS. Clin Infect Dis 1992; 15: 211–22
Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med 1992; 327: 1643–8
Ruskin J, Remington J. Toxoplasmosis in the compromised host. Ann Intern Med 1976; 84: 193–9
Wanke C, Tuazon CU, Kovacs A, et al. Toxoplasma encephalitis in patients with acquired immune deficiency syndrome: Diagnosis and response to therapy. Am J Trop Med Hyg 1987; 36: 509–16
Luft BJ, Hafner R, Korzun AH, et al. Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. N Engl J Med 1993; 329: 995–1000
Dannemann B, McCutchan JA, Israelski D, et al. Treatment of toxoplasmic encephalitis in patients with AIDS. A randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfadiazine. Ann Int Med 1992; 116: 33–43
American Foundation for AIDS Research. Toxoplasmosis. AIDS/HIV Treatment Directory 1993; 7: 106–10
Fernandez-Martin J, Leport C, Morlat P, et al. Pyrimethamine-clarithromycin combination for therapy of acute Toxoplasma encephalitis in patients with AIDS. Antimicrob Agents Chemother 1991; 35: 2049–52
Kovacs JA, Polis MA, Baird B, et al. Evaluation of azithromycin or the combination of 566C80 and pyrimethamine in the treatment of toxoplasmosis. Eighth International Conference on AIDS. Abstract. Amsterdam PoB., Congrex Holland B.V.; 1992: 3199
Farthing C, Rendel M, Currie B, et al. Azithromycin for cerebral toxoplasmosis. Lancet 1992; 339: 437–8
Kovacs JA, O’Neill D, Feuerstein I, et al. Efficacy of atovaquone in treatment of toxoplasmosis in patients with AIDS. Lancet 1992; 340: 637–8
Masur H, Polis MA, Tuazon CU, et al. Salvage trial of trimetrexate-leucovorin for the treament of cerebral toxoplasmosis in patients with AIDS. J Infect Dis 1993; 167: 1422–6
Solbreux P, Sonnet J, Zech F. A retrospective study about the use of cotrimoxazole as diagnostic support and treatment of suspected cerebral toxoplasmosis in AIDS. cta Clin Belg 1990; 45: 85–96
Kronawitter U, Jacob K, Zoller WG, et al. Acute kidney failure by sulphadiazine stones. A complication of the therapy of toxoplasmosis in AIDS. Dtsch Med Wochenschr 1993; 118: 1683–6
Simon DI, Brosius III FC, Rothstein DM. Sulfadiazine crystal-luria revisited. Arch Intern Med 1990; 150: 2379–84
Tenant-Flowers M, Boyle MJ, Carey D, et al. Sulphadiazine desensitization in patients with AIDS and cerebral toxoplasmosis. AIDS 1991; 5: 311–5
Goldman MP, Longworth DL. The role of zithromycin and clarithromycin in clinical practices. Cleve Clin J Med 1993; 60: 359–64
Jacobson MA, Besch CL, Child C, et al. Toxicity of clindamycin as prophylaxis for AIDS-associated toxoplasmic encephalitis. Lancet 1992; 339: 333–4
Lipman MCI, Swaden LS, McCarthy KH, et al. Reduced incidence of toxoplasmosis in patients taking cotrimoxazole (CTM) as Pneumocystis carinii prophylaxis. Ninth International Conference on AIDS [abstract]. Berlin, Wellcome Foundation Ltd; 1993: 1443
Carr A, Tindali B, Brew BJ, et al. Low-dose trimethoprim-sulfamethoxazole prophylaxis for toxoplasmic encephalitis in patients with AIDS. Ann Intern Med 1992; 117: 106–11
Girard PM, Landman R, Gaudebout C, et al. Dapsone-pyrimeth-amine (D/P) vs. aerosolized pentamidine (AP) for primaryprophylaxis of pneumocystosis (PCP) and neurotoxoplasmosis. Eighth International Conference on AIDS. Abstract. Amsterdam, Congrex Holland B.V.; 1992: 1017
Ruf B, Schürmann D, Bergmann F, et al. Efficacy of pyrimeth-amine/sulfadoxine in the prevention of toxoplasmic encephalitis relapses and Pneumocystis carinii pneumonia in HIV-infected patients. Eur J Clin Microbiol Infect Dis 1993; 12: 325–9
Knani L, Bouslama K, Varette C, et al. Toxoplasmose pulmonaire au cours du SIDA: à propos de 3 cas. Ann Med Interne (Paris) 1990; 141: 469–71
Oksenhendler E, Cadranel J, Sarfati C, et al. Toxoplasma gondii pneumonia in patients with the acquired immunodeficiency syndrome. Am J Med 1990; 88 Suppl. 5N: 18N–21N
Adair OV, Randive N, Krasnow N. Isolated toxoplasma myocarditis in acquired immunodeficiency syndrome. Am Heart J 1989; 118: 856–7
Anderson DW, Virmani R, Reilly JM, et al. Prevalent myocarditis at necropsy in the acquired immunodeficiency syndrome. J Am Coll Cardiol 1988; 11: 792–9
Grange F, Kinney EL, Monsuez JJ, et al. Successful therapy for Toxoplasma gondii myocarditis in acquired immunodeficiency syndrome. Am Heart J 1990; 120: 443–4
Monsuez JJ, Kinney EL, Vittecoq D, et al. Comparison among acquired immune deficiency syndrome patients with and without clinical evidence of cardiac disease. Am J Cardiol 1988; 62: 1311–3
Roldan EO, Moskowitz L, Hensley GT. Pathology of the heart in acquired immunodeficiency syndrome. Arch Pathol Lab Med 1989; 111: 943–6
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Georgiev, S. Management of Toxoplasmosis. Drugs 48, 179–188 (1994). https://doi.org/10.2165/00003495-199448020-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199448020-00005