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Case 2: Prophylaxis for Toxoplasma Encephalitis

You answered:

A The patient's positive IgG antibody to Toxoplasma shows evidence of immunity to Toxoplasma and thus she does not need prophylaxis against Toxoplasma encephalitis.

This answer is incorrect. A positive IgG antibody implies previous and latent infection with Toxoplasma gondii. This organism can reactivate in HIV-infected patients who have depressed immunity, most often manifesting as Toxoplasma encephalitis. Thus, all HIV-infected patients who have a positive IgG Toxoplasma antibody test and a CD4 count less than 100 cells/mm3 should receive prophylaxis against Toxoplasma encephalitis.

Choose another answer:

B The patient should receive prophylaxis for Toxoplasma encephalitis and the dapsone she takes for Pneumocystis prophylaxis will provide adequate prophylaxis against Toxoplasma encephalitis.
C The patient should add atovaquone (Mepron) to the dapsone to provide adequate prophylaxis for both Pneumocystis pneumonia and Toxoplasma encephalitis.
D The patient should receive prophylaxis for Toxoplasma encephalitis. Dapsone alone does not provide sufficient protection against reactivation of Toxoplasma; she should take pyrimethamine in addition to dapsone.

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