Case 2: Prophylaxis for Toxoplasma Encephalitis

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You answered:

	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:

	The patient should receive prophylaxis for Toxoplasma encephalitis and the dapsone she takes for Pneumocystis prophylaxis will provide adequate prophylaxis against Toxoplasma encephalitis.
	The patient should add atovaquone (Mepron) to the dapsone to provide adequate prophylaxis for both Pneumocystis pneumonia and Toxoplasma encephalitis.
	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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