Case 2: Prophylaxis for Toxoplasma Encephalitis

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Case last updated: June 30, 2004

A 28-year-old HIV-infected woman from rural Mexico presents to clinic for primary care. She has a history of Pneumocystis pneumonia and oral candidiasis. In the past, she received treatment for latent tuberculosis. Serologic testing detects antibodies to Toxoplasma (IgG) and her current CD4 count is 85 cells/mm3. Her current medications are dapsone and clotrimazole (Mycelex) troches; she has declined antiretroviral therapy. She has a history of a mild rash when taking trimethoprim-sulfamethoxazole (Bactrim, Septra) approximately 1 year ago. She is sexually active, does not routinely use effective birth control measures, and her last menstrual period was more than 2 months ago.

Which of the following is TRUE regarding prophylaxis for Toxoplasma encephalitis in this patient:

	The patient has an IgG antibody to Toxoplasma that is evidence of immunity to infection and she does not need prophylaxis for Toxoplasma encephalitis.
	The patient does need prophylaxis for Toxoplasma encephalitis and the dapsone she takes for Pneumocystis prophylaxis will provide protection against Toxoplasma encephalitis.
	The patient does need prophylaxis for Toxoplasma encephalitis. Dapsone alone does not provide sufficient protection against reactivation of Toxoplasma; she should take pyrimethamine in addition to dapsone.
	If possible, the patient should be desensitized to and then treated with trimethoprim-sulfamethoxazole for prophylaxis against both Pneumocystis pneumonia and Toxoplasma encephalitis.
	The patient should be prescribed atovaquone (Mepron) as prophylaxis for Pneumocystis pneumonia and Toxoplasma encephalitis.