Question | Discussion | References | CME Credit

Updated October 25, 2011

Case 2: Prophylaxis for Toxoplasma Encephalitis

Author: Robert D. Harrington, MD

A 48-year-old HIV-infected woman from 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 most recent CD4 count is 78 cells/mm3. Her current medications are dapsone and fluconazole (Diflucan); she has declined antiretroviral therapy. She has a history of a severe rash when taking trimethoprim-sulfamethoxazole (Bactrim, Septra) approximately 1 year ago. She is not sexually active and her last menstrual period was 2 weeks ago.

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

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.
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.