Management of Congenital Toxoplasmosis
2014
Prompt diagnosis and rapid initiation of medical treatment are critical for the best outcomes in infants with congenital
toxoplasmosis. This is important for pregnant women, fetuses, and infants, including those with active retinitis and
choroidal neovascularmembranes. For hydrocephalus, prompt placement of a ventriculoperitoneal shunt is key for improved outcomes.
Pyrimethamineand
Sulfadiazinewith Leucovorin are first-line medicines. For later recurrences of active retinitis,
Azithromycinor
Clindamycinare sometimes substituted for
Sulfadiazineas second-line treatments, given with Pyramethamine. Following resolution of active retinitis, these medicines may be useful without
Pyrimethaminefor suppression and avoid the risk of hypersensitivity from
Trimethoprim/
Sulfamethoxazole. Antibody to VEGF, in conjunction with antimicrobial therapy, results in resolution of
choroidal neovascularmembranes. Serologic screening of seronegative pregnant women to detect primary infection during gestation, and facilitating medicine administration and thereby preventing or treating fetal infection, is an optimal, apparently cost-effective, means to reduce disease. Definitively curative medicines currently being developed likely will improve future management and outcomes of this disease.
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