Infectious Diseases More Infectious Diseases Toxoplasmosis Guide Toxoplasmosis Guide Overview Symptoms Causes Diagnosis Treatment Treatment and Prevention of Toxoplasmosis By James Myhre & Dennis Sifris, MD Dennis Sifris, MD, is an HIV specialist and Medical Director of LifeSense Disease Management. James Myhre is an American journalist and HIV educator. Learn about our editorial process James Myhre & Dennis Sifris, MD Medically reviewed by Medically reviewed by Andy Miller, MD on July 11, 2019 Andy Miller, MD, is board-certified in internal medicine and infectious disease. He is an associate professor at Weill Cornell Medicine in New York City. Learn about our Medical Review Board Andy Miller, MD Updated on July 17, 2019 Print photo © Getty / Buena Vista Images Table of Contents View All Acute Treatment In Pregnancy In People With HIV Tools for Prevention Next in Toxoplasmosis Guide Understanding Toxoplasmosis Toxoplasmosis (also known as "toxo") in an infectious disease caused by a single-celled parasite known as Toxoplasma gondii. In the vast majority of cases, a toxo infection will be mild and resolve on its own without treatment. If treatment is needed, it would typically involve one or more antibiotic or antimalarial drugs able to clear the infection. However, in patients with acute toxoplasmosis who are either pregnant or immunocompromised, antimicrobial treatment is sometimes offered to avoid serious complications of infection. This is especially true in cases of advanced HIV infection. Acute Treatment In people with normal immune systems, most T. gondii infections will have no symptoms at all. Those that do will often be mild and easily mistaken for the flu, even by a doctor. On the off chance toxo is diagnosed, the doctor will most often recommend bed rest and maybe an over-the-counter (OTC) pain reliever like Tylenol (acetaminophen) or Advil (ibuprofen). Treatment is primarily recommended for people with compromised immune systems who don’t have the immune defenses to fight off an infection. These mainly include people with advanced HIV infection but can also involve organ transplant recipients and people undergoing cancer chemotherapy (both of whom commonly take immune suppressive drugs). Recommended Therapies To treat an acute (active) infection, doctors will prescribe antibiotics and other medications able to clear the infection and prevent the disease from progressing. The most commonly prescribed medications include: Pyrimethamine, an antimalarial drug considered the most effective agent in treating an acute toxo infectionSulfadiazine, an antibiotic drug used in combination with pyrimethamineClindamycin, an alternative antibiotic used alongside pyrimethamineMinocycline, an antibiotic used only when a person is resistant to both sulfadiazine and clindamycinFolinic acid used as a supplement to reduce the risk of thrombocytopenia (low platelets) The course of therapy often lasts for six weeks and usually includes pyrimethamine in combination with at least one other antibiotic. To prevent recurrence, the antibiotic drug trimethoprim and sulfamethoxazole (TMP-SMX) would be taken once daily for four weeks. In Pregnancy The transmission of T. gondii from mother to child is rare unless the mother is severely immune compromised. Among these mothers, treatment is commonly prescribed to prevent fetal infection. Scientists remain less certain about mothers with normal immune function. Even if a toxo infection were to occur, there remains considerable debate as to how effective antibiotics are in preventing transmission, particularly since it can be difficult to diagnose toxoplasmosis during pregnancy. To this end, specialist care should be sought if you are pregnant and are at increased risk of toxoplasmosis. Treatment is typically prescribed as follows: If an acute infection occurs during the first trimester, spiramycin would be prescribed from the time of diagnosis to the time of delivery.After the first trimester (or if fetal infection has been confirmed), pyrimethamine, sulfadiazine, and folinic acid would be used from diagnosis to delivery. Pediatric Recommendations Treatment is strongly recommended for newborns whose mothers were diagnosed with T. gondii during pregnancy. This is true whether or not the mother had symptoms or was given preventive therapy. The duration of treatment (pyrimethamine, sulfadiazine, and folinic acid) can vary but may last for as long as 12 months. If the infant or child is diagnosed with toxoplasmosis and HIV, TMP-SMX would be prescribed along with HIV therapy. The TMP-SMX would be used to prevent toxoplasmic encephalitis (one of the severe complication of congenital toxoplasmosis) and continued until such time as the HIV drugs are able to normalize the baby’s immune system. In the event of toxoplasmic encephalitis, corticosteroids would be prescribed to reduce brain inflammation. Anticonvulsive drugs may also be used to prevent seizures. In People With HIV Toxoplasmosis in people with HIV can cause serious, and potentially life-threatening, illnesses affecting the brain, eyes, and lungs. In most cases, the disease will be caused by the reactivation of a past infection rather than a new one. Without the immune defenses to control the infection, a person can quickly succumb to the illness without proper treatment including treatment of the toxoplasmosis and improvement of the immunocompromising condition, in addition to supportive care. Antiretroviral Therapy Toxoplasmosis in people with HIV is considered opportunistic because it can only cause disease when the immune system is too weak to stop it. To this end, the only way to recover from toxoplasmosis is to restore the body immune defenses. Antiretroviral drugs do this by interfering with HIV's ability to replicate. While they cannot cure the disease, they keep the viral population as low as possible so that it can no longer infect and kill the immune cells that are meant to protect us. Commonly prescribed in a combination of three drugs, antiretroviral therapy can restore the immune function even in severely ill people, often within the span of a few months. Treatment would be continued for a lifetime and include regular doctor visits to monitor your immune status and check for possible side effects. Antibiotic Therapy The treatment of a reactivated T. gondii infection is similar to that of an acute infection and may include: Pyrimethamine, sulfadiazine, and folinic acidPyrimethamine, clindamycin, and folinic acidAtovaquone (a potent antifungal) used in combination with pyrimethamine and folinic acidAzithromycin (another common antibiotic), pyrimethamine, and folinic acidAtovaquone and sulfadiazine Once the infection is cleared, TMP-SMX would be prescribed to prevent recurrence and continued until such time as the antiretroviral drugs can restore immune function. Treating Disease Complications Three common complications of toxoplasmosis in people with HIV are ocular toxoplasmosis (affecting the eyes), CNS toxoplasmosis (affecting the brain and nervous system), and pulmonary toxoplasmosis. The treatment of each would be directed by the severity of symptom and the health status of the affected individual. Treatment options for ocular toxoplasmosis may include: Systemic corticosteroids to help alleviate inflammationInjections of corticosteroids and clindamycin into the eyeThe surgical implantation of clindamycin pellets into the eye Treatment options for CNS toxoplasmosis may include: Systemic corticosteroids to reduce inflammation of the brain and central nervous system (CNS)Anticonvulsive drugs to treat seizures Treatment options for pulmonary toxoplasmosis may include: Systemic corticosteroids to alleviate inflammationTMX-SMP to treat an active pneumocystis infection of the lungs Prophylactic Therapies If you have HIV, prophylactic (preventive) medications may be prescribed if your immune system is compromised. This can be determined by your CD4 count which measures the number of defensive CD4 T-cells your blood. In a healthy individual, the CD4 count would be between 800 and 1,500. In persons with a compromised immune system, that number would drop below 200. To prevent toxoplasmosis, TMP-SMX would be prescribed in a daily dose as your CD4 count approaches the "danger zone" of 100. Along with your antiretroviral medication, you would continue taking TMP-SMX until such time as your CD4 count is well above 200 and is able to stay there. You can then stop the antibiotic and continue to take your HIV drugs. Tools for Prevention If you are pregnant or have a compromised immune system, you would need to take steps to avoid exposure to T. gondii in your daily life. These safeguards can protect you from toxoplasmosis far better than all of the treatments in the world. Some of the most effective preventive measures include: Wearing a pair of disposable gloves when cleaning the cat litter box or, better yet, having someone else do itWearing gloves when you are outdoor gardeningCooking your meat, poultry, and fish well donePeeling and washing any vegetables or fruits that come from the garden or farmer's marketCleaning cutting boards, knives, or surfaces raw meat may have come into contact withAvoiding unpurified water of any sortKeeping your cat indoorsFeeding your cat only canned or dried food and avoiding raw or undercooked meatsCovering your child’s sandboxWashing your hands thoroughly with hot water and soap after gardening, playing with your cat, preparing food, or cleaning the sandboxTeaching your children proper handwashing skills Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Liu Q, Wang ZD, Huang SY, Zhu XQ. Diagnosis of toxoplasmosis and typing of Toxoplasma gondii. Parasit Vectors. 2015;8:292. doi:10.1186/s13071-015-0902-6 Alday PH, Doggett JS. Drugs in development for toxoplasmosis: advances, challenges, and current status. Drug Des Devel Ther. 2017;11:273-293. doi:10.2147/DDDT.S60973 Guex-crosier Y. Update on the treatment of ocular toxoplasmosis. Int J Med Sci. 2009;6(3):140-2. Mcauley JB. Congenital Toxoplasmosis. J Pediatric Infect Dis Soc. 2014;3 Suppl 1:S30-5. doi:10.1093/jpids/piu077 Milewska-bobula B, Lipka B, Gołąb E, et al. Recommended management of Toxoplasma gondii infection in pregnant women and their children. Przegl Epidemiol. 2015;69(2):291-8, 403-10. Oz HS. Maternal and congenital toxoplasmosis, currently available and novel therapies in horizon. Front Microbiol. 2014;5:385. doi:10.3389/fmicb.2014.00385 Basavaraju A. Toxoplasmosis in HIV infection: An overview. Trop Parasitol. 2016;6(2):129-135. doi:10.4103/2229-5070.190817 Cambrea SC, Carp SD, Halichidis S. Disseminated toxoplasmosis in an HIV positive patient in cART era. BMC Infectious Diseases. 2014;14(S4). doi:10.1186/1471-2334-14-s4-p41 Sadiq U, Zomer H, Guzman N. HIV Prevention Of Opportunistic Infections. Treasure Island, Fl: StatPearls Publishing; 2019. CD4 Lymphocyte Count: MedlinePlus Lab Test Information. MedlinePlus.. Published November 7, 2018. CDC - Toxoplasmosis - Prevention & Control. Centers for Disease Control and Prevention. Sept 27, 2018. Additional Reading Centets for Disease Control and Prevention. "Parasites - Toxoplasmosis (Toxoplasma Disease): Prevention and Control." Atlanta, Georgia; updated January 10, 2013. Lee, S. and Lee. T. "Toxoplasmic Encephalitis in Patient with Acquired Immunodeficiency Syndrome." Brain Tumor Res Treat. 2017; 5(1): 34-36. DOI: 10.1479/btrt.2017.5.1.34. Park, Y. and Nam. H. "Clinical Features and Treatment of Ocular Toxoplasmosis." Korean J Parasitol. 2013; 51(4): 393-399. DOI: 10.3357/kjp.2013.51.4.393. U.S. Department of Health and Human Services. "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents." AIDSInfo. Rockville, Maryland; updated October 28, 2015.