Successful Treatment of Cerebral Toxoplasmosis Using Pyrimethamine Oral Solution Compounded From Inexpensive Bulk Powder

Hodgson, Hayley A; Sim, Taeyong; Gonzalez, Hemil; Aziz, Mariam; Rhee, Yoona; Lewis, Paul O.; Jhobalia, Neel; Shields, Beth; Wang, Sheila K

doi:10.1093/ofid/ofy055

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…The cornerstone of treatment is a combination of pyrimethamine or trimethoprim-sulfamethoxazole, sulfadiazine or clindamycin, in addition to treatment for HIV infection by combination antiretroviral therapy (cART) [44][45][46][47][48]. Timely initiation of proper antibiotics to treat toxoplasma encephalitis is critical and should be started promptly when there is a high clinical suspicion of toxoplasmosis [11,41].…”

Section: Discussionmentioning

confidence: 99%

Fulminant and Diffuse Cerebral Toxoplasmosis as the First Manifestation of HIV Infection: A Case Presentation and Review of the Literature

et al. 2020

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Unusual clinical course Background: One of the most common causes of central nervous system (CNS) opportunistic infections in immunocompromised patients is toxoplasmosis. It can cause focal or disseminated brain lesions leading to neurological deficit, coma, and death. Prompt management with optimal antibiotics is vital. However, the diagnosis of cerebral toxoplasmosis is challenging in infected individuals with human immunodeficiency virus (HIV). The possible diagnosis is based on clinical presentation, imaging, and specific serologic investigations. The diagnosis can be confirmed by histopathological examination and/or by finding nucleic material in the spinal cerebrospinal fluid (CSF) examination. Case Report: We present a review of the literature with a rare illustrative case of diffuse CNS toxoplasmosis as the first manifestation of HIV infection in a young patient. Brain MRI showed diffuse, ring-enhancing lesions, and significant midline shift. Decompressive hemicraniectomy for control of intracranial pressure and anti-infectious therapy were performed. Conclusions: This should raise awareness that cerebral toxoplasmosis can occur in pediatric patients with HIV infection, and, more importantly, as the first manifestation of AIDS. Although the prognosis is often poor, early diagnosis and immediate treatment of this life-threatening opportunistic infection can improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Fulminant and Diffuse Cerebral Toxoplasmosis as the First Manifestation of HIV Infection: A Case Presentation and Review of the Literature

et al. 2020

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“…Clindamycin is beneficial when used in conjunction with pyrimethamine in the treatment of acute toxoplasmosis in the central nervous system that occurs in patients with HIV-AIDS. 16…”

Section: Discussionmentioning

confidence: 99%

Co-occuring Toxoplasma Infection and Psychotic Symptoms : Case Report

Marchira

Kusumadewi

Wulandari

2020

SciPsy

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Abstract Introduction Schizophrenia is a neuropsychiatric disease that is global and is experienced by 1% of the population in the United States and Europe. This study raises awareness of the role of infectious agents in the initiation of psychotic symptoms in schizophrenia. Case Presentation A 20-year-old man is taken by the family to the emergency department because he has decreased consciousness, and the body suddenly stiffens. Patients begin to experience changes in behavior in the form of difficulty sleeping, when invited to talk quietly, laughing alone and whispering without the other person. TORCH examination found an increase in anti-toxoplasma IgM and IgG. This patient is then given basic life support in the form of ABC (airway, breathing, circulation support) and seizure management. Also given risperidone 2 mg / 12 hours, pyrimethamine 1-II (1x200 mg), pyrimethamine day III-XXI (1x 25 mg), intravenous Cefotaxim 2g / 8 hours, Clindamycin 500 mg / 8 hours. The patient experienced improvement after the second week of treatment. Conclusion Toxoplasmosis causes lesions in the brain that cause changes in brain neurotransmitter pathways, which lead to changes in patient behavior.

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“…Unfortunately, limited access to first-line drugs for acute TE may oblige physicians to choose an alternative therapy. A lower-priced PYR oral suspension successfully controlled TE in a PLWH (196), providing a new solution to tackle the challenge of affordability of the PYR-based regimen. While the aim of the study is laudable, it highlights concerns beyond issues of efficacy and safety, such as rising drug prices, industry profits, and patient access to crucial drugs, especially uninsured patients.…”

Section: Management Pharmacotherapymentioning

confidence: 99%

Epidemiology, Pathophysiology, Diagnosis, and Management of Cerebral Toxoplasmosis

2020

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SUMMARY Toxoplasma gondii is known to infect a considerable number of mammalian and avian species and a substantial proportion of the world’s human population. The parasite has an impressive ability to disseminate within the host’s body and employs various tactics to overcome the highly regulatory blood-brain barrier and reside in the brain. In healthy individuals, T. gondii infection is largely tolerated without any obvious ill effects. However, primary infection in immunosuppressed patients can result in acute cerebral or systemic disease, and reactivation of latent tissue cysts can lead to a deadly outcome. It is imperative that treatment of life-threatening toxoplasmic encephalitis is timely and effective. Several therapeutic and prophylactic regimens have been used in clinical practice. Current approaches can control infection caused by the invasive and highly proliferative tachyzoites but cannot eliminate the dormant tissue cysts. Adverse events and other limitations are associated with the standard pyrimethamine-based therapy, and effective vaccines are unavailable. In this review, the epidemiology, economic impact, pathophysiology, diagnosis, and management of cerebral toxoplasmosis are discussed, and critical areas for future research are highlighted.

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Successful Treatment of Cerebral Toxoplasmosis Using Pyrimethamine Oral Solution Compounded From Inexpensive Bulk Powder

Cited by 8 publications

References 11 publications

Fulminant and Diffuse Cerebral Toxoplasmosis as the First Manifestation of HIV Infection: A Case Presentation and Review of the Literature

Fulminant and Diffuse Cerebral Toxoplasmosis as the First Manifestation of HIV Infection: A Case Presentation and Review of the Literature

Co-occuring Toxoplasma Infection and Psychotic Symptoms : Case Report

Epidemiology, Pathophysiology, Diagnosis, and Management of Cerebral Toxoplasmosis

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