levoleucovorin and Toxoplasmosis

We report a case of watery diarrhea due to duodenal toxoplasmosis in a patient with the acquired immunodeficiency syndrome. Treatment with pyrimethamine, clindamycin, and folinic acid decreased the diarrhea as well as the duodenal toxoplasma cyst load. Hepatic toxoplasmosis was also present, associated with an elevated serum alkaline phosphatase activity and a minimally elevated lactate dehydrogenase level.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Clindamycin; Diarrhea; Duodenal Diseases; Humans; Intestinal Diseases, Parasitic; Leucovorin; Liver Diseases, Parasitic; Male; Prevalence; Pyrimethamine; Toxoplasmosis

Topics: Abortion, Spontaneous; Adult; Animals; Diagnosis, Differential; Eye Diseases; Female; Humans; Hypersensitivity; Infant, Newborn; Inflammation; Leucovorin; Male; Prednisone; Pregnancy; Pregnancy Complications, Infectious; Pyrimethamine; Sulfadiazine; Syphilis; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular; Tuberculosis

Pyrimethamine (50 mg) with folinic acid (15 mg) given three times weekly was assessed as primary prophylaxis for toxoplasmic encephalitis (TE) in 554 human immunodeficiency virus-infected patients seropositive for Toxoplasma gondii and with < 200 CD4 cells/mm3. At 1 year, the incidence of TE was similar in pyrimethamine, 12%, and placebo, 13%, groups (relative risk [RR], 0.9; 95% confidence interval [CI], 0.6-1.4), and the survival rate was also similar, 85% and 80%, respectively (RR, 0.9; 95% CI, 0.7-1.2). Rash was the only adverse event that appeared significantly more frequently in the pyrimethamine arm (7% vs. 1%). In the on-treatment analysis, the incidence of TE was lower in the pyrimethamine arm, 4%, than in the placebo arm, 12% (P < .006). Thus, pyrimethamine cannot be recommended as a first-line regimen for primary prophylaxis of TE if the patient can take cotrimoxazole. However, it should be considered for patients who are intolerant to cotrimoxazole, especially in high-risk patients with < 100 CD4 cells/mm3.

Topics: Adult; AIDS-Related Opportunistic Infections; Animals; Anti-Infective Agents; Antibodies, Protozoan; Double-Blind Method; Drug Therapy, Combination; Encephalitis; Female; Follow-Up Studies; Humans; Leucovorin; Male; Multivariate Analysis; Pyrimethamine; Survival Rate; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Cerebral

To report on a unique combination of cerebral toxoplasmosis and ocular toxoplasmosis in an HIV-positive patient in Slovakia.. A 35-year-old heterosexual patient who presented with headache and major seizures underwent computed tomography (CT) and magnetic resonance imaging (MRI). Based on clinical findings, serological tests for toxoplasmosis were performed on serum and ocular fluid specimens. PCR was also used to detect Toxoplasma gondii and cytomegalovirus DNA. Goldmann and Witmer coefficient calculation was applied to demonstrate the synthesis of intraocular IgG antibodies.. CT and MRI revealed cystic lesions suspected of metastasis in the occipital and temporal regions, and we searched for the primary tumor. After vision loss in the left eye, which rapidly progressed to complete blindness, an eye examination detected macular edema. Anti-edema treatment was initiated. HIV positivity with a very low CD4 T-cell count (20/μL) was found, and the viral load was 100 400 HIV-RNA copies/ml. The serum was positive for anti-Toxoplasma IgG antibodies (> 200 IU/mL), IgM negative, and IgA borderline. As toxoplasmic encephalitis and retinitis were suspected, antitoxoplasmic therapy with pyrimethamine, spiramycin, and folinic acid was started. The ophthalmologist considered cytomegalovirus retinitis, which was not confirmed by serology or PCR. In contrast, the presence of IgG antibodies in ocular fluid and serum with the calculation of the Goldmann-Witmer coefficient (GW = 32) as well as PCR DNA positivity pointed to Toxoplasma gondii as the etiological agent. Follow-up MRI scan confirmed regression of the pathological lesions, neurological deficit also improved, CD4 T-lymphocytes increased above 200/μL, but blindness of the left eye persisted.. CT and MRI scans offered no clue as to Toxoplasma etiology of the brain and eye involvement in an HIV-positive patient, which was only confirmed by laboratory tests. Due to the delay in the diagnosis of toxoplasmosis, time from the epileptic seizure to treatment initiation was 16 days, which assumedly caused irreversible blindness in the patient.

Topics: Adult; Antibodies, Protozoan; Blindness; Central Nervous System; HIV Infections; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Leucovorin; Pyrimethamine; RNA; Spiramycin; Toxoplasma; Toxoplasmosis

Toxoplasma gondii is a protozoan that has great genetic diversity and is prevalent worldwide. In 2018, an outbreak of toxoplasmosis occurred in Santa Maria, Brazil, which was considered the largest outbreak ever described in the world. This paper describes the isolation and molecular characterization of Toxoplasma gondii from the placenta of two pregnant women with acute toxoplasmosis who had live births and were receiving treatment for toxoplasmosis during the outbreak. For this, placental tissue samples from two patients underwent isolation by mice bioassay, conventional PCR and genotyping using PCR-RFLP with twelve markers. Both samples were positive in isolation in mice. The isolate was lethal to mice, suggesting high virulence. In addition, the samples were positive in conventional PCR and isolates submitted to PCR-RFLP genotyping presented an atypical genotype, which had never been described before. This research contributes to the elucidation of this great outbreak in Brazil.

Topics: Animals; Brazil; Coccidiostats; Disease Models, Animal; Disease Outbreaks; Female; Genotype; Humans; Leucovorin; Live Birth; Mice; Placenta; Polymorphism, Restriction Fragment Length; Pregnancy; Pregnancy Complications, Infectious; Pyrimethamine; Sulfadiazine; Toxoplasma; Toxoplasmosis

We report an unusual case of acute acquired toxoplasmosis (AAT) presenting as lymphadenopathy and recurrent seizures in an immunocompetent 15-year-old boy.. The patient reported an 18-day vacation to Africa (Ethiopia), 39 days prior to the first seizure. Electroencephalogram (EEG) showed sporadic single-spike or sharp-wave paroxysms and the magnetic resonance imaging (RMI) of the brain was negative. The serology for T. gondii was compatible with an acute infection defined as positive for both toxoplasma-specific IgG and IgM and a low avidity (6 %), confirmed by a reference laboratory. The patient reported other two episodes of seizures, occurring 7 days apart. He was treated with pyrimethamine plus sulfadiazine and leucovorin for 4 weeks, with an improvement of lymphadenitis and normalization of EEG. After 5 months, new seizures were reported and a diagnosis of epilepsy was done. Toxoplasma polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) and blood were negative. A treatment with valproic acid was started, obtaining control of the neurological disease.. Awareness of this neurologic manifestation by clinicians is required, also in immunocompetent patients. The relationship between toxoplasmosis and recurrent seizure needs to be investigated by new studies.

Topics: Adolescent; Antibodies, Protozoan; Anticonvulsants; Antiprotozoal Agents; Epilepsy; Ethiopia; Humans; Immunoglobulin G; Immunoglobulin M; Leucovorin; Male; Pyrimethamine; Recurrence; Seizures; Sulfadiazine; Toxoplasma; Toxoplasmosis; Travel; Treatment Outcome; Valproic Acid

Although Toxoplasma gondii infection is normally asymptomatic, severe cases of toxoplasmosis may occur in immunosuppressed patients or congenitally infected newborns. When a fetal infection is established, the recommended treatment is a combination of pyrimethamine, sulfadiazine and folinic acid (PSA). The aim of the present study was to evaluate the efficacy of azithromycin to control T. gondii infection in human villous explants.. Cultures of third trimester human villous explants were infected with T. gondii and simultaneously treated with either PSA or azithromycin. Proliferation of T. gondii, as well as production of cytokines and hormones by chorionic villous explants, was analyzed.. Treatment with either azithromycin or PSA was able to control T. gondii infection in villous explants. After azithromycin or PSA treatment, TNF-α, IL-17A or TGF-β1 levels secreted by infected villous explants did not present significant differences. However, PSA-treated villous explants had decreased levels of IL-10 and increased IL-12 levels, while treatment with azithromycin increased production of IL-6. Additionally, T. gondii-infected villous explants increased secretion of estradiol, progesterone and HCG+β, while treatments with azithromycin or PSA reduced secretion of these hormones concurrently with decrease of parasite load.. In conclusion, these results suggest that azithromycin may be defined as an effective alternative drug to control T. gondii infection at the fetal-maternal interface.

Topics: Azithromycin; Chorionic Villi; Female; Humans; In Vitro Techniques; Leucovorin; Pregnancy; Pyrimethamine; Sulfadiazine; Toxoplasma; Toxoplasmosis

Toxoplasmosis is a ubiquitous protozoal infection that during pregnancy commonly affects the fetus severely, with maternal infection usually being mild self-limiting. Disseminated toxoplasmosis in a healthy pregnant woman has, to the best of our knowledge, not been reported before. We present a case of disseminated toxoplasmosis involving pulmonary, central nervous system, and lymph nodes in a pregnant woman and imaging findings on radiography, computed tomography, and magnetic resonance imaging.

Topics: Abortion, Spontaneous; Adult; Antimalarials; Brain; Clindamycin; Diagnosis, Differential; Female; Humans; Leucovorin; Lung; Lymph Nodes; Magnetic Resonance Imaging; Pregnancy; Pregnancy Complications, Parasitic; Pyrimethamine; Sulfadoxine; Tomography, X-Ray Computed; Toxoplasmosis

Monthly serological screening of non immune pregnant women is recommended for prevention of congenital toxoplasmosis. However, this screening is often interrupted before delivery. We report a case of congenital toxoplasmosis following infection occurring late in pregnancy. This documented case highlights the need for a final routine serological test, 2-3 weeks post-partum for all seronegative pregnant women. In fact, the screening of congenital toxoplasmosis cases allows the early administration of specific treatment that avoids later severe complications such as chorioretinitis.

Topics: Adult; Antiprotozoal Agents; Child, Preschool; Drug Therapy, Combination; Early Diagnosis; Female; Humans; Infant; Leucovorin; Male; Mass Screening; Pregnancy; Pregnancy Complications, Parasitic; Pyrimethamine; Sulfadiazine; Toxoplasmosis; Toxoplasmosis, Congenital

The purpose of this report is to evaluate the efficacy and safety of spiramycin/cotrimoxazole in the mother-to-child transmission of Toxoplasma gondii infection. We retrospectively analysed 76 infants born to mothers with toxoplasmosis during pregnancy and estimated the risk of mother-to-child transmission considering the gestational age at the time of infection. Seventy-six mothers were given spiramycin, cotrimoxazole and folinic acid; only two babies (2.6%) were infected by Toxoplasma and none of them showed signs or symptoms of congenital infection or interference of sulphamid on tetrahydrofolate reductase (THFR) either at birth or during follow-up. Treatment did not need to be stopped in any mother because of adverse drug effects. Our results seem to encourage the use of spiramycin/cotrimoxazole in women with toxoplasmosis during pregnancy.

Topics: Animals; Anti-Infective Agents; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Leucovorin; Pregnancy; Pregnancy Complications, Parasitic; Retrospective Studies; Spiramycin; Toxoplasma; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

This report present an infant with nystagmus, strabismus, salt and pepper and scars in funduscopy, calcification in Brain CT scan and high titer of Anti Toxoplasmosis antibody. A 10 month old infant that referred with nystagmus, strabismus after fever which appeared five months ago. In funduscopy of both eyes, salt and pepper and scars and in Brain CT scan multiple calcification were seen. The diagnosis of congenital Toxoplasmosis was established by positive serum Anti toxoplasma Ab (IgG) (> 400). Toxoplasmosis may present with only nystagmus and strabismus and physicians should consider this infection in the differential diagnosis of a abnormal eye movement.

Topics: Brain; Electroencephalography; Eye Movements; Fever; Humans; Infant; Leucovorin; Male; Nystagmus, Pathologic; Prednisolone; Pyrimethamine; Strabismus; Sulfadiazine; Tomography, X-Ray Computed; Toxoplasmosis

Congenital toxoplasmosis usually results from acquired infection in non-immune pregnant women. However, severely HIV-infected women with a latent Toxoplasma infection can transmit the parasite as a result of reactivation. We report a case of toxoplasmic reactivation in an HIV-infected woman with moderate immunosuppression resulting in a severe congenital toxoplasmosis.

Topics: Adult; Animals; Antibodies, Protozoan; Antiprotozoal Agents; Female; Fetal Blood; HIV Infections; Humans; Immunocompromised Host; Infant, Newborn; Infectious Disease Transmission, Vertical; Leucovorin; Male; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Complications, Parasitic; Pyrimethamine; Recurrence; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Congenital; Vitamin B Complex

Laboratory acquired infection with toxoplasmosis has been described. The clinical features in this situation can vary from asymptomatic to severe disease. Prophylactic therapy is recommended on the basis of clinical experience and case reports. We describe a case in a young man, where prophylaxis resulted in neutropenia complicated by subsequent Listeria meningitis.

Topics: Adult; Anti-Bacterial Agents; Drug Combinations; Humans; Leucovorin; Male; Meningitis, Listeria; Neutropenia; Occupational Exposure; Pyrimethamine; Sulfadiazine; Toxoplasmosis

The clinical management of perinatal toxoplasmosis involves a gynaecologist during pregnancy and a neonatologist after delivery. Then, in the absence of a uniform approach, early evaluation of infected infants requires a thorough long-term follow-up also in asymptomatic children, who have to be observed for at least one year due to unpredictable sequelae in later life. We retrospectively analyzed pregnancy management of 54 women with certain infection from Toxoplasma gondii (TG) and prospectively enrolled their infants to compare prenatal management with postnatal clinical outcome. All mothers with seroconversion for TG infection were from the Palermo area and were retrospectively analyzed, whereas their newborns referred to G. Di Cristina Children Clinical Hospital between 1999-2004 were prospectively enrolled in a 48-month follow-up. Timing of infection was dated for 24 women (45%) to the first trimester, 18 (33%) to the second and 12 (22%) the third. The maternal-fetal transmission rate was 17.2%. Prenatal diagnosis from amniotic fluid was performed in 25/54 pregnant subjects and showed positive results in 6. Despite diagnosis of TG infection, 9 women were untreated and only 2 with positive amniocentesis received combined therapy. 10/55 enrolled infants were infected and half of them were preterm and/or SGA at birth. None showed peculiar signs of TG at birth but 4 had abnormalities during the follow-up. 9/10 infected children were born to mothers who had undergone neither amniocentesis nor combined therapy.. Our work confirms the difficulty of applying standardized therapeutic protocol for TG infection during pregnancy. The asymptomatic course of TG infection at birth confirms the importance of an instrumental long-term follow-up to identify typical TG lesion to prevent sequelae.

Topics: Adolescent; Adult; Amniocentesis; Animals; Antibodies, Protozoan; Antiprotozoal Agents; Chorioretinitis; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Hydrocephalus; Immunoglobulin G; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Small for Gestational Age; Infectious Disease Transmission, Vertical; Italy; Leucovorin; Male; Prednisone; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimesters; Prenatal Care; Prospective Studies; Pyrimethamine; Retrospective Studies; Spiramycin; Sulfadiazine; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Cerebral; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

Topics: AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-Infective Agents; Antiprotozoal Agents; Antitubercular Agents; Antiviral Agents; Clarithromycin; Cytomegalovirus Infections; Drug Therapy, Combination; Ethambutol; Ganciclovir; Humans; Leucovorin; Mycobacterium avium-intracellulare Infection; Pneumonia, Pneumocystis; Pyrimethamine; Recurrence; Rifabutin; Sulfadiazine; Sulfamethoxazole; Toxoplasmosis; Trimethoprim

Topics: Adult; Animals; Anti-Infective Agents; Antibodies, Protozoan; Cadaver; Fatal Outcome; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Leucovorin; Male; Middle Aged; Postoperative Complications; Pyrimethamine; Retrospective Studies; Sulfadiazine; Tissue Donors; Toxoplasma; Toxoplasmosis

As more drugs are approved for the prevention of opportunistic infections, concerns regarding the benefits and potential risks of these therapies are arising. A synopsis of the data for prophylaxis against opportunistic infections is provided for the following: Pneumocystis carinii pneumonia, fungal infections, Mycobacterium avium complex, cytomegalovirus infections, and toxoplasmosis. General precautions in using preventive medications for people with fewer than 100 CD4 plus cells are highlighted.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Clarithromycin; Clindamycin; Clinical Trials as Topic; Clotrimazole; Cytomegalovirus Infections; Dapsone; Fluconazole; Ganciclovir; Humans; Itraconazole; Leucovorin; Mycobacterium avium-intracellulare Infection; Mycoses; Pentamidine; Pneumonia, Pneumocystis; Pyrimethamine; Rifabutin; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Valacyclovir; Valine

The authors report a case of a patient who in the 24th week of a twin pregnancy became sero-positive for toxoplasmosis. This was diagnosed by cordocentesis as being infected, and the treatment was therefore started with pyrimethamine and sulfadiazine and folic acid at the 28th week of pregnancy. At 35 weeks, the patient had an acute medullary aplasia due to the absence of the folates. The mother's state was improved rapidly by giving her folinic acid and the twins were normal haematologically. In this case, the authors point out how important the folates are in a pregnancy, especially in twin pregnancies, and point out the precautions that have to be taken when treatment with pyrimethamine and sulfadiazine is started for congenital toxoplasmosis.

Topics: Adult; Anemia, Aplastic; Anemia, Sideroblastic; Cordocentesis; Female; Folic Acid; Folic Acid Deficiency; Humans; Leucovorin; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Second; Pregnancy, Multiple; Pyrimethamine; Spiramycin; Sulfadiazine; Toxoplasmosis; Twins

An 18-year-old woman, while suffering from acute acquired toxoplasmosis, experienced sudden deafness and a total loss of vestibular function first in the right ear and three months later also in the left. Following treatment with sulphadiazine and pyrimethamine, hearing was retrieved to such a degree that the patient was enabled to communicate by means of a body-worn hearing aid and lip-reading. Taking the differential diagnostic possibilities into account, we believe that toxoplasmosis was the cause of the severe hearing loss. Since effective treatment seems to be available, we recommend that patients with acute bilateral sensorineural hearing loss of unknown origin are examined for acute toxoplasmosis with a view to instituting chemotherapy.

Topics: Acute Disease; Adolescent; Audiometry; Drug Therapy, Combination; Female; Hearing Loss, Sudden; Humans; Leucovorin; Pyrimethamine; Sulfadiazine; Toxoplasmosis; Vestibular Diseases

Cerebral toxoplasmosis related to AIDS was treated with a combination regimen of pyrimethamine, clindamycin, and spiramycin, and in a second trial with a combination of pyrimethamine and clindamycin. Both regimens proved to be equally effective. The experience with the second trial shows that spiramycin does not provide additional benefit. Myelosuppressive side-effects due to pyrimethamine were prevented in most cases by addition of folinic acid to the regimen at the start of the antitoxoplasmic therapy. These data suggest that the combination of pyrimethamine and clindamycin is an effective alternative to the commonly used regimen consisting of pyrimethamine and sulfonamides.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Brain Diseases; Clindamycin; Drug Therapy, Combination; Humans; Leucovorin; Pyrimethamine; Spiramycin; Toxoplasmosis

An AIDS patient with cerebral toxoplasmosis had a folate deficiency-induced acute pancytopenia, which was rapidly reversed by the administration of folic acid. This observation is particularly important as a possible preventive therapy to be given to all HIV-infected patients because of the anti-folic activity of the majority of anti-infectious agents used during the course of this disease and the many potential sites of hematopoietic involvement. The patient's condition is stressed because the undernourished subject is at greater risk for this type of manifestation.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Adult; Brain Diseases; Folic Acid Antagonists; Folic Acid Deficiency; HIV-1; Humans; Leucovorin; Male; Pancytopenia; Pyrimethamine; Toxoplasmosis

Topics: Acquired Immunodeficiency Syndrome; Adult; Brain Diseases; Diagnosis, Differential; False Negative Reactions; Female; HIV Seropositivity; Humans; Infant, Newborn; Kidney Transplantation; Leucovorin; Magnetic Resonance Imaging; Pregnancy; Pyrimethamine; Sulfisoxazole; Tomography, X-Ray Computed; Toxoplasmosis

A retrospective study was made of the cases of cerebral toxoplasmosis (CT) diagnosed since 1985 in patients with AIDS. In the period studied, out of a total of 70 patients with AIDS, 13 (18.5%) were diagnosed with CT. In eight cases (11%) CT was the first illness indicating AIDS. The clinical, neuro-radiological and serological findings were analyzed. Also the response to treatment with pyrimethamine and sulfadiazine. Although the rate of mortality from CT has been very low among our patients, relapses have been frequent, even in patients who were on maintenance treatment with pyrimethamine, and in the medium term the prognosis is made more gloomy by the appearance of other opportunistic infections.

Topics: Acquired Immunodeficiency Syndrome; Adult; Brain Diseases; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Leucovorin; Male; Pyrimethamine; Retrospective Studies; Sulfadiazine; Toxoplasmosis

Although Toxoplasma gondii is the most commonly recognized cause of central nervous system mass lesions in patients with acquired immune deficiency syndrome, published investigations have provided little information about criteria for diagnosis of toxoplasmosis or the response to therapy. In this series the method of diagnosis and response to therapy were assessed in 14 patients who had evidence for toxoplasmosis based on routine histopathology, immunoperoxidase staining, or mouse inoculation. These patients presented with clinical and radiologic findings that did not clearly distinguish them from patients with other infectious or neoplastic processes. Excisional biopsies usually showed tachyzoites on routine histology, but needle biopsies were usually negative unless mouse inoculation or immunoperoxidase staining was employed. Response to pyrimethamine and sulfadiazine therapy was often prompt, but therapy had to be continued for long periods of time to maintain a clinical response, and no alternative regimen of one or more drugs appeared to be effective in patients unable to tolerate both pyrimethamine and sulfadiazine.

Topics: Acquired Immunodeficiency Syndrome; Adult; Antibodies; Drug Therapy, Combination; Encephalitis; Humans; Leucovorin; Male; Middle Aged; Pyrimethamine; Sulfadiazine; Tomography, X-Ray Computed; Toxoplasma; Toxoplasmosis

Topics: Acute Disease; Adult; Drug Therapy, Combination; Encephalitis; Humans; Leucovorin; Male; Pyrimethamine; Sulfadiazine; Toxoplasmosis

A 10-year-old girl with aplastic anemia developed seizures and a mild hemiparesis following a bone marrow transplant. Based on serologic evidence and a computed tomography scan, which showed a left parietal lucency with ring enhancement, a diagnosis of toxoplasmosis was considered. A brain biopsy of the lucent area demonstrated the inflammation and necrosis but no organisms were seen. During a six-week course of pyrimethamine, sulfadiazine, and folinic acid therapy there was clinical and neuroradiologic resolution. The short course of therapy as well as the inadvertent substitution of folic acid for folinic acid and trimethoprim-sulfamethoxazole for sulfadiazine resulted in the reappearance of neurologic deficits. Reinstitution of appropriate therapy produced gradual improvement over a nine-month period. Serial computer tomography scans correlated with the clinical course. In the immunologically compromised host CNS toxoplasmosis should be considered in the differential diagnosis of an evolving CNS syndrome. Early detection and prolonged therapy with appropriate drugs can result in a favorable outcome. Computed tomography scanning may be helpful in diagnosis and follow-up.

Topics: Anemia, Aplastic; Bone Marrow; Bone Marrow Transplantation; Calcinosis; Child; Drug Therapy, Combination; Female; Humans; Immunosuppression Therapy; Leucovorin; Neurologic Examination; Pyrimethamine; Sulfadiazine; Thalamus; Tomography, X-Ray Computed; Toxoplasmosis

The majority of clinically recognizable acute infections in the neonate are bacterial. Such infections may be acquired from the mother prior to or at birth or from environmental sources. Because of the limited ability of neonates--especially those born prematurely--to express symptoms, even minor deviations from normal behavior should suggest bacterial disease. Chronic congenital and perinatal infections, unlike acute bacterial disease, are generally asymptomatic in mother and neonate and may remain latent or subclinically active in host tissue for prolonged periods, possibly causing insidious injury to the central nervous and perceptual systems. When overt, these infections almost invariably cause mental or perceptual handicaps or both. In view of the significant mortality and morbidity associated with either acute or chronic infections, diagnosis and treatment should be aggressive.

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Chronic Disease; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Infections; Leucovorin; Penicillin G Benzathine; Pyrimethamine; Sulfadiazine; Syphilis; Toxoplasmosis

Topics: Drug Therapy, Combination; Female; Humans; Leucovorin; Pregnancy; Pregnancy Complications, Infectious; Pyrimethamine; Sulfonamides; Toxoplasmosis

A patient with toxoplasmosis had cerebellar, spinal cord, nerve root, and skeletal muscle symptoms. Toxoplasma gondii was isolated from skeletal muscle, and toxoplasma antibody titers were persistently elevated. The disease has been recurrent during a 3-year period with only temporary response to specific antimicrobial therapy.

Topics: Antigens; Biopsy; Cerebellar Ataxia; Complement Fixation Tests; Creatine Kinase; Gold Colloid, Radioactive; Humans; Leucovorin; Lymphocyte Activation; Lymphocytes; Male; Methylene Blue; Middle Aged; Mitogens; Muscles; Myositis; Pyrimethamine; Recurrence; Serologic Tests; Sulfadiazine; Toxoplasmosis

Topics: Abortion, Spontaneous; Abortion, Therapeutic; Female; Humans; Infant; Infant, Newborn; Leucovorin; Pregnancy; Pregnancy Complications, Infectious; Pyrimethamine; Sulfadiazine; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Congenital

Topics: Autopsy; Bone Marrow; Bone Marrow Cells; Cytarabine; Daunorubicin; Humans; Leucovorin; Leukemia, Myeloid, Acute; Pyrimethamine; Toxoplasmosis

Topics: Anti-Bacterial Agents; Cerebrospinal Fluid; Drug Combinations; Fluorescent Antibody Technique; Hemagglutination Tests; Humans; Immunosuppressive Agents; Leucovorin; Neoplasms; Pneumonia, Pneumocystis; Pyrimethamine; Sulfadiazine; Toxoplasma; Toxoplasmosis

Topics: Adult; Bone Marrow; Bone Marrow Diseases; Female; Humans; Leucovorin; Pregnancy; Pregnancy Complications, Infectious; Pyrimethamine; Thrombocytopenia; Time Factors; Toxoplasmosis; Toxoplasmosis, Congenital

Topics: Diagnosis, Differential; Eye; Female; Humans; Leucovorin; Prednisone; Pregnancy; Pregnancy Complications, Infectious; Pyrimethamine; Sulfadiazine; Toxoplasmosis; Toxoplasmosis, Congenital; Toxoplasmosis, Ocular

Topics: Anemia; Anemia, Macrocytic; Blood Platelets; Drug Therapy; Folic Acid; Hemoglobinometry; Humans; Leucovorin; Leukocyte Count; Metabolism; Myocarditis; Pigmentation Disorders; Purpura; Purpura, Thrombocytopenic; Pyrimethamine; Sulfonamides; Thrombocytopenia; Toxicology; Toxoplasmosis; Toxoplasmosis, Ocular

Topics: Eye; Folic Acid; Injections; Injections, Intraperitoneal; Injections, Subcutaneous; Leucovorin; Mice; Pyrimethamine; Research; Statistics as Topic; Toxicology; Toxoplasmosis; Toxoplasmosis, Animal; Toxoplasmosis, Ocular

Topics: Adrenal Cortex Hormones; Blood Platelets; Drug Therapy; Erythrocyte Count; Hematocrit; Hemoglobinometry; Humans; Leucovorin; Pyrimethamine; Sulfadiazine; Toxicology; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Ocular; Uveitis

Topics: Calcium; Humans; Leucovorin; Pyrimethamine; Sulfadiazine; Toxoplasmosis; Treatment Outcome