Resumo
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- coriorretinite
- deficit neurológico focal
Other diagnostic factors
- visão embaçada
- fala indistinta
- cefaleia
- marcha instável
- confusão
- febre
- linfadenopatia
- microcefalia fetal
- calcificação intracraniana fetal
- hidrocefalia fetal
- restrição do crescimento intrauterino fetal
- convulsão
- mal-estar
- hepatite
- pneumonite
- miocardite
Risk factors
- imunossupressão
- exposição durante a gestação
- residência em áreas de alto risco
- ingestão de carne crua ou malcozida
- exposição a fezes de gato
- alta exposição aos solos
- ingestão de frutas e vegetais com a casca e não lavados
- exposição ocupacional
Diagnostic investigations
1st investigations to order
- IgG antitoxoplasma (sérica)
- IgM antitoxoplasma (sérica)
- TC do cérebro (com contraste intravenoso)
- RNM do cérebro (com contraste intravenoso)
Investigations to consider
- IgA antitoxoplasma (sérica)
- Índice de avidez da IgG específica para Toxoplasma (sérica)
- teste de aglutinação diferencial (CA/HS)
- reação em cadeia da polimerase (tecido ou fluido corporal)
- biópsia
Emerging tests
- imunoblot de IgG ou IgM (sérico)
- ensaio de immunospot ligado a enzimas
- testes de liberação de gamainterferona
Treatment algorithm
exposição ocupacional
vírus da imunodeficiência humana (HIV) positivo com contagem de linfócitos T CD4+ <100
receptores soronegativos de órgãos sólidos de doadores soropositivos; receptores soropositivos de transplante alogênico de células-tronco hematopoéticas
neonatos: doença congênita confirmada ou altamente suspeita
pacientes não gestantes e crianças: doença suspeita ou confirmada
gestante: com soroconversão
imunocomprometido: subsequente à doença sintomática
Contributors
Authors
Sarah Hochman, MD
Assistant Professor
Department of Medicine
Division of Infectious Diseases and Immunology
New York University School of Medicine
New York
NY
Disclosures
SH declares that she has no competing interests.
Kami Kim, MD
Professor of Medicine (Infectious Diseases) and Microbiology and Immunology
Albert Einstein College of Medicine
Bronx
NY
Disclosures
KK is on the advisory board for the Sanford Guide for Antibiotic Therapy. KK is the author of a reference cited in this topic.
Peer reviewers
Fabrizio Bruschi, MD
Professor of Parasitology
University of Pisa
School of Medicine
Pisa
Italy
Disclosures
FB declares that he has no competing interests.
Srikrishna Nagri, MD
Gastroenterologist
Dartmouth-Hitchcock Nashua
Nashua
NH
Disclosures
SN declares that he has no competing interests.
George Y. Wu, MD, PhD
Professor of Medicine
University of Connecticut Health Center
Farmington
CT
Disclosures
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Maldonado YA, Read JS, Committee on Infectious Diseases. Diagnosis, treatment, and prevention of congenital toxoplasmosis in the United States. Pediatrics. 2017 Feb;139(2):e20163860.Full text
Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases - toxoplasmosis. May 2023 [internet publication].Full text
National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: toxoplasmosis. Dec 2024 [internet publication].Full text
Hoz RM La, Morris MI; Infectious Diseases Community of Practice of the American Society of Transplantation. Tissue and blood protozoa including toxoplasmosis, Chagas disease, leishmaniasis, Babesia, Acanthamoeba, Balamuthia, and Naegleria in solid organ transplant recipients - guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019 Sep;33(9):e13546. Abstract
National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Children with and Exposed to HIV. Guidelines for the prevention and treatment of opportunistic infections in children with and exposed to HIV: toxoplasmosis. Oct 2015 [internet publication].Full text
Pradhan E, Bhandari S, Gilbert RE, et al. Antibiotics versus no treatment for toxoplasma retinochoroiditis. Cochrane Database Syst Rev. 2016 May 20;(5):CD002218.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Linfoma do sistema nervoso central
- Lesões cerebrais metastáticas provenientes de malignidade primária
- Doença micobacteriana do sistema nervoso central
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- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV - Toxoplasma gondii
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