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Immunocompetent persons with primary infection are usually asymptomatic, but latent infection can persist for the life of the host. In immunosuppressed patients, especially patients with AIDS, the parasite can reactivate and cause disease, usually when the CD4 lymphocyte count falls below 100 cells/mm3.

Diagnostic Criteria

  • Patients can present with focal paralysis or motor weakness depending on the brain area affected 

  • Neuro-psychiatric manifestations corresponding to the affected area in the brain, seizures or altered mental status. 


Note: Diagnosis is predominantly based on clinical findings after exclusion of other common causes of neurological deficit. If available, a CT scan is very useful for confirmation. Toxoplasma serology has to be done for addition in diagnosis.

Supportive Therapy

Similar to bacterial meningitis 


Pharmacological Treatment

Acute infection

  • Sulphadiazine 1 gm 6 hourly for 6 weeks        


  • Pyrimethamine 100mg loading dose then 50mg /day for 6 weeks       


  • Folinic acid tabs 10mg /day for 6 weeks. 


After six weeks of treatment give prophylaxis therapy with Sulphadiazine tabs 500mg 6 hourly + Pyrimethamine tabs 25-50mg /day + Folinic acid tabs 10mg /day. 

For those allergic to sulphur replace Sulphadiazine tabs with

  • Clindamycin capsules 450mg 6 hourly for for 6 weeks.

Updated on, 31.10.2020


1. STG 

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