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Infectious Diseases

Infectious Disease

06/26/2002

Question:

I have been infected of toxoplasmosis in October 2000 whilst I was 4 months pregnant. I was taking spiramycine until delivery. Though IgG has been going down, I am still infected after more than 19 months. THe infection is still acute. I have tried two medications - Bactrim; which I had to stop because of skin rashes and Tetracycline because of nausea. I wish to seek medical help on the issue. WHat are the alternate medications available. Doctors in the country are not familiar with the disease and those medications are given on a trial basis - after consulting the internet. I will also be very happy to have the name of a physician whom I can contact for treatment.

Answer:

Once somebody becomes infected with Toxoplasma, it is thought that the parasite remains within the infected person for life. However, this chronic infection is typically asymptomatic and does not cause any problems unless the infected individual becomes immunosuppressed (i.e. recipients of transplanted organs, patients on chemotherapy for cancer, patients with AIDS). Approximately 30% of the adults in the US are chronically infected with Toxoplasma. Typically, no treatment is indicated unless the infection reactivates in immunosuppresed patients. Most acutely infected patients do not require treatment if they have a healthy immune system. Occasionally a healthy individual with an acute infection may develop fever, swollen lymph nodes, malaise. These patients may benefit from antibiotics. A pregnant woman acutely infected with Toxoplasma is given antibiotics not to treat her per se but to lessen the likelihood of transmission of the infection to the baby. Fetuses can develop severe disease if infected with Toxoplasma because their immune system is immature. IgG against Toxoplasma can remain elevated for years after acquiring infection with Toxoplasma. Therefore, a high IgG titer does not mean that the infection is `acute`.

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Response by:

Carlos   Subauste, MD Carlos Subauste, MD
Assistant Professor
College of Medicine
University of Cincinnati