Overview of Toxoplasma gondii encephalitis in adults and children
Toxoplasma gondii encephalitis most commonly occurs in patients with immune compromise (eg HIV infection). In these patients, cerebral infection with T. gondii usually presents with multiple ring-enhancing brain lesions on MRI.
Patients with undiagnosed HIV infection may present initially with T. gondii infection. Cerebral toxoplasmosis is an indicator condition for HIV testing1. If cerebral toxoplasmosis identified, offer HIV testing, regardless of whether the patient has behavioural or epidemiological risk factors for HIV infection.
In patients with T. gondii encephalitis and newly diagnosed HIV, the timing of antiretroviral therapy initiation is complex – seek expert advice. In patients with HIV infection taking antiretroviral therapy, check for drug interactions when prescribing antibiotics (see Antiretroviral drug interactions).
For the treatment of T. gondii encephalitis in adults, see Primary treatment of Toxoplasma gondii encephalitis in adults. Patients with T. gondii encephalitis who have completed 6 weeks of primary treatment should receive secondary prophylaxis to suppress infection.
Treatment of T. gondii encephalitis in children and neonates is not covered in these guidelines.
Information on the management of children with T. gondii encephalitis is available in the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children.
Information on the management of neonates with or at risk of congenital T. gondii encephalitis is available in the Australasian Society for Infectious Diseases (ASID) Management of perinatal infections guidelines. These guidelines also provide advice on the management of the birthing parent (eg mother) with toxoplasmosis.