Complications
Pyrimethamine can suppress the bone marrow. Calcium folinate is given to prevent this toxicity. Calcium folinate dosing can be increased further to offset effects on bone marrow. If this is ineffective, dosing of pyrimethamine may have to be decreased.
Drug-induced rash can develop at any time during treatment. If a rash typical of drug reaction occurs, may substitute clindamycin or atovaquone for sulfadiazine.
Early treatment failure may be due to a lack of effect of the prescribed regimen. Late treatment failure is more likely to be from a patient's poor compliance with taking medications as prescribed. In HIV-infected patients, early failure may indicate incorrect diagnosis of toxoplasmosis. Brain biopsy should be performed if not done previously, to confirm the diagnosis, in patients with central nervous system symptoms and signs. HIV-infected patients also have a high risk of drug intolerance, including rash and hepatitis caused by the sulfa component.
While many cases of congenitally acquired infection seem asymptomatic at birth, careful examination may reveal evidence of eye disease, neurological impairment, hepatosplenomegaly, or bone marrow involvement. Long-term sequelae include impaired vision or blindness, loss of hearing, seizures, palsies, learning impairment or intellectual disability, hydrocephalus, or microcephaly. Children should have repeat audiometric evaluation (at 24-30 months if compliant with recommended treatment, or annually if untreated/treated otherwise).[11][54]
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