Toxoplasmosis

For all patients receiving therapy with pyrimethamine, perform periodic monitoring of blood counts to detect leukopenia, anemia, and thrombocytopenia.

For congenitally infected patients, long-term follow-up (beyond completion of 1 year of medical therapy) should include frequent retinal exams to evaluate for chorioretinitis.​[11]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. https://publications.aap.org/pediatrics/article/139/2/e20163860/59988/Diagnosis-Treatment-and-Prevention-of-Congenital ​

Children should have repeat audiometric evaluation (at 24-30 months if compliant with recommended treatment, or annually if untreated/treated otherwise).[57]Brown ED, Chau JK, Atashband S, et al. A systematic review of neonatal toxoplasmosis exposure and sensorineural hearing loss. Int J Pediatr Otorhinolaryngol. 2009 May;73(5):707-11. http://www.ncbi.nlm.nih.gov/pubmed/19215990?tool=bestpractice.com

HIV-infected patients not taking antiretroviral therapy (ART), as well as those on ART who do not regain CD4+ T lymphocytes >100 cells/microliter with suppression of the HIV plasma viral load, and patients who continue to receive immunosuppressive medications, will require lifelong suppressive therapy to prevent toxoplasmic encephalitis or disseminated disease. Medication adherence should be assessed and encouraged by the healthcare provider at every visit.

Patients with toxoplasmic eye disease should routinely follow-up with an ophthalmologist, as symptomatic disease is frequently recurrent.