Cerebral toxoplasmosis (toxoplasmic encephalitis, TE) is a focal brain infection that requires prompt initiation of acute antiparasitic therapy. Early treatment is aimed at halting neurological deterioration, resolving brain lesions, and preventing relapse.

Treatment approach

Preferred acute therapy involves a multi-drug antiparasitic combination with weight-based dosing; an alternative regimen is available for patients who require parenteral treatment. Adjunctive agents may be added when clinically indicated.

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Adjunctive corticosteroids (e.g., dexamethasone) should only be administered when clinically indicated to treat a mass effect associated with focal lesions or associated edema (BIII); discontinue as soon as clinically feasible.
Antiseizure medications should be administered to patients with TE and associated seizures (AII) and continued through at least the period of acute treatment (BII); antiseizure medications should not be used as prophylaxis in patients without seizures (BII).
Neurological improvement will occur by 14 days in over 90% of patients; if no improvement is seen by that time, other diagnoses should be considered.
The radiologic goals for treatment include resolution of the lesion(s) in terms of size, contrast enhancement, and associated edema, although residual contrast-enhancing lesions may persist for prolonged periods, especially in people with HIV receiving ARVs.

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What Is the First-Line Treatment for Cerebral Toxoplasmosis?

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