A toxoplasmose cerebral (encefalite toxoplásmica, TE) é uma infecção cerebral focal que requer início imediato de terapia antiparasitária aguda. O tratamento precoce tem como objetivo interromper a deterioração neurológica, resolver as lesões cerebrais e prevenir recidivas.

Abordagem terapêutica

A terapia aguda preferencial envolve uma combinação antiparasitária com múltiplos fármacos e dosagem baseada no peso; um esquema alternativo está disponível para pacientes que necessitam de tratamento parenteral. Agentes adjuvantes podem ser adicionados quando clinicamente indicado.

References

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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Qual É o Tratamento de Primeira Linha para Toxoplasmose Cerebral?

References