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PubMed2000

Toxoplasmosis after hematopoietic stem cell transplantation.

Forty-one cases of toxoplasmosis were diagnosed in 15 European transplantation centers in patients who had undergone allogeneic hematopoietic stem cell transplantation (HSCT) from 1994 through 1998. Most patients (39 [94%]) were seropositive for Toxoplasma gondii before they underwent transplantation, and 30 (73%) had developed moderate to severe acute graft-versus-host disease before they developed toxoplasmosis. Thirty-five (85%) patients had Toxoplasma disease with evidence of organ involvement, whereas 6 (15%) patients had Toxoplasma infection, as defined by fever and a positive polymerase chain reaction (PCR) finding for T. gondii in blood. Nine patients were diagnosed at autopsy. Thirty patients (73%) had not received antimicrobial prophylaxis with anti-Toxoplasma activity after undergoing transplantation. The median day of onset of disease after HSCT was 64. Twenty-two (63%) patients died from toxoplasmosis, and 23 (66%) received adequate anti-Toxoplasma therapy for > or =3 days. Among these 23 patients, 11 (48%) showed a complete response and 3 (13%) showed improvement. In univariate and multivariate analyses, having received adequate therapy and experiencing late infection (>63 days after HSCT) were associated with a lower risk of dying from toxoplasmosis. Toxoplasmosis after HSCT is a severe infection with a high mortality rate even when diagnosed soon after HSCT, and PCR may help establish the diagnosis earlier.

Adolescent↗
PubMed1992

Cutaneous manifestations of toxoplasmosis.

Toxoplasmosis is a common, largely asymptomatic infection. Early reports of acquired disease noted frequent dermatologic manifestations, whereas recent reviews of toxoplasmosis stress the lymphadenopathic presentation of the disease. We report the case of a patient with acute toxoplasmosis associated with a prominent macular and papular rash involving the palms and soles. We have reviewed the literature on dermatologic manifestations of acute acquired toxoplasmosis to underscore the importance of considering toxoplasmosis in the differential diagnosis of febrile illnesses with varied dermatologic presentations.

Acute Disease↗
PubMed1989

Disseminated toxoplasmosis presenting as symptomatic orchitis and nephrotic syndrome.

Toxoplasma gondii is a common pathogen in patients with acquired immune deficiency syndrome (AIDS). The most common modes of presentation are related to the central nervous system (CNS), usually with headache, fever, and focal neurological signs. Extra-neural manifestations are unusual in patients with AIDS. The authors present a patient with AIDS who had disseminated toxoplasmosis whose initial clinical presentation was symptomatic orchitis and the nephrotic syndrome (NS). Testicular involvement with toxoplasmosis has been described only rarely, predominantly as an incidental finding at autopsy. Toxoplasmosis is a rare cause of nephrotic syndrome, with the majority of cases associated with congenital infection. In this case, the nephrotic syndrome remitted only after orchiectomy and chemotherapy for toxoplasmosis, but recurred when the patient had a relapse of his CNS disease. Toxoplasmosis in AIDS may present with extra-neural manifestations and may be an etiologic agent for NS in some patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Congenital toxoplasmosis: a review.

Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. In the United States, approximately 85% of women of childbearing age are susceptible to acute infection with T. gondii. Acute infections in pregnant women may cause serious health problems when the organism is transmitted to the fetus (congenital toxoplasmosis), including mental retardation, seizures, blindness, and death. An estimated 400 to 4000 cases of congenital toxoplasmosis occur in the U.S. each year. Manifestations of congenital toxoplasmosis may not become apparent until the second or third decade of life. Serologic tests are used to diagnose acute infection in pregnant women, but false-positive tests occur frequently, therefore, serologic diagnosis must be confirmed at a reference laboratory before treatment with potentially toxic drugs should be considered. Much of congenital toxoplasmosis can be prevented by educating women of childbearing age and pregnant women to avoid eating raw or undercooked meat, to avoid cross-contamination of other foods with raw or undercooked meat, and to use proper cat-litter and soil-related hygiene.

Animals↗
PubMed2001

Epidemiology of congenital toxoplasmosis identified by population-based newborn screening in Massachusetts.

BACKGROUND: Fourteen years of newborn screening in Massachusetts for congenital toxoplasmosis infection identified subpopulations that appeared to have higher rates of infection. Elaborating an epidemiologic profile and risk correlates might aid implementing targeted prenatal education and newborn screening strategies with the goal of early postnatal treatment to prevent morbidity. OBJECTIVE: To describe the epidemiology of congenital toxoplasmosis in Massachusetts and risk correlates of infection using birth certificate data. METHODS: A case-control study was conducted based on Massachusetts birth certificate data. Cases were all infants with congenital toxoplasmosis identified by statewide universal newborn screening from 1988 to 1999. Controls were all children born on the same day as those infants in Massachusetts. RESULTS: Factors that strongly predicted congenital toxoplasmosis infection were mother's country of birth outside the US (especially the southeast Asian refugee origin countries of Cambodia and Laos), mother's educational level and higher gravidity. CONCLUSIONS: More extensive, culturally and linguistically appropriate, prenatal education is needed for pregnant women, regardless of a mother's educational level, especially for non-US-born mothers, and not focused only on primiparous women. Other states may be able to use their state-specific birth certificate data to compare risk profiles with those of Massachusetts to guide a toxoplasmosis screening policy on the basis of population similarities and differences.

Adult↗
PubMed2005

Toxoplasmosis retinochoroiditis and elevated intraocular pressure: a retrospective study.

OBJECTIVES: To report the prevalence of abnormal intraocular pressure (IOP) in patients with toxoplasmosis retinochoroiditis and to determine risk factors for such abnormality. METHODS: In a retrospective clinic-based chart review, the IOP levels of 61 patients with active retinochoroiditis were recorded. Patients were separated into groups with elevated IOP, equal IOP, and lower IOP. The time taken for normalization of IOP was also recorded. Additionally, age, gender, visual acuity, anterior chamber and vitreous inflammatory activity, presence of macular lesions, keratoprecipitates, synechiae, toxoplasmosis antibody titers, and required medical and surgical treatments were noted. The IOP in 61 patients with active retinochoroiditis were also compared with the IOP in 59 age- and gender-matched control patients with unilateral anterior uveitis. RESULTS: Thirty-eight percent of patients (23/61) with active retinochoroiditis had elevated IOP > 21 mm Hg, demonstrated IOP difference > 4 mm Hg between involved and uninvolved eyes, or received on IOP-lowering medications. In the equal IOP category, 55.7% (34/61) of patients had an IOP < or = 21 mm Hg in the actively inflamed eye and had an IOP difference of < or = 3 mm Hg between the active and inactive eyes. Only 6.6% (4/61) of patients with active ocular toxoplasmosis had a decreased IOP in the affected eye. The mean IOP in patients with active retinochoroiditis was 21.2 mm Hg (SD 11.5) and 15.6 mm Hg (SD 2.9) in involved and uninvolved eyes, respectively. A statistically significant average IOP difference of 5.8 mm Hg (SD 11.6) was found between the involved and uninvolved eyes (P < 0.001 by two-tailed student T test). Of the patients with abnormal IOP, 20 patients had IOP > 21 mm Hg, 10 of whom had IOP > 30 mm Hg, 6 of whom had IOP > 40 mm Hg, and 2 of whom had IOP > 50 mm Hg. In the elevated IOP group, the average time from onset of symptoms until presentation for their IOP measurement was 13 days (median: 7 days; range: 1 to 100) with resolution of abnormal IOP occurring in 32 days (median: 28 days; range: 1 to 84 days). The average time of onset of symptoms in the normal to low IOP category was 70 days (median: 17.5 days; range: 2 to 330 days). Elevated IOP was more common in active retinochoroiditis, 23/61 (38%), when compared with anterior uveitis control group, 6/59 (10%) (odds ratio of 5.3; P < 0.001). No statistically significant predictor of elevated IOP was identified, though a trend associating anterior chamber cells with elevated IOP (P = 0.08, r = 0.25 Spearman rank correlation coefficient) was seen. CONCLUSION: Abnormal IOP is a feature in almost half of patients with active toxoplasmosis retinochoroiditis. Elevated IOP occurs in 38% and low IOP occurs in 6.6% of affected eyes. Patients with elevated IOP due to active toxoplasmosis present for earlier evaluation than patients with normal or low IOP. The IOP elevation is generally transient and concurs with the uveitic episode. Medical management of IOP is usually sufficient to treat this generally transient eye pressure rise though chronic administration of eye pressure lowering drops or glaucoma surgery may be necessary in a small proportion of patients.

Adolescent↗
PubMed1981

Polymyositis and toxoplasmosis.

Extensive severe polymyositis in a patient with toxoplasmosis was presented. Toxoplasmosis was serologically substantiated by a serial two tube rise in a toxoplasma-antibody titer by a hemagglutination test. When appeared to be toxoplasma gondii was detected in areas of myositis. Toxoplasma gondii was found in a single small area of hepatic necrosis, but no other organ or tissue was involved. Thus, the present case was peculiar in respect that skeletal muscles were the major target of toxoplasmosis. A causal relationship between toxoplasmosis and polymyositis was discussed and the literatures were reviewed. Serological investigation and histopathological search for toxoplasma gondii should be done in every case of polymyositis not only for the appropriate therapy but also for the further elucidation of the relationship between toxoplasmosis and polymyositis.

Aged↗
PubMed2005

Seasonal variations in acute toxoplasmosis in pregnant women in Slovenia.

Between December 1999 and December 2004, 40 081 pregnant women were examined for toxoplasmosis with Toxo-IgG, Toxo-IgM enzyme immunoassay. Women with positive results were then retested with the Toxo-IgG avidity assay for recent toxoplasmosis. Recent acute toxoplasmosis in pregnant women was found to be significantly more frequent (p < 0.01) during winter than summer. The incidence of acute toxoplasmosis during winter-spring was also significantly more frequent (p < 0.025) than summer-autumn. This phenomenon should be taken into account when formulating preventive measures for toxoplasmosis, especially for pregnant women.

Acute Disease↗
PubMed1996

Antenatal diagnosis of congenital toxoplasmosis: evaluation of the biological parameters in a cohort of 286 patients.

OBJECTIVE: To evaluate the biological parameters obtained by cordocentesis and amniocentesis in the antenatal diagnosis of congenital toxoplasmosis. DESIGN: Nine-year retrospective study. SETTING: Parasitology Laboratory, Department of Obstetrics and Gynaecology and Department of Paediatrics, Centre Hospitalo-Universitaire, Montpellier, France. PARTICIPANTS: Two hundred and eighty-six pregnant women infected with toxoplasmosis between 7 and 34 weeks of gestation. METHODS: Detection of abnormalities by ultrasound examination. Detection in fetal blood of Toxoplasma, of specific IgM and IgA and of nonspecific biological markers. Detection in amniotic fluid of Toxoplasma. RESULTS: Out of 286 antenatal diagnoses, 211 were negative (1st group), 40 were positive (2nd group) and led to 8 medical abortions, and 35 were uncertain (3rd group). In the 1st and 3rd groups respectively, 7 (3.3%) and 5 (14.3%) cases of congenital toxoplasmosis were observed. Overall, 52 cases of congenital toxoplasmosis were detected: 12 were clinically apparent, 36 subclinical (of which 12 were in groups 1 and 3) and 4 were lost to follow up. CONCLUSION: There is substantial importance in making the diagnosis of toxoplasmosis antenatally in order to limit the number of medical abortions. In our series, the most accurate predictor was the detection of the fetal antibody response (specific IgM and IgA) to Toxoplasma.

Animals↗
PubMed1999

Value of PCR for detection of Toxoplasma gondii in aqueous humor and blood samples from immunocompetent patients with ocular toxoplasmosis.

Toxoplasma gondii infection is an important cause of chorioretinitis in the United States and Europe. Most cases of Toxoplasma chorioretinitis result from congenital infection. Patients are often asymptomatic during life, with a peak incidence of symptomatic illness in the second and third decades of life. Diagnosis is mainly supported by ophthalmological examination and a good response to installed therapy. However, establishment of a diagnosis by ophthalmological examination alone can be difficult in some cases. To determine the diagnostic value of PCR for the detection of T. gondii, 56 blood and 56 aqueous humor samples from 56 immunocompetent patients were examined. Fifteen patients with a diagnosis of ocular toxoplasmosis had increased serum anti-T. gondii immunoglobulin G levels but were negative for anti-T. gondii immunoglobulin M (group 1), and 41 patients were used as controls (group 2). Samples were taken before antiparasitic therapy was initiated, and only one blood sample and one aqueous humor sample were obtained for each patient. Single nested PCRs and Southern blot hybridization were performed with DNA extracted from these samples. The results obtained showed sensitivity and specificity values of 53. 3 and 83%, respectively. Interestingly, among all patients with ocular toxoplasmosis, a positive PCR result with the aqueous humor sample was accompanied by a positive PCR result with the blood sample. This result suggests that ocular toxoplasmosis should not be considered a local event, as PCR testing of blood samples from patients with ocular toxoplasmosis yielded the same result as PCR testing of aqueous humor samples. PCR testing may be useful for discriminating between ocular toxoplasmosis and other ocular diseases, and also can avoid the problems associated with ocular puncture.

Adolescent↗
PubMed2006

The national neonatal screening programme for congenital toxoplasmosis in Denmark: results from the initial four years, 1999-2002.

AIMS: To describe the outcome of four years' nationwide neonatal screening for congenital toxoplasmosis in liveborn newborns. METHODS: Congenital toxoplasmosis was diagnosed if specific Toxoplasma gondii IgM antibodies were detected in eluate from the PKU Guthrie filter paper card from a child. Infants diagnosed with congenital toxoplasmosis were examined for intracranial and retinal lesions and treated for three months with sulphadiazine, pyrimethamine, and folinic acid continuously. RESULTS: Eluates from PKU-cards from 262 912 newborns were analysed. The birth prevalence of congenital toxoplasma infection was 2.1 per 10 000 liveborns. Congenital toxoplasmosis was suspected in 96 infants and confirmed in 55. Forty seven children were examined for intracranial and retinal lesions soon after birth; 12 had clinical signs at this first examination. Of these, 5 had intracranial calcifications, 2 had retinochoroidal lesions, 4 had intracranial calcifications and retinochoroidal lesions, and 1 had hydrocephalus, intracranial calcifications, and retinochoroidal lesions. Ninety four eyes were examined soon after birth; there were central retinochoroidal lesions in 9. Two children had macular lesion of both eyes, five had macular lesions of one eye. At 1 year of age, 10/68 eyes had central lesions, and at 3 years of age, 5/32 had central lesions. Thus new retinochoroidal lesions developed in three eyes in the observation period. CONCLUSIONS: Neonatal screening is feasible for diagnosing children with congenital toxoplasmosis at birth in low endemic areas. Retinochoroiditis with macular lesion was diagnosed in 9.6% of the eyes at birth and in 15.6% of the eyes examined at 3 years of age.

Algorithms↗
PubMed2006

Visual function in human ocular toxoplasmosis.

AIM: To assess functional impairment in terms of visual acuity reduction and visual field defects in inactive ocular toxoplasmosis. METHODS: 61 patients with known ocular toxoplasmosis in a quiescent state were included in this prospective, cross-sectional study. A complete ophthalmic examination, retinal photodocumentation and standard automated perimetry (Octopus perimeter, program G2) were performed. Visual acuity was classified on the basis of the World Health Organization definition of visual impairment and blindness: normal (> or =20/25), mild (20/25 to 20/60), moderate (20/60 to 20/400) and severe (<20/400). Visual field damage was correspondingly graded as mild (mean defect <4 dB), moderate (mean defect 4-12 dB) or severe (mean defect >12 dB). RESULTS: 8 (13%) patients presented with bilateral ocular toxoplasmosis. Thus, a total of 69 eyes was evaluated. Visual field damage was encountered in 65 (94%) eyes, whereas only 28 (41%) eyes had reduced visual acuity, showing perimetric findings to be more sensitive in detecting chorioretinal damage (p<0.001). Correlation with the clinical localisation of chorioretinal scars was better for visual field (in 70% of the instances) than for visual acuity (33%). Moderate to severe functional impairment was registered in 65.2% for visual field, and in 27.5% for visual acuity. CONCLUSION: In its quiescent stage, ocular toxoplasmosis was associated with permanent visual field defects in >94% of the eyes studied. Hence, standard automated perimetry may better reflect the functional damage encountered by ocular toxoplasmosis than visual acuity.

Adolescent↗
PubMed2006

Vitreoretinal morphology in active ocular toxoplasmosis: a prospective study by optical coherence tomography.

AIM: To investigate the third generation optical coherence tomography (OCT3) findings in patients with active ocular toxoplasmosis. METHODS: A prospective observational case series, including 15 patients with active ocular toxoplasmosis in at least one eye evaluated at a single centre. Vitreoretinal morphological features at baseline and changes within a 24-week follow-up interval on OCT3 were evaluated. RESULTS: The active ocular toxoplasmosis lesion was classified clinically as punctate (n = 6), focal (n = 6) or satellite (n = 3). Retinal layers were hyper-reflective at the active lesion site, and some degree of retinal pigment epithelium-choriocapillaris/choroidal optical shadowing was seen in all patients. In general, the retina was thinned at the active lesion site in eyes with punctate lesions and thickened in eyes with focal and satellite lesions. When detected by OCT3, the posterior hyaloid appeared thickened. While focally detached over punctate lesions, the posterior hyaloid was partially detached, but still attached to the lesion in focal and satellite lesions. Additional findings (not detected on clinical examination) include diffuse macular oedema (n = 6), vitreomacular traction (n = 3) and maculoschisis (n = 1). During follow-up, a decrease in retinal thickness and focal choriocapillaris/choroidal relative hyper-reflectivity were observed at the former lesion site, and posterior vitreous detachment progressed/occurred in all patients. CONCLUSION: OCT3 enabled identification of morphological features underestimated on clinical examination in patients with ocular toxoplasmosis, which may expand the clinical spectrum of the disease. Further studies are needed to verify the relevance of OCT3 in assisting with the diagnosis and management of ocular toxoplasmosis.

Acute Disease↗
PubMed1996

Detection by PCR of Toxoplasma gondii in blood in the diagnosis of cerebral toxoplasmosis in patients with AIDS.

The polymerase chain reaction (PCR) for amplification of Toxoplasma gondii DNA was performed prospectively in the blood of 19 patients with AIDS and cerebral toxoplasmosis. The B1 gene and TGR1E sequence were used as targets and results were confirmed by hybridisation. Controls consisted of 24 HIV infected patients with tissue culture proven T gondii parasitaemia and 57 HIV infected patients without toxoplasmosis. PCR was positive with both targets in 20 of 24 samples (84%) from patients with parasitaemia. Three of 57 samples (5%) from patients without toxoplasmosis were PCR positive with either target, but none was positive with both targets. Only three of the 19 patients (16%) with cerebral toxoplasmosis had a positive PCR with both targets before the start of specific treatment. PCR performed in blood is of little diagnostic value in cases of cerebral toxoplasmosis but could be useful in patients with disseminated infection.

AIDS-Related Opportunistic Infections↗
PubMed1992

Treatment and results of chronic toxoplasmosis. Analysis of 33 cases.

Women who grew up in Turkey, where undercooked meat is part of the usual diet, have an increased risk of toxoplasmosis. This study covers treatment and prognosis of 33 cases with chronic toxoplasmosis. The study group was selected among the patients with a history of repeated abortions, recurrent preterm labor, stillbirths and babies with congenital anomaly after all other causative reasons were ruled out. IgG and IgM antibody titers were detected by Sabin-Feldman's dye test and indirect fluorescence antibody test. 33 patients, who had negative IgM and IgG antibody titers above 1/64, were accepted as having chronic toxoplasmosis and were included in our study group. These patients were treated with our pyrimethamine treatment protocol (Dinçer Formula) for 36 days before their pregnancies. IgG antibody titers were repeated in the 8th and the 20th week of pregnancy. With the exception of 7 cases, 24 patients (72.7%) still had IgG antibody titers of more than 1/64 and were given the same treatment protocol in the 8th week of pregnancy. Very early abortions occurred in 2 cases. Of 24 patients, 8 had antibody titers still above 1/64 and were treated with spiramycine. While 28 cases (84.8%) had healthy and living infants, pregnancies of 3 cases are still continuing. No teratogenic effects of pyrimethamine on the fetuses were seen. As a result, we can say that a patient who presents with complaints of repeated abortions, recurrent preterm labor or stillbirth should be investigated for toxoplasmosis during pregnancy; even if the IgG antibody test is normal before pregnancy, she should be treated with the protocol mentioned above before pregnancy and in the 8th week of pregnancy when chronic toxoplasmosis is diagnosed.

Abortion, Spontaneous↗
PubMed1995

Fulminant disseminated toxoplasmosis in an HIV patient.

Disseminated toxoplasmosis in AIDS is a rare condition. We present an unusual case of a fulminant form of disseminated toxoplasmosis in a young male homosexual. He was a 30-year-old HIV-positive (diagnosed 4 months earlier), admitted with a 5-day history of diarrhea, vomiting, fever, and cough. He had been generally healthy except for an 8-week history of weight loss and malaise. On admission, except for a temperature of 37.6 degrees C, the physical examination was normal. He was treated symptomatically. Four days after admission he suddenly became short of breath. Despite intensive management, he continued to deteriorate and expired 6 h later. Postmortem examination revealed disseminated toxoplasmosis involving the heart, lungs, brain, stomach, small intestine, and colon. This is an unusual presentation of disseminated toxoplasmosis because of its rapid course with no prior indication of infection. To our knowledge, such an atypical and rapid downhill course of toxoplasmosis (with minimal clinical and laboratory features) has not been reported previously. Increased awareness of this infection in all HIV patients and its possibly rapid course is needed.

AIDS-Related Opportunistic Infections↗
PubMed1981

In vitro lymphocyte stimulation with specific antigen in congenital toxoplasmosis.

The development of specific cell mediated immunity was studied in children with congenital toxoplasmosis and the in vitro lymphocyte stimulation test (LST) evaluated as diagnostic test for congenital infection. The test was performed in 35 children, including 5 with a confirmed or suspected congenital toxoplasmosis and for comparison, in 19 dye test positive and 7 negative women. The development of delayed type hypersensitivity (DTH) seemed to follow approximately the same time course in children with congenital toxoplasmosis as in adults with toxoplasmosis. The lymphocyte responses to toxoplasma antigen were low during the first year, but increased markedly during the second and third years after infection. Chemotherapy during the first year of life did not prevent the later development of DTH. It is concluded that a positive LST during the first year of life may be an indication of congenital toxoplasmosis. A negative test is not decisive.

Adolescent↗
PubMed1995

Intermittent trimethoprim-sulfamethoxazole compared with dapsone-pyrimethamine for the simultaneous primary prophylaxis of Pneumocystis pneumonia and toxoplasmosis in patients infected with HIV.

OBJECTIVE: To evaluate the efficacy and safety of two oral, intermittent drug regimens for the simultaneous primary prophylaxis of Pneumocystis carinii pneumonia and toxoplasmosis in patients with HIV infection. DESIGN: Nonblinded randomized study: Patients received either 1) trimethoprim-sulfamethoxazole (160 mg-800 mg orally twice a day on a thrice weekly regimen) or 2) 100 mg of dapsone plus 50 mg of pyrimethamine orally twice weekly. SETTING: University teaching hospital in Barcelona. PATIENTS: 230 patients infected with HIV who had CD4 cell counts of less than 200 x 10(6)/L and who had not previously had P. carinii pneumonia or toxoplasmosis. MEASUREMENTS: Clinical and biological evaluations; adverse reactions; and end points of P. carinii pneumonia, toxoplasmosis, and death. RESULTS: After a median follow-up of 430 days, 6 (6.3%) of 96 evaluable patients receiving dapsone-pyrimethamine and 0 of 104 evaluable patients receiving trimethoprim-sulfamethoxazole developed P. carinii pneumonia (P < 0.0001). The cumulative rates of P. carinii pneumonia at 12 and 24 months were 0% and 0% for patients receiving trimethoprim-sulfamethoxazole and 4% and 11% for patients receiving dapsone-pyrimethamine (Mantel-Cox, P = 0.014). However, only one episode of P. carinii pneumonia developed while patients were taking these drugs. No differences were observed for toxoplasmosis (one episode in the trimethoprim-sulfamethoxazole arm and two in the dapsone-pyrimethamine arm), with cumulative rates at 12 and 24 months of 0% and 4% for the trimethoprim-sulfamethoxazole arm and 2% and 7% for the dapsone-pyrimethamine arm (P = 0.65). Similar mortality rates were observed during follow-up (P = 0.85). Nineteen patients (9.5%) discontinued therapy with the drugs because of adverse effects: Ten were in the trimethoprim-sulfamethoxazole arm and 9 were in the dapsone-pyrimethamine arm (P = 0.95). CONCLUSIONS: Thrice-weekly trimethoprim-sulfamethoxazole is an effective and well-tolerated regimen for the simultaneous primary prophylaxis of P. carinii pneumonia and toxoplasmosis in patients infected with HIV. Twice-weekly dapsone-pyrimethamine appears to be a safe and effective alternative.

AIDS-Related Opportunistic Infections↗