Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- chorioretinitis
- focal neurological deficit
Other diagnostic factors
- blurry vision
- slurred speech
- headache
- unsteady gait
- confusion
- fever
- lymphadenopathy
- fetal microcephaly
- fetal intracranial calcification
- fetal hydrocephalus
- fetal intrauterine growth restriction
- seizure
- malaise
- hepatitis
- pneumonitis
- myocarditis
Risk factors
- immunosuppression
- exposure during pregnancy
- residence in a high-risk area
- ingestion of undercooked or raw meat
- exposure to cat faeces
- heavy exposure to soil
- ingestion of unwashed unpeeled raw fruits and vegetables
- occupational exposure
Diagnostic investigations
1st investigations to order
- anti-Toxoplasma IgG (serum)
- anti-Toxoplasma IgM (serum)
- CT (with intravenous contrast) or MRI of brain
Investigations to consider
- anti-Toxoplasma IgA (serum)
- Toxoplasma-specific IgG avidity index (serum)
- differential agglutination test (AC/HS)
- polymerase chain reaction (body fluids and tissue)
- biopsy
Emerging tests
- IgG or IgM Immunoblot (serum)
- enzyme-linked immunosorbent spot assay
- interferon-gamma release assay
Treatment algorithm
occupational exposure
HIV-positive with CD4+ T lymphocyte count <100
seronegative recipients of solid organs from seropositive donors; seropositive recipients of allogeneic haematopoietic stem cell transplant
newborns: confirmed or highly suspected congenital disease
non-pregnant adults and children: confirmed or suspected disease
pregnant: with seroconversion
immunocompromised: following symptomatic disease
Contributors
Authors
Sarah Hochman, MD
Assistant Professor
Department of Medicine
Division of Infectious Diseases and Immunology
New York University School of Medicine
New York
NY
Disclosures
SH declares that she has no competing interests.
Kami Kim, MD
Professor of Medicine (Infectious Diseases) and Microbiology and Immunology
Albert Einstein College of Medicine
Bronx
NY
Disclosures
KK is on the advisory board for the Sanford Guide for Antibiotic Therapy. KK is the author of a reference cited in this topic.
Peer reviewers
Fabrizio Bruschi, MD
Professor of Parasitology
University of Pisa
School of Medicine
Pisa
Italy
Disclosures
FB declares that he has no competing interests.
Srikrishna Nagri, MD
Gastroenterologist
Dartmouth-Hitchcock Nashua
Nashua
NH
Disclosures
SN declares that he has no competing interests.
George Y. Wu, MD, PhD
Professor of Medicine
University of Connecticut Health Center
Farmington
CT
Disclosures
GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text
Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases - toxoplasmosis. May 2023 [internet publication].Full text
Department of Health and Human Services, Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. May 2024 [internet publication].Full text
Hoz RM La, Morris MI; Infectious Diseases Community of Practice of the American Society of Transplantation. Tissue and blood protozoa including toxoplasmosis, Chagas disease, leishmaniasis, Babesia, Acanthamoeba, Balamuthia, and Naegleria in solid organ transplant recipients - guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019 Sep;33(9):e13546. Abstract
Desmonts G. Couvreur J. Congenital toxoplasmosis: a prospective study of 378 pregnancies. N Eng J Med. 1974 May 16;290(20):1110-6. Abstract
Department of Health and Human Services, Panel on Opportunistic Infections in Children with and Exposed to HIV. Guidelines for the prevention and treatment of opportunistic infections in children with and exposed to HIV. Aug 2023 [internet publication].Full text
McLeod R, Boyer K, Karrison T, et al. Outcome of treatment for congenital toxoplasmosis, 1981-2004: the National Collaborative Chicago-Based, Congenital Toxoplasmosis Study. Clin Infect Dis. 2006 May 15;42(10):1383-94. Abstract
Pradhan E, Bhandari S, Gilbert RE, et al. Antibiotics versus no treatment for toxoplasma retinochoroiditis. Cochrane Database Syst Rev. 2016 May 20;(5):CD002218.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Central nervous system lymphoma
- Metastatic brain lesions from primary malignancy
- Mycobacterial central nervous system disease
More DifferentialsGuidelines
- Parasites - toxoplasmosis (Toxoplasma infection)
- Red Book: Toxoplasma gondii infections
More GuidelinesPatient information
Toxoplasmosis in pregnancy: what is it?
Toxoplasmosis in pregnancy: what treatments work?
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