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Toxoplasma Encephalitis — SCE Infectious Diseases MCQ

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HardHIV MedicineToxoplasma EncephalitisSCE Infectious Diseases

A person with advanced HIV has a solitary ring-enhancing brain lesion, positive Toxoplasma IgG and no prophylaxis. Empirical toxoplasmosis therapy is started. When should failure to improve prompt tissue diagnosis for an alternative such as lymphoma?

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Correct answer: A — Reassess clinically and radiologically at about 2 weeks and pursue biopsy if there is no convincing response with follow-up

The best answer is “Reassess clinically and radiologically at about 2 weeks and pursue biopsy if there is no convincing response with follow-up”. In the characteristic phenotype, a therapeutic trial is appropriate; lack of response by roughly 10–14 days materially increases concern for another diagnosis. “Biopsy every lesion before giving any anti-toxoplasma treatment” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Continue unchanged treatment for 6 months before reassessment” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use whole-brain radiotherapy as the diagnostic test” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Rely on repeat serum Toxoplasma IgG to prove intracranial response” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: BHIVA opportunistic-infection guidelines: https://bhiva.org/clinical-guideline/oi-guidelines/