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Toxoplasma Treatment Response — SCE Infectious Diseases MCQ

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EasyHIV MedicineToxoplasma Treatment ResponseSCE Infectious Diseases

A 35-year-old man with HIV (CD4 40) not on ART presents with multiple ring-enhancing lesions on MRI brain. Toxoplasma IgG is positive. He is started on empirical anti-Toxoplasma therapy (Pyrimethamine, Sulfadiazine, Folinic Acid). At 10 days, repeat MRI shows significant reduction in lesion size. What does this confirm?

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Correct answer: B — The radiological response supports the diagnosis of Toxoplasma encephalitis — continue treatment for 6 weeks total, then secondary prophylaxis

Clinical and radiological improvement within 10–14 days of empirical anti-Toxoplasma therapy effectively confirms the diagnosis of Toxoplasma encephalitis in the appropriate clinical context (advanced HIV, positive Toxoplasma IgG, typical MRI findings). Biopsy is not needed if there is a clear response. Treatment should continue for at least 6 weeks, followed by secondary prophylaxis (Pyrimethamine plus Sulfadiazine or Clindamycin at reduced doses) until CD4 >200 for ≥6 months on ART. If no response at 14 days, biopsy should be performed to exclude lymphoma.

Reference: BHIVA 2022 – OI guidelines; NICE 2024 – CNS infections in HIV