Pediatric Toxoplasmosis Treatment & Management

Updated: Sep 20, 2019
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Russell W Steele, MD  more...
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Approach Considerations

Outpatient care is sufficient for acquired toxoplasmosis in patients with ocular toxoplasmosis and hosts who are immunocompetent. Immunocompetent patients who are not pregnant and have no vital organ damage can be observed without therapy.

Initial inpatient care is appropriate for patients with CNS toxoplasmosis and immunocompromised hosts with acute disease.

Usually, no treatment is necessary for asymptomatic hosts, except in those younger than 5 years. Symptomatic patients should be treated until immunity is assured. Suppressive therapy must continue for patients who are HIV positive with active infection and a CD4+ count less than 200.

Limitation of activity in patients with toxoplasmosis depends on the severity of disease and the organ systems involved.



A study by Carellos et al that included 190 children identified with congenital toxoplasmosis who were treated with sulfadiazine, pyrimethamine, and folinic acid reported that 44% of the children had hematologic adverse events (neutropenia occurred in 31%); however, most were not severe cases and reversed after an increase in folinic acid dose (25.7%) or suspension of treatment (1.8%). [12]



The following consultations are indicated:

  • Infectious disease specialist
  • Ophthalmologist
  • Neurologist
  • Radiologist
  • Audiologist


Preventing the infection is particularly important for women who are pregnant and for patients who are seronegative and immunocompromised. [13]

Avoid consuming raw or undercooked meat, unpasteurized milk, and uncooked eggs. Wash hands after touching raw meat and after gardening or having other contact with soil. Wash fruits and vegetables. Avoid contact with cat feces. Disinfect litter for 5 minutes with nearly boiling water. In an attempt to prevent congenital toxoplasmosis, routine serologic screening of pregnant women has been performed in order to identify fetuses at risk of becoming infected. Treatment during pregnancy results in a 50% reduction in incidence of infection in infants.

When feasible, avoid transfusions of blood products from a donor who is seropositive to a patient who is seronegative and immunocompromised. In addition, transplant recipients who are seronegative should, if possible, receive organs from donors who are seronegative. [14]


Long-Term Monitoring

Follow-up visits should occur every 2 weeks until the patient is stable, then monthly during therapy. Obtain a complete blood count (CBC) weekly for the first month, then every 2 weeks. Perform renal and liver function tests monthly.