Toxoplasmosis Prophylaxis
Primary Prophylaxis
Toxoplasmosis in intensively treated patients is rare and is usually related to disease reactivation within allogeneic recipients. The following is recommended:
- Standard allogeneic recipients are tested for IgG antibodies pre-transplant to assess whether they are at risk for disease reactivation post-SCT. Some patients who are seronegative pre-transplant can still develop the infection post-transplant.
- Allogeneic recipients who are seropositive for toxoplasmosis or who have a clinical history of toxoplasmosis should receive chemoprophylaxis with trimethoprim + sulfamethoxazole 80 + 400 mg PO ONCE daily and be monitored closely for features of toxoplasmosis. This should start after engraftment. Patients who are intolerant of trimethoprim + sulfamethoxazole should receive clindamycin 300-450 mg PO three time daily, pyrimethamine 25-75 mg ONCE daily PO and folinic acid 15 mg ONCE daily PO. Patients who receive therapy for toxoplasmosis should receive maintenance therapy for the duration of their immunosuppression. See below.
- Allogeneic stem cell transplant recipients should avoid eating undercooked meat and take precautions handling domestic animals pre-transplant and post-transplant, for as long as their duration of immunosuppression persists.
- Prophylaxis is not given to other intensively treated patients.
Secondary Prophylaxis
This is to prevent a recurrence after proven toxoplasmosis.
- Pyrimethamine 25 mg ONCE daily PO and
- Folinic acid 15 mg ONCE daily PO and
- Either sulphadiazine 500 mg four times a day PO or clindamycin 450 mg three times daily
Check CBC + diff weekly. Continue for at least six months, or longer if continued immune suppression / GvHD.
Topic Code: 4983
Disclaimer