Re:archer question please answer - confusedclinician

[ArchivalUser]

agree "c bcoz if serology is negative excludes toxo"
also, pt is on prophylax for toxo which makes it more likely to r/o for other ddx.
'
Book or recent papers say that.... we must confirm the dx of toxo in hiv pts with imaging and serology (like to see if it is acute or chronic infc...or it is not toxo). In most cases, negative serology for antitoxoplasma IgG antibodies should prompt the physician to consider diagnoses other than toxoplasmosis in HIV-infected patients (such as TB or av malform or hemorage which can mimic the same, brain abscess...else.

[ArchivalUser]

"and prophylactic medications for Pneumocystis jiroveci and Mycobacterium Avium Complex for the past one year"

he is Not taking prophylaxis for toxo, mery.

[ArchivalUser]

ring-enhancing lesion could be CNS lymphona, serology is to d/d between both, mery.

[ArchivalUser]

Prophylaxis Options: Alternative Regimens

Other options for prophylaxis include the following:
TMP-SMX one double-strength tablet TIW (e.g., Monday, Wednesday, and Friday) (Note: This regimen also is likely to be effective in preventing toxoplasmosis.)
Dapsone 100 mg PO once daily or 50 mg PO BID (Note: These regimens do not prevent toxoplasmosis.)
Dapsone 50 mg PO once daily + pyrimethamine 50 mg PO once weekly + leucovorin 25 mg PO once weekly (Note: This regimen also is effective in reducing the risk of toxoplasmosis.)


actually, i had a similar im board q like this and the reviewer said bla bla bla...keep in mind that not all qs even board qs are standard.

[ArchivalUser]

Prophylaxis Options: Recommended Regimens
Trimethoprim-sulfamethoxazole (TMP-SMX) (also known as cotrimoxazole, Bactrim, and Septra) one double-strength tablet PO once daily (Note: This regimen also is effective in preventing toxoplasmosis.)
TMP-SMX one single-strength tablet PO once daily (this lower-dose regimen may be better tolerated) (Note: This also is likely to be effective in preventing toxoplasmosis.)

and we discussed that since we can cover all of the bugs with 1 single regimen, we shud opt for such to make sure we are covering for most of them....meanwhile that pt dont need to take lots of extra meds...and u knw most of hiv/aids pts dont have adherence to tx unless we try to reduce the amount of meds and the frequencies...which is art of medicine. gl

[ArchivalUser]

thanks mery. C is more sensible answer

[ArchivalUser]

jupitor you are confusing everyone as usual. Mery posted the prophylactic regimens

[ArchivalUser]

This is a cleat cut case of toxoplamosis. HIv patient ring enhancing lesion there are two most important possibilities one is toxoplasmosis and other is CNS lymphoma. so first treat with sulfa and pyrimethamine beacause it has both diagnostic and therapeutic value. give this medicine for two weeks and do repeat MRI. If the lesion shrinks then the diagnosis is certain. if consider lymphoma. I hope it will work.

[ArchivalUser]

Toxoplasma gondii serology should be part of the standard check-up for every HIV-infected patient, and toxoplasmosis chemoprophylaxis should be given to those with positive toxoplasma serology. Presumptive therapy of toxoplasmosis should be started for all HIV positive patients with focal neurological manifestations in the absence of a cerebral scanner.


PMID: 10774487 [PubMed - indexed for MEDLINE]

[ArchivalUser]

Ans is B.
In patients with HIV, a ring enhancing lesion on brain imaging is first treated as for Tox. Then the scan is repeated in 2 weeks time. So TMP/SMX plays a threapeutic as well as diagnostic role.
If the lesion doesn't decrease in size, it is most likely lymphoma and therefore should be biopsied.
Serology is not a good choice for Tox because most people have been infected at some point in their life.
Hope that helps.