Focal paralysis or motor weakness depending on area affected
Neuro-psychiatric manifestation corresponding to the affected area in the brain
Altered mental status (forgetfulness etc.)
Predominantly based on clinical findings after exclusion of other common causes of neurological deficit. If available, a CT scan is very useful for confirmation.
Tabs Sulphadiazine 1 gm 6hourly + Tabs Pyrimethamine 100mg loading dose then 50mg/day + Tabs Folinic acid 10mg/day for 6 weeks.
After six weeks of treatment
Tabs Sulphadiazine 500mg 6hourly + Tabs Pyrimethamine 25-50mg/day + Tabs Folinic acid 10mg/day.
For those allergic to sulphur:
Replace Tab Sulphadiazine with capsule Clindamycin 450mg 6 hourly.
Discontinue maintenance therapy when CD4 count>200 cells/ml for 6 months, initial therapy completed and patient is asymptomatic
Primary prophylaxis therapy for toxoplasmosis
Tabs Trimethoprim - Sulphamethoxazole (TMP-SMX) 160/800mg orally/day.
For those allergic to sulphur, give Tab Dapsone 50mg/day + Tab Pyrimethamine 50mg per week + Tab Folinic Acid 10 mg 3 times a week.
For intestinal protozoa which is a common cause of diarrhoea and difficult to diagnose, the recommended treatment: Tabs Albendazole 800mg BD for one week.