Cerebral toxoplasmosis: Parasitology, diagnosis, treatment, and prevention - a narrative review

Cerebral toxoplasmosis is a major opportunistic infection caused by Toxoplasma gondii, particularly in individuals with advanced HIV/AIDS and other forms of immunosuppression. This narrative review synthesizes current knowledge on the parasitology, diagnosis, treatment, and prevention of cerebral toxoplasmosis, with emphasis on clinical relevance and public health implications. We outline the parasite's life cycle and mechanisms of central nervous system invasion, distinguishing latent CNS infection in immunocompetent hosts from reactivated disease in immunocompromised patients. Diagnostic challenges are highlighted, including nonspecific clinical features, overlapping radiological findings, and variable sensitivity of serological and molecular assays. Therapeutic strategies are reviewed, focusing on standard regimens that suppress tachyzoite replication but fail to eradicate tissue cysts, necessitating prolonged maintenance therapy until immune recovery. Preventive measures such as food hygiene, avoidance of cat exposure, prophylaxis in HIV patients, and antiretroviral therapy are discussed as key interventions to reduce disease burden. Despite advances, significant gaps remain in diagnostics, definitive treatment, and preventive approaches. This review underscores the need for integrated clinical, molecular, and epidemiological research to improve outcomes and reduce the global impact of cerebral toxoplasmosis.