Issues in toxoplasmosis

Toxoplasma has become a well-recognized cause of disease in the last decade, primarily due to the prominence of AIDS. Diagnosis of toxoplasmic encephalitis is discussed, with emphasis on serologic tests, their pitfalls, and empiric therapeutic trials. Randomized trials for treatment of toxoplasmic encephalitis are few, but the combinations of pyrimethamine and sulfadiazine and of pyrimethamine and clindamycin appear comparable. Needs and methods for specific prophylaxis of toxoplasmic encephalitis are not well defined. It is now feasible to diagnose Toxoplasma infection in utero with a high degree of sensitivity and specificity, but whether such diagnosis is effective in the usual practice situation in the United States remains to be proved. Toxoplasmosis in transplant recipients is reviewed briefly.