Place du cotrimoxazole dans la prophylaxie primaire de la toxoplasmose chez les patients infectés par le VIH

Toxoplasmose chez les patients immunodéprimés. Apport à la connaissance de l'infection toxoplasmique

Toxoplasmosis can be a severe infection in immunosuppressed patients. In these patients it can present as collected encephalitis, diffuse hypoxemic pneumopathy, or disseminated infection with fatal outcome. These presentations are observed mainly in HIV-infected patients, and less frequently in bone-marrow transplanted, or heart or heart and lung transplanted patients, or in patients given long term steroids or immunosuppressive therapy. The disease is due most often to the reactivation of latent persistent forms of the parasite at a moment of depression of host defense mechanisms, with local reactivation, and/or hematogenous dissemination. In some cases, the disease is favored by an insufficient protective response after primary infection. Treatment, based on the pyrimethamine-sulfadiazine combination should be continued as long as a profound immunosuppression is present. Prevention is based on recommendations to avoid acquisition of the parasite for seronegative patients, and on chemoprophylaxis, using cotrimoxazole as first line regimen, in patients already infected with Toxoplasma gondii.