Infectious diseases: cerebral toxoplasmosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: cerebral toxoplasmosis

Sample item

A 32-year-old man with HIV, a CD4 count of 60 cells/mm3 and positive Toxoplasma IgG has headache, fever and right hemiparesis. MRI shows multiple ring-enhancing lesions with surrounding oedema and mass effect. What is the most appropriate initial therapy?

AIntravenous acyclovirBAlbendazole with corticosteroidCPyrimethamine, sulfadiazine and folinic acidDLiposomal amphotericin B

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Pyrimethamine, sulfadiazine and folinic acid

In advanced HIV, multiple ring-enhancing lesions in a Toxoplasma-seropositive patient are treated empirically as toxoplasma encephalitis, with clinical and radiological response expected in 10 to 14 days. Pyrimethamine and sulfadiazine inhibit sequential steps of folate synthesis, and folinic acid prevents marrow suppression. Biopsy is considered if there is no response.

Option by option

A. Intravenous acyclovir
Acyclovir treats herpes simplex encephalitis, which presents with temporal lobe changes.
B. Albendazole with corticosteroid
Albendazole is used for neurocysticercosis, which does not usually occur in this immunosuppressed setting with a positive IgG.
C. Pyrimethamine, sulfadiazine and folinic acid (correct)
Pyrimethamine and sulfadiazine are the standard empirical treatment.
D. Liposomal amphotericin B
Amphotericin treats cryptococcal and other fungal infection, not toxoplasma.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Pyrimethamine, sulfadiazine and folinic acid. In advanced HIV, multiple ring-enhancing lesions in a Toxoplasma-seropositive patient are treated empirically as toxoplasma encephalitis, with clinical and radiological response expected in 10 to 14 days.

Why is "Intravenous acyclovir" not the answer?

Acyclovir treats herpes simplex encephalitis, which presents with temporal lobe changes.

Why is "Albendazole with corticosteroid" not the answer?

Albendazole is used for neurocysticercosis, which does not usually occur in this immunosuppressed setting with a positive IgG.

Why is "Liposomal amphotericin B" not the answer?

Amphotericin treats cryptococcal and other fungal infection, not toxoplasma.

What concept does this question test?

It tests Infectious diseases: cerebral toxoplasmosis in General Medicine. Pyrimethamine and sulfadiazine inhibit sequential steps of folate synthesis, and folinic acid prevents marrow suppression. Biopsy is considered if there is no response.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: cerebral toxoplasmosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.