Parasitology: Toxoplasma gondii: practice question

A Microbiology 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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Microbiology · Parasitology: Toxoplasma gondii

Sample item

A man with HIV and a CD4 count of 50 per microlitre has headache and left hemiparesis. MRI shows multiple ring-enhancing basal ganglia lesions, and Toxoplasma IgG is positive. What is the most appropriate next step?

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

The answer and the reasoning

D. Empirical pyrimethamine, sulfadiazine and folinic acid with reassessment in about 2 weeks

Cerebral toxoplasmosis, from reactivation of latent cysts in advanced HIV, is the commonest cause of multiple ring-enhancing lesions. Empirical therapy with pyrimethamine, sulfadiazine and folinic acid (to avert marrow suppression) is started, and clinical and radiological response at 10 to 14 days confirms the diagnosis. Biopsy is reserved for non-responders.

Option by option

  • A. Albendazole with dexamethasone

    Albendazole with steroids treats neurocysticercosis, which is less likely with this CD4 and serology.

  • B. Intravenous amphotericin B alone

    Amphotericin B treats cryptococcal or fungal disease, not Toxoplasma.

  • C. Immediate stereotactic brain biopsy before any treatment

    Biopsy first exposes the patient to avoidable risk when empirical therapy is effective.

  • D. Empirical pyrimethamine, sulfadiazine and folinic acid with reassessment in about 2 weeks (correct)

    Correct. Empirical anti-toxoplasma therapy with response assessment is standard.

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.

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Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is D, Empirical pyrimethamine, sulfadiazine and folinic acid with reassessment in about 2 weeks. Cerebral toxoplasmosis, from reactivation of latent cysts in advanced HIV, is the commonest cause of multiple ring-enhancing lesions.

Why is "Albendazole with dexamethasone" not the answer?

Albendazole with steroids treats neurocysticercosis, which is less likely with this CD4 and serology.

Why is "Intravenous amphotericin B alone" not the answer?

Amphotericin B treats cryptococcal or fungal disease, not Toxoplasma.

Why is "Immediate stereotactic brain biopsy before any treatment" not the answer?

Biopsy first exposes the patient to avoidable risk when empirical therapy is effective.

What concept does this question test?

It tests Parasitology: Toxoplasma gondii in Microbiology. Empirical therapy with pyrimethamine, sulfadiazine and folinic acid (to avert marrow suppression) is started, and clinical and radiological response at 10 to 14 days confirms the diagnosis. Biopsy is reserved for non-responders.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Parasitology: Toxoplasma gondii?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology 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.