Diagnosis

Diagnosis Toxoplasmosis secara klinis sukar ditentukan karena gejalanya tidak spesifik atau bahkan tidak
menunjukkan gejala, sehingga sulit untuk mengetahui adanya toksoplasma dalam tubuh seseorang hanya
dari gejalanya saja. Oleh karena itu, pemeriksaan laboratorium mutlak diperlukan untuk mendapatkan
diagnosis yang tepat. Pemeriksaan yang dilakukan adalah Anti-Toxoplasma g! dan Anti-Toxoplasma g".
Pemeriksaan tersebut perlu dilakukan pada orang yang diduga terinfeksi Toxoplasma, ibu sebelum atau
selama masa hamil serta pada bayi baru lahir dari ibu yang terinfeksi Toxoplasma.
INTERPRESTASI HASIL LABORATORIUM
#. $ila g" dan g! yang positif menunjukkan adanya infeksi primer. %al ini perlu pengobatan dan
e&aluasi, baik pada ibu maupun bayinya.
'. $ila g! positif sedangkan g" negatif berarti menunjukkan adanya infeksi baru.
(. $ila g " positif dan g ! negatif berarti menunjukkan telah terinfeksi lebih dari setahun yang lalu.
)aat ini mungkin telah mengembangkan kekebalan terhadap parasit itu sehingga tidak perlu kha*atir
untuk hamil
Diagnosis of toxoplasmosis is usually made by detection ofToxoplasma-specific IgG, IgM, or
IgA antibodies. There are several tests available that detect these immunoglobulin antibodies
ithin several ee!s of infection"
dye test #DT$
indirect fluorescent antibody test #I%A$
en&yme immunoassays #'(I)A, immunoblots$
If acute infection is suspected, the patient*s serum should be tested for IgG and
IgMToxoplasma-specific antibodies. %or a testing results algorithm, see +D+*s
D,Dx Toxoplasmosis: Antibody Detection page.
)erologic tests are sometimes unreliable in immunosuppressed patients. -ecause of the
persistence of Toxoplasma cysts and antibody in asymptomatic chronic latent infections,
immunosuppressed persons ith both positive ,+. and serologic results should have their
diagnostic testing results interpreted in relation to clinical features of an active infection. A
negative ,+. does not rule out active infection. ,+. can also be performed on amniotic fluid
hich can be helpful in determining fetal infection folloing acute ac/uired infection of the
mother.
Diagnosis can be made by direct observation of the parasite in stained tissue sections,
cerebrospinal fluid #+)%$, or other biopsy material. These techni/ues are used less fre/uently
because of the difficulty of obtaining these specimens. ,arasites can also be isolated from
blood or other body fluids #for example, +)%$ but this process can be difficult and re/uires
considerable time.
Treatment
Treatment of immunocompetent adults ith lymphadenopathic toxoplasmosis is rarely
indicated0 this form of the disease is usually self-limited. If visceral disease is clinically evident
or symptoms are severe or persistent, treatment may be indicated for 1 to 2 ee!s.
Treatment for ocular diseases should be based on a complete ophthalmologic evaluation. The
decision to treat ocular disease is dependent on numerous parameters including acuteness of
the lesion, degree if inflamation, visual acuity, and lesion si&e, location, and persistance #for
example, 3classic therapy3 for ocular toxoplasmosis, adults" pyrimethamine 455 mg for 4
day as a loading dose, then 16 to 65 mg per day, plus sulfadiazine 4 gram four times per
day, plus folinic acid #leucovorin) 6-16 mg ith each dose of pyrimethamine0 pediatric dose"
pyrimethamine 1 mg7!g first day then 4 mg7!g each day, plus sulfadia&ine 65 mg7!g to
times per day, plus folinic acid #leucovorin$ 8.6 mg per day$ for 2 to 9 ee!s folloed by
reevaluation of the patient*s condition. (eucovorin protects the bone marro from the toxic
effects of pyrimethamine. If the patient has a hypersensitivity reaction to sulfa drugs,
pyrimethamine plusclindamycin can be used instead. The fixed combination
of trimethoprim ithsulfamethoxazole has been used as an alternative, as ell as other
drugs such as atova/uone and pyrimethamine plus a&ithromycin, hich have not been
extensively studied #see" Montoya :G, -oothroyd :+, ;ovacs :A. Toxoplasma gondii in Mandell,
Douglas, and -ennett*s ,rinciples and ,reactice of Infectious Diseases, 8th, 'dition, 1545.
Mandell G(, -ennett :', Dolin ., 'ds. +hurchill (ivingstone 'lsevier, ,hiladelphia, ,A.0 and de-
la-Torre A, )tanford M, +uri A, :affe G:, Gome&-Marin :'. Therapy for ocular toxoplasmosis.
<cul Immunol Inflamm. 154404=">42-15. +orticosteroids are sometimes prescribed in addition
to antiparasitic agents.
Management of maternal and fetal infection varies depending on the treatment center. In
general, spiramycin is recommended #for the first and early second trimesters$
orpyrimethamine/sulfadiazine and leucovorin #for late second and third trimesters$ for
omen ith acute T. gondii infection diagnosed at a reference laboratory during gestation.
,+. is often performed on the amniotic fluid at 4? gestation ee!s to determine if the infant is
infected. If the infant is li!ely to be infected, then treatment ith drugs such as
pyrimethamine, sulfadia&ine, and leucovorin is typical. +ongenitally infected neborns are
generally treated ith pyrimethamine, a sulfonamide, and leucovorin for 4 year #see Montoya
:G, (iesenfeld <.Toxoplasmosis . (ancet. 1552 :un 410>9>"4=96-4=890 for additional
information regarding management in pregnant omen, see Montoya :G, .emington :).
Management of Toxoplasma gondii infection in pregnancy. +lin Infect Dis 155?028"662-699$.
,ersons ith AID) ho develop active toxoplasmosis #usually toxoplasmic enchephalitis$ need
treatment that must be ta!en until a significant immunologic improvement is achieved as a
result of antiretroviral therapy #see Guidelines for Prevention and Treatment of
Opportunistic nfections in !"#nfected Adults and Adolescents.