Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Tourette Syndrome Toxoplasmosis 1437

■If not effective, haloperidol

■Nicotine gum or patch may provide days of relief

■Botulinum toxin: may help simple tics

Attention deficit w/ or w/o hyperactivity

■Clonidine patch: start TTS1 patch; may increase to TTS3 if necessary

■Guanfacine

■Pemoline

■Methylphenidate

■Dextroamphetamine

Obsessive-compulsive disorder

■Sertraline, fluoxetine, citalopram, fluvoxamine

■Clomipramine

follow-up

■Depends on severity of symptoms & treatment

complications and prognosis

■Tardive dyskinesia may occur in 30% of those treated w/ neuroleptics

■TS is a lifelong illness but is not progressive

■Some symptoms may improve

TOXOPLASMOSIS

J. GORDON FRIERSON, MD

history & physical

History

■Life cycle: Cats are principal host, pass oocysts in stool, ingested by

human and pass through bowel wall to reach various tissues where

they encyst. Humans and cats also infected by eating rare meat that

contains cysts (includes lamb, beef, pork).

■Exposure: Ingesting oocysts through contaminated food, fingers, or

eating rare or raw meat containing toxoplasma cysts.

Signs & Symptoms

■Acute infection: fever, headache, myalgias, lymphadenopathy,

splenomegaly, rash. Incubation period is 10–12 days.

■Ocular toxoplasmosis: acutely presents as painless, focal, unilateral

retinochoroiditis. Later there is retinal scar.

In AIDS, usually presents at CD4 <100 (reactivation) as cerebral

abscess or encephalitis.