Internal Medicine

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

Toxoplasmosis Transfusion Reactions 1439

Side Effects & Complications

■Pyrimethamine: bone marrow suppression, GI distress, bad taste in

mouth.

■Sulfadiaziine: skin rashes, crystal-induced nephrotoxicity, encepha-

lopathic symptoms.

■Clindamycin: rash, nausea, vomiting, pseudomembranous colitis.

■Contraindications to treatment: absolute: drug allergies, Pyrime-

thamine cannot be given in first trimester of pregnancy.

■Contraindications to treatment: relative: asymptomatic or lightly

symptomatic acute cases. Treatment in pregnancy not always cura-

tive for fetus, though severity of neonatal disease decreased. Risks

and benefits need discussion.

follow-up

During Treatment

■Watch blood count for signs of marrow suppression, and urine and

renal function for signs of nephritis. Administer liberal fluids to pre-

vent nephritis.

Routine

■Clinical follow. In neonatal disease intellectual function needs follow.

IGG remains up for years and not helpful. Chorioretinitis can be

chronic and recurrent, may need retreatment.

AIDS – secondary prophylaxis required until CD4 >200.

complications and prognosis

■Acute infection: good prognosis.

■Neonatal infection: prognosis depends on extent of pathology at

birth.

■Retinal disease: treatment arrests disease, but may reactivate.

■Immunocompromised patients have poorer prognosis, require

larger doses of drugs and longer therapy.

TRANSFUSION REACTIONS

RICHARD KAUFMAN, MD; FRANK STROBL, MD;

JONATHAN KURTIS, MD; and LESLIE SILBERSTEIN, MD

history & physical

History

■Acute transfusion reaction: transfusion w/ any blood product within

several hr: