2019
DOI: 10.3201/eid2504.181689
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Combination of Clindamycin and Azithromycin as Alternative Treatment for Toxoplasma gondii Encephalitis

Abstract: Current standard therapies for toxoplasmic encephalitis often cause severe adverse events. A 57-year-old HIV-positive man in Japan who had toxoplasmic encephalitis but was intolerant to trimethoprim/sulfamethoxazole, pyrimethamine, sulfadiazine, and atovaquone was successfully treated with the combination of clindamycin and azithromycin. This drug combination can be an alternative treatment for this condition.

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Cited by 19 publications
(18 citation statements)
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(11 reference statements)
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“…T. gondii has the ability to infect all tissue types in the affected host, however, this parasite has preference for the brain and muscles, where it remains for a long time in these tissues as dormant cysts. Chronic T. gondii infection can lead to neurological disorders, such as bipolar disease and schizophrenia Shiojiri et al, 2019). A correlation between dysregulated immune-inflammation and brain dysfunctions during T. gondii infection has been discussed previously (Parlog et al, 2015;Wohlfert et al, 2017).…”
Section: Introductionmentioning
confidence: 99%
“…T. gondii has the ability to infect all tissue types in the affected host, however, this parasite has preference for the brain and muscles, where it remains for a long time in these tissues as dormant cysts. Chronic T. gondii infection can lead to neurological disorders, such as bipolar disease and schizophrenia Shiojiri et al, 2019). A correlation between dysregulated immune-inflammation and brain dysfunctions during T. gondii infection has been discussed previously (Parlog et al, 2015;Wohlfert et al, 2017).…”
Section: Introductionmentioning
confidence: 99%
“…In view of the urgent need for new medicines for toxoplasmosis treatment, the search for compounds with different mechanisms of action against T. gondii has been a target for many researchers (El-Zawawy et al ., 2015 a , 2015 b ; Montazeri et al ., 2017; Murata et al ., 2017). Drugs currently used for other purposes could be tested – alone or in combination – as alternative anti- T. gondii treatments (Shiojiri et al ., 2019; Zhang et al ., 2019). Additionally, the in vivo evaluation of new anti- T. gondii compounds is conducted mainly in the acute phase of toxoplasmosis (RH strain) (Montazeri et al ., 2017).…”
Section: Introductionmentioning
confidence: 99%
“…Treatment guidelines for toxoplasmosis recommend, as first-line therapies for all of the clinical manifestations, a combination between three agents: Pyrimethamine and sulfadiazine, which act synergistically through inhibition of the folate synthetic pathways of the parasite, disrupting its DNA synthesis; and folinic acid, which acts as a coadjuvant in restoring the host's folate levels [9,22,23]. In hypersensitive patients, protein synthesis inhibitor antimicrobials, such as clindamycin, clarithromycin, azithromycin, or the mitochondrial electron-transport inhibitor atovaquone, may be used as replacements for sulfonamides.…”
Section: Currently Available Drugsmentioning
confidence: 99%
“…Although currently available drugs allow for elimination of an active infection, these drugs present several side effects, such as renal, hepatic, and hematological toxicity and hypersensitivity [23]. To circumvent these issues and to allow for complete eradication of the parasite, efforts must be made towards the development of novel chemotherapies.…”
Section: Congenital Toxoplasmosismentioning
confidence: 99%