In immunocompetent subjects, in general, no specific treatment for toxoplasmosis is required . The disease almost always resolves spontaneously within a few months; if necessary it is possible to adopt symptomatic therapies.
In immunodepressed individuals and in congenital forms, on the other hand, treatment with a combination of pyrimethamine and sulfadiazine, combined with folinic acid (ie 5-methyl-tetrahydrofolate: folic acid converted to tetrahydrofolate and added with a methyl group) is indicated to contain the risks of damage from antagonism with folates (including myelosuppression). Furthermore, corticosteroids should be given to patients with ocular toxoplasmosis .
As for the pregnant woman with primary infection, antibiotic treatment can reduce the risk of fetal damage. In particular, spiramycin is prescribed if toxoplasmosis has been contracted during the first trimester (well tolerated and without toxicity to the fetus, as it does not cross the placenta) or the combination of sulfadiazine, pyrimethamine and folinic acid. This last therapeutic scheme is theoretically more effective if the fetus has already been infected, but is more toxic (pyrimethamine should not be used during the first trimester, as it is teratogenic). This treatment must therefore be carried out under strict medical supervision and requires constant monitoring of the blood count.
