Abstract
This study aims to analyze the profile of adverse events (AEs) of drugs for the treatment of Toxoplasmosis. This is a review carried out through a bibliographic search in the electronic databases PubMed, SciELO, Cochrane Digital Library and LILACS. The keywords “Toxoplasmosis” AND “Drug Therapy” AND “Drug-Related Side Effects and Adverse Reactions” were used. The selection was performed by two independent reviewers and the articles were included considering the presence of retrospective studies and case reports published in the literature in Portuguese and English and without time restrictions. In total, 40 articles were found, of which 14 met the inclusion criteria. Cases of cerebral, ocular, gestational and congenital Toxoplasmosis were identified. Among these, we observed a total of 85 patients with reports of AEs due to the use of Pyrimethamine, Sulfadiazine, Spiramycin, Clindamycin, Atovaquone, Trimethoprim and Sulfamethoxazole and Sulfadoxine. Clinical reactions were in the form of skin rash (57.1%), hematological alterations (28.5%), Lyell syndromes (7.1%), Stevens-Johnson (21.4%) and DRESS (21 .4%). The prevalence of AEs related to hematological alterations was seen mainly in treatments based on Pyrimethamine + Sulfadiazine, Trimethoprim and Sulfamethoxazole; on the other hand, those associated with severe syndromes are often related to the use of Pyrimethamine + Sulfadiazine. It is important to establish a standard protocol for drug therapy for Toxoplasmosis, which does not yet exist. In addition, the need to monitor patients after drug administration is highlighted, given the possibility of the occurrence of adverse events that can represent a threat to life.
Highlights
Toxoplasmosis is caused by Toxoplasma gondii protozoan (T. gondii), a mandatory intracellular parasite belonging to the phylum Apicomplexa
Sulfadiazine, clindamycin, azithromycin, trimethoprim, sulfamethoxazole, dapsone, spiramicin, and atovaquone can be used to treat toxoplasmosis. None of these is satisfactory regarding effectiveness against all forms of T. gondii and safety due to the frequent occurrence of adverse events, as demonstrated in 85% of patients treated for ophthalmic toxoplasmosis (Guaraldo et al, 2018; Iaccheri et al, 2008)
Eight studies used drugs such as trimethoprim combined with sulfamethoxazole, or a combination of sulfadiazine and pyrimethamine, and reported the concomitant administration of folinic acid, since these drugs inhibit the synthesis of folic acid and are mainly related to adverse events (AEs) associated with bone marrow suppression
Summary
Toxoplasmosis is caused by Toxoplasma gondii protozoan (T. gondii), a mandatory intracellular parasite belonging to the phylum Apicomplexa It is widespread globally and is capable of infecting a wide range of hosts, with felids as the definitive hosts, and humans, birds, and other mammals as intermediate hosts. Most human T. gondii infections occur through ingestion of sporulated oocysts, which are eliminated in feline feces and contaminate soil, water, and food, or through bradyzoites found in the form of tissue cysts in raw or undercooked meat. They are present in biological fluids and found during acute infection; they are responsible for transplacental transmission (Paradynski et al, 2019)
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