Antibiotic therapy with sulfadiazine and pyrimethamine is effective in treating acute toxoplasmosis. However, since the organism is never eliminated, suppressive therapy with these antibiotics is necessary for the duration of the client's life to prevent active infection. It typically presents with fever and severe headache, although initial symptoms may be more subtle with mild headache, nausea, and ill-defined malaise. Mental status changes may range from mild behavioral or personality changes to severe memory loss and confusion similar to that seen in HIV-associated dementia. To accurately diagnose cryptococcal brain disease, clients must undergo lumbar puncture and CSF analysis.
Several tests detect the presence of the fungus in the spinal fluid.
Brain imaging with MRI or CT is generally not useful except to rule out other conditions, since cryptococcus rarely causes the mass lesions that would become apparent through these scans. Effective treatment requires intravenous amphotericin B for six weeks. Following successful treatment, ongoing suppressive anti-fungal therapy with fluconazole should prevent relapse. Following JC infection, PML develops quickly causing extensive damage to the myelin covering the nerves responsible for carrying motor signals to the muscles. Although the course of PML may be variable, with periods of decline alternating with periods of relative stability, usually clients require major assistance with tasks of daily living and often become bed-bound.