Toxicity | Full blood count to be done at baseline then during treatment to look for drug-induced neutropenia, aplastic anaemia and haemolysis (if co-existing G6PD deficiency). Suggested timing is once weekly when on daily pyrimethamine then monthly if stable. Withhold treatment if absolute neutrophil count <0.5 x10∧9/L, but continue folinic acid (±consider increasing dose up to 20 mg).
Liver function tests and renal profile to be done at baseline then monthly if stable.
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Response to therapy | Interval serology testing: T. gondii-specific IgG and IgM every 3 months until therapy is completed then at the end of treatment and at 1, 3 and 6 months off treatment. Rebound rise in T. gondii-specific IgM±IgG levels may be seen following treatment; this does not necessarily indicate relapse but more likely reflects a delayed serological response to infection.
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Disease progression and recurrence | Follow-up with paediatric infectious disease specialist team. Measurement of head circumference at each outpatient visit. Regular ophthalmology and vision assessments throughout treatment and at 3, 6 and 12 months following completion, then at least annually for life (to identify potential late-onset complications). Consider neurodevelopmental, neurological and auditory review. Inform parents about the risks of development of seizures and/or raised intracranial pressure: ensure they have an emergency action plan. Urgently repeat brain imaging if there are any signs/symptoms of raised intracranial pressure.
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