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Have ocular toxoplasmosis. Got fever and cold after medication. Side effect of dalacin?

Dec 2012
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Answered by

General & Family Physician
Practicing since : 2012
Answered : 1694 Questions
Hello Doctor ... My son is 13 yrs weighing 58kgs was diagnosed with Ocular toxoplasmosis on 5th XXXXXXX 2013 and has been on Septran for 3.5 weeks ever since and Dalacin 300mg x4 times a day for the last 7 weeks and on omnacortil steroids on tapering dose starting from 50mg to now on 5mg since last 2.5 weeks.. septran was stopped due to allergic reaction (rashes on the skin) after 3.5 weeks ....... the issue now is that after 7 weeks my son is down with 101 degree fever ... with chills... can I administer him Crocin and what could possibly the cause of the fever , can long term use of Clindamycin cause anyvside effects all blood tests performed last week were normal I.e. cbc , lft, kft ... kindly advice thanks....
Posted Sun, 17 Mar 2013 in Medicines and Side Effects
Answered by Dr. Nsah Bernard 34 minutes later

Thanks for posting,

Let me start with the first question. Yes you can administer crocin (paracetamol) as it is an antipyretic and should be used especially in children with fever. If your son was diagnosed with ocular toxo and was given those treatments first septran (which in high doses is very effective) and dalacin (clindamycin, which is not best indicated for toxoplasma gondii infection-a parasitic protozoa but can be an alternative treatment). Spiramycin is drug of choice when patients develop allergy to cotrimoxazole (septran) as your son had. Given the present symptoms your son is having my impression is that he might have developed systemic toxoplasmosis (as it can cause fever + chills just like malaria). If septran was not in high doses and properly taken then it is possible that the treatment was not effective. Blood tests being normal is not strange as toxoplasmosis can present that way and specific blood test for toxoplasma IgG/IgM should be done. If positive then drug of choice should be spiramycin and should be started immediately before more severe complications like cerebral toxoplasmosis develop. Depending on your environmental/epidemological context it will be wise from your doctor's part to rule out other affections such as malaria, dengue fever, typhoid fever, AOM etc.

Hope this was helpful and let me know if you got further questions.
Dr Nsah
Above answer was peer-reviewed by
Follow-up: Have ocular toxoplasmosis. Got fever and cold after medication. Side effect of dalacin? 6 hours later
He was adminidtered septran 1.5 tablets twice a day which he had for 3.5 weeks.... his blood test for toxoplasma shows Ig/g as positive at 26 but Ig/M is negative....he does not congenital toxoplasma and the physicians and retinal experts at XXXXXXX Netralaya say it's localized occurance .... the lesion in the retina has subsided and his vision is now 90% better than thevday ocular toxoplasma was diagnosed. ... my question is can ocular toxo spread to other parts of the body ?? Even if it is not congenial. ... And if septran was administered for 3.5 weeks as above mentioned dosage was that enough as there is marked improvement in the retina...
Our physicians hv asked to get cbc, lft, kft, malaria, ns1, H1N1 tests done which we hv n await the reports....
We had sdministered him crocin at 4am and the fever dince then has not vome back, the phydivian has asked us to give him dolo 650 if fever returns till we hv the reports...

Kindly provide your inputs

Answered by Dr. Nsah Bernard 10 hours later

Thanks for updating,
If toxoplasma IgG are positive and IgM negative it simply means there was an exposure of toxoplasma in blood but some how the active protozoal parasite is no longer available in blood. Yes it is possible for the parasite to spread from the ocular regions to the blood stream. The dosage of septran is fairly optimal for toxoplasmosis ( so we need not worry about the dosage). Just wish to know when the toxoplasma IgG was done, is it before or after starting treatment with septran? If before, then it needs to be redone again and the IgM tested equally too. The lab tests requested are good and you should just wait for the report. Dolo 650 or Crocin are both antipyretics (each with basic molecule of paracetamol). Either will still control the fever.

Hope this is a useful insight.

Dr Bernard, Nsah
Above answer was peer-reviewed by
Follow-up: Have ocular toxoplasmosis. Got fever and cold after medication. Side effect of dalacin? 20 minutes later
Thank you for your valable advice.... please be informed diagnosis was done on 5th XXXXXXX 2013 a day after my son had blurred vision in his left eye...and Septran was started immediately on 5th XXXXXXX itself along with corticosteroids 50mg tapering dose, clindamycin 300mgx4 times a day....the septran was however stopped on 30th XXXXXXX 2013 I.e. after 3.5 weeks due to rash allergy...

We did the following blood tests today CBC, ESR, LFT, MP, NS1, H1N1 ....all the tests are ok and within desired parameters. .. the H1N1 result is awaited tomorrow. .. .. Do you still feel he has developed systemic toxo and I would like to know how can we rule this out ..

A retest of Toxoplasmosis Ig/G n Ig/M was carried out on 30th XXXXXXX 2013 and it was same as the 5th XXXXXXX report I.e. Ig/G was positive n Ig/M was negative....

Kindly advice what tests can rule out systemic toxoplasmosis. ..

The chief physician in Mumbai one of the topmost in medicine Dr XXXXXXX Medhekar under whome my son is being treated feels its not even toxo and it is a idiopathic...

We had also checked him for XXXXXXX etc.. for auto immune disease however even that is negstive.. he is even negative for sarcoidosis. ....

Kindly give me your verdict....

Thanking you

Answered by Dr. Nsah Bernard 34 minutes later

If Toxoplasma IgM is persistently negative, then there is a very high chance that there is active systemic diseases. The only possible way to actually determine the presence of toxoplasma is by doing blood culture and analysis. A parasitologist will be the specialist of choice to contact.
Fever of unknown origin is hardly idiopathic and there is always almost an underlying cause ranging first from infection, autoimmune diseases, tumors/blood cancers etc, hormonal imbalance, and other possible rare viral infections before we can even start thinking of idiopathic ( no cause) causes of the fever/other symptoms.
My suggestion is, if from the test nothing is identified, then a blood culture should be done and thorough investigation of all organs should be done.

Hope this helps
Dr Nsah
Above answer was peer-reviewed by
Follow-up: Have ocular toxoplasmosis. Got fever and cold after medication. Side effect of dalacin? 2 hours later
Hello Doctor,

The fever had just come up 24hrs ago .. it's not been there through out he trestment of toxoplasmosis. .. the patient otherwise has been normal and very active.... also we to take unto account that in Mumbai India right now due to extreme difference in day and night tempretures, there is a lot of viral with people being down with bad throat etc.. infact my other son was having a bad throat two days prior and he too was having mild fever, he however recovered and then my younger son got the fever.... infact even my wife is down with a bad throat infection ....

There have also been articles in Mumbai news papers on 18th Feb about viral infections
My question is can this not be just a viral with no co relation with the toxo issue...

Kindly advice....

Answered by Dr. Nsah Bernard 23 minutes later

Yes it is very possible that it is just the viral infection and no more toxo. Like i said before toxo IgM being negative signifies there is no active systemic toxoplasma parasite. If the fever has not come back again there, it is good sign. A few days of observation will be worthwhile.
Since you present a whether as a possible issue, I am totally for that proposition.
To me the fever is nothing to worry about. Just wait a little for the test results to be out, if negative, then you can say for sure that your child has nothing to worry about.

If there is a viral flu going on, then your son must have been affected. If that is the case, then just paracetamol for fever will be enough and since there is no more fever, then it would not be necessary.

Wish you the best with your son and hope he stays healthy.
Dr Nsah
Above answer was peer-reviewed by
Follow-up: Have ocular toxoplasmosis. Got fever and cold after medication. Side effect of dalacin? 15 minutes later
Thanks a lot doc ... appreciate your quick responses....

Answered by Dr. Nsah Bernard 7 hours later
Your Welcome Mr. XXXXXXX Wish your son a better health.

Dr Nsah
Above answer was peer-reviewed by
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