1
|
Štajner T, Vujić D, Srbljanović J, Bauman N, Zečević Ž, Simić M, Djurković-Djaković O. Risk of reactivated toxoplasmosis in haematopoietic stem cell transplant recipients: a prospective cohort study in a setting withholding prophylaxis. Clin Microbiol Infect 2021; 28:733.e1-733.e5. [PMID: 34555535 DOI: 10.1016/j.cmi.2021.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Reactivation of latent toxoplasmosis may be life-threatening in haematopoietic stem cell transplant (HSCT) recipients. We conducted an 8-year-long prospective study on the diagnosis and monitoring of reactivated toxoplasmosis in paediatric HSCT recipients. The primary objective was to determine the incidence of reactivated toxoplasmosis in a setting that withholds prophylaxis until engraftment. The second objective was to identify the subgroups of HSCT recipients particularly prone to reactivation who may benefit the most from regular PCR follow-up. METHODS Serological and qPCR screening targeting the Toxoplasma 529 bp gene was performed before HSCT, and continued by weekly monitoring after HSCT for a median time of 104 days. RESULTS Reactivated toxoplasmosis was diagnosed in 21/104 (20.2%), predominantly in allo- (19/75) and rarely in auto-HSCT (2/29) recipients. Over 50% (14/21) of cases were diagnosed during the first month after HSCT, while awaiting engraftment without prophylaxis. Toxoplasma disease evolved in only three (14.3%, 3/21) patients, all treated by allo-HSCT. Reactivation was more frequent in patients treated for acute lymphoblastic leukaemia (3/27, p 0.03) and especially, in recipients of haploidentical stem cells (10/20, p 0.005). Seronegative status of the donor (where was known) contributed to 75% (12/16) cases of reactivated toxoplasmosis after allo-HSCT. DISCUSSION The presented results show that peripheral blood-based qPCR, both before and after HSCT, is a valuable asset for the diagnosis of reactivated toxoplasmosis, whereas the results of serology in recipients should be interpreted with caution. Weekly qPCR monitoring, at least until successful engraftment and administration of prophylaxis, allows for prompt introduction of specific treatment.
Collapse
Affiliation(s)
- Tijana Štajner
- National Reference Laboratory for Toxoplasmosis, Group for Microbiology with Parasitology, Centre of Excellence for Food- and Vector-borne Zoonoses, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Dragana Vujić
- Faculty of Medicine, University of Belgrade, Serbia; Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Jelena Srbljanović
- National Reference Laboratory for Toxoplasmosis, Group for Microbiology with Parasitology, Centre of Excellence for Food- and Vector-borne Zoonoses, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Neda Bauman
- National Reference Laboratory for Toxoplasmosis, Group for Microbiology with Parasitology, Centre of Excellence for Food- and Vector-borne Zoonoses, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Željko Zečević
- Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Marija Simić
- Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Olgica Djurković-Djaković
- National Reference Laboratory for Toxoplasmosis, Group for Microbiology with Parasitology, Centre of Excellence for Food- and Vector-borne Zoonoses, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia.
| |
Collapse
|
2
|
Botein EF, Darwish A, El-Tantawy NL, El-Baz R, Eid MI, Shaltot AM. Serological and molecular screening of umbilical cord blood for Toxoplasma gondii infection. Transpl Infect Dis 2019; 21:e13117. [PMID: 31102567 DOI: 10.1111/tid.13117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Human umbilical cord blood has proven to be a successful alternate source of hematopoietic stem cells for pediatric patients with major hematologic disorders. Toxoplasma gondii is a global opportunistic protozoan which cause fatal complications in immunocompromised individuals. AIM Our goal is to study the prevalence of toxoplasmosis in umbilical cord blood (UCB) and to assess the sensitivity of ELISA and PCR for Toxoplasma infection screening. MATERIAL AND METHODS One hundred cord blood samples were collected immediately after delivery. Anti-Toxoplasma IgG and IgM antibodies were determined using ELISA method; Toxoplasma DNA was detected using nested PCR technique. Total nucleated cells (TNC) and HB were also determined. Demographic data and risk factors data related to the transmission of toxoplasmosis, were collected from mothers. RESULTS Among 100 cord blood samples, 36 (36%) were positive for anti-Toxoplasma IgG antibodies and 6 (6%) were positive for anti-Toxoplasma IgM antibodies. The nested PCR showed 11 (11%) samples containing Toxoplasma DNA from which, 6 (55%) samples were IgM positive. There was no significant association between the risk of Toxoplasma transmission and cord blood positivity for toxoplasmosis. CONCLUSION Owing to the prevalence of toxoplasmosis, its rapid progression and its fatal outcome in immunocompromised patients, cord blood screening for toxoplasmosis with nested PCR should be incorporated into cord blood bank screening protocols.
Collapse
Affiliation(s)
- Eman F Botein
- Department of Pediatrics, Faculty of Medicine, Hematology/Oncology Unit, Mansoura University, Mansoura, Egypt
| | - Ahmad Darwish
- Department of Pediatrics, Faculty of Medicine, Hematology/Oncology Unit, Mansoura University, Mansoura, Egypt
| | - Nora L El-Tantawy
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rizk El-Baz
- Department of Pediatrics, Faculty of Medicine, Genetics Unit, Mansoura University, Mansoura, Egypt
| | - Mohamed I Eid
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ali M Shaltot
- Department of Pediatrics, Faculty of Medicine, Genetics Unit, Mansoura University, Mansoura, Egypt
| |
Collapse
|
3
|
Dard C, Marty P, Brenier-Pinchart MP, Garnaud C, Fricker-Hidalgo H, Pelloux H, Pomares C. Management of toxoplasmosis in transplant recipients: an update. Expert Rev Anti Infect Ther 2018; 16:447-460. [DOI: 10.1080/14787210.2018.1483721] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Céline Dard
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
- Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209 - CNRS UMR5309, Université Grenoble Alpes, Grenoble France
| | - Pierre Marty
- Faculté de Médecine, Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, 06202 Nice, France Université de la Côte d’Azur, Nice, France
- 38043, INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, C3M, Nice, France
| | - Marie-Pierre Brenier-Pinchart
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
- Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209 - CNRS UMR5309, Université Grenoble Alpes, Grenoble France
| | - Cécile Garnaud
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
| | - Hélène Fricker-Hidalgo
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
| | - Hervé Pelloux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Cedex France
- Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions and Immunity to Infection, INSERM U1209 - CNRS UMR5309, Université Grenoble Alpes, Grenoble France
| | - Christelle Pomares
- Faculté de Médecine, Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, 06202 Nice, France Université de la Côte d’Azur, Nice, France
- 38043, INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, C3M, Nice, France
| |
Collapse
|
4
|
A matched case-control study of toxoplasmosis after allogeneic haematopoietic stem cell transplantation: still a devastating complication. Clin Microbiol Infect 2016; 22:636-41. [PMID: 27172809 DOI: 10.1016/j.cmi.2016.04.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/26/2016] [Accepted: 04/30/2016] [Indexed: 11/22/2022]
Abstract
Toxoplasmosis (TXP) is a life-threatening complication of allogeneic haematopoietic stem cell transplantation (AHSCT). Little is known about the risk factors and there is no consensus on prophylactic measures. To investigate the risk factors, we conducted a single-centre, retrospective matched case-control study among adults who underwent AHSCT from January 2006 to March 2015 in our hospital. TXP cases were identified from the prospectively maintained hospital's database. The 1:2 control population consisted of the two patients who received an AHSCT immediately before and after each case with similar donor relationship (related, unrelated) but who did not develop TXP. Risk factors were identified by conditional logistic regression. Clinical features and outcome of TXP were examined. Twenty-three (3.9%) cases of TXP (20 diseases, three infections) were identified among 588 AHSCT recipients. Twenty (87%) cases had a positive pre-transplant Toxoplasma gondii serology. In comparison with 46 matched control patients, risk factors were the absence of effective anti-Toxoplasma prophylaxis (odds ratio (OR) 11.95; 95% CI 3.04-46.88; p <0.001), high-grade (III-IV) acute graft-versus-host-disease (OR 3.1; 95% CI 1.04-9.23; p 0.042) and receipt of the tumour necrosis factor-α blocker etanercept (OR 12.02; 95% CI 1.33-108.6; p 0.027). Mortality attributable to TXP was 43.5% (n = 10). Non-relapse mortality rates during the study period of cases and controls were 69.6% (n = 16) and 17.4% (n = 8), respectively. Lung involvement was the dominant clinical feature (n = 14). Two cases were associated with graft failure, one preceded by haemophagocytic syndrome. Given TXP-related morbidity and attributable mortality, anti-Toxoplasma prophylaxis is essential for optimized management of seropositive AHSCT recipients.
Collapse
|
5
|
Toxoplasma prophylaxis in haematopoietic cell transplant recipients: a review of the literature and recommendations. Curr Opin Infect Dis 2016; 28:283-92. [PMID: 26098500 DOI: 10.1097/qco.0000000000000169] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Toxoplasmosis in haematopoietic cell transplant (HCT) recipients is associated with high morbidity and mortality rates. Prophylaxis following HCT is recommended for high-risk pre-HCT toxoplasma-seropositive (pre-HCTSP) recipients. However, there is no agreement or consistency among programmes on whether to adopt prophylaxis or not, or if used, on the chosen antitoxoplasma prophylactic regimen. This review discusses the role of prophylaxis, and preemptive treatment, for toxoplasmosis in the setting of HCT. RECENT FINDINGS Approximately two-thirds of toxoplasmosis cases following HCT are reported in allogeneic pre-HCTSP (allo pre-HCTSP) patients. This finding confirms a major role of reactivation of latent infection in the pathogenesis of toxoplasmosis in this patient population. Toxoplasma disease-related mortality in allo pre-HCTSP patients was reported at 62%, but it can be significantly decreased with early detection and treatment of toxoplasma infection. There are no randomized trials comparing the efficacy of different prophylactic agents to prevent toxoplasmosis after HCT. Several observational studies have demonstrated the efficacy of trimethoprim-sulfamethoxazole (TMP/SMX) in decreasing the incidence of toxoplasmosis following HCT. There is limited information regarding efficacy of other prophylactic agents. Preemptive treatment using routine blood PCR monitoring seems to be beneficial in detecting infection early and preventing disease in several observational studies and has been adopted for allo pre-HCTSP HCT patients when universal prophylaxis is not possible. SUMMARY Universal prophylaxis with TMP/SMX in allo pre-HCTSP patients should be implemented by all transplant programmes. Preemptive treatment with routine blood PCR monitoring is an option if prophylaxis cannot be used.
Collapse
|
6
|
Miyagi T, Itonaga H, Aosai F, Taguchi J, Norose K, Mochizuki K, Fujii H, Furumoto A, Ohama M, Karimata K, Yamanoha A, Taniguchi H, Sato S, Taira N, Moriuchi Y, Fukushima T, Masuzaki H, Miyazaki Y. Successful treatment of toxoplasmic encephalitis diagnosed early by polymerase chain reaction after allogeneic hematopoietic stem cell transplantation: two case reports and review of the literature. Transpl Infect Dis 2015; 17:593-8. [PMID: 25970830 DOI: 10.1111/tid.12401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/31/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
Toxoplasmic encephalitis represents a rare, but often fatal infection after allogeneic hematopoietic stem cell transplantation. Polymerase chain reaction (PCR)-based preemptive therapy is considered promising for this disease, but is not routinely applied, especially in low seroprevalence countries including Japan. We encountered 2 cases of toxoplasmic encephalitis after transplantation that were successfully treated. The diagnosis of toxoplasmic encephalitis in these cases was confirmed by PCR testing when neurological symptoms were observed. Both patients received pyrimethamine and sulfadiazine treatments within 2 weeks of the development of neurological symptoms, and remained free of recurrence for 32 and 12 months. These results emphasized the importance of the PCR test and immediate treatment after diagnosis for the management of toxoplasmic encephalitis.
Collapse
Affiliation(s)
- T Miyagi
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - H Itonaga
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
| | - F Aosai
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
| | - J Taguchi
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki City, Japan
| | - K Norose
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K Mochizuki
- Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan
| | - H Fujii
- Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan
| | - A Furumoto
- Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan
| | - M Ohama
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - K Karimata
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - A Yamanoha
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - H Taniguchi
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
| | - S Sato
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
| | - N Taira
- Department of Hematology, Heartlife Hospital, Okinawa, Japan
| | - Y Moriuchi
- Department of Hematology, Sasebo City General Hospital, Sasebo, Japan
| | - T Fukushima
- Laboratory of Hematoimmunology, Department of Clinical Laboratory Sciences, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - H Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Y Miyazaki
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki City, Japan
| |
Collapse
|
7
|
Xiao J, Yolken RH. Strain hypothesis of Toxoplasma gondii infection on the outcome of human diseases. Acta Physiol (Oxf) 2015; 213:828-45. [PMID: 25600911 DOI: 10.1111/apha.12458] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/13/2014] [Accepted: 01/12/2015] [Indexed: 12/28/2022]
Abstract
The intracellular protozoan Toxoplasma gondii is an exceptionally successful food and waterborne parasite that infects approximately 1 billion people worldwide. Genotyping of T. gondii isolates from all continents revealed a complex population structure. Recent research supports the notion that T. gondii genotype may be associated with disease severity. Here, we (1) discuss molecular and serological approaches for designation of T. gondii strain type, (2) overview the literatures on the association of T. gondii strain type and the outcome of human disease and (3) explore possible mechanisms underlying these strain-specific pathology and severity of human toxoplasmosis. Although no final conclusions can be drawn, it is clear that virulent strains (e.g. strains containing type I or atypical alleles) are significantly more often associated with increased frequency and severity of human toxoplasmosis. The significance of highly virulent strains can cause severe diseases in immunocompetent patients and might implicated in brain disorders such as schizophrenia should led to reconsideration of toxoplasmosis. Further studies that combine parasite strain typing and human factor analysis (e.g. immune status and genetic background) are required for better understanding of human susceptibility or resistance to toxoplasmosis.
Collapse
Affiliation(s)
- J. Xiao
- Stanley Division of Developmental Neurovirology; Department of Pediatrics; Johns Hopkins School of Medicine; Baltimore MD USA
| | - R. H. Yolken
- Stanley Division of Developmental Neurovirology; Department of Pediatrics; Johns Hopkins School of Medicine; Baltimore MD USA
| |
Collapse
|
8
|
Molecular diagnosis of toxoplasmosis in immunocompromised patients: a 3-year multicenter retrospective study. J Clin Microbiol 2015; 53:1677-84. [PMID: 25762774 DOI: 10.1128/jcm.03282-14] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/07/2015] [Indexed: 11/20/2022] Open
Abstract
Toxoplasmosis is a life-threatening infection in immunocompromised patients (ICPs). The definitive diagnosis relies on parasite DNA detection, but little is known about the incidence and burden of disease in HIV-negative patients. A 3-year retrospective study was conducted in 15 reference laboratories from the network of the French National Reference Center for Toxoplasmosis, in order to record the frequency of Toxoplasma gondii DNA detection in ICPs and to review the molecular methods used for diagnosis and the prevention measures implemented in transplant patients. During the study period, of 31,640 PCRs performed on samples from ICPs, 610 were positive (323 patients). Blood (n = 337 samples), cerebrospinal fluid (n = 101 samples), and aqueous humor (n = 100 samples) were more frequently positive. Chemoprophylaxis schemes in transplant patients differed between centers. PCR follow-up of allogeneic hematopoietic stem cell transplant (allo-HSCT) patients was implemented in 8/15 centers. Data from 180 patients (13 centers) were further analyzed regarding clinical setting and outcome. Only 68/180 (38%) patients were HIV(+); the remaining 62% consisted of 72 HSCT, 14 solid organ transplant, and 26 miscellaneous immunodeficiency patients. Cerebral toxoplasmosis and disseminated toxoplasmosis were most frequently observed in HIV and transplant patients, respectively. Of 72 allo-HSCT patients with a positive PCR result, 23 were asymptomatic; all were diagnosed in centers performing systematic blood PCR follow-up, and they received specific treatment. Overall survival of allo-HSCT patients at 2 months was better in centers with PCR follow-up than in other centers (P < 0.01). This study provides updated data on the frequency of toxoplasmosis in HIV-negative ICPs and suggests that regular PCR follow-up of allo-HSCT patients could guide preemptive treatment and improve outcome.
Collapse
|
9
|
An unusual case of disseminated toxoplasmosis in a previously healthy pregnant patient: radiographic, CT, and MRI findings. Jpn J Radiol 2014; 32:664-9. [PMID: 25151528 DOI: 10.1007/s11604-014-0352-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
Toxoplasmosis is a ubiquitous protozoal infection that during pregnancy commonly affects the fetus severely, with maternal infection usually being mild self-limiting. Disseminated toxoplasmosis in a healthy pregnant woman has, to the best of our knowledge, not been reported before. We present a case of disseminated toxoplasmosis involving pulmonary, central nervous system, and lymph nodes in a pregnant woman and imaging findings on radiography, computed tomography, and magnetic resonance imaging.
Collapse
|
10
|
Schmidt M, Sonneville R, Schnell D, Bigé N, Hamidfar R, Mongardon N, Castelain V, Razazi K, Marty A, Vincent F, Dres M, Gaudry S, Luyt CE, Das V, Micol JB, Demoule A, Mayaux J. Clinical features and outcomes in patients with disseminated toxoplasmosis admitted to intensive care: a multicenter study. Clin Infect Dis 2013; 57:1535-41. [PMID: 23994819 DOI: 10.1093/cid/cit557] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Characteristics and outcomes of adult patients with disseminated toxoplasmosis admitted to the intensive care unit (ICU) have rarely been described. METHODS We performed a retrospective study on consecutive adult patients with disseminated toxoplasmosis who were admitted from January 2002 through December 2012 to the ICUs of 14 university-affiliated hospitals in France. Disseminated toxoplasmosis was defined as microbiological or histological evidence of disease affecting >1 organ in immunosuppressed patients. Isolated cases of cerebral toxoplasmosis were excluded. Clinical data on admission and risk factors for 60-day mortality were collected. RESULTS Thirty-eight patients were identified during the study period. Twenty-two (58%) had received an allogeneic hematopoietic stem cell transplant (median, 61 [interquartile range {IQR}, 43-175] days before ICU admission), 4 (10%) were solid organ transplant recipients, and 10 (27%) were infected with human immunodeficiency virus (median CD4 cell count, 14 [IQR, 6-33] cells/µL). The main indications for ICU admission were acute respiratory failure (89%) and shock (53%). The 60-day mortality rate was 82%. Allogeneic hematopoietic stem cell transplant (hazard ratio [HR] = 2.28; 95% confidence interval [CI], 1.05-5.35; P = .04) and systolic cardiac dysfunction (HR = 3.54; 95% CI, 1.60-8.10; P < .01) within 48 hours of ICU admission were associated with mortality. CONCLUSIONS Severe disseminated toxoplasmosis leading to ICU admission has a poor prognosis. Recipients of allogeneic hematopoietic stem cell transplant appear to have the highest risk of mortality. We identified systolic cardiac dysfunction as a major determinant of outcome. Strategies aimed at preventing this fatal opportunistic infection may improve outcomes.
Collapse
Affiliation(s)
- Matthieu Schmidt
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Sumi M, Aosai F, Norose K, Takeda W, Kirihara T, Sato K, Fujikawa Y, Shimizu I, Ueki T, Hirosima Y, Ueno M, Ichikawa N, Watanabe M, Kobayashi H. Acute exacerbation of Toxoplasma gondii infection after hematopoietic stem cell transplantation: five case reports among 279 recipients. Int J Hematol 2013; 98:214-22. [PMID: 23749548 DOI: 10.1007/s12185-013-1379-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/22/2013] [Accepted: 05/28/2013] [Indexed: 11/30/2022]
Abstract
Toxoplasmosis is a rare and possibly underestimated complication following hematopoietic stem cell transplantation (HSCT) associated with a high mortality rate, although the incidence of toxoplasmosis after HSCT in Japan has not been established. We retrospectively studied patients with toxoplasmosis after HSCT, and identified five patients who had been diagnosed with an acute exacerbation of toxoplasmosis among 279 HSCT recipients at our institution between 1998 and 2011, representing an incidence of 1.8 %. Among 87 autologous HSCT recipients, one definite case was diagnosed. The serological test for Toxoplasma gondii before HSCT was positive in 18 of 192 allogeneic HSCT recipients. Of the 18 seropositive patients, three had definite infections, and one had possible infection. All four definite cases were diagnosed at autopsy. In the definite cases, three allogeneic HSCT recipients had disseminated or pulmonary toxoplasmosis and one autologous HSCT recipient had toxoplasmic encephalitis, although toxoplasmosis was not suspected at the premortem examination due to non-specific clinical and radiological manifestations. Thus, acute exacerbation of toxoplasmosis should be suspected in recipients after HSCT. Early diagnosis and treatment for toxoplasmosis would certainly contribute to a decrease in mortality after HSCT.
Collapse
Affiliation(s)
- Masahiko Sumi
- Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano 380-8582, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Zhao ZJ, Zhang J, Wei J, Li Z, Wang T, Yi SQ, Shen JL, Yang TB, Hide G, Lun ZR. Lower expression of inducible nitric oxide synthase and higher expression of arginase in rat alveolar macrophages are linked to their susceptibility to Toxoplasma gondii infection. PLoS One 2013; 8:e63650. [PMID: 23691079 PMCID: PMC3655142 DOI: 10.1371/journal.pone.0063650] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 04/05/2013] [Indexed: 11/20/2022] Open
Abstract
Rats are naturally resistant to Toxoplasma gondii infection, particularly the RH strain, while mice are not. Previous studies have demonstrated that inducible nitric oxide synthase (iNOS) and arginase-1 of rodent peritoneal macrophages are linked to the mechanism of resistance. As an increasing number of studies on human and animal infections are showing that pulmonary toxoplasmosis is one of the most severe clinical signs from T. gondii infection, we are interested to know whether T. gondii infection in alveolar macrophages of rats is also linked to the levels of iNOS and arginase-1 activity. Our results demonstrate that T. gondii could grow and proliferate in rat alveolar macrophages, both in vitro and in vivo, at levels higher than resistant rat peritoneal macrophages and at comparable levels to sensitive mouse peritoneal macrophages. Lower activity and expression levels of iNOS and higher activity and expression levels of arginase-1 in rat alveolar macrophages were found to be linked to the susceptibility of T. gondii infection in these cells. These novel findings could aid a better understanding of the pathogenesis of clinical pulmonary toxoplasmosis in humans and domestic animals.
Collapse
Affiliation(s)
- Zhi-Jun Zhao
- State Key Laboratory of Biocontrol, Center for Parasitic Organisms, School of Life Sciences, and Key Laboratory of Tropical Disease and Control (Sun Yat-Sen University), Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, PR China
- General Hospital of Ningxia Medical University, Yinchuan, PR China
| | - Jia Zhang
- State Key Laboratory of Biocontrol, Center for Parasitic Organisms, School of Life Sciences, and Key Laboratory of Tropical Disease and Control (Sun Yat-Sen University), Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, PR China
| | - Jun Wei
- General Hospital of Ningxia Medical University, Yinchuan, PR China
| | - Zhi Li
- State Key Laboratory of Biocontrol, Center for Parasitic Organisms, School of Life Sciences, and Key Laboratory of Tropical Disease and Control (Sun Yat-Sen University), Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, PR China
| | - Tao Wang
- State Key Laboratory of Biocontrol, Center for Parasitic Organisms, School of Life Sciences, and Key Laboratory of Tropical Disease and Control (Sun Yat-Sen University), Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, PR China
| | - Si-Qi Yi
- State Key Laboratory of Biocontrol, Center for Parasitic Organisms, School of Life Sciences, and Key Laboratory of Tropical Disease and Control (Sun Yat-Sen University), Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, PR China
| | - Ji-Long Shen
- Provincial Laboratory of Microbiology and Parasitology and the Key Laboratory of Zoonoses Anhui, Department of Parasitology, Anhui Medical University, Hefei, Anhui, PR China
| | - Ting-Bao Yang
- State Key Laboratory of Biocontrol, Center for Parasitic Organisms, School of Life Sciences, and Key Laboratory of Tropical Disease and Control (Sun Yat-Sen University), Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, PR China
| | - Geoff Hide
- Ecosystems and Environment Research Centre and Biomedical Research Centre, School of Environment and Life Sciences, University of Salford, Salford, United Kingdom
| | - Zhao-Rong Lun
- State Key Laboratory of Biocontrol, Center for Parasitic Organisms, School of Life Sciences, and Key Laboratory of Tropical Disease and Control (Sun Yat-Sen University), Ministry of Education, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, PR China
- Ecosystems and Environment Research Centre and Biomedical Research Centre, School of Environment and Life Sciences, University of Salford, Salford, United Kingdom
- * E-mail:
| |
Collapse
|
13
|
Xiao J, Viscidi RP, Kannan G, Pletnikov MV, Li Y, Severance EG, Yolken RH, Delhaes L. The Toxoplasma MAG1 peptides induce sex-based humoral immune response in mice and distinguish active from chronic human infection. Microbes Infect 2012; 15:74-83. [PMID: 23142034 DOI: 10.1016/j.micinf.2012.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/18/2012] [Accepted: 10/24/2012] [Indexed: 11/30/2022]
Abstract
To distinguish active from inactive/chronic infection in Toxoplasma gondii-seropositive individuals, we have developed an enzyme-linked immunosorbent assay (ELISA) using specific peptides derived from Toxoplasma matrix antigen MAG1. We used this assay to measure matrix specific antibodies and pilot studies with infected mice established the validity of two peptides. The immune response against MAG1 occurs in about 12 days postinfection and displays a sex difference later on in mouse model, with males producing higher antibody titers than females. Serum samples from 22 patients with clinical toxoplasmosis and from 26 patients with serological evidence of past exposure to Toxoplasma (more than one year infection history) were analyzed. Both MAG1 peptides detected antibodies significant frequently and robustly from active stage than from the chronic stage of toxoplasmosis. The results indicate that both MAG1 peptides may be used as a tool to differentiate active from inactive infection. It also may be considered in the design of potential vaccines in humans.
Collapse
Affiliation(s)
- Jianchun Xiao
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Bautista G, Ramos A, Forés R, Regidor C, Ruiz E, de Laiglesia A, Navarro B, Bravo J, Portero F, Sanjuan I, Fernández M, Cabrera R. Toxoplasmosis in cord blood transplantation recipients. Transpl Infect Dis 2012; 14:496-501. [DOI: 10.1111/j.1399-3062.2012.00735.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 11/01/2011] [Accepted: 12/26/2011] [Indexed: 12/01/2022]
Affiliation(s)
- G. Bautista
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - A. Ramos
- Department of Internal Medicine; Infectious Disease Unit; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - R. Forés
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - C. Regidor
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - E. Ruiz
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - A. de Laiglesia
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - B. Navarro
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - J. Bravo
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - F. Portero
- Department of Microbiology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - I. Sanjuan
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - M.N. Fernández
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| | - R. Cabrera
- Department of Hematology; Hospital Universitario Puerta de Hierro; Majadahonda; Madrid; Spain
| |
Collapse
|
15
|
Monaco SE, Monaghan SA, Stamm JA, Khalbuss WE, Nichols L, Pantanowitz L. Toxoplasmosis in a post-transplant bronchoalveolar lavage: A case report. Diagn Cytopathol 2011; 40:629-34. [DOI: 10.1002/dc.21646] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/09/2010] [Indexed: 11/09/2022]
|
16
|
Correlation of parasite load determined by quantitative PCR to clinical outcome in a heart transplant patient with disseminated toxoplasmosis. J Clin Microbiol 2010; 48:2541-5. [PMID: 20463167 DOI: 10.1128/jcm.00252-10] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Disseminated toxoplasmosis is a life-threatening infection in transplant recipients, which results either from reactivation of latent infection or from organ-transmitted primary infection. Preventive measures and diagnostic screening methods differ between countries and are related to the seroprevalence of Toxoplasma spp. in the general population. Here we report a case of disseminated toxoplasmosis in a heart transplant recipient with previous immunity that occurred after cotrimoxazole prophylaxis for the prevention of Pneumocystis jirovecii pneumonia was stopped. Quantitative PCR proved useful for the diagnosis and monitoring of Toxoplasma infection. Decreasing parasitic burdens in sequential samples of cerebrospinal fluid, blood, and bronchoalveolar lavage fluid correlated with a favorable outcome and allowed modulation of the immunosuppressive drug regimen. The duration of anti-Toxoplasma treatment and the need for maintenance prophylaxis are discussed, as well as prophylaxis for solid-organ transplant recipients. Although a rare event in heart transplant recipients, Toxoplasma reactivation must be investigated promptly, since early treatment improves the prognosis.
Collapse
|