1
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Kayabaşı M, Mammadov T, Köksaldı S, Arıkan G, Kaynak S, Saatci AO. Active toxoplasma chorioretinitis in immunocompromised patients: a case series. Arch Clin Cases 2024; 11:5-12. [PMID: 38655271 PMCID: PMC11034477 DOI: 10.22551/2024.42.1101.10278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Toxoplasma chorioretinitis (TC) can exhibit atypical features in immunocompromised patients including bilaterality, extensive spread, multifocal presentation, large areas of retinal necrosis without adjacent retinal scarring, and diffuse necrotizing retinitis resembling the viral retinitis that may cause confusion in the differential diagnosis. The aim of this study was to present the clinical features of four eyes of three immunocompromised patients with active toxoplasma chorioretinitis. Two of the patients were female and one, male. Two patients had hematological malignancies and the remaining patient was under adalimumab treatment for ankylosing spondylitis. Visual complaints began 10 days to four months prior to TC diagnosis. All four eyes had mild-to-moderate anterior chamber cells together with severe vitritis on slit-lamp examination while there were solitary chorioretinitis lesions on fundoscopy. Despite all patients were negative for anti-toxoplasma immunoglobulin M, all were positive for immunoglobulin G. All three patients were successfully treated with a combined treatment of systemic and intravitreal anti-toxoplasmic drugs. Clinicians should be cautious for the possible toxoplasma chorioretinitis besides the other infectious entities when a new uveitis episode is detected in an immunosuppressed patient in order to avoid misdiagnosis and thereby wrong treatment.
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Affiliation(s)
| | - Turhan Mammadov
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Seher Köksaldı
- Department of Ophthalmology, Mus State Hospital, Mus, Turkey
| | - Gül Arıkan
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Süleyman Kaynak
- Department of Ophthalmology, Tinaztepe University, Izmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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2
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Komitopoulou A, Goussetis E, Oikonomopoulou C, Paisiou A, Kaisari K, Ioannidou E, Sipsas NV, Kosmidis H, Vessalas G, Peristeri I, Kitra V. Toxoplasma gondii: How fatal is it in pediatric allogeneic bone marrow transplantation setting? Transpl Infect Dis 2019; 22:e13226. [PMID: 31785038 DOI: 10.1111/tid.13226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 12/21/2022]
Abstract
Toxoplasmosis is a disease of the immunocompetent population. However, cases of toxoplasma infection associated with immunosuppression have been reported, especially the first months after transplantation. Limited data are available about toxoplasma infection, occurring even many months post-transplant in pediatric patients with nonmalignant and malignant diseases. We report the cases of three patients with early and late disseminated toxoplasmosis and review the literature.
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Affiliation(s)
- Anna Komitopoulou
- Stem Cell Transplant Unit "Agia Sofia Children's Hospital", Athens, Greece
| | - Evgenios Goussetis
- Stem Cell Transplant Unit "Agia Sofia Children's Hospital", Athens, Greece
| | | | - Anna Paisiou
- Stem Cell Transplant Unit "Agia Sofia Children's Hospital", Athens, Greece
| | - Katerina Kaisari
- Stem Cell Transplant Unit "Agia Sofia Children's Hospital", Athens, Greece
| | - Eleni Ioannidou
- Stem Cell Transplant Unit "Agia Sofia Children's Hospital", Athens, Greece
| | - Nikolaos V Sipsas
- Infectious Diseases Unit, Department of Pathophysiology, Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Kosmidis
- Pediatric Oncology Department, MITERA HOSPITAL, Athens, Greece
| | - Georgios Vessalas
- Stem Cell Transplant Unit "Agia Sofia Children's Hospital", Athens, Greece
| | - Ioulia Peristeri
- Stem Cell Transplant Unit "Agia Sofia Children's Hospital", Athens, Greece
| | - Vassiliki Kitra
- Stem Cell Transplant Unit "Agia Sofia Children's Hospital", Athens, Greece
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3
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Jorgenson MR, Descourouez JL, Cardinale B, Lyu B, Astor BC, Garg N, Saddler CM, Smith JA, Mandelbrot DA. Risk of opportunistic infection in kidney transplant recipients with cytomegalovirus infection and associated outcomes. Transpl Infect Dis 2019; 21:e13080. [DOI: 10.1111/tid.13080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/30/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Margaret R. Jorgenson
- Department of Pharmacy University of Wisconsin Hospital and Clinics Madison Wisconsin
| | | | | | - Beini Lyu
- Department of Medicine and Population Health Sciences University of Wisconsin‐Madison School of Medicine and Public Health Madison Wisconsin
| | - Brad C. Astor
- Department of Medicine and Population Health Sciences University of Wisconsin‐Madison School of Medicine and Public Health Madison Wisconsin
| | - Neetika Garg
- Department of Medicine University of Wisconsin‐Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics Madison Wisconsin
| | - Christopher M. Saddler
- Department of Medicine University of Wisconsin‐Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics Madison Wisconsin
| | - Jeannina A. Smith
- Department of Medicine University of Wisconsin‐Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics Madison Wisconsin
| | - Didier A. Mandelbrot
- Department of Medicine University of Wisconsin‐Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics Madison Wisconsin
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4
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Autier B, Dion S, Robert-Gangneux F. The liver as an organ at risk for Toxoplasma transmission during transplantation: myth or reality? J Clin Pathol 2018. [PMID: 29535213 DOI: 10.1136/jclinpath-2018-205066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM Toxoplasmosis following liver transplant with donor-recipient mismatch is rare, but is often life-threatening. However, there are no data on the frequency of cyst carriage in the liver, nor consensual chemoprophylaxis guidelines. This study aimed at describing frequency and localisation of Toxoplasma cysts in the liver in a mouse model of chronic infection to predict the risk in liver transplantation. METHODS Heart, brain and liver lobes of 21 mice chronically infected with Toxoplasma were collected for DNA extraction and amplification of Toxoplasma gondii rep529 sequence by real-time PCR. RESULTS Parasite DNA was detected in the liver of 19/21 mice (90.5%), with no preferential anatomical localisation, but with higher parasite loads in the papillary process. Parasite loads in the liver were far lower than in brain and heart. The number of infected lobes was inversely correlated to the total liver weight, but was independent of the brain parasite load and of the parasite strain. CONCLUSIONS The liver is a frequent site of cyst carriage, confirming that transplantation of an organ from a seropositive donor to seronegative recipient is at high risk for acquired toxoplasmosis. Systematic serological screening prior to transplantation and chemoprophylaxis in patients at risk are fully justified.
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Affiliation(s)
- Brice Autier
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sarah Dion
- Institut de recherche en santé, environnement et travail, Inserm U0185, Rennes, France.,Université Rennes 1, Rennes, France
| | - Florence Robert-Gangneux
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Institut de recherche en santé, environnement et travail, Inserm U0185, Rennes, France.,Université Rennes 1, Rennes, France
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5
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Galván-Ramírez MDLL, Sánchez-Orozco LV, Gutiérrez-Maldonado AF, Rodriguez Pérez LR. Does Toxoplasma gondii infection impact liver transplantation outcomes? A systematic review. J Med Microbiol 2018; 67:499-506. [PMID: 29458555 DOI: 10.1099/jmm.0.000694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Approximately one-third of the world's population has Toxoplasma gondii infection, and one of the main routes of transmission is organ transplantation. The aim of this study was to evaluate the impact of Toxoplasma infection on liver transplantation patients. METHODOLOGY We searched PubMed, Lilacs, Medline, Science direct, Scielo, Ebsco, Springer, Wiley, Ovid and Google Scholar for reports published up to June 2017, and a systematic review was performed. RESULTS Twenty cases were analysed before and after liver transplantation. Primary and reactivated infections were investigated. Before transplantation, positive IgG antibodies were the predominant serological markers in donors and recipients: 40 % (D+/R-), 20 % (D+/R+) and 20 % (D-/R+). IgM was present in only 5 % of the donors (D+/R-). In four cases, the serological markers were not specified or were negative (D?/R? or D?/R-). After transplantation, IgM anti-Toxoplasma antibodies were found in 30 % of the recipients, and in 67 % of the seronegative recipients the presence of Toxoplasma DNA or tachyzoites was reported, suggesting a primary infection. Clinical symptoms were meningitis, massive cerebral oedema, encephalitis and seizures. Treatment was administered in 70 % of the patients, and 40 % died after presenting symptoms associated with Toxoplasma infection. CONCLUSIONS Although we review Toxoplasma infection and liver transplantation cases, problems associated with the parasite may be greater than identified. Hence, follow-up studies on Toxoplasma infection in liver transplantation patients are recommended.
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Affiliation(s)
- Maria de la Luz Galván-Ramírez
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Laura V Sánchez-Orozco
- Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Adrián Fernando Gutiérrez-Maldonado
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Laura Roció Rodriguez Pérez
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
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Webb GJ, Shah H, David MD, Tiew S, Beare N, Hirschfield GM. Post-prophylaxis Toxoplasma chorioretinitis following donor-recipient mismatched liver transplantation. Transpl Infect Dis 2017; 18:805-808. [PMID: 27500398 PMCID: PMC5053268 DOI: 10.1111/tid.12589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/19/2016] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Abstract
Toxoplasmosis may be transferred by organ transplantation. The most common clinical presentation is with multisystem disease, although isolated ocular toxoplasmosis has been described. Many centers have suggested that universal use of co-trimoxazole prophylaxis obviates the need for specific Toxoplasma testing. We report a case of donor-acquired ocular toxoplasmosis after liver transplantation despite co-trimoxazole prophylaxis. The diagnosis was confirmed by Toxoplasma polymerase chain reaction assay in conjunction with seroconversion. The fact that the infection was donor acquired was confirmed by serological mismatch and the absence of sporozoite-specific antigen antibody in the recipient.
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Affiliation(s)
- G J Webb
- National Institute of Health Research Birmingham Liver Biomedical Research Unit, Birmingham, UK
| | - H Shah
- National Institute of Health Research Birmingham Liver Biomedical Research Unit, Birmingham, UK
| | - M D David
- Clinical Microbiology, Queen Elizabeth Hospital, Birmingham, UK
| | - S Tiew
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - N Beare
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - G M Hirschfield
- National Institute of Health Research Birmingham Liver Biomedical Research Unit, Birmingham, UK.
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7
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Is Toxoplasma gondii type related to clinical outcome in human congenital infection? Systematic and critical review. Eur J Clin Microbiol Infect Dis 2016; 35:1079-88. [PMID: 27146878 DOI: 10.1007/s10096-016-2656-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/19/2016] [Indexed: 01/23/2023]
Abstract
In human congenital toxoplasmosis the effects of parasite burden and pregnancy time at infection on clinical outcome are well known, but there is controversy regarding the role of Toxoplasma gondii type. Through a systematic review of the literature, we aimed to discern if T. gondii type has a role on clinical outcome in human congenital toxoplasmosis. We built up a database of congenital toxoplasmosis from reports of cases, case series and screening-based cohorts, which had information about parasite type, gestation time at maternal infection and/or clinical outcome in the product. Then, we obtained frequencies for loci used to genotype geographical origin of cases and types found. Also, odds ratios were calculated for association between time of maternal infection or parasite type on outcome. Type II parasites were the most common in Europe, Asia and Africa, while in America there were mainly atypical strains. More newborns with clinical problems were born from mothers infected during the first half of gestation than from those acquiring the parasite after week 24, regardless of parasite genotype (92.9 vs. 16.1 %, OR = 67.9, CI95 25.4-181.6). Type I and atypical parasites were associated with clinical problems as opposed to types II and III, regardless of pregnancy period at infection (86.9 vs. 72.9 %, OR = 2.47, CI95 1.1-5.4). A significant and remarkable tendency of type I parasites to be present during early pregnancy was also observed (94.4 vs. 5.6 %, P < 0.009). In addition to parasite burden and period of gestation, T. gondii genotype seems involved in CT clinical outcome.
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8
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Hernández-Cortazar I, Acosta-Viana KY, Ortega-Pacheco A, Guzman-Marin EDS, Aguilar-Caballero AJ, Jiménez-Coello M. Toxoplasmosis in Mexico: epidemiological situation in humans and animals. Rev Inst Med Trop Sao Paulo 2016; 57:93-103. [PMID: 25923887 PMCID: PMC4435006 DOI: 10.1590/s0036-46652015000200001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/16/2014] [Indexed: 11/22/2022] Open
Abstract
Toxoplasmosis is a parasitic disease widely distributed throughout the world,
infecting a wide variety of animal species including humans. In Mexico, this parasite
has been detected in different parts of the country, particularly in the tropical
areas where the parasite can remain infective for long periods of time due to the
environmental conditions (i.e. high temperature and humidity over the whole year).
Several epidemiological studies have been conducted in both human and animal
populations, but despite the wide distribution of the agent in the country, there is
a significant lack of knowledge on the parasite transmission, treatment alternatives
and control measures. The lack of feral cat populations and control measures in sites
of meat production for human consumption are playing a role that has led to the wide
spread of the disease in the country, particularly in tropical areas of Southeastern
Mexico. For these reasons, this manuscript aims to review the published information
on relevant epidemiological aspects of infection with T. gondii in
humans and animals from Mexico.
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Affiliation(s)
- Ivonne Hernández-Cortazar
- CA Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Hideyo Noguchi", Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Karla Y Acosta-Viana
- CA Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Hideyo Noguchi", Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Antonio Ortega-Pacheco
- CA Salud Animal, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Eugenia del S Guzman-Marin
- CA Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Hideyo Noguchi", Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Armando J Aguilar-Caballero
- CA Salud Animal, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
| | - Matilde Jiménez-Coello
- CA Biomedicina de Enfermedades Infecciosas y Parasitarias, Centro de Investigaciones Regionales "Hideyo Noguchi", Universidad Autonoma de Yucatan, Merida, Yucatan, Mexico
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9
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Dvir R, Mancini N, Assanelli A, Racca S, Rolla S, Clementi N, Piemontese S, Ciceri F, Burioni R, Clementi M. Acute respiratory distress in a neutropenic febrile patient after hematopoietic cell transplantation. J Clin Virol 2013; 57:1-4. [DOI: 10.1016/j.jcv.2012.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/12/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
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10
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Sabia C, Montesano M, Napoli C. Transplantation and host immune response toToxoplasma gondii. Transpl Infect Dis 2013; 15:E124-5. [DOI: 10.1111/tid.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/09/2013] [Accepted: 01/29/2013] [Indexed: 01/08/2023]
Affiliation(s)
- C. Sabia
- U.O.C. Division of Immunohematology; Transfusion Medicine and Transplantation Immunology (SIMT) and Regional Reference Laboratory of Immunogenetics and Transplantation Immunology (LIT); Second University of Naples; Italy
| | - M.L. Montesano
- U.O.C. Division of Immunohematology; Transfusion Medicine and Transplantation Immunology (SIMT) and Regional Reference Laboratory of Immunogenetics and Transplantation Immunology (LIT); Second University of Naples; Italy
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11
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Galvan-Ramirez MDLL, Troyo R, Roman S, Calvillo-Sanchez C, Bernal-Redondo R. A systematic review and meta-analysis of Toxoplasma gondii infection among the Mexican population. Parasit Vectors 2012; 5:271. [PMID: 23181616 PMCID: PMC3549773 DOI: 10.1186/1756-3305-5-271] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/27/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Toxoplasmosis is a disease caused by Toxoplasma gondii and at least one-third of the world's population has detectable T. gondii antibodies. The seroprevalence of T.gondii ranges from 15% to 50% among the Mexican general population. The aim of this work was to determine the mean prevalence and weighted mean prevalence of T. gondii infection, and to evaluate the epidemiological transition of infection in Mexico. METHODS Pub Med, Lilacs, Medline, Latindex, Google Scholar data bases were searched to retrieve reports from 1951 up to 2012 regarding prevalence data, diagnostic tests and risk factors of infection among the adult population. Data collection and criteria eligibility was established in order to determine the crude prevalence (proportion of positive cases) of each study, together with weighted population prevalence according to individual research group categories to limit the bias that may impose the heterogeneous nature of the reports. A Forest Plot chart and linear regression analysis were performed by plotting the prevalence of infection reported from each study over a period of sixty years. RESULTS A total of 132 studies were collected from 41 publications that included 70,123 individuals. The average mean prevalence was 27.97%, and weighted mean prevalence was 19.27%. Comparisons among different risk groups showed that the weighted prevalence was higher in women with miscarriages (36.03%), immunocompromised patients (28.54%), mentally-ill patients (38.52%) and other risk groups (35.13%). Toxoplasma infection among the Mexican population showed a downward trend of 0.1%/year over a period of sixty years that represents a 5.8% reduction in prevalence. CONCLUSIONS This analysis showed a downward trend of infection; however, there are individuals at high risk for infection such as immunocompromised patients, mentally-ill patients and pregnant women. Further research is required to provide better prevention strategies, effective diagnostic testing and medical management of patients. Educational efforts are required to avoid the transmission of infection in populations that cannot be controlled by drugs alone.
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Affiliation(s)
- Ma de la Luz Galvan-Ramirez
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Sierra Mojada # 950 Edificio N, Col. Independencia, Guadalajara, Jalisco 44320, México
| | - Rogelio Troyo
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Sierra Mojada # 950 Edificio N, Col. Independencia, Guadalajara, Jalisco 44320, México
| | - Sonia Roman
- Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara “Fray Antonio Alcalde”, University of Guadalajara, Hospital #278, Guadalajara, Jalisco 44280, Mexico
| | - Carlos Calvillo-Sanchez
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Sierra Mojada # 950 Edificio N, Col. Independencia, Guadalajara, Jalisco 44320, México
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12
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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
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13
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Caner A, Döşkaya M, Karasu Z, Değirmenci A, Guy E, Kiliç M, Zeytunlu M, Francis J, Bozoklar A, Gürüz Y. Incidence and diagnosis of active toxoplasma infection among liver transplant recipients in Western Turkey. Liver Transpl 2008; 14:1526-32. [PMID: 18825713 DOI: 10.1002/lt.21558] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Toxoplasmosis is a serious and potentially life-threatening disease in liver transplant recipients while they are immunosuppressed. We report the clinical and laboratory findings related to active toxoplasma infection associated with 40 immunosuppressed liver transplant procedures that took place over a 12-month period at a major transplant unit in Izmir, Turkey. Twenty-seven (67.5%) of the 40 transplant recipients were found to be seropositive for toxoplasma infection and therefore at risk of reactivated infection. From the serological status of the donors, which was ascertained in 38 of 40 cases, we identified 3 (7.9%) of 38 transplants to be from a seropositive donor to a seronegative recipient. In 10 (26.3%) of 38 transplants, both the donor and recipient were seronegative, and this excluded toxoplasma as a risk. A comparison of real-time polymerase chain reaction (PCR) and nested PCR was undertaken in combination with a range of serological assays (the Sabin-Feldman dye test, enzyme immunoassay immunoglobulin M, and immunosorbent agglutination assay immunoglobulin M). Ethylene diamine tetraacetic acid blood samples from 3 of the 30 recipients at risk from toxoplasma were found positive by PCR, but only 1 of these was found positive in both assays. Among the 3 PCR-positive patients, immunoglobulin M and immunoglobulin G antibody levels increased in only 1 patient. Correlations between symptoms, laboratory findings, and clinical management (use of anti-toxoplasma therapy) are presented. Our findings suggest that toxoplasma presents a significant risk to our liver transplant population and that PCR is a helpful addition in identifying active infections and hence in informing clinical management decisions.
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Affiliation(s)
- Ayşe Caner
- Department of Parasitology, Ege University Medical School, Bornova/Izmir, Turkey
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14
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Egli A, Bergamin O, Müllhaupt B, Seebach J, Mueller N, Hirsch H. Cytomegalovirus-associated chorioretinitis after liver transplantation: case report and review of the literature. Transpl Infect Dis 2008; 10:27-43. [DOI: 10.1111/j.1399-3062.2007.00285.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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