SUMMARY Of the first 250 heart and 35 heart and lung transplant recipients at Papworth Hospital, Cambridge, who survived for more than one month after transplantation, 217 heart and 33 heart and lung patients were investigated serologically for evidence of Toxoplasma gondii infection. Six patients acquired primary Tgondii infection, most probably from the donor organ. Five patients experienced Tgondii recrudescence, two of whom had recovered from primary infection a few years earlier. Two patients died from primary Tgondii infection and the severity of symptoms in the other patients with primary infection was related to the amount of immunosuppressive treatment. Prophylaxis with pyrimethamine (25 mg a day for six weeks) was introduced for Tgondii antibody negative transplant recipients who received a heart from a T gondii antibody positive donor after the first four cases of primary toxoplasmosis. Ofthe seven patients not given pyrimethamine, four (57%) acquired primary Tgondii infection. This compared with two of the 14 patients (14%) given prophylaxis.

Of 163 dogs, randomly selected from those examined at the University of Liverpool Small Animal Hospital, 12.9 per cent had antibody titres > or = to 1/200 to Neospora caninum in an indirect fluorescent antibody test. None was apparently suffering clinical neosporosis. There was no association between the occurrence of neospora antibodies and either toxoplasma antibodies measured by the dye test, sex, age, type of feeding or the presence of other dogs in the household. Antibody was detected at titres > or = to 1/200 in nine breeds, suggesting that there is a substantial level of subclinical infection in British dogs.

Aims: To assess the value of detecting Toxoplasma gondii in human blood samples using the polymerase chain reaction (PCR). (7 Clin Pathol 1992;45:910-913)

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The toxoplasma serological status of 50 patients with systemic lupus erythematosus (SLE) was compared with that of 50 healthy controls; high titres of toxoplasma antibody were significantly more common in the patients with SLE. These titres did not correlate with any of the routinely measured indices in SLE nor with the patients' prior treatment. A case history is used to illustrate the difficulty in diagnosing toxoplasmosis in the presence of SLE.Toxoplasmosis and systemic lupus erythematosus (SLE) produce similar symptoms, such as lymphadenopathy, arthralgia, and fever, and increased awareness of these conditions and refinements in 'diagnostic markers' have led to both conditions being recognised more often. We present a case history to highlight the problems faced when attempting to diagnose toxoplasmosis in the presence of SLE. The persistently high toxoplasma antibody levels found in the patient described prompted this study of the toxoplasma serological status in a cohort of patients with SLE. Case report A 28 year old Ghanaian woman presented in 1976 with a facial rash, periorbital oedema, mucosal ulceration, and widespread papular lesions associated with tachycardia and fever (39°C). Stevens-Johnson syndrome was considered, and she reponded well to steroids, but no immunological investigations were performed. Within six months of presentation she developed alopecia and polyarthritis, involving wrists, metacarpophalangeal joints, and proximal interphalangeal joints, and was treated with non-steroidal anti-inflammatory agents.In 1979 lethargy and arthralgia were a problem and examination showed widespread tender lymphadenopathy and synovitis of the wrists and left knee. Investigations disclosed abnormal lymphocytes on a peripheral blood film, a negative Paul-Bunnell test, reactive changes in bone marrow and lymph node biopsy specimens, a negative sickle test, erythrocyte sedimentation rate 60 mm/h, and normal hand radiographs.