Clinical characteristics and computed tomography findings of pulmonary toxoplasmosis after hematopoietic stem cell transplantation

Abstract

The prognosis of pulmonary toxoplasmosis, including disseminated toxoplasmosis involving the lungs, following hematopoietic stem cell transplantation (HSCT) is extremely poor due to the difficulties associated with early diagnosis and the rapidly progressive deterioration of multiorgan function. In our institution, we identified nine cases of toxoplasmosis, representing incidences of 2.2 and 19.6 % among all HSCT recipients and seropositive HSCT recipients, respectively. Of the patients with toxoplasmosis, six had pulmonary toxoplasmosis. Chest computed tomography (CT) findings revealed centrilobular, patchy ground-glass opacities (n = 3), diffuse ground-glass opacities (n = 2), ground-glass opacities with septal thickening (n = 1), and marked pleural effusion (n = 1). All cases died, except for one with suspected pulmonary toxoplasmosis who was diagnosed by a polymerase chain reaction assay 2 days after the onset of symptoms. In pulmonary toxoplasmosis, CT findings are non-specific and may mimic pulmonary congestion, atypical pneumonia, viral pneumonitis, and bronchopneumonia. Early diagnosis and treatment is crucial for overcoming this serious infectious complication. Pulmonary toxoplasmosis should be considered during differential diagnosis in a recipient with otherwise unexplained signs of infection and CT findings with ground-glass opacities, regardless of the distribution.

Diagnosis of severe respiratory infections in immunocompromised patients

“…In immunocompromised patients, fever may be the presenting symptom of toxoplasmosis, which may progress to multiple organ failure. The symptoms of disseminated toxoplasmosis are nonspecific; the lungs and central nervous system are often involved, and hepatitis, myocarditis, and chorioretinitis may develop [108]. Other features include lymphopenia, thrombocytopenia, rhabdomyolysis, and lactate dehydrogenase elevation [104].…”

“…In the rare cases with isolated pulmonary involvement, the presentation may mimic interstitial pneumonia, PJP, or CMV pneumonia. CT may show lobar consolidations, ground-glass opacities, and thickening of the interlobular septa [108]. Serological testing is unreliable in immunocompromised patients, but may be useful in previously seronegative patients.…”

Toxoplasmosis after allogeneic hematopoietic stem cell transplantation: Impact of serostatus‐based management

“…8,9 Compared to the seroprevalence of regions such as Europe, Latin America, and the Middle East, the seroprevalence in Japan has been known to be low (5%-16%). [10][11][12][13] Although such a low seroprevalence results in the low incidence of toxoplasmosis, a certain proportion of patients in Japan are seropositive for T. gondii and at risk for developing life-threatening toxoplasmosis. In fact, 5…”

“…However, because of the difficulty in the accurate diagnosis of pulmonary toxoplasmosis mimicking other more common pulmonary diseases, the incidence of pulmonary toxoplasmosis could have been underestimated. 11,15 Although the seroprevalence of T. gondii is low and thus the incidence of toxoplasmosis is low in Japan, there have been several reports by Japanese investigators showing the ominous prognosis of toxoplasmosis, especially disseminated disease, developing after allogeneic HSCT. 11,15,16 Therefore, there is a specific guideline of 'Toxoplasmosis' from Japan Society for Hematopoietic Cell Transplantation presenting the details of the basic background and epidemiology, prevention, and treatment of toxoplasmosis after HSCT.…”

Cytokine Profile in Sweet's Syndrome under the Treatment of Pulmonary Toxoplasmosis Complicated with Myelodysplastic Syndrome

“…T. gondii infection in immunocompromised hosts often becomes lethal. Lung involvement is extremely rare, but it is known to be complicated in severely immunocompromised patients, such as hematopoietic stem cell transplantation (HSCT) recipients (14). Toxoplasmosis is an opportunistic infection that induces a strong cellular immune response.…”