Disseminated toxoplasmosis after bone marrow transplantation: report of 9 cases

Abstract

Toxoplasma infection following bone marrow transplantation (BMT) is infrequently reported. We report 9 cases of disseminated Toxoplasma gondii infection in BMT recipients documented during an 11-year period at our institution. The incidence of T. gondii infection in our institution (1.14 per 100 allogeneic BMT) is higher than previously reported. The most frequently affected sites were the brain, lungs, and heart. Findings common to most patients who developed toxoplasmosis were positive pre-transplant serology, allogeneic transplant and graft-versus-host disease and its treatment, as well as BMT from matched unrelated donors. All 9 patients died and 8 were diagnosed only after autopsy. Heightened awareness of the occurrence of toxoplasmosis in marrow recipients, especially in highly endemic areas, and early diagnosis and therapy are needed for a better outcome.

Incidence and diagnosis of active toxoplasma infection among liver transplant recipients in Western Turkey

“…1,5,7,10 The mortality and morbidity rates of toxoplasmosis in liver transplant patients are high because of the potential for late diagnosis and delayed treatment, 8,9 even though toxoplasmosis is reported to be less common in liver transplant patients. 2,6,14,28 Indeed, only 17 cases of toxoplasmosis have been reported in liver transplant recipients since 1972.…”

“…[1][2][3][4][5][6] As the number of transplants performed in the world continues to increase, the burden of disease associated with the reactivation of toxoplasmosis has also increased. 5,7 The mortality and morbidity rates of toxoplasmosis in liver transplant recipients are high because of late diagnosis and delayed initiation of treatment. 8,9 Serological assays are useful for identifying patients at risk before transplantation, 10,11 but they are of limited value in diagnosing reactivated infection because profound immunosuppressive treatment can result in a decrease in the total antibody amount due to leukoneutropenia.…”

Toxoplasmosis and allogeneic stem cell transplantation: can we do better?

“…It is higher in areas of endemicity, ranging from 6% in Europe [5,6] and 3% in Brazil [7] compared to 50.5% in USA [3,4] or Japan [8]. In one prospective study of seropositive allo-SCT recipients, 16% reactivated the infection over the first 6 months after transplant and 6% developed disease [6].…”

“…The highest risk patients are seropositive allo-SCT recipients who have received cord blood or unrelated donor transplant, T cell depleted transplants, previous alemtuzumab, who have GVHD, or are unable to take trimethoprim/sulphamethaxoazole (TMP/ SMX) Pneumocystis jiroveci prophylaxis [6,7], although toxoplasmosis occurs even in patients receiving TMP/SMX prophylaxis [3,7,8]. Almost half of the cases in one US center occurred in patients born outside of the USA [4].…”

Timely Diagnosis of Disseminated Toxoplasmosis by Sputum Examination

“…A high dosage of TMP-SMZ appears to be more effective for the prevention of toxoplasmosis than a low one (13). In part because TMP-SMZ might reduce hematopoiesis, prophylactic treatment against Toxoplasma in BMT recipients is rarely used nowadays even in high-risk patients, and no evidence-based data support this practice (5,13,16). Nevertheless, the empirical observation that patients who do not receive chemoprophylaxis developed disseminated toxoplasmosis is in keeping with the AIDS data (6).…”