Is Toxoplasmosis Prophylaxis Necessary in Cardiac Transplantation? Long-term Follow-up at Two Transplant Centers

Baran, David A.; Alwarshetty, Mamata; Alvi, Saad; Arroyo, Luis H.; Lubitz, Steven A.; Pinney, Sean; Gass, Alan; Zucker, Mark

doi:10.1016/j.healun.2006.08.001

Cited by 36 publications

(16 citation statements)

References 13 publications

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“…The combination of both methods yields a better sensitivity, reaching 74% in one study (137). Similarly to IgM serologic screening, a decreased sensitivity for parasite detection by mouse inoculation was reported in some studies when mothers were treated with a regimen combining pyrimethamine and a sulfonamide (16,20,22). Despite heterogeneous results for sensitivity, the positive predictive value (PPV) was high, ranging from 91 to 100% for the mouse assay (134,275); thus, a positive placenta result is a parameter of critical importance for the management of neonates with suspected congenital infection.…”

Section: Diagnosis Of Congenital Toxoplasmosismentioning

confidence: 89%

Epidemiology of and Diagnostic Strategies for Toxoplasmosis

2012

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SUMMARY The apicomplexan parasite Toxoplasma gondii was discovered a little over 100 years ago, but knowledge of its biological life cycle and its medical importance has grown in the last 40 years. This obligate intracellular parasite was identified early as a pathogen responsible for congenital infection, but its clinical expression and the importance of reactivations of infections in immunocompromised patients were recognized later, in the era of organ transplantation and HIV infection. Recent knowledge of host cell-parasite interactions and of parasite virulence has brought new insights into the comprehension of the pathophysiology of infection. In this review, we focus on epidemiological and diagnostic aspects, putting them in perspective with current knowledge of parasite genotypes. In particular, we provide critical information on diagnostic methods according to the patient's background and discuss the implementation of screening tools for congenital toxoplasmosis according to health policies.

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Section: Diagnosis Of Congenital Toxoplasmosismentioning

confidence: 89%

Epidemiology of and Diagnostic Strategies for Toxoplasmosis

2012

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“…The routine use of TMP/SMX for post‐SOT prophylaxis has decreased the risk of toxoplasmosis and is currently the most common prophylaxis against this parasite. Multiple studies support the efficacy of primary prophylaxis with TMP/SMX, although the optimal dose and duration of TMP/SMX remains unclear.…”

Section: Tissue and Blood Protozoamentioning

confidence: 99%

Parasitic Infections in Solid Organ Transplantation

Schwartz

Mawhorter

2013

American Journal of Transplantation

149

130

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“…The true incidence of toxoplasmosis in cases of mismatch (D + /R − ) is not precisely known but can reach 25–75% in the absence of prophylaxis (Table 2). Administration of co‐trimoxazole for prophylaxis of pneumocystosis proved efficient in preventing toxoplasmosis in cases of mismatch patients [28,29].…”

Section: Pathogenesis Of Toxoplasmosis In Transplant Recipientsmentioning

confidence: 99%

Prevention of toxoplasmosis in transplant patients

Derouin

Pelloux

2008

Clinical Microbiology and Infection

302

220

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Toxoplasmosis is a life-threatening opportunistic infection that affects haematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. Its incidence in these patients is closely related to the prevalence of toxoplasmosis in the general population, which is high in Europe. In SOT recipients, toxoplasmosis results mainly from transmission of the parasite with the transplanted organ from a Toxoplasma-seropositive donor to a Toxoplasma-seronegative recipient. This risk is high in cases of transplantation of organs that are recognized sites of encystation of the parasite, e.g. the heart, and is markedly lower in other SOT recipients. Clinical symptoms usually occur within the first 3 months after transplantation, sometimes as early as 2 weeks post transplant, and involve febrile myocarditis, encephalitis or pneumonitis. In HSCT recipients, the major risk of toxoplasmosis results from the reactivation of a pre-transplant latent infection in seropositive recipients. The median point of disease onset is estimated at 2 months post transplant, with <10% of cases occurring before 30 days and 15-20% later than day 100. Toxoplasmosis usually manifests as encephalitis or pneumonitis, and frequently disseminates with multiple organ involvement. Diagnosis of toxoplasmosis is based on the demonstration of parasites or parasitic DNA in blood, bone marrow, cerebrospinal fluid, bronchoalveolar lavage fluid or biopsy specimens, and serological tests do not often contribute to the diagnosis. For prevention of toxoplasmosis, serological screening of donors and recipients before transplantation allows the identification of patients at higher risk of toxoplasmosis, i.e. seropositive HSCT recipients and mismatched (seropositive donor/seronegative recipients) SOT recipients. Preventing toxoplasmosis disease in those patients presently relies on prophylaxis via prescription of co-trimoxazole.

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Is Toxoplasmosis Prophylaxis Necessary in Cardiac Transplantation? Long-term Follow-up at Two Transplant Centers

Cited by 36 publications

References 13 publications

Epidemiology of and Diagnostic Strategies for Toxoplasmosis

Epidemiology of and Diagnostic Strategies for Toxoplasmosis

Parasitic Infections in Solid Organ Transplantation

Prevention of toxoplasmosis in transplant patients

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