Low seroprevalence and low incidence of infection with Toxoplasma gondii (Nicolle et Manceaux, 1908) in pediatric hematopoietic cell transplantation donors and recipients: Polish nationwide study

Abstract

Toxoplasmosis is a potentially fatal complication after hematopoietic cell transplantation (HCT). Pre-transplant seropositivity of graft recipient to Toxoplasma gondii (Nicolle et Manceaux, 1908) is an important factor for disease reactivation after HCT. As toxoplasmosis epidemiology varies all over the world, we performed a Polish nationwide retrospective cohort study to determine the seroprevalence of toxoplasmosis in donors and pediatric allogeneic and autologous HCT recipients and the incidence of clinically evident toxoplasmosis in this patient group. Polish adult donors had higher anti-T. gondii seroprevalence than Polish pediatric donors (28% vs 8%; OR = 4.4; p = 0.02) and allo-HCT recipients (28% vs 17%; OR = 1.9; p = 0.01). Clinically apparent disease occurred in 1% of allo-HCT recipients: it was diagnosed by PCR as cerebral and/or ocular toxoplasmosis and successfully treated with antiprotozoal therapy. Regarding current practice, no prospective screening for infection of T. gondii in pediatric HCT centres is being performed, but, vast majority of HCT pediatric patients are receiving anti-T. gondii active prophylaxis. Since pre-HCT T. gondii serology was not assessed in all HCT; recipients, we propose this test should be a standard practice. Standardisation of management with infection of T. gondii in children after HCT is needed.

Comparison of serologic status of Toxoplasma gondii infection in pre‐ and post‐heart transplantation in a pediatric population: A preliminary study

“…According to the European Group for Blood and Marrow Transplantation Infectious Diseases Working Party guidelines, toxoplasmosis infection is defined as positive PCR in blood of a patient without any evidence of organ involvement or seroconversion of T gondii after transplant in a previously seronegative patient (with or without fever). 11,12 Children with previous heart transplantation and known T gondii serology status before transplant were entered into the study.…”

Toxoplasma gondii infection in children after allogeneic hematopoietic stem cell transplantation: A case report and literature review

“…Many researchers have proposed prevention strategies for toxoplasmosis. First, pre‐transplantation screening for Toxoplasma antibodies can be performed in donors and recipients to identify high‐risk patients and allow for preventive measures for seropositive high‐risk patients 5,6,18 . In France and 11 other European countries included in the Euro transplant network, serological screening before transplantation is mandatory 5 .…”

“…We used “ Toxoplasma gondii or Toxoplasmosis or Toxoplasma infection and children or pediatrics and hematopoietic stem cell transplantation” as the search term and retrieved the relevant literature from PubMed and summarized it, including 12 article s with 26 patients. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 European patients represented 46.2% (12/26) of the patients overall. Detailed information was provided in the literature for 18 patients aged 4–18 years.…”

Common Sources of Inflammation and Their Impact on Hematopoietic Stem Cell Biology

“…Toxoplasma gondii (T. gondii), the agent of toxoplasmosis, is a widespread intracellular protozoan parasite that infects up to a third of the world's population [41]. Given its overall prevalence, reactivation of toxoplasmosis is a significant side effect among recipients of hematopoietic stem cell transplantation (HSCT) [42]. T. gondii infection leads to bone marrow suppression, reducing white blood cells, reticulocytes, and platelets [43].…”