The Use of Donor and Recipient Screening for Toxoplasma in the Era of Universal Trimethoprim Sulfamethoxazole Prophylaxis

Gourishankar, Sita; Doucette, Karen; Fenton, Jayne; Purych, Dale; Kowalewska-Grochowska, Kinga; Preiksaitis, Jutta

doi:10.1097/tp.0b013e318169bebd

Cited by 57 publications

(42 citation statements)

References 33 publications

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“…We also confirmed that heart transplant patients are more at risk of donor-related toxoplasmosis than other SOT patients, which has been recognized through multiple case reports and cohort studies (reviewed in reference 25). More rarely, Toxoplasma seroconversion has been described in SOT patients in the absence of clinical signs (26,27), even in patients who did not receive prophylaxis (26). Here, we observed a positive blood PCR result in two heart transplant patients who were asymptomatic.…”

Section: Discussionsupporting

confidence: 47%

Molecular Diagnosis of Toxoplasmosis in Immunocompromised Patients: a 3-Year Multicenter Retrospective Study

et al. 2015

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T oxoplasmosis is a widespread parasitic infection that is frequently asymptomatic in immunocompetent patients. However, this obligate intracellular protozoan parasite can evade the immune system (1, 2) and persist for the life of its host in cyst form, predominantly in the brain, retina, and muscles. Reactivation of latent cysts may occur when the immune system fails to maintain cytokine pressure, which mainly relies on gamma interferon (IFN-␥) (3). Cyst reactivation can lead to ocular toxoplasmosis, cerebral toxoplasmosis (CT), or disseminated toxoplasmosis, which involves most frequently the lungs but potentially all organs. Failure of an efficient Th1 immune response mainly results from acquired immunosuppression, through HIV infection or immunosuppressive therapy. Both primary acquired and reactivated infections are life-threatening in immunocompromised patients (ICPs). Definitive diagnosis can be obtained by the detection of parasites in blood, cerebrospinal fluid (CSF), bronchoalveolar lavage (BAL) fluid, or virtually any tissue by using PCR, which is the most sensitive method (4).Prevention of CT in patients with HIV is an object of consensus, and guidelines recommend co-trimoxazole (sulfamethoxazole-trimethoprim) chemoprophylaxis in Toxoplasma-seropositive patients when CD4 ϩ cell counts fall below 200 cells/l (4), a prophylactic regimen which also protects patients from Pneumocystis jirovecii pneumonia. Nevertheless, toxoplasmosis remains Citation Robert-Gangneux F, Sterkers Y, Yera H, Accoceberry I, Menotti J, Cassaing S, Brenier-Pinchart M-P, Hennequin C, Delhaes L, Bonhomme J, Villena I, Scherer E, Dalle F, Touafek F, Filisetti D, Varlet-Marie E, Pelloux H, Bastien P. 2015. Molecular diagnosis of toxoplasmosis in immunocompromised patients: a 3-year multicenter retrospective study.

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Section: Discussionsupporting

confidence: 47%

Molecular Diagnosis of Toxoplasmosis in Immunocompromised Patients: a 3-Year Multicenter Retrospective Study

et al. 2015

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“…Knowledge of the serologic status of both the recipient and donor allows the start of primary chemoprophylaxis at the time of transplantation in the case of a mismatch, particularly for heart transplant patients. However, it was argued that in countries with a low Toxoplasma seroprevalence, such an occurrence is rare and that the systemic use of cotrimoxazole for the prevention of Pneumocystis pneumonia counterbalances the risk of primary Toxoplasma infection, at least in the first months following transplantation (154). If chemoprophylaxis is usually the rule for heart transplant patients in the case of a known mismatch, there is no consensus concerning the duration, which usually does not exceed 6 months.…”

Section: Screening For and Chemoprophylaxis Of Toxoplasmosis In Immunmentioning

confidence: 99%

“…However, it must be acknowledged that serologic reactivation is rarely associated with clinical reactivation but may prompt further investigation when associated with clinical signs. TMP-SMX (160 mg-800 mg) daily or three times a week is also the first-line drug regimen to prevent toxoplasmosis in SOT patients who also need to be protected against PCP (81,154,234). In the case of intolerance, pyrimethamine alone (25 mg/day) can be an alternative for T. gondii prophylaxis (234,339), and aerosolized pentamidine can be used for Pneumocystis pneumonia.…”

Section: Screening For and Chemoprophylaxis Of Toxoplasmosis In Immunmentioning

confidence: 99%

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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“…In France, where seroprevalence is high, serological screening is mandatory for every organ donor; screening of recipients is strongly recommended; and the risk of graft-transmitted toxoplasmosis is reduced both by prolonged chemoprophylaxis and by careful follow-up of patients in cases of mismatch. However, in countries with low Toxoplasma seroprevalence, guidelines may differ, and serological screening is not routinely recommended for all patients (18,25,34).…”

Section: Discussionmentioning

confidence: 99%

“…Heart and heart-lung transplants carry the highest risk of Toxoplasma graft transmission to a seronegative recipient (32), which can be prevented by cotrimoxazole prophylaxis (25). In high-risk mismatched heart recipients, the efficacy and safety of cotrimoxazole has been established (2,18) at the same dose regimen commonly used to prevent P. jirovecii pneumonia, but trimethoprim-sulfamethoxazole (160 and 800 mg) three times a week is also effective (2,24). In contrast, a combination of pyrimethamine and sulfadoxine (75 mg and 1,500 mg) every 2 weeks has been reported to be ineffective at preventing heart-transmitted infection (13).…”

Section: Discussionmentioning

confidence: 99%

Correlation of Parasite Load Determined by Quantitative PCR to Clinical Outcome in a Heart Transplant Patient with Disseminated Toxoplasmosis

et al. 2010

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Disseminated toxoplasmosis is a life-threatening infection in transplant recipients, which results either from reactivation of latent infection or from organ-transmitted primary infection. Preventive measures and diagnostic screening methods differ between countries and are related to the seroprevalence of Toxoplasma spp. in the general population. Here we report a case of disseminated toxoplasmosis in a heart transplant recipient with previous immunity that occurred after cotrimoxazole prophylaxis for the prevention of Pneumocystis jirovecii pneumonia was stopped. Quantitative PCR proved useful for the diagnosis and monitoring of Toxoplasma infection. Decreasing parasitic burdens in sequential samples of cerebrospinal fluid, blood, and bronchoalveolar lavage fluid correlated with a favorable outcome and allowed modulation of the immunosuppressive drug regimen. The duration of anti-Toxoplasma treatment and the need for maintenance prophylaxis are discussed, as well as prophylaxis for solid-organ transplant recipients. Although a rare event in heart transplant recipients, Toxoplasma reactivation must be investigated promptly, since early treatment improves the prognosis.

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The Use of Donor and Recipient Screening for Toxoplasma in the Era of Universal Trimethoprim Sulfamethoxazole Prophylaxis

Abstract: We therefore conclude that in transplant centers with low Toxoplasma seroprevalence, routine screening for Toxoplasma in solid organ donors and recipients is not necessary, particularly in the era of routine TMP/SMX prophylaxis.

Cited by 57 publications

References 33 publications

Molecular Diagnosis of Toxoplasmosis in Immunocompromised Patients: a 3-Year Multicenter Retrospective Study

Molecular Diagnosis of Toxoplasmosis in Immunocompromised Patients: a 3-Year Multicenter Retrospective Study

Epidemiology of and Diagnostic Strategies for Toxoplasmosis

Correlation of Parasite Load Determined by Quantitative PCR to Clinical Outcome in a Heart Transplant Patient with Disseminated Toxoplasmosis

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