Toxoplasma Encephalitis in Atypical Hosts at an Academic Cancer Center

Morjaria, Sejal; Epstein, David G.; Romero, Fabián Andrés Rosas; Taur, Ying; Seo, Susan K.; Papanicolaou, Genovefa A.; Hatzoglou, Vaios; Rosenblum, Marc; Perales, Miguel-Ángel; Scordo, Michael; Kaltsas, Anna

doi:10.1093/ofid/ofw070

Cited by 14 publications

(14 citation statements)

References 14 publications

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“…[24][25][26] Central nervous system involvement and encephalitis may lead to severe morbidity and mortality in untreated cancer patients. 3,[27][28][29] Other symptoms have also been attributed to toxoplasmosis, including fever, rash, myocarditis, pneumonitis and lymphadenopathy. 3,30 Clearly an early diagnosis and treatment of toxoplasmosis will limit its morbidity.…”

Section: Discussionmentioning

confidence: 99%

Screening of toxoplasmosis in cancer patients: a concern

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Screening of toxoplasmosis in cancer patients: a concern

et al. 2018

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“…Nontransplant, non-HIV-infected immunocompromised patients. Toxoplasmosis has been reported in patients with malignancy and other T-cell and B-cell immune deficiencies and likely occurs via reactivation of latent infection (91,(100)(101)(102). A recent restrospective multicenter French study of 180 PCR-positive toxoplasmosis cases in immunocompromised patients found that 14% of cases occurred in the nontransplant, non-HIV-infected group, especially in patients with hematologic malignancy and connective tissue disease on immunosuppressive medications (91).…”

Section: Immunocompromised Patientsmentioning

confidence: 99%

Treatment of Toxoplasmosis: Historical Perspective, Animal Models, and Current Clinical Practice

et al. 2018

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SUMMARYPrimary infection is usually subclinical, but cervical lymphadenopathy or ocular disease can be present in some patients. Active infection is characterized by tachyzoites, while tissue cysts characterize latent disease. Infection in the fetus and in immunocompromised patients can cause devastating disease. The combination of pyrimethamine and sulfadiazine (pyr-sulf), targeting the active stage of the infection, is the current gold standard for treating toxoplasmosis, but failure rates remain significant. Although other regimens are available, including pyrimethamine in combination with clindamycin, atovaquone, clarithromycin, or azithromycin or monotherapy with trimethoprim-sulfamethoxazole (TMP-SMX) or atovaquone, none have been found to be superior to pyr-sulf, and no regimen is active against the latent stage of the infection. Furthermore, the efficacy of these regimens against ocular disease remains uncertain. In multiple studies, systematic screening for infection during gestation, followed by treatment with spiramycin for acute maternal infections and with pyr-sulf for those with established fetal infection, has been shown to be effective at preventing vertical transmission and minimizing the severity of congenital toxoplasmosis (CT). Despite significant progress in treating human disease, there is a strong impetus to develop novel therapeutics for both the acute and latent forms of the infection. Here we present an overview of toxoplasmosis treatment in humans and in animal models. Additional research is needed to identify novel drugs by use of innovative high-throughput screening technologies and to improve experimental models to reflect human disease. Such advances will pave the way for lead candidates to be tested in thoroughly designed clinical trials in defined patient populations.

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“…9 Toxoplasmosis after allo-and, to much less extent autologous, HCT and in patients with hematological malignancies has been described with variable manifestations including CNS infection characterized by multiple brain abscesses, but also presenting as meningoencophelitis and ventriculitis, pneumonia, cutaneous eruption, and disseminated infection. [10][11][12][13][14][15][16][17][18] In our institution,…”

Section: Discussionmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis induced by Toxoplasma gondii infection diagnosed by a bone marrow biopsy and DNA next‐generation sequencing in an allogeneic hematopoietic stem cell transplant recipient

Obeid

Grzywacz

Ferrieri

et al. 2021

Transplant Infectious Dis

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A 58-year-old female received a single umbilical cord blood (CB) unit transplantation with reduced intensity conditioning for FLT3+, NPM1+ AML in second complete remission. The preparative regimen consisted of cyclophosphamide, fludarabine, total body irradiation (TBI), and anti-thymocyte globulin (ATG). Tacrolimus and mycophenolate mofetil used for graft-versus-host disease prevention. Engraftment was achieved at day +20, as defined by an absolute neutrophil count >2.5 × 10 9 /L for 2 consecutive days. Standard antibacterial, antifungal, and antiviral prophylaxis included levofloxacin, micafungin during the conditioning period followed by voriconazole starting day +1, and high-dose acyclovir, respectively.Inhaled pentamidine starting on day +28 was substituted for trimethoprim/sulfamethoxazole (TMP/SMX) for Pneumocystis jirovecii pneumonia (PJP) prophylaxis to avoid myelosuppression.The hospital course (Figure 1) was complicated by febrile neutropenia on day +10 with findings of ground glass opacities on chest CT with non-revealing workup, which included negative blood and urine cultures, Aspergillus galactomannan (AG) and (1-3)β-d-glucan (BDG) and bronchoscopy with unremarkable bacterial and mycobacterial staining with no growth on bacterial-, fungal-, mycobacterial-,

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Toxoplasma Encephalitis in Atypical Hosts at an Academic Cancer Center

Cited by 14 publications

References 14 publications

Screening of toxoplasmosis in cancer patients: a concern

Screening of toxoplasmosis in cancer patients: a concern

Treatment of Toxoplasmosis: Historical Perspective, Animal Models, and Current Clinical Practice

Hemophagocytic lymphohistiocytosis induced by Toxoplasma gondii infection diagnosed by a bone marrow biopsy and DNA next‐generation sequencing in an allogeneic hematopoietic stem cell transplant recipient

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