Toxoplasmosis, a Severe Complication in Allogeneic Hematopoietic Stem Cell Transplantation: Successful Treatment Strategies during a 5-Year Single-Center Experience

Abstract

Toxoplasmosis is a rare but often fatal complication that occurs after patients undergo allogeneic hematopoietic stem cell transplant. At our institution, toxoplasmosis was diagnosed in 8 of 301 patients who received stem cell transplants. Disseminated toxoplasmosis with a rapid fatal course was observed in 2 patients. Six patients had cerebral toxoplasmosis diagnosed on the basis of neurological signs and observation of the patients' mental confusion, seizures, and typical lesions (which were assessed by computed tomography, magnetic resonance imaging, or both). Seroconversion of antitoxoplasma immunoglobulin and a discovery of toxoplasma deoxyribonucleic acid in the cerebrospinal fluid (confirmed by use of polymerase chain reaction) were documented in all patients. Treatment consisted of clindamycin therapy (for 2 patients) and of pyrimethamine-clindamycin therapy, sulfadiazine therapy, or both (for 5 patients). Patients showed improvement after therapy, as assessed by clinical and radiological means. Three of 8 patients survive-1 without any residual neurological symptoms and 2 with minimal neurological symptoms.

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

“…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. 2,10,[12][13][14] Currently, the diagnosis of active toxoplasma infection in immunosuppressed patients is based principally on the detection of DNA by polymerase chain reaction (PCR) because of the relatively high sensitivity and specificity of this method 2,9,12,[15][16][17][18][19] ; nested PCR is a particularly good method. 15,20 More recently, quantitative real-time PCR has been employed to assess changes in the levels of T. gondii DNA in order to monitor the efficacy of treatment.…”

“…15,20 More recently, quantitative real-time PCR has been employed to assess changes in the levels of T. gondii DNA in order to monitor the efficacy of treatment. 17,18,[21][22][23] Although toxoplasmosis has been reported to be uncommon in liver transplant recipients, there is only limited evidence addressing the rate of transplant-mediated transmission. 2,5,6,14 Thus, the present study was designed to assess the rate of primary or reactivated toxoplasmosis associated with liver transplantation.…”

Serological monitoring of a Toxoplasma infection after hematopoietic stem cell transplantation

“…Toxoplasmosis is a rare but serious complication in allogeneic HSCT recipients 3,5,7,8,10 . Most cases of Toxoplasma infections occur in seropositive HSCT recipients, suggesting that toxoplasmosis usually results from the reactivation of latent tissue parasites 5,8 .…”

“…Most cases of Toxoplasma infections occur in seropositive HSCT recipients, suggesting that toxoplasmosis usually results from the reactivation of latent tissue parasites 5,8 . In the present case, the seropositive recipient received hematopoietic stem cells from a seronegative donor.…”

Cutaneous toxoplasmosis: a case of confounding diagnosis

“…1,2 The overall prevalence of toxoplasmosis in stem cell transplant recipients range from o0.5% in the United States up to 3-5% in Europe where infection rates are higher in the general population. [3][4][5] T. gondii reactivation mainly involves the central nervous system. Pneumonia may occur occasionally, however, skin involvement is rare even in severely immunosuppressed individuals.…”