Toxoplasmosis as an Early Complication of Allogeneic Hematopoietic Cell Transplantation

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Section: Discussionsupporting

confidence: 88%

“…However, breakthrough infections occur, prophylaxis may cause gastrointestinal intolerance and skin rashes, and the absorption is reduced in patients with intestinal GvHD. Also, given its myelotoxic effect, TMP-SMX is preferentially started after stable engraftment, although early Toxoplasma reactivation occurs [4].…”

Section: Introductionmentioning

confidence: 99%

Toxoplasmosis after allogeneic haematopoietic cell transplantation: experience using a PCR-guided pre-emptive approach

Aerts

Mercier

Beckers

et al. 2022

“…Toxoplasma-specific IgM was not detected in any sample, regardless of the parasite load and symptomatology. Since this study was based on seropositive patients, specific IgG was detectable at some time point during follow-up in all patients but not necessarily immediately prior to the HSCT procedure (see Table S2, patients 1,3,6,9,11,16,17,18) nor in every PCR positive peripheral blood sample (e.g. see Table S2, patient 3).…”

Section: Serologymentioning

confidence: 99%

Risk of reactivated toxoplasmosis in haematopoietic stem cell transplant recipients: a prospective cohort study in a setting withholding prophylaxis

Štajner

Vujić

Srbljanović

et al. 2022

Objectives: Reactivation of latent toxoplasmosis may be life-threatening in haematopoietic stem cell transplant (HSCT) recipients. We conducted an 8-year-long prospective study on the diagnosis and monitoring of reactivated toxoplasmosis in paediatric HSCT recipients. The primary objective was to determine the incidence of reactivated toxoplasmosis in a setting that withholds prophylaxis until engraftment. The second objective was to identify the subgroups of HSCT recipients particularly prone to reactivation who may benefit the most from regular PCR follow-up. Methods: Serological and qPCR screening targeting the Toxoplasma 529 bp gene was performed before HSCT, and continued by weekly monitoring after HSCT for a median time of 104 days. Results: Reactivated toxoplasmosis was diagnosed in 21/104 (20.2%), predominantly in allo-(19/75) and rarely in auto-HSCT (2/29) recipients. Over 50% (14/21) of cases were diagnosed during the first month after HSCT, while awaiting engraftment without prophylaxis. Toxoplasma disease evolved in only three (14.3%, 3/21) patients, all treated by allo-HSCT. Reactivation was more frequent in patients treated for acute lymphoblastic leukaemia (3/27, p 0.03) and especially, in recipients of haploidentical stem cells (10/ 20, p 0.005). Seronegative status of the donor (where was known) contributed to 75% (12/16) cases of reactivated toxoplasmosis after allo-HSCT. Discussion: The presented results show that peripheral blood-based qPCR, both before and after HSCT, is a valuable asset for the diagnosis of reactivated toxoplasmosis, whereas the results of serology in recipients should be interpreted with caution. Weekly qPCR monitoring, at least until successful engraftment and administration of prophylaxis, allows for prompt introduction of specific treatment.

“…Little systematic data exist on long-term neurological, neuropsychological and neurocognitive sequelae in allogeneic HCT recipients who survive an episode of cerebral toxoplasmosis. Similar to a report in immunocompromised patients [15], durations of treatment and definite outcomes in survivors are not provided in most recent larger series of allogeneic HCT patients [5,7,22,66,68]. Residual neurological symptoms after successful treatment of cerebral toxoplasmosis have been actively reported in only a few HCT recipients [26,69,70].…”

Section: Outcome and Late Effectsmentioning

confidence: 82%

“…Diagnosis was based on PCR (89%), imaging (37%) and serology (32%). In general, outcome remained poorer for HCT patients than for solid organ transplant patients Robin et al, 2019 [68] Single-centre retrospective cohort study from Henri Mondor Hospital, Cr eteil, France, including 419 allogeneic HCT recipients between 2007 and 2018…”

Section: Methodsmentioning

confidence: 99%

Toxoplasmosis after allogeneic haematopoietic cell transplantation—disease burden and approaches to diagnosis, prevention and management in adults and children

Rauwolf

Floeth

Kerl

et al. 2021

Background: Toxoplasmosis is a rare but highly lethal opportunistic infection after allogeneic haematopoietic cell transplantation (HCT). Successful management depends on screening, early recognition and effective treatment. Objectives: To review the current epidemiology and approaches to diagnosis, prevention and treatment of toxoplasmosis in adult and paediatric allogeneic HCT recipients. Source: Search of the English literature published in MEDLINE up to 30 June 2020 using combinations of broad search terms including toxoplasmosis, transplantation, diagnosis, epidemiology, prevention and treatment. Selection of articles for review and synthesis on the basis of perceived quality and relevance of content. Content: Toxoplasmosis continues to be a major challenge in the management of allogeneic HCT recipients. Here we provide a summary of published case series of toxoplasmosis in adult and paediatric patients post allogeneic HCT. We review and discuss the pathogenesis, epidemiology, clinical presentation, diagnosis and current recommendations for prevention and treatment. We also discuss impacts of toxoplasmosis in this setting and factors affecting outcome, emphasizing attention to neurological, neuropsychological and neurocognitive late effects in survivors. Implications: Apart from careful adherence to established strategies of disease prevention through avoidance of primary infection, identification of seropositive patients and implementation of molecular monitoring, future perspectives to improve the control of toxoplasmosis in allogeneic HCT recipients may include the systematic investigation of pre-emptive treatment, development of immunomodulatory approaches, antimicrobial agents with activity against the cyst form and vaccines to prevent chronic infection.