Disseminated toxoplasmosis associated with hemophagocytic syndrome after kidney transplantation: A case report and review

Gendron, Nicolas; Verney, Charles; Joste, Valentin; Dardé, Marie‐Laure; Loheac, Charlotte; Vrtovsnik, François; Argy, Nicolas; Houzé, Sandrine

doi:10.1111/tid.13154

Cited by 17 publications

(11 citation statements)

References 29 publications

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“…In humans, infection is thought to persist in the body in the chronic, latent form [ 17 ] after primary infection. It is a lifelong condition for humans who are not immunocompromised, contrary to those with autoimmune diseases [ 10 , 18 ], chronic corticosteroid applications [ 19 ], bone-marrow transplants or patients with AIDS [ 20 ]. In these cases the latent form can turn into an active, acute form, with consequences for the brain [ 21 ], eyes, senses and other structures.…”

Section: Discussionmentioning

confidence: 99%

Toxoplasmosis impact on prematurity and low birth weight

et al. 2022

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Background Toxoplasma gondii, one of the most common parasites, causes toxoplasmosis, one of the most frequent zoonotic diseases worldwide. T. gondii infects about one-third of the world’s population. T. gondii infection is generally considered a major risk for spontaneous abortion, prematurity and low birth weight in the animal sphere. Less commonly, a toxoplasma serological profile is correlated with the particular data of delivery. Acute T. gondii infection during pregnancy often leads to spontaneous abortion and/or a severe injury of the eyes, brain, and other structures of the foetus. Latent T. gondii infection of pregnant women could lead to less obvious but important changes during pregnancy, including the end product of pregnancy and the timing of labour. This study aimed to contribute to the current knowledge by comparing serological T. gondii profiles of pregnant women with prematurity and low birth weights of newborns. Material and methods A retrospective study design was adopted. The study participants included a cohort of 1733 pregnant women who consecutively gave birth to their children and underwent regular antenatal biochemical screening between the 14th and 16th weeks of pregnancy. Prematurity was defined as the liveborn preterm delivery in gestational age of pregnancy <37 weeks. Low birth weight was defined as weight at birth of ≤2499 grams. The complement-fixation test (CFT) provided serological profiles for toxoplasmosis that expresses the overall levels of toxoplasma immunoglobulins of all classes. Enzyme-linked immunosorbent assay (ELISA) tests for IgG and IgM were used simultaneously. IgM positivity helped to differentiate acute from the latent stage of toxoplasmosis. Birth data, especially the week of delivery and fetal weight, were evaluated accordingly. Results Of the 1733 pregnant women, 25% were diagnosed as latent toxoplasma positive, and 75% as toxoplasma negative. There were 87 premature deliveries versus 1646 timely births. We observed 88 low birth weights and 1645 normal fetal weights. We found a statistically significant association between latent toxoplasmosis and prematurity, χ2(1) = 5.471, p = .019 and between latent toxoplasmosis and low birth weight of newborns, χ2(1) = 7.663, p = .006. There was a 1.707 times higher risk of prematurity for toxoplasma-positive women, while the risk for low birth weight was 1.861 times higher. The strength of both tests of association was mild. We tested the correlation between the levels of CFT titres and week of delivery and weight of newborns. No association was found between the level of latent toxoplasmosis and the week of delivery and fetal weight. Conclusion Latent toxoplasmosis was associated with premature birth rate and lower birth weight of newborns. The odds of premature delivery was 1.7 and low birth weight 1.9 times higher in women with latent toxoplasmosis compared to toxoplasma negative women. Even though the strength of the association in our large sample is relatively mild, the combination of latent toxoplasmosis with other adverse factors could cause serious harm. Whole CFT and specific IgG levels of latent toxoplasmosis are not linked to the severity of prematurity or low birth weight in newborns.

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Section: Discussionmentioning

confidence: 99%

Toxoplasmosis impact on prematurity and low birth weight

et al. 2022

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“…An immunoblot test can have varying reliability of its specificity and sensitivity depending on the type of sample used (Villard et al, 2003;Stroehle et al, 2005). Western blot is also complementary for the early postnatal diagnosis of congenital toxoplasmosis (Robert-Gangneux et al, 1999), diagnosis of human patients (Gay et al, 2019) and characterization and evaluation of T. gondii proteins (Appiah-Kwarteng et al, 2019;Liu et al, 2019).…”

Section: Western Blottingmentioning

confidence: 99%

Review on the Current Trends of Toxoplasmosis Serodiagnosis in Humans

Ybañez

Nishikawa

2020

Front. Cell. Infect. Microbiol.

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Toxoplasmosis is a widely distributed zoonotic infection caused by the obligate intracellular apicomplexan parasite Toxoplasma gondii. It is mainly transmitted through the ingestion of oocysts shed by an infected cat acting as its definitive host. The key to effective control and treatment of toxoplasmosis is prompt and accurate detection of T. gondii infection. Several laboratory diagnostic methods have been established, including the most commonly used serological assays such as the dye test (DT), direct or modified agglutination test (DAT/MAT), indirect hemagglutination test (IHA), latex agglutination test (LAT), indirect immunofluorescent test (IFAT), enzyme-linked immunosorbent assays (ELISA), immunochromatographic tests (ICT), and the western blot. Nonetheless, creating specific and reliable approaches for serodiagnosis of T. gondii infection, and differentiating between acute and chronic phases of infection remains a challenge. This review provides information on the current trends in the serodiagnosis of human toxoplasmosis. It highlights the advantages of the use of recombinant proteins for serological testing and provides insight into the possible future direction of these methods.

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“…Six cases of HPS in the setting of invasive toxoplasmosis and kidney transplantation were reviewed by Gay et al. in 2019 10 . Attempts to give an incidence of HPS in transplantation usually quote an estimate of 0.4% by Karras based on a 17 patients case series, still the largest 16 years after publication 11 .…”

Section: Discussionmentioning

confidence: 99%

Hemophagocytic syndrome triggered by donor‐transmitted toxoplasmosis as a complication in same‐donor recipients of renal transplantation: Case report and review of the literature

Franci

Flores

Candel

et al. 2021

Transplant Infectious Dis

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Background Hemophagocytic syndrome (HPS) is an infrequent complication of transplantation caused by an inflammatory response with a benign proliferation of macrophages and defective lytic capability of T lymphocytes and NK cells that can lead to multiorgan failure. Transplant patients are particularly exposed as a result of the increased risk of both infections and malignancies derived from immunosuppressive drugs. There is no consensus for therapy or immunosuppression; mortality is high. We report a case and present a review of all cases of HPS occurring in solid organ transplant recipients. Case report We report two cases of infection by Toxoplasma gondii transmitted by the kidney allograft. One of the recipients was seronegative before transplantation and developed disseminated primary toxoplasmosis. An immune reaction compatible with an HPS ensued. Both were treated with Trimethoprim/sulfamethoxazole, immunosuppression was tapered, and after a 2‐week period a complete response was obtained. Conclusion HPS presents therapeutic challenges in the context of transplantation. If HPS is suspected, the search of a very likely underlying infection should be central to the management.

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Disseminated toxoplasmosis associated with hemophagocytic syndrome after kidney transplantation: A case report and review

Cited by 17 publications

References 29 publications

Toxoplasmosis impact on prematurity and low birth weight

Toxoplasmosis impact on prematurity and low birth weight

Review on the Current Trends of Toxoplasmosis Serodiagnosis in Humans

Hemophagocytic syndrome triggered by donor‐transmitted toxoplasmosis as a complication in same‐donor recipients of renal transplantation: Case report and review of the literature

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