Disseminated toxoplasmosis in cardiac transplantation.

Abstract

Cambridge, the tPHL, Cambridge and the tPHL, St George's Hospital, London SUMMARY The first case of disseminated toxoplasmosis following cardiac transplantation in the UK is described, with details of Toxoplasma antibody tests made on other cardiac transplant patients. Sixteen of 40 (39%) of recipients had Toxoplasma antibody before operation. Eleven of 30 (37%) of donors had Toxoplasma antibody. The were four occasions when a negative recipient received a heart from a positive donor. Three survived the immediate postoperative period and two became infected with toxoplasmosis. The implications of this are discussed.Disseminated toxoplasmosis appears much more often when heart muscle from a dye test positive donor is given to a dye test negative recipient. Antibiotic therapy is limited by the fact that the antitoxoplasma drugs available are static in their effect, and need to be given for prolonged periods postoperatively. Disseminated toxoplasmosis has been described in immunocompromised hosts after transplantation of the heart,' liver,2 and kidney.

Parasitic diseases of the heart

“…Iatrogenic immunosuppression associated with chemotherapy and transplantation results in disseminated disease due to the reactivation of latent toxoplasmosis (87). The decline in cell mediated immunity associated with advanced HIV infection (CD4+ less than 100 cells/ µl) may result in reactivation toxoplasmosis presenting as Toxoplasma encephalitis that may also be associated with dissemination to other organs (88,89).…”

“…Treatment for toxoplasmosis in these immunocompromised patients is pyrimethamine (50-75 mg/day) and sulfadiazine (6-8 gm/day). Disseminated toxoplasmosis has been described after heart (87,(110)(111)(112)(113)(114)(115)(116)(117), liver (118,119), and kidney (120) transplantation. Toxoplasma encephalitis has been reported in 2 to 5% of cardiac transplant recipients (87,(110)(111)(112)(113)(114)(115)(116)(117).…”

“…Toxoplasma encephalitis has been reported in 2 to 5% of cardiac transplant recipients (87,(110)(111)(112)(113)(114)(115)(116)(117). The highest risk of disseminated toxoplasmosis occurs when a seronegative recipient receives a heart from a seropositive donor (87,(110)(111)(112)(113)(114)(115)(116)(117).…”

Screening of donor and recipient prior to solid organ transplantation

“…Toxoplasmosis is a major concern particularly in heart transplantation, where the Toxoplasma ‐seronegative recipient of a Toxoplasma ‐seropositive heart is at highest risk for developing active toxoplasmosis post‐transplant (33). Toxoplasmosis has also rarely been transmitted to liver (34) and kidney (35) recipients.…”

Toxoplasmosis in High Risk Personell in Lithuania

“…Most often, chronic and latent forms of toxoplasmosis are observed. The latter do not manifest itself in clinical symptoms, but, unfortunately, they are dangerous to people, for some outer factors ( such as overheating or overcooling) as well as the changes of the state of the organism (for example, the cases of immunosuppression) may make the process more acute and cause undesirable effects (till disablement or even lethal outcomes) (Cohen, 1970;Deronin et al, 1992;Luft et al, 1984;McGregor et al, 1984).…”