Toxoplasma prophylaxis in haematopoietic cell transplant recipients

Gajurel, Kiran; Dhakal, Reshika; Montoya, José G.

doi:10.1097/qco.0000000000000169

Cited by 85 publications

(147 citation statements)

References 53 publications

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“…There are many case reports of toxoplasmosis in transplant recipients, including haematopoietic cell (Barcan et al, 2002), heart (Gajurel et al, 2015), liver (Hamza et al, 2015), and kidney (Petty et al, 2015) transplant patients. A previous study reported a higher prevalence of T. gondii infection in renal transplant recipients (Soltani et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…It seems that danger of transplanting an infected organ into a seronegative recipient is greater than that of transplanting a non-infected organ into a seropositive recipient (Chehrazi-Raffle et al, 2015). Fatal toxoplasmosis has been reported in heart, liver and bone marrow, haematopoietic stem cell transplant recipients (Castagnini et al, 2007; Caner et al, 2008; Stajner et al, 2013; Gajurel et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

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Toxoplasma gondii Infection in Immunocompromised Patients: A Systematic Review and Meta-Analysis

Wang¹,

Liu

Ma³

et al. 2017

Front. Microbiol.

173

190

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Toxoplasma gondii has been suggested as an important opportunistic pathogen in immunocompromised patients. We conducted a global meta-analysis to assess the prevalence and odds ratios (ORs) of T. gondii infection in immunocompromised individuals. Electronic databases were reviewed for T. gondii infection in HIV/AIDS patients, cancer patients, and transplant recipients, and meta-analyses were conducted to calculate overall estimated prevalence and ORs using random or fixed-effects models. Totally, 72 eligible studies were included. The estimated pooled prevalence of T. gondii infection in immunocompromised patients and the control was 35.9 and 24.7% (p < 0.001), with an OR of 2.24, i.e., 42.1 and 32.0% for HIV/AIDS patients and the control (p < 0.05), 26.0 and 12.1% for cancer patients and the control (p < 0.001), and 42.1 and 34.5% for transplant recipients and the control (p > 0.05), whose estimated pooled ORs were 1.92 (95% CI, 1.44–2.55), 2.89 (95% CI, 2.36–3.55), and 1.51 (95% CI, 1.16–1.95), respectively. This study is the first to demonstrate that the immunocompromised patients are associated with higher odds of T. gondii infection, and appropriate prevention and control measures are highly recommended for these susceptible populations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Toxoplasma gondii Infection in Immunocompromised Patients: A Systematic Review and Meta-Analysis

Wang¹,

Liu

Ma³

et al. 2017

Front. Microbiol.

173

190

View full text Add to dashboard Cite

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“…T. gondii sero-prevalence in the United States is approximately 10% [6]. While the most common cause of post-transplant toxoplasmosis is reactivation of latent infection, toxoplasmosis can rarely be transmitted from a donor (even if asymptomatic) to recipients [11,14].…”

Section: Discussionmentioning

confidence: 99%

“…In allo-HCT patients, toxoplasmosis usually results from reactivation of a latent infection, instead of a primary infection [4,5]. The sero-prevalence of T. gondii in the United States is approximately 10%, and it is estimated that at least 800 allo-HCT patients are at risk for reactivation annually [6]. Post-transplant toxoplasmosis is more common in endemic countries [4].…”

Section: Introductionmentioning

confidence: 99%

“…For example, in the USA, it was found to be 0.3%, while in France it was 5% [4,10]. Toxoplasmosis usually (90%) develops within the first 6 months after HCT, with the highest incidence in the second and third months [5,6,10–13]. Although central nervous system (CNS) infection is not common after HCT, cerebral toxoplasmosis accounts for most post-transplant CNS infections [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Late-Onset Cerebral Toxoplasmosis After Allogeneic Hematopoietic Stem Cell Transplantation

et al. 2017

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Patient: Male, 44Final Diagnosis: Cerebral toxoplasmosis after HSCTSymptoms: Hemiparesis • muscle weaknessMedication: —Clinical Procedure: —Specialty: HematologyObjective:Unusual clinical courseBackground:Toxoplasmosis is an uncommon but potentially fatal complication following allogeneic hematopoietic stem cell transplantation (HCT). Post-transplant toxoplasmosis is often a reactivation of prior infection and typically occurs within the first 6 months of transplant. Herein, we report that cerebral toxoplasmosis may occur 22 months after allogeneic hematopoietic stem cell transplantation.Case Report:We describe a case of cerebral toxoplasmosis that occurred 22 months after an allogeneic HCT while the patient was on aerosolized pentamidine for Pneumocystis jiroveci pneumonia (PCP) prophylaxis. The disease was only diagnosed after brain biopsy because of atypical MRI appearance of the cerebral lesion and negative Toxoplasma gondii IgG antibody test result in the cerebrospinal fluid (CSF). The patient received pyrimethamine and sulfadiazine treatment, with dramatic improvement after several months. The patient is alive 2 years after infection diagnosis, with no evidence of disease and is off Toxoplasma prophylaxis.Conclusions:Cerebral toxoplasmosis can occur late after allogeneic HCT while patients are on immunosuppression therapy, with atypical features on imaging studies and negative Toxoplasma gondii IgG antibody test result in the CSF. Pre-transplant serologic screening for T. gondii antibodies in allogeneic transplant candidates is warranted. Brain biopsy can be a helpful diagnostic tool for cerebral lesions.

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Toxoplasmosis as a cause of life‐threatening respiratory distress in a dog receiving immunosuppressive therapy

Pepper

Mansfield

Stent

et al. 2019

Clinical Case Reports

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Key Clinical Message Disseminated toxoplasmosis is a potentially fatal complication in dogs receiving immunosuppressive therapy, particularly if multiple immunosuppressive drugs are used. Toxoplasmosis should be considered if signs of acute respiratory or hepatic disease develop, and diagnosis would rely on demonstration of organisms via cytology or PCR rather than a single time‐point serological assay.

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Toxoplasma prophylaxis in haematopoietic cell transplant recipients

Abstract: Universal prophylaxis with TMP/SMX in allo pre-HCTSP patients should be implemented by all transplant programmes. Preemptive treatment with routine blood PCR monitoring is an option if prophylaxis cannot be used.

Cited by 85 publications

References 53 publications

Toxoplasma gondii Infection in Immunocompromised Patients: A Systematic Review and Meta-Analysis

Toxoplasma gondii Infection in Immunocompromised Patients: A Systematic Review and Meta-Analysis

Late-Onset Cerebral Toxoplasmosis After Allogeneic Hematopoietic Stem Cell Transplantation

Toxoplasmosis as a cause of life‐threatening respiratory distress in a dog receiving immunosuppressive therapy

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