Toxoplasmosis in heart and heart and lung transplant recipients.

Abstract

SUMMARY Of the first 250 heart and 35 heart and lung transplant recipients at Papworth Hospital, Cambridge, who survived for more than one month after transplantation, 217 heart and 33 heart and lung patients were investigated serologically for evidence of Toxoplasma gondii infection. Six patients acquired primary Tgondii infection, most probably from the donor organ. Five patients experienced Tgondii recrudescence, two of whom had recovered from primary infection a few years earlier. Two patients died from primary Tgondii infection and the severity of symptoms in the other patients with primary infection was related to the amount of immunosuppressive treatment. Prophylaxis with pyrimethamine (25 mg a day for six weeks) was introduced for Tgondii antibody negative transplant recipients who received a heart from a T gondii antibody positive donor after the first four cases of primary toxoplasmosis. Ofthe seven patients not given pyrimethamine, four (57%) acquired primary Tgondii infection. This compared with two of the 14 patients (14%) given prophylaxis.

Epidemiology of and Diagnostic Strategies for Toxoplasmosis

“…TMP-SMX (160 mg-800 mg) daily or three times a week is also the first-line drug regimen to prevent toxoplasmosis in SOT patients who also need to be protected against PCP (81,154,234). In the case of intolerance, pyrimethamine alone (25 mg/day) can be an alternative for T. gondii prophylaxis (234,339), and aerosolized pentamidine can be used for Pneumocystis pneumonia. If prophylaxis must be stopped for any reason, the onset of clinical signs must prompt further investigations based on CT scans and parasite detection by PCR (248).…”

Correlation of Parasite Load Determined by Quantitative PCR to Clinical Outcome in a Heart Transplant Patient with Disseminated Toxoplasmosis

“…In contrast, a combination of pyrimethamine and sulfadoxine (75 mg and 1,500 mg) every 2 weeks has been reported to be ineffective at preventing heart-transmitted infection (13). In cases of intolerance, pyrimethamine alone (25 mg/day) can be a valuable alternative (24,33). Prevention also relies on serological screening of the donor and the recipient, as well as counseling of seronegative patients to avoid exposure through food (31).…”

Evaluation of the Effects of Sulfamethoxazole on Toxoplasma gondii Loads and Stage Conversion in IFN‐γ Knockout Mice Using QC‐PCR

“…Iatrogenic myocarditis and acute lethal toxoplasmosis have been observed as results of heart (9, 28), kidney (11), and lung transplantations (37). These observations may justify the need for continuation of long-term therapy in human patients and may indicate that complementary studies are needed to determine the pharmacokinetics of therapeutic agents in animal and human tissues in relation to the distribution of T. gondii following an acute infection.…”