Toxoplasmosis in non‐cardiac solid organ transplant recipients: A case series and review of literature

Abstract

The risk of toxoplasmosis in high‐risk cardiac transplant recipients is well recognized prompting universal donor and candidate screening with administration of targeted post‐transplant chemoprophylaxis in high‐risk (D+/R−) cardiac transplant patients. In contrast, until recently, there have been neither well‐defined recommendations nor consensus regarding toxoplasmosis preventive strategies among non‐cardiac solid organ transplant recipients. We report 3 cases of post‐transplant toxoplasmosis in non‐cardiac transplant recipients (one lung and two liver); all 3 infections presumed to be donor‐derived. Not surprisingly, pre‐transplant Toxoplasma serology was negative in all the patients. None of the patients were on trimethoprim‐sulfamethoxazole (TMP‐SMX) prophylaxis at the time of diagnosis of toxoplasmosis. The median time from transplant to onset of infection was 90 days (range: 30‐120 days). Clinical presentations included cerebral (n = 1) and disseminated infections (n = 2). Two of the 3 patients, both with disseminated infection died (mortality ~ 67%).

Infectious Complications in Lung Transplant Recipients

“…Typically, prophylaxis with TMP-SMX prevents disease. Transmission of infection from seropositive donors to seronegative recipients has been described in patients placed on pentamidine for prophylaxis [ 58 , 59 ].…”

Comprehensive Overview of Toxoplasma gondii-Induced and Associated Diseases

“…Indeed, despite the availability of prophylactic and treatment options, the reactivation of chronic toxoplasmosis still occurs and can become life threatening [4,[46][47][48]. In immunocompromised patients, the reactivation of chronic toxoplasmosis is due to various factors impairing the protective cellular immune response such as HIV infection, immunosuppressive therapies administered in the context of hematopoietic stem cell transplantation, solid organ transplant, or chemotherapy against cancer [30,[49][50][51][52][53][54]. In HIV patients, toxoplasmic encephalitis is the predominant manifestation of the disease, while pulmonary or disseminated toxoplasmosis is more characteristic of transplant patients [2,55].…”

Imiquimod Targets Toxoplasmosis Through Modulating Host Toll-Like Receptor-MyD88 Signaling

“…In immunocompromised patients, reactivation of CT associates with severe morbidity and mortality (18)(19)(20). Reactivation usually occurs in HIV patients or in those who receive immunosuppressive therapies in the context of bone marrow and solid organ transplantation, or chemotherapy against cancer (21)(22)(23)(24).…”