Summary:A 34-year-old man with refractory acute myelogenous leukemia underwent allogeneic peripheral blood stem cell transplantation (PBSCT) from his HLA-matched sibling. Engraftment was prompt and no acute GVHD developed. However, high fever persisted even after engraftment, and the patient developed headache, diplopia, vertigo and nuchal rigidity on day 20 posttransplant. Cerebrospinal fluid (CSF) showed pleocytosis with no detectable microorganisms. Despite therapy with broad-spectrum antibiotics, antifungal agents and antituberculous drugs, he developed rapid mental deterioration with seizures and died on day 40. Just prior to his death, trichomonads were isolated from both CSF and urine. Scanning electron microscopic examination identified the trichomonad as Trichomonas foetus. At autopsy, trichomonads were detected histopathologically in an area involving meningoencephalitis. To our knowledge, this is the first case of T. foetus meningoencephalitis in a recipient of allogeneic PBSCT and, more importantly, the first human case of T. foetus infection. Keywords: trichomonad; meningitis; infection; allogeneic transplantation; peripheral blood stem cell Trichomoniasis is a commonly reported sexually transmitted disease occurring both in animals and humans. Trichomonads are known to have strict host specificity, and Trichomonas foetus is associated in nature only with bovine diseases such as vaginitis. However, T. foetus infection in humans has never been reported.
1,2Allogeneic peripheral blood stem cell transplantation (alloPBSCT) is increasingly employed in treating hematologic malignancies. Reported experience consistently shows rapid recovery of both granulocytes and platelets after alloPBSCT. However, data on immune recovery and infec- 3-5 We describe the first case of T. foetus meningoencephalitis occurring in a severely immunosuppressed patient following alloPBSCT. To the best of our knowledge, this occurrence is also the first case of T. foetus infection in humans.
Case reportA 34-year-old man was diagnosed with AML in March 1995. Complete remission was achieved in May, but the leukemia subsequently became resistant to chemotherapy. The patient was referred to Keio University Hospital for marrow transplantation in February 1996. On admission he was neutropenic and subsequently developed necrotizing gingivitis and perianal abscess. These infections were treated successfully with broad-spectrum antibiotics, and he became afebrile. He then received BU (16 mg/kg) and CY (120 mg/kg) as conditioning. Non-T cell-depleted PBSC with 5.1 × 10 6 CD34-positive cells/kg of patient body weight were infused 2 days after completion of CY. PBSC had been collected from his HLA-matched brother using G-CSF. Cyclosporine as GVHD prophylaxis and G-CSF were given after transplantation. Engraftment was prompt, and the ANC reached 500/l on day 8. No acute GVHD occurred. BM examination on day 13 showed normo cellular marrow with trilineage hematopoiesis and no leukemic cells.The patient became febrile during conditioning and was...