ABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Tick-Borne Diseases/complications , Rickettsia conorii/pathogenicity , Graft vs Host Disease/diagnosis , Graft vs Host Disease/parasitology , Exanthema/diagnosis , Rickettsia conorii/drug effects , Cloxacillin/administration & dosage , Exanthema/drug therapy , Methylprednisolone/administration & dosage , Cyclosporine/administration & dosageABSTRACT
Infectious complications remain a major problem after allogeneic hematopoietic stem cell transplant (HSCT). Specifically Toxoplasma gondii infection is a life-threatening condition in immunocompromised patients. In order to highlight the difficulties in obtaining an early and definitive diagnosis, we report three cases of toxoplasmosis after HSCT for hematologic malignancies: two cases of T. gondii retinochoroiditis, and one case of encephalitis. All patients had unrelated donors and received antithymocyte globulin; none had received trimethoprim/sulfamethoxazole prophylaxis. Toxoplasmosis occurred early post-transplant and diagnosis was obtained by real-time PCR. In one case, the correct diagnosis could only be established by PCR analysis of a retinal biopsy specimen. Rapid diagnosis--by invasive approaches--and an immediate onset of antiparasite treatment are crucial to avoid disseminated and often lethal Toxoplasma infections in the post-transplant period. Post-transplant prevention strategies and treatment to control advanced infection in this setting are discussed.
Subject(s)
Graft vs Host Disease/diagnosis , Hematopoietic Stem Cell Transplantation/adverse effects , Multiple Myeloma/parasitology , Myelodysplastic Syndromes/parasitology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/parasitology , Toxoplasma/pathogenicity , Toxoplasmosis/diagnosis , Anti-Infective Agents/therapeutic use , DNA, Protozoan/genetics , Female , Graft vs Host Disease/drug therapy , Graft vs Host Disease/parasitology , Humans , Immunocompromised Host , Male , Middle Aged , Multiple Myeloma/therapy , Myelodysplastic Syndromes/therapy , Polymerase Chain Reaction , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Survival Rate , Toxoplasma/genetics , Toxoplasmosis/drug therapy , Toxoplasmosis/parasitology , Transplantation, Homologous , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
Active infection with Toxoplasma gondii in immunocompromised transplant recipients can lead to toxoplasmosis, which may have a rapid disease course and in some cases be fatal. It is of paramount importance to diagnose toxoplasmosis at an early stage, and to initiate specific treatment to improve the outcome. Polymerase chain reaction (PCR) is today the primary diagnostic tool to diagnose toxoplasmosis in immunocompromised patients. Timely diagnosis may, however, be difficult if toxoplasmosis is at first asymptomatic. To investigate the magnitude of toxoplasmosis after bone marrow transplantation (BMT), we conducted a screening study by PCR where 21 autologous and 12 allogeneic BMT recipients were included. Peripheral blood samples were taken one week prior to BMT; thereafter, blood samples were drawn weekly for the first 6 months, and monthly up to one year after BMT. The samples were analyzed by conventional PCR and real-time PCR. T. gondii DNA was detected in peripheral blood from one patient 5 days post allogeneic BMT. There were no clinical signs of toxoplasmosis. Medical records were reviewed and showed a previously undiagnosed eye infection in another allogeneic BMT recipient. These two patients were seropositive for T. gondii. We concluded that monitoring for T. gondii DNA in peripheral blood samples using PCR might be a valuable method for identifying toxoplasma-seropositive stem cell transplant recipients.
