Subject(s)
Leeches , Leukemia, Myeloid, Acute , Respiratory Insufficiency , Adult , Animals , Fatal Outcome , Female , Humans , Leukemia, Myeloid, Acute/diagnostic imaging , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/parasitology , Respiratory Insufficiency/diagnostic imaging , Respiratory Insufficiency/drug therapy , Respiratory Insufficiency/parasitologySubject(s)
High-Throughput Nucleotide Sequencing , Immunocompromised Host , Leukemia, Myeloid, Acute , Multiple Organ Failure , Peripheral Blood Stem Cell Transplantation , Toxoplasma/genetics , Adolescent , Allografts , Female , Humans , Leukemia, Myeloid, Acute/blood , Leukemia, Myeloid, Acute/genetics , Leukemia, Myeloid, Acute/parasitology , Leukemia, Myeloid, Acute/therapy , Multiple Organ Failure/blood , Multiple Organ Failure/diagnosis , Multiple Organ Failure/genetics , Toxoplasmosis/blood , Toxoplasmosis/diagnosis , Toxoplasmosis/geneticsSubject(s)
Amphotericin B/administration & dosage , Antiprotozoal Agents/administration & dosage , Cord Blood Stem Cell Transplantation , Duodenal Diseases , Leishmaniasis , Leukemia, Myeloid, Acute/therapy , Duodenal Diseases/drug therapy , Duodenal Diseases/etiology , Duodenal Diseases/parasitology , Duodenal Diseases/pathology , Fatal Outcome , Female , Humans , Leishmaniasis/drug therapy , Leishmaniasis/etiology , Leishmaniasis/parasitology , Leishmaniasis/pathology , Leukemia, Myeloid, Acute/parasitology , Leukemia, Myeloid, Acute/pathology , Middle Aged , Transplantation, HomologousABSTRACT
Toxoplasmosis is a rare but rapidly fatal complication that can occur following hematopoietic stem cell transplantation (HSCT). Over a 17-yr period at our institutions, a definite diagnosis of toxoplasmosis was made in only two of 925 allogeneic HSCT recipients (0.22%) and none of 641 autologous HSCT recipients. These two patients received a conventional conditioning regimen followed by transplantation from an HLA-matched donor; however, they developed severe graft-vs.-host disease, which required intensive immunosuppressive therapy. Despite prophylactic treatment with trimethoprim/sulfamethoxazole, their immunosuppressive state, as indicated by a low CD4(+) cell count, might have resulted in toxoplasmosis encephalitis. Rapid and non-invasive methods such as a polymerase chain reaction (PCR) test of their cerebrospinal fluid for Toxoplasma gondii and magnetic resonance imaging of the brain were useful for providing a definitive diagnosis and prompt therapy in these patients: one patient stabilized and survived after responding to treatment with pyrimethamine/sulfodiazine whereas the other died of bacterial infection. In addition, retrospective PCR analyses of the frozen stored peripheral blood samples disclosed that detection of T. gondii preceded the onset of disease, indicating routine PCR testing of peripheral blood specimens may be an early diagnostic tool. It should be noted that when patients receiving HSCT have an unexplained fever and/or neurological complications, PCR tests should be considered to avoid cerebral lesions and improve the outcome of the patients.
Subject(s)
Encephalitis/etiology , Graft vs Host Disease/complications , Hematopoietic Stem Cell Transplantation , Toxoplasma , Toxoplasmosis, Cerebral/etiology , Animals , Antimalarials/administration & dosage , Asian People , Bacterial Infections/blood , Bacterial Infections/cerebrospinal fluid , Bacterial Infections/diagnostic imaging , Bacterial Infections/drug therapy , Bacterial Infections/etiology , CD4 Lymphocyte Count , DNA, Protozoan/blood , DNA, Protozoan/cerebrospinal fluid , Encephalitis/blood , Encephalitis/cerebrospinal fluid , Encephalitis/diagnostic imaging , Encephalitis/drug therapy , Fatal Outcome , Female , Graft vs Host Disease/blood , Graft vs Host Disease/cerebrospinal fluid , Graft vs Host Disease/diagnostic imaging , Graft vs Host Disease/drug therapy , Humans , Japan , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/cerebrospinal fluid , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/parasitology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Leukemia, Myeloid, Acute/blood , Leukemia, Myeloid, Acute/cerebrospinal fluid , Leukemia, Myeloid, Acute/diagnostic imaging , Leukemia, Myeloid, Acute/parasitology , Leukemia, Myeloid, Acute/therapy , Magnetic Resonance Imaging , Male , Middle Aged , Polymerase Chain Reaction , Radiography , Remission Induction , Retrospective Studies , Severity of Illness Index , Toxoplasmosis, Cerebral/blood , Toxoplasmosis, Cerebral/cerebrospinal fluid , Toxoplasmosis, Cerebral/diagnostic imaging , Toxoplasmosis, Cerebral/drug therapy , Transplantation Conditioning , Transplantation, Autologous , Transplantation, HomologousSubject(s)
Endophthalmitis/parasitology , Eye Infections, Parasitic/parasitology , Leukemia, Myeloid, Acute/parasitology , Microsporidia/isolation & purification , Microsporidiosis/parasitology , Albendazole/therapeutic use , Animals , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antiprotozoal Agents/therapeutic use , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Parasitic/diagnosis , Eye Infections, Parasitic/drug therapy , Humans , Infant , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/drug therapy , Magnetic Resonance Imaging , Male , Microsporidiosis/diagnosis , Microsporidiosis/drug therapy , Retinal Detachment/diagnosis , Retinal Detachment/drug therapy , Retinal Detachment/parasitologyABSTRACT
The clinical presentation and autopsy findings in the case of a patient with acute myelomonocytic leukemia and trichinosis are described. Cellular immunity is an important host defense against nematode infections such as strongyloidiasis. It is therefore probable that the severe trichinosis seen in this immunosuppressed patient was more than coincidental. Due to concomitant failure of humoral immunity, serodiagnosis of trichinosis would have been impossible. The only means of making the diagnosis antemortem would have been muscle biopsy.
