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Toxoplasmosis after allogeneic stem cell transplantation—a single centre experience

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Abstract

Toxoplasmosis is a rare but possibly underestimated complication following allogeneic stem cell transplantation with a high mortality rate. One reason might be the limitation of the diagnostic instruments relying mainly on imaging and molecular-based techniques. In this report, we present three cases of toxoplasmosis identified among 155 allograft recipients treated at Greifswald University Hospital. Widely disseminated toxoplasmosis was detected post-mortem in two patients allografted for high-risk multiple myeloma. Clinical signs suspicious for toxoplasmosis occurred after days +32 and +75, respectively. In one case, serology and conventional Toxoplasma gondii PCR, targeting the B1 gene, revealed negative results, while in the other patient, toxoplasmosis was not investigated. Both patients received pentamidine for Pneumocystis jirovecii pneumonia (PcP) prophylaxis. The third patient, a 68-year-old woman allografted for AML, developed cerebral toxoplasmosis from day +395 after allogeneic SCT with typical signs in magnetic resonance tomography. Toxoplasma DNA was amplified from one of two samples of cerebrospinal fluid. The patient died of disseminated toxoplasmosis despite immediate initiation of therapy. Retrospective comparative testing of clinical specimens by the conventional T. gondii PCR and by a real-time PCR targeting a 529-bp genomic fragment suggests a higher sensitivity of the latter method in our patients. In conclusion, we suggest a rigorous real-time PCR monitoring for high-risk patients or patients with signs of infections suspicious for toxoplasmosis, even though low-copy results are presently difficult to interpret. Our reported cases might also encourage the use of trimethoprim–sufmethoxazole instead of pentamidine for PcP prophylaxis in those patients.

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Authors and Affiliations

  1. Department of Internal Medicine C (Haematology and Oncology, Marrow Transplantation), Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany

    Christoph Busemann, Thomas Kiefer, Christian A. Schmidt, Gottfried Dölken & William H. Krüger

  2. Institute for Pathology, Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany

    Silvia Ribback, Verena Sailer & Frank Dombrowski

  3. Friedrich-Loeffler Institute for Medical Microbiology, Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany

    Kathrin Zimmermann, Katrin Schulz & Ivo Steinmetz

Authors
  1. Christoph Busemann
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  2. Silvia Ribback
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  3. Kathrin Zimmermann
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  4. Verena Sailer
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  5. Thomas Kiefer
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  6. Christian A. Schmidt
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  7. Katrin Schulz
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  8. Ivo Steinmetz
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  9. Frank Dombrowski
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  10. Gottfried Dölken
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  11. William H. Krüger
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Correspondence to William H. Krüger.

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Silvia Ribback and Kathrin Zimmermann contributed equally to the paper.

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Busemann, C., Ribback, S., Zimmermann, K. et al. Toxoplasmosis after allogeneic stem cell transplantation—a single centre experience. Ann Hematol 91, 1081–1089 (2012). https://doi.org/10.1007/s00277-012-1406-5

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  • DOI: https://doi.org/10.1007/s00277-012-1406-5

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