Toxoplasmosis After Solid Organ Transplantation



Toxoplasma gondii is an obligated intracellular protozoan with worldwide distribution. T. gondii can cause asymptomatic infection, ocular disease, congenital infection, and life-threatening disease in the immunocompromised host such as those with AIDS and transplant recipients. Transmission to humans occurs by ingestion of meat containing tissue cysts or of food or water contaminated with oocysts. The risk of toxoplasmosis following solid organ transplantation (SOT) differs by the transplanted organ, pre-transplant toxoplasmosis serostatus in donors/recipients, and the degree of immunosuppression. Hence, donors and SOT-candidates should be systematically screened for toxoplasmosis with IgG/IgM prior to transplantation. Transplant recipients with toxoplasmosis present more frequently with disseminated disease including encephalitis, pneumonitis, myocarditis, and multi-organic dysfunction. PCR and histopathology are the main diagnostic tools in SOT-patients. If untreated, toxoplasmosis in SOT-patients is 100 % fatal. Pyrimethamine+sulfadiazine+folinic acid or trimethoprim/sulfamethoxazole (TMP-SMX) are the regimens of choice. TMP-SMX used for Pneumocystis prophylaxis is sufficient for suppression of toxoplasmosis in high-risk SOT-recipients: mismatched D+/R-heart transplant and seropositive (R+) SOT-recipients with high-degree of immunosuppression. Seronegative SOT-recipients must be educated on appropriate preventive measures in order to avoid primary toxoplasma infection.


Toxoplasmosis Toxoplasma gondii Solid organ transplantation Trimethoprim–sulfamethoxazole Pneumonia Myocarditis Heart transplantation Prevention Treatment 


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Authors and Affiliations

  1. 1.Division of Infectious Diseases and Geographic MedicineStanford University School of Medicine, Stanford Hospital and ClinicsStanfordUSA

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