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Toxoplasmosis After Hematopoietic Stem Cell Transplantation

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Transplant Infections

Abstract

In immunocompromised individuals, toxoplasmosis mostly occurs as a reactivation of a latent infection, causing severe to life-threatening disease. Thus, recipients who are seropositive for Toxoplasma gondii before an allogeneic hematopoietic stem cell transplant (HCT) are at highest risk, although primary infections may also cause severe toxoplasmosis. The disease most often affects the central nervous system, but in HCT recipients other organs are involved in more than half of the cases. Because of the alteration of the immune response in these patients, serodiagnosis is not sufficiently reliable in the diagnosis of post-HCT toxoplasmosis, and direct detection of the causative agent is required for an etiologic diagnosis (ideally by microscopy, but most commonly through detection of its DNA by PCR). If inadequately treated or left untreated, toxoplasmosis generally has a fatal outcome in HCT recipients. Therefore, treatment must be started as early as possible. However, due to the high mortality of established disease, preemptive treatment using routine blood PCR monitoring seems effective in detecting infection early and preventing disease, especially in seropositive high-risk alloHCT recipients when chemo-prophylaxis is not possible. The gold standard both in the treatment of reactivation and disease is the combination of pyrimethamine–sulfadiazine–folinic acid, while cotrimoxazole is the agent of choice in the primary prophylaxis for high-risk patients.

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References

  1. Derouin F, Devergie A, Auber P, et al. Toxoplasmosis in bone marrow transplant recipients: report of seven cases and review. Clin Infect Dis. 1992;15:267–70.

    CAS  PubMed  Google Scholar 

  2. Chandrasekar PH, Momin F, The Bone Marrow Transplant Team. Disseminated toxoplasmosis in marrow transplant recipients: a report of three cases and review of the literature. Bone Marrow Transplant. 1997;19:685–9.

    CAS  PubMed  Google Scholar 

  3. Sing A, Leitritz L, Roggenkamp A, et al. Pulmonary toxoplasmosis in bone marrow transplant recipients: report of two cases and review. Clin Infect Dis. 1999;29:429–33.

    CAS  PubMed  Google Scholar 

  4. Slavin MA, Meyers JD, Remington JS, et al. Toxoplasma gondii infection in marrow transplant recipients: a 20 year experience. Bone Marrow Transplant. 1994;13:549–57.

    CAS  PubMed  Google Scholar 

  5. Bretagne S, Costa JM, Kuentz M, et al. Late toxoplasmosis evidenced by PCR in a marrow transplant recipient. Bone Marrow Transplant. 1995;15:809–11.

    CAS  PubMed  Google Scholar 

  6. Maschke M, Dietrich U, Prumbaum M, et al. Opportunistic CNS infection after bone marrow transplantation. Bone Marrow Transplant. 1999;23:1167–76.

    CAS  PubMed  Google Scholar 

  7. Martino R, Maertens J, Bretagne S, et al. Toxoplasmosis after hematopoietic stem cell transplantation. A study by the European Group for Blood and Marrow Transplantation (EBMT) Infectious Diseases Working Party (IDWP). Clin Infect Dis. 2000;31:1188–94.

    CAS  PubMed  Google Scholar 

  8. Mele A, Paterson PJ, Prentice HG, et al. Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature. Bone Marrow Transplant. 2002;29:691–8.

    CAS  PubMed  Google Scholar 

  9. Roemer E, Blau IW, Basara N, et al. Toxoplasmosis, a severe complication in allogeneic hematopoietic stem cell transplantation: successful treatment strategies during a 5-year single-center experience. Clin Infect Dis. 2001;32:e1–8.

    CAS  PubMed  Google Scholar 

  10. Small TN, Leung L, Stiles J, et al. Disseminated toxoplasmosis following T-cell-depleted related and unrelated bone marrow transplantation. Bone Marrow Transplant. 2000;25:969–73.

    CAS  PubMed  Google Scholar 

  11. Matsuo Y, Takeishi S, Miyamoto T, et al. Toxoplasmosis encephalitis following severe graft-vs.-host disease after allogeneic hematopoietic stem cell transplantation: 17 yr experience in Fukuoka BMT group. Eur J Haematol. 2007;79(4):317–21.

    CAS  PubMed  Google Scholar 

  12. Janitschke K, Held T, Kruiger D, et al. Diagnostic value of tests for Toxoplasma gondii-specific antibodies in patients undergoing bone marrow transplantation. Clin Lab. 2003;49(5–6):239–42.

    CAS  PubMed  Google Scholar 

  13. Lim Z, Baker B, Zuckerman M, et al. Toxoplasmosis following alemtuzumab based allogeneic haematopoietic stem cell transplantation. J Infect. 2007;54(2):e83–6.

    PubMed  Google Scholar 

  14. Aoun M, Georgala A, Mboumi K, et al. Changing the outcome of toxoplasmosis in bone marrow transplant recipients. Int J Antimicrob Agents. 2006;27(6):570–2.

    CAS  PubMed  Google Scholar 

  15. de Medeiros BC, de Medeiros CR, Werner B, et al. Disseminated toxoplasmosis after bone marrow transplantation: report of 9 cases. Transpl Infect Dis. 2001;3(1):24–8.

    PubMed  Google Scholar 

  16. Foot AB, Garin YJ, Ribaud P, et al. Prophylaxis of toxoplasmosis infection with pyrimethamine/sulfadoxine (Fansidar) in bone marrow transplant. Bone Marrow Transplant. 1994;14:241–5.

    CAS  PubMed  Google Scholar 

  17. O’Driscoll JC, Holliman RE. Toxoplasmosis and bone marrow transplantation. Rev Med Microbiol. 1991;2:215–22.

    Google Scholar 

  18. Yadlapati S, Dorsky D, Remington JS, et al. Ocular toxoplasmosis after autologous peripheral-blood stem-cell transplantation. Clin Infect Dis. 1997;25:1255–6.

    CAS  PubMed  Google Scholar 

  19. Hoyle C, Goldman JM. Life-threatening infections occurring more than 3 months after BMT. 18 UK Bone Marrow Transplant Teams. Bone Marrow Transplant. 1994;14:247–52.

    CAS  PubMed  Google Scholar 

  20. Held TK, Krüger D, Switala AR, et al. Diagnosis of toxoplasmosis in bone marrow transplant recipients: comparison of PCR-based results and immunohistochemistry. Bone Marrow Transplant. 2000;25:1257–62.

    CAS  PubMed  Google Scholar 

  21. Martino R, Bretagne S, Rovira M, et al. Toxoplasmosis after hematopoietic stem transplantation. Report of a five-year survey from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation (EBMT-IDWP). Bone Marrow Transplant. 2000;25:1111–3.

    CAS  PubMed  Google Scholar 

  22. Saad R, Vincent JF, Cimon B, et al. Pulmonary toxoplasmosis after allogeneic bone marrow transplantation: case report and review. Bone Marrow Transplant. 1996;18:211–2.

    CAS  PubMed  Google Scholar 

  23. Pendry K, Tait RC, McLay A, et al. Toxoplasmosis after BMT for CML. Bone Marrow Transplant. 1990;5:65–7.

    CAS  PubMed  Google Scholar 

  24. Geissmann F, Derouin F, Marolleau JP, et al. Disseminated toxoplasmosis following autologous bone marrow transplantation [letter]. Clin Infect Dis. 1994;19:800–1.

    CAS  PubMed  Google Scholar 

  25. Pauleikhoff D, Messmer E, Beelen DW, et al. Bone marrow transplantation and toxoplasmic retinochoroiditis. Graefes Arch Clin Exp Ophthalmol. 1987;225:239–43.

    CAS  PubMed  Google Scholar 

  26. Peacock JF, Greven CM, Couz JM, et al. Reactivation toxoplasmic retinochoroiditis in patients undergoing bone marrow transplantation: is there a role for chemoprophylaxis? Bone Marrow Transplant. 1995;15:983–7.

    PubMed  Google Scholar 

  27. Hohlfeld P, Daffos F, Costa JM, et al. Prenatal diagnosis of congenital toxoplasmosis with a polymerase chain-reaction test on amniotic fluid. N Engl J Med. 1994;331:695–9.

    CAS  PubMed  Google Scholar 

  28. Ellis JT. Polymerase chain reaction approaches for the detection of Neospora caninum and Toxoplasma gondii. Int J Parasitol. 1998;28:1053–60.

    CAS  PubMed  Google Scholar 

  29. Costa JM, Munoz C, Kruger D, et al. Quality control for the diagnosis of Toxoplasma gondii reactivation in SCT patients using PCR assays. Bone Marrow Transplant. 2001;28:527–8.

    CAS  PubMed  Google Scholar 

  30. Bretagne S, Costa JM, Foulet F, et al. Prospective study of toxoplasma reactivation by PCR in allogeneic stem cell transplant recipients. Transplant Infect Dis. 2000;2:127–32.

    CAS  Google Scholar 

  31. Martino R, Bretagne S, Einsele H, et al. Early detection of Toxoplasma infection by molecular monitoring of Toxoplasma gondii in peripheral blood samples after allogeneic stem cell transplantation. Clin Infect Dis. 2005;40(1):67–78.

    PubMed  Google Scholar 

  32. Edvinsson B, Lundquist J, Ljungman P, et al. A prospective study of diagnosis of Toxoplasma gondii infection after bone marrow transplantation. Acta Pathol Microbiol Immunol Scand. 2008;116(5):345–51.

    Google Scholar 

  33. Fricker-Hidalgo H, Bulabois CE, Brenier-Pinchart MP, et al. Diagnosis of toxoplasmosis after allogeneic stem cell transplantation: results of DNA detection and serological techniques. Clin Infect Dis. 2009;48:e9–15.

    PubMed  Google Scholar 

  34. Paya E, Noemi I, Tassara R, Catalan P, Aviles CL. [Prophylaxis against Toxoplasma gondii disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation]. Rev Chilena Infectol. 2012;29(Suppl 1):S37–9.

    Google Scholar 

  35. Rusinakova Z, Raida L, Faber E, et al. [Toxoplasmosis after immunosuppressive therapy--our experience]. Klin Mikrobiol Infekc Lek. 2009;15:95–8.

    CAS  PubMed  Google Scholar 

  36. Mulanovich VE, Ahmed SI, Ozturk T, et al. Toxoplasmosis in allo-SCT patients: risk factors and outcomes at a transplantation center with a low incidence. Bone Marrow Transplant. 2011;46:273–7.

    CAS  PubMed  Google Scholar 

  37. Bautista G, Ramos A, Fores R, et al. Toxoplasmosis in cord blood transplantation recipients. Transpl Infect Dis. 2012;14:496–501.

    CAS  PubMed  Google Scholar 

  38. Martino R, Bautista G, Parody R, et al. Severe infections after single umbilical cord blood transplantation in adults with or without the co-infusion of CD34+ cells from a third-party donor: results of a multicenter study from the Grupo Espanol de Trasplante Hematopoyetico (GETH). Transpl Infect Dis. 2015;17:221–33.

    CAS  PubMed  Google Scholar 

  39. Busemann C, Ribback S, Zimmermann K, et al. Toxoplasmosis after allogeneic stem cell transplantation—a single centre experience. Ann Hematol. 2012;91:1081–9.

    PubMed  Google Scholar 

  40. Sumi M, Aosai F, Norose K, et al. Acute exacerbation of Toxoplasma gondii infection after hematopoietic stem cell transplantation: five case reports among 279 recipients. Int J Hematol. 2013;98:214–22.

    PubMed  Google Scholar 

  41. Hakko E, Ozkan HA, Karaman K, Gulbas Z. Analysis of cerebral toxoplasmosis in a series of 170 allogeneic hematopoietic stem cell transplant patients. Transpl Infect Dis. 2013;15:575–80.

    CAS  PubMed  Google Scholar 

  42. Nigro MG, Figueroa C, Ledesma BA. [Retrospective study of the implementation of the qualitative PCR technique in biological samples for monitoring toxoplasmosis in pediatric patients receiving hematopoietic stem cell transplantation]. Rev Argent Microbiol. 2014;46:24–9.

    PubMed  Google Scholar 

  43. Daval S, Poirier P, Armenaud J, Cambon M, Livrelli V. [Development of a real-time PCR assay for quantitative diagnosis of Toxoplasma gondii after allogeneic bone marrow transplantation]. Pathol Biol (Paris). 2010;58:104–9.

    CAS  PubMed  Google Scholar 

  44. Meers S, Lagrou K, Theunissen K, et al. Myeloablative conditioning predisposes patients for Toxoplasma gondii reactivation after allogeneic stem cell transplantation. Clin Infect Dis. 2010;50:1127–34.

    PubMed  Google Scholar 

  45. Caner A, Donmez A, Doskaya M, et al. Determining Toxoplasma high-risk autologous and allogeneic hematopoietic stem cell transplantation patients by systematic pre-transplant PCR screening of stem cell originated buffy coat. Parasitol Int. 2012;61:565–71.

    CAS  PubMed  Google Scholar 

  46. Osthoff M, Chew E, Bajel A, et al. Disseminated toxoplasmosis after allogeneic stem cell transplantation in a seronegative recipient. Transpl Infect Dis. 2013;15:E14–9.

    CAS  PubMed  Google Scholar 

  47. Gajurel K, Dhakal R, Montoya JG. Toxoplasma prophylaxis in haematopoietic cell transplant recipients: a review of the literature and recommendations. Curr Opin Infect Dis. 2015;28:283–92.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Servei d’Hematologia Clinica, Hospital de la Santa Creu i Sant Pau, Barcelona, 08041, Spain

    Rodrigo Martino M.D.

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  1. Rodrigo Martino M.D.
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Correspondence to Rodrigo Martino M.D. .

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Editors and Affiliations

  1. Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Per Ljungman

  2. Tufts University School of Medicine Tufts Medical Center, Boston, MA, USA

    David Snydman

  3. University of Washington Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Michael Boeckh

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Martino, R. (2016). Toxoplasmosis After Hematopoietic Stem Cell Transplantation. In: Ljungman, P., Snydman, D., Boeckh, M. (eds) Transplant Infections. Springer, Cham. https://doi.org/10.1007/978-3-319-28797-3_42

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  • DOI: https://doi.org/10.1007/978-3-319-28797-3_42

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