Abstract
Seven (11%) of the first 65 patients who received heart transplants at Papworth Hospital were mismatched for Toxoplasma gondii. Of these, four (57%) experienced T. gondii infection and two died. The remaining two had severe symptoms and received anti-T-gondii chemotherapy for a year after transplantation. In an attempt to reduce the impact of donor-acquired T. gondii in our heart transplant recipients, we decided in April 1984 to give prophylactic pyrimethamine to all T. gondii-mismatched patients. In this study, 7 years later, we review the efficacy of this policy. Five of 37 (14%) patients given prophylactic pyrimethamine acquired T. gondii infection; only one was symptomatic, and none died. This compares with 100% symptomatic infection in the pre-1984 patients, who did not receive prophylactic pyrimethamine. We believe that our experience has shown that pyrimethamine is effective in reducing the incidence and severity of primary donor-acquired T. gondii infection in mismatched heart and heart-lung transplant recipients.
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References
Balfour AH, Fleck DG, Hughes HPA, Sharp D (1982) Comparative study of three tests (dye test, indirect haemagglutination test, latex agglutination test) for the detection of antibodies to Toxoplasma gondii in human sera. J Clin Pathol 35: 228–232
Hakim M, Wreghitt TG, English TAH, Stovin PGI, Cory-Pearce R, Wallwork J (1985) Significance of donor-transmitted disease in cardiac transplantation. Heart Trans IV: 302–305
Hunter D, Chadwick P, Balfour AH, Bridges JB (1980) An assessment of a commercially available haemagglutination test for detecting toxoplasma antibodies in ovinesera. Br Vet J 136: 339–342
Hunter D, Chadwick P, Balfour AH, Bridges JB (1982) Examination of ovine foetal fluid for antibodies to Toxoplasma gondii by the dye test and an indirect immunofluorescence test for specific IgM. Br Vet J 138: 29–33
Luft BJ, Naot Y, Araujo FG, Stinson FB, Remington JS (1983) Primary and reactivated Toxoplasma infection in patients with cardiac transplants. Clinical spectrum and problems in diagnosis in a defined population. Ann Int Med 99: 27–31
Payne RA, Joynson DHM, Balfour AH, et al (1987) Public Health Laboratory Service enzyme-linked immunosorbent assay for detecting Toxoplasma-specific IgM antibody. J Clin Pathol 40: 276–281
Remington JS, Cavanaugh EN (1965) Isolation of the encysted form of Toxoplasma gondii from human skeletal muscle and brain. N Engl J Med 273: 1308–1310
Remington JS, Jacobs L, Kaufman HE (1960) Toxoplasmosis in the adult. N Engl J Med 262: 180–186
Ruskin J, Remington JS (1976) Toxoplasmosis in the compromised host. Ann Intern Med 84: 193–199
Sluiters JF, Balk AHMM, Essed CE, Mochtar B, Weimar W, Simoons ML, Ijkerman EPF (1989) Indirect enzyme-linked immunosorbent assay for immunoglobulin G and four immunoassays for immunoglobulin M to Toxoplasma gondii in a series of heart transplant recipients. J Clin Microbiol 27: 529–535
Speirs GE, Hakim M, Calne RY, Wreghitt TG (1988) Relative risk of donor-transmitted Toxoplasma gondii infection in heart, liver and kidney transplant recipients. Clin Transplant 2: 257–260
Wreghitt TG (1989) Cytomegalovirus infections in heart and heart-lung transplant recipients. J Antimicrob Chemother 23 [Suppl E]: 49–60
Wreghitt TG, Hakim M, Gray JJ, Balfour AH, Stovin PGI, Stewart S, Scott J, English TAH, Wallwork J (1989) Toxoplasmosis in heart and heart and lung transplant recipients. J Clin Pathol 42: 194–199
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Wreghitt, T.G., Gray, J.J., Pavel, P. et al. Efficacy of pyrimethamine for the prevention of donor-acquired Toxoplasma gondii infection in heart and heart-lung transplant patients. Transplant Int 5, 197–200 (1992). https://doi.org/10.1007/BF00336069
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DOI: https://doi.org/10.1007/BF00336069