Abstract
Toxoplasmosis is a rare and possibly underestimated complication following hematopoietic stem cell transplantation (HSCT) associated with a high mortality rate, although the incidence of toxoplasmosis after HSCT in Japan has not been established. We retrospectively studied patients with toxoplasmosis after HSCT, and identified five patients who had been diagnosed with an acute exacerbation of toxoplasmosis among 279 HSCT recipients at our institution between 1998 and 2011, representing an incidence of 1.8 %. Among 87 autologous HSCT recipients, one definite case was diagnosed. The serological test for Toxoplasma gondii before HSCT was positive in 18 of 192 allogeneic HSCT recipients. Of the 18 seropositive patients, three had definite infections, and one had possible infection. All four definite cases were diagnosed at autopsy. In the definite cases, three allogeneic HSCT recipients had disseminated or pulmonary toxoplasmosis and one autologous HSCT recipient had toxoplasmic encephalitis, although toxoplasmosis was not suspected at the premortem examination due to non-specific clinical and radiological manifestations. Thus, acute exacerbation of toxoplasmosis should be suspected in recipients after HSCT. Early diagnosis and treatment for toxoplasmosis would certainly contribute to a decrease in mortality after HSCT.
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References
Montoya JG, Liesenfeld O. Toxoplasmosis. Lancet. 2004;363:1965–76.
Derouin F, Pelloux H, ESCMID Study Group on Clinical Parasitology. Prevention of toxoplasmosis in transplant patients. Clin Microbiol Infect. 2008;14:1089–101.
Matsuo Y, Takeishi S, Miyamoto T, Nonami A, Kikushige Y, Kunisaki Y, 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;79:317–21.
Sumi M, Hata S, Sato K, Fujikawa Y, Shimizu I, Ueki T, et al. Severe pulmonary toxoplasmosis mimicking viral pneumonitis after a third allogeneic stem cell transplantation in a man with acute lymphoblastic leukemia. Intern Med. 2012;51:2943–7.
Martino R, Bretagne S, Einsele H, Maertens J, Ullman AJ, Parody R, 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;40:67–78.
Fricker-Hidalgo H, Bulabois CE, Brenier-Pinchart MP, Hamidfar R, Garban F, Brion JP, et al. Diagnosis of toxoplasmosis after allogeneic stem cell transplantation: results of DNA detection and serological techniques. Clin Infect Dis. 2009;48:e9–15.
Cavattoni I, Ayuk F, Zander AR, Zabelina T, Bacher A, Cayroglu E, et al. Diagnosis of Toxoplasma gondii infection after allogeneic stem cell transplant can be difficult and requires intensive scrutiny. Leuk Lymphoma. 2010;51:1530–5.
Aoun M, Georgala A, Mboumi K, De Bruyne JM, Duchateau V, Lemort M, et al. Changing the outcome of toxoplasmosis in bone marrow transplant recipients. Int J Antimicrob Agents. 2006;27:570–2.
Martino R, Maertens J, Bretagne S, Rovira M, Deconinck E, Ullman AJ, et al. Toxoplasmosis after hematopoietic stem cell transplantation. Clin Infect Dis. 2000;31:1188–94.
Mele A, Paterson PJ, Prentice HG, Leoni P, Kibbler CC. Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature. Bone Marrow Transplant. 2002;29:691–8.
Busemann C, Ribback S, Zimmermann K, Sailer V, Kiefer T, Schmidt CA, et al. Toxoplasmosis after allogeneic stem cell transplantation—a single centre experience. Ann Hematol. 2012;91:1081–9.
Mulanovich VE, Ahmed SI, Öztürk T, Khokhar FA, Kontoyiannis DP, de Lima M. Toxoplasmosis in allo-SCT patients: risk factors and outcomes at a transplantation center with a low incidence. Bone Marrow Transplant. 2011;46:273–7.
Meers S, Lagrou K, Theunissen K, Dierickx D, Delforge M, Devos T, et al. Myeloablative conditioning predisposes patients for Toxoplasma gondii reactivation after allogeneic stem cell transplantation. Clin Infect Dis. 2010;50:1127–34.
Saad R, Vincent JF, Cimon B, de Gentile L, Francois S, Bouachour G, et al. Pulmonary toxoplasmosis after allogeneic bone marrow transplantation: case report and review. Bone Marrow Transplant. 1996;18:211–2.
Delhaes L, Mraz JC, Fréalle E, Durand-Joly I, Magro L, Ajzenberg D, et al. Severe pulmonary toxoplasmosis after allo-SCT in two patients: from Toxoplasma genotyping to clinical management. Bone Marrow Transplant. 2010;45:580–3.
Chandrasekar PH, Momin F, Bone Marrow Transplant Team. Disseminated toxoplasmosis in marrow recipients: a report of three cases and a review of the literature. Bone Marrow Transplant. 1997;19:685–9.
de Medeiros BC, de Medeiros CR, Werner B, Loddo G, Pasquini R, Bleggi-Torres LF. Disseminated toxoplasmosis after bone marrow transplantation: report of 9 cases. Transpl Infect Dis. 2001;3:24–8.
Small TN, Leung L, Stiles J, Kiehn TE, Malak SA, O’Reilly RJ, et al. Disseminated toxoplasmosis following T cell-depleted related and unrelated bone marrow transplantation. Bone Marrow Transplant. 2000;25:969–73.
Laibe S, Ranque S, Curtillet C, Faraut F, Dumon H, Franck J. Timely diagnosis of disseminated toxoplasmosis by sputum examination. J Clin Microbiol. 2006;44:646–8.
Atsuta Y, Morishima Y, Suzuki R, Nagamura-Inoue T, Taniguchi S, Takahashi S, et al. Comparison of unrelated cord blood transplantation and HLA-mismatched unrelated bone marrow transplantation for adults with leukemia. Biol Blood Marrow Transplant. 2012;18:780–7.
Kurokawa T, Ishiyama K, Ozaki J, Yamashita Y, Iwaki N, Saito C, et al. Haploidentical hematopoietic stem cell transplantation to adults with hematologic malignancies: analysis of 66 cases at a single Japanese center. Int J Hematol. 2010;91:661–9.
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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 98, 214–222 (2013). https://doi.org/10.1007/s12185-013-1379-8
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DOI: https://doi.org/10.1007/s12185-013-1379-8