Toxoplasmosis after hematopoietic stem cell transplantation.
Forty-one cases of toxoplasmosis were diagnosed in 15 European transplantation centers in patients who had undergone allogeneic hematopoietic stem cell transplantation (HSCT) from 1994 through 1998. Most patients (39 [94%]) were seropositive for Toxoplasma gondii before they underwent transplantation, and 30 (73%) had developed moderate to severe acute graft-versus-host disease before they developed toxoplasmosis. Thirty-five (85%) patients had Toxoplasma disease with evidence of organ involvement, whereas 6 (15%) patients had Toxoplasma infection, as defined by fever and a positive polymerase chain reaction (PCR) finding for T. gondii in blood. Nine patients were diagnosed at autopsy. Thirty patients (73%) had not received antimicrobial prophylaxis with anti-Toxoplasma activity after undergoing transplantation. The median day of onset of disease after HSCT was 64. Twenty-two (63%) patients died from toxoplasmosis, and 23 (66%) received adequate anti-Toxoplasma therapy for > or =3 days. Among these 23 patients, 11 (48%) showed a complete response and 3 (13%) showed improvement. In univariate and multivariate analyses, having received adequate therapy and experiencing late infection (>63 days after HSCT) were associated with a lower risk of dying from toxoplasmosis. Toxoplasmosis after HSCT is a severe infection with a high mortality rate even when diagnosed soon after HSCT, and PCR may help establish the diagnosis earlier.
Martino
R
R
Servei d'Hematologia Clínica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. rmartino@hsp.santpau.es
Maertens
J
J
Bretagne
S
S
Rovira
M
M
Deconinck
E
E
Ullmann
A J
AJ
Held
T
T
Cordonnier
C
C
D000293:Adolescent; D000328:Adult; D000818:Animals; D000981:Antiprotozoal Agents; D001344:Autopsy; D002648:Child; D002981:Clindamycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011739:Pyrimethamine; D013411:Sulfadiazine / Q000627:therapeutic use; D015996:Survival Rate; D014122:Toxoplasma / Q000302:isolation & purification*; D014123:Toxoplasmosis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000981:Antiprotozoal Agents; D013411:Sulfadiazine; D002981:Clindamycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011739:Pyrimethamine