Prospective study of toxoplasma reactivation by polymerase chain reaction in allogeneic stem-cell transplant recipients.
Toxoplasmosis is a rare but life-threatening complication of allogeneic stem-cell transplantation. Polymerase chain reaction (PCR) offers the possibility to make the diagnosis earlier than conventional techniques, and is then expected to improve the prognosis. We undertook a prospective screening using a competitive PCR in blood in 32 stem-cell transplant recipients. The sampling covered the first 150 days post-transplant, at days 21, 30, 45, 60, 90, 120, and 150. Twenty-four patients had anti-toxoplasma antibodies before transplant. Three of them (12.5%) had transient PCR-positive samples at 21, 45, and 90 days post-transplant, respectively. The three PCR-positive patients were febrile but had no funduscopic examination or cerebral computerised tomography (CT) scan abnormalities. The PCR signal disappeared when the patients were given trimethoprim-sulfamethoxazole, and no full-blown toxoplasmosis was observed. Toxoplasma reactivation evidenced using PCR is frequent in seropositive patients not receiving trimethoprim-sulfamethoxazole during the 1-3 months post-transplant. Toxoplasma PCR should be included in the diagnostic strategy of fever of unexplained origin in allogeneic stem-cell transplant recipients. Then, prompt specific therapy can be initiated to avoid development of full-blown toxoplasmosis.
Bretagne
S
S
Laboratoire de Parasitologie-Mycologie, Hôpital Henri Mondor, Créteil, France. bretagne@univ-paris12.fr
Costa
J M
JM
Foulet
F
F
Jabot-Lestang
L
L
Baud-Camus
F
F
Cordonnier
C
C
D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000913:Antibodies, Protozoan / Q000097:blood; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D014122:Toxoplasma / Q000254:growth & development* / Q000302:isolation & purification; D014123:Toxoplasmosis / Q000175:diagnosis / Q000517:prevention & control*; D014184:Transplantation, Homologous; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D000913:Antibodies, Protozoan; D015662:Trimethoprim, Sulfamethoxazole Drug Combination