Toxoplasmosis encephalitis following severe graft-vs.-host disease after allogeneic hematopoietic stem cell transplantation: 17 yr experience in Fukuoka BMT group.
Toxoplasmosis is a rare but rapidly fatal complication that can occur following hematopoietic stem cell transplantation (HSCT). Over a 17-yr period at our institutions, a definite diagnosis of toxoplasmosis was made in only two of 925 allogeneic HSCT recipients (0.22%) and none of 641 autologous HSCT recipients. These two patients received a conventional conditioning regimen followed by transplantation from an HLA-matched donor; however, they developed severe graft-vs.-host disease, which required intensive immunosuppressive therapy. Despite prophylactic treatment with trimethoprim/sulfamethoxazole, their immunosuppressive state, as indicated by a low CD4(+) cell count, might have resulted in toxoplasmosis encephalitis. Rapid and non-invasive methods such as a polymerase chain reaction (PCR) test of their cerebrospinal fluid for Toxoplasma gondii and magnetic resonance imaging of the brain were useful for providing a definitive diagnosis and prompt therapy in these patients: one patient stabilized and survived after responding to treatment with pyrimethamine/sulfodiazine whereas the other died of bacterial infection. In addition, retrospective PCR analyses of the frozen stored peripheral blood samples disclosed that detection of T. gondii preceded the onset of disease, indicating routine PCR testing of peripheral blood specimens may be an early diagnostic tool. It should be noted that when patients receiving HSCT have an unexplained fever and/or neurological complications, PCR tests should be considered to avoid cerebral lesions and improve the outcome of the patients.
Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
Yayoi
Y
Matsuo
Shoichiro
S
Takeishi
Toshihiro
T
Miyamoto
Atsushi
A
Nonami
Yoshikane
Y
Kikushige
Yuya
Y
Kunisaki
Kenjiro
K
Kamezaki
Liping
L
Tu
Hajime
H
Hisaeda
Katsuto
K
Takenaka
Naoki
N
Harada
Tomohiko
T
Kamimura
Yuju
Y
Ohno
Tetsuya
T
Eto
Takanori
T
Teshima
Hisashi
H
Gondo
Mine
M
Harada
Koji
K
Nagafuji
D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage; D044466:Asian People; D001424:Bacterial Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D018791:CD4 Lymphocyte Count; D016054:DNA, Protozoan / Q000097:blood / Q000134:cerebrospinal fluid; D004660:Encephalitis / Q000097:blood / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000134:cerebrospinal fluid / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007564:Japan; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000097:blood / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000469:parasitology / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000469:parasitology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011859:Radiography; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014122:Toxoplasma; D016781:Toxoplasmosis, Cerebral / Q000097:blood / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D000962:Antimalarials; D016054:DNA, Protozoan