title: Correlation of parasite load determined by quantitative PCR to clinical outcome in a heart transplant patient with disseminated toxoplasmosis.
abstract: Disseminated toxoplasmosis is a life-threatening infection in transplant recipients, which results either from reactivation of latent infection or from organ-transmitted primary infection. Preventive measures and diagnostic screening methods differ between countries and are related to the seroprevalence of Toxoplasma spp. in the general population. Here we report a case of disseminated toxoplasmosis in a heart transplant recipient with previous immunity that occurred after cotrimoxazole prophylaxis for the prevention of Pneumocystis jirovecii pneumonia was stopped. Quantitative PCR proved useful for the diagnosis and monitoring of Toxoplasma infection. Decreasing parasitic burdens in sequential samples of cerebrospinal fluid, blood, and bronchoalveolar lavage fluid correlated with a favorable outcome and allowed modulation of the immunosuppressive drug regimen. The duration of anti-Toxoplasma treatment and the need for maintenance prophylaxis are discussed, as well as prophylaxis for solid-organ transplant recipients. Although a rare event in heart transplant recipients, Toxoplasma reactivation must be investigated promptly, since early treatment improves the prognosis.
authors.affiliation: Service de Réanimation Médicale et Maladies Infectieuses, Centre Hospitalier et Universitaire de Rennes, Rennes, France.
authors.forename: Solène
authors.initials: S
authors.lastname: Patrat-Delon
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Gangneux
authors.forename: Sylvain
authors.initials: S
authors.lastname: Lavoué
authors.forename: Bernard
authors.initials: B
authors.lastname: Lelong
authors.forename: Claude
authors.initials: C
authors.lastname: Guiguen
authors.forename: Yves
authors.initials: Y
authors.lastname: le Tulzo
authors.forename: Florence
authors.initials: F
authors.lastname: Robert-Gangneux
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000913:Antibodies, Protozoan; D016054:DNA, Protozoan / Q000032:analysis*; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008297:Male; D051379:Mice; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D014122:Toxoplasma / Q000235:genetics / Q000302:isolation & purification; D014123:Toxoplasmosis / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D000913:Antibodies, Protozoan; D016054:DNA, Protozoan; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
references.citation: Transpl Int. 2000;13(6):448-52
references.pmid: 11140244
references.citation: Pediatr Infect Dis J. 2010 Jan;29(1):33-8
references.pmid: 19858771
references.citation: Transplantation. 2003 Feb 15;75(3):339-43
references.pmid: 12589155
references.citation: Transpl Infect Dis. 2002 Jun;4(2):93-6
references.pmid: 12220246
references.citation: Clin Ther. 1996 Nov-Dec;18(6):1037-56; discussion 1036
references.pmid: 9001822
references.citation: Transpl Immunol. 2007 Nov;18(2):193-7
references.pmid: 18005867
references.citation: Clin Infect Dis. 2001 Jul 1;33 Suppl 1:S26-31
references.pmid: 11389519
references.citation: Clin Infect Dis. 2009 Jan 15;48(2):e9-e15
references.pmid: 19072243
references.citation: Clin Infect Dis. 1992 Aug;15(2):267-70
references.pmid: 1520761
references.citation: J Infect. 1994 Nov;29(3):249-53
references.pmid: 7884217
references.citation: Bone Marrow Transplant. 2010 Mar;45(3):580-3
references.pmid: 19597419
references.citation: Clin Infect Dis. 1992 Apr;14(4):847-51
references.pmid: 1576279
references.citation: Clin Infect Dis. 2005 Jan 1;40(1):67-78
references.pmid: 15614694
references.citation: Transpl Infect Dis. 2008 Feb;10(1):71-4
references.pmid: 17605745
references.citation: Clin Infect Dis. 2003 Apr 1;36(7):932-3; author reply 933
references.pmid: 12652396
references.citation: Transpl Infect Dis. 2005 Mar;7(1):38-40
references.pmid: 15984948
references.citation: J Heart Lung Transplant. 2006 Nov;25(11):1380-2
references.pmid: 17097506
references.citation: J Clin Microbiol. 2002 May;40(5):1648-50
references.pmid: 11980935
references.citation: Eur J Clin Microbiol Infect Dis. 2002 May;21(5):353-61
references.pmid: 12072919
references.citation: Bone Marrow Transplant. 1994 Aug;14(2):241-5
references.pmid: 7994239
references.citation: J Infect Dis. 2009 Apr 15;199(8):1155-67
references.pmid: 19265484
references.citation: Clin Microbiol Infect. 2008 Dec;14(12):1089-101
references.pmid: 19018809
references.citation: Pediatr Blood Cancer. 2007 Feb;48(2):222-6
references.pmid: 16333839
references.citation: J Clin Microbiol. 2003 Nov;41(11):5313-6
references.pmid: 14605193
references.citation: J Clin Microbiol. 2005 Jul;43(7):3544-7
references.pmid: 16000502
references.citation: Eur J Clin Microbiol Infect Dis. 2000 Feb;19(2):89-95
references.pmid: 10746493
references.citation: J Clin Pathol. 1989 Feb;42(2):194-9
references.pmid: 2493490
references.citation: Transplantation. 2008 Apr 15;85(7):980-5
references.pmid: 18408578
references.citation: Transpl Infect Dis. 2000 Sep;2(3):127-32
references.pmid: 11429023
references.citation: Am J Trop Med Hyg. 2009 Apr;80(4):583-7
references.pmid: 19346380
references.citation: Ann Intern Med. 1983 Jul;99(1):27-31
references.pmid: 6344718
references.citation: Eur J Clin Microbiol Infect Dis. 1996 May;15(5):389-93
references.pmid: 8793397
references.citation: Clin Infect Dis. 2001 Sep 1;33(5):629-40
references.pmid: 11486285