title: Diagnosis of Toxoplasma gondii infection after allogeneic stem cell transplant can be difficult and requires intensive scrutiny.
abstract: Infectious complications remain a major problem after allogeneic hematopoietic stem cell transplant (HSCT). Specifically Toxoplasma gondii infection is a life-threatening condition in immunocompromised patients. In order to highlight the difficulties in obtaining an early and definitive diagnosis, we report three cases of toxoplasmosis after HSCT for hematologic malignancies: two cases of T. gondii retinochoroiditis, and one case of encephalitis. All patients had unrelated donors and received antithymocyte globulin; none had received trimethoprim/sulfamethoxazole prophylaxis. Toxoplasmosis occurred early post-transplant and diagnosis was obtained by real-time PCR. In one case, the correct diagnosis could only be established by PCR analysis of a retinal biopsy specimen. Rapid diagnosis--by invasive approaches--and an immediate onset of antiparasite treatment are crucial to avoid disseminated and often lethal Toxoplasma infections in the post-transplant period. Post-transplant prevention strategies and treatment to control advanced infection in this setting are discussed.
authors.affiliation: Interdisciplinary Clinic for Stem Cell Transplantation, University of Hamburg, Germany. irene.cavattoni@asbz.it
authors.forename: Irene
authors.initials: I
authors.lastname: Cavattoni
authors.forename: Francis
authors.initials: F
authors.lastname: Ayuk
authors.forename: Axel R
authors.initials: AR
authors.lastname: Zander
authors.forename: Tatjana
authors.initials: T
authors.lastname: Zabelina
authors.forename: Adelbert
authors.initials: A
authors.lastname: Bacher
authors.forename: Erdogan
authors.initials: E
authors.lastname: Cayroglu
authors.forename: Volker
authors.initials: V
authors.lastname: Knospe
authors.forename: Till
authors.initials: T
authors.lastname: Illies
authors.forename: Martin
authors.initials: M
authors.lastname: Aepfelbacher
authors.forename: Gisbert
authors.initials: G
authors.lastname: Richard
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D016054:DNA, Protozoan / Q000235:genetics; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000469:parasitology* / Q000628:therapy; D009190:Myelodysplastic Syndromes / Q000469:parasitology* / Q000628:therapy; D016133:Polymerase Chain Reaction; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000469:parasitology* / Q000628:therapy; D015996:Survival Rate; D014122:Toxoplasma / Q000235:genetics / Q000472:pathogenicity*; D014123:Toxoplasmosis / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D016054:DNA, Protozoan; D015662:Trimethoprim, Sulfamethoxazole Drug Combination