Toxoplasma gondii primary infection in renal transplant recipients. Two case reports and literature review.
Toxoplasmosis after solid organ transplantation is a complication associated with high morbidity and mortality. Universal prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is effective to prevent post-transplant toxoplasmosis. We report two cases of renal transplant recipients with negative antibodies against Toxoplasma gondii pretransplant who developed toxoplasmosis after TMP-SMX discontinuation. We have also performed a review of published cases of primary toxoplasmosis after renal transplantation. Of 20 cases reviewed, 11 were male and the mean age was 37.8 years (SD = 13.8). Donor serology for T. gondii was determined in 15 donors, two of them (13%) with negative immunoglobulin (Ig)G and four (27%) with positive IgG and IgM antibodies. Fever was present in 85% of primary toxoplasmosis and hematologic abnormalities were observed in 69% of the cases. Ten patients died (50%). All patients with fatal outcomes had clinical evidence of toxoplasmosis during the early post-transplant period (first 90 days), while no patient with late toxoplasmosis died (P = 0.003). Primary toxoplasmosis is associated with high mortality rates and TMP-SMX prophylaxis can delay the onset of symptoms resulting in an improvement of prognosis.
Renal Transplant Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
María-Noel
MN
Martina
Carlos
C
Cervera
Nuria
N
Esforzado
Laura
L
Linares
Vicenç
V
Torregrosa
Gemma
G
Sanclemente
Irma
I
Hoyo
Federico
F
Cofan
Federico
F
Oppenheimer
Jose M
JM
Miro
Jose María
JM
Campistol
Asunción
A
Moreno
D000293:Adolescent; D000328:Adult; D000913:Antibodies, Protozoan / Q000032:analysis; D053626:Atovaquone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D014122:Toxoplasma / Q000276:immunology; D014123:Toxoplasmosis / Q000188:drug therapy / Q000517:prevention & control*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000913:Antibodies, Protozoan; D007075:Immunoglobulin M; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D053626:Atovaquone