title: Risk factors, clinical features, and outcomes of toxoplasmosis in solid-organ transplant recipients: a matched case-control study.
abstract: BACKGROUND
  Solid-organ transplant (SOT) recipients are considered to be at increased risk for toxoplasmosis. However, risk factors for this infection have not been assessed. The aim of this study was to determine the risk factors, clinical features, and outcomes of toxoplasmosis in SOT recipients.
  
  
  METHODS
  A multicenter, matched case-control study (1:2 ratio) was conducted between 2000 and 2009. Control subjects were matched for center, transplant type, and timing. Cases were identified from the hospitals' microbiology and transplantation program databases. Logistic regression was performed to identify independent risk factors.
  
  
  RESULTS
  Twenty-two cases (0.14%) of toxoplasmosis were identified among 15 800 SOTs performed in 11 Spanish hospitals, including 12 heart, 6 kidney, and 4 liver recipients. Diagnosis was made by seroconversion (n = 17), histopathologic examination (n = 5), polymerase chain reaction (n = 2), and autopsy (n = 2). In a comparison of case patients with 44 matched control subjects, a negative serostatus prior to transplantation was the only independent risk factor for toxoplasmosis (odds ratio, 15.12 [95% confidence interval, 2.37-96.31]; P = .004). The median time to diagnosis following transplantation was 92 days. Primary infection occurred in 18 (81.8%) cases. Manifestations included pneumonitis (n = 7), myocarditis (n = 5), brain abscesses (n = 5), chorioretinitis (n = 3), lymph node enlargement (n = 2), hepatosplenomegaly (n = 2), and meningitis (n =1). Five patients (22.7%) had disseminated disease. Crude mortality rate was 13.6% (3 of 22 patients).
  
  
  CONCLUSIONS
  Although uncommon, toxoplasmosis in SOT patients causes substantial morbidity and mortality. Seronegative recipients are at high risk for developing toxoplasmosis and should be given prophylaxis and receive careful follow-up.
authors.affiliation: Infectious Disease Service, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)-Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Fernàndez-Sabé
authors.forename: Carlos
authors.initials: C
authors.lastname: Cervera
authors.forename: M Carmen
authors.initials: MC
authors.lastname: Fariñas
authors.forename: Marta
authors.initials: M
authors.lastname: Bodro
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Mercè
authors.initials: M
authors.lastname: Gurguí
authors.forename: Julián
authors.initials: J
authors.lastname: Torre-Cisneros
authors.forename: Pilar
authors.initials: P
authors.lastname: Martín-Dávila
authors.forename: Ana
authors.initials: A
authors.lastname: Noblejas
authors.forename: Oscar
authors.initials: O
authors.lastname: Len
authors.forename: Ana
authors.initials: A
authors.lastname: García-Reyne
authors.forename: José Luis
authors.initials: JL
authors.lastname: Del Pozo
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011241:Prednisone / Q000494:pharmacology; D012307:Risk Factors; D014123:Toxoplasmosis / Q000209:etiology* / Q000473:pathology*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D011241:Prednisone