title: Toxoplasmosis after allogeneic stem cell transplantation--a single centre experience.
abstract: Toxoplasmosis is a rare but possibly underestimated complication following allogeneic stem cell transplantation with a high mortality rate. One reason might be the limitation of the diagnostic instruments relying mainly on imaging and molecular-based techniques. In this report, we present three cases of toxoplasmosis identified among 155 allograft recipients treated at Greifswald University Hospital. Widely disseminated toxoplasmosis was detected post-mortem in two patients allografted for high-risk multiple myeloma. Clinical signs suspicious for toxoplasmosis occurred after days +32 and +75, respectively. In one case, serology and conventional Toxoplasma gondii PCR, targeting the B1 gene, revealed negative results, while in the other patient, toxoplasmosis was not investigated. Both patients received pentamidine for Pneumocystis jirovecii pneumonia (PcP) prophylaxis. The third patient, a 68-year-old woman allografted for AML, developed cerebral toxoplasmosis from day +395 after allogeneic SCT with typical signs in magnetic resonance tomography. Toxoplasma DNA was amplified from one of two samples of cerebrospinal fluid. The patient died of disseminated toxoplasmosis despite immediate initiation of therapy. Retrospective comparative testing of clinical specimens by the conventional T. gondii PCR and by a real-time PCR targeting a 529-bp genomic fragment suggests a higher sensitivity of the latter method in our patients. In conclusion, we suggest a rigorous real-time PCR monitoring for high-risk patients or patients with signs of infections suspicious for toxoplasmosis, even though low-copy results are presently difficult to interpret. Our reported cases might also encourage the use of trimethoprim-sufmethoxazole instead of pentamidine for PcP prophylaxis in those patients.
authors.affiliation: Department of Internal Medicine C (Haematology and Oncology, Marrow Transplantation), Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Busemann
authors.forename: Silvia
authors.initials: S
authors.lastname: Ribback
authors.forename: Kathrin
authors.initials: K
authors.lastname: Zimmermann
authors.forename: Verena
authors.initials: V
authors.lastname: Sailer
authors.forename: Thomas
authors.initials: T
authors.lastname: Kiefer
authors.forename: Christian A
authors.initials: CA
authors.lastname: Schmidt
authors.forename: Katrin
authors.initials: K
authors.lastname: Schulz
authors.forename: Ivo
authors.initials: I
authors.lastname: Steinmetz
authors.forename: Frank
authors.initials: F
authors.lastname: Dombrowski
authors.forename: Gottfried
authors.initials: G
authors.lastname: Dölken
authors.forename: William H
authors.initials: WH
authors.lastname: Krüger
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D012189:Retrospective Studies; D014123:Toxoplasmosis / Q000175:diagnosis* / Q000209:etiology*; D014184:Transplantation, Homologous / Q000009:adverse effects