title: Clinical features and outcomes in patients with disseminated toxoplasmosis admitted to intensive care: a multicenter study.
abstract: BACKGROUND
  Characteristics and outcomes of adult patients with disseminated toxoplasmosis admitted to the intensive care unit (ICU) have rarely been described.
  
  
  METHODS
  We performed a retrospective study on consecutive adult patients with disseminated toxoplasmosis who were admitted from January 2002 through December 2012 to the ICUs of 14 university-affiliated hospitals in France. Disseminated toxoplasmosis was defined as microbiological or histological evidence of disease affecting >1 organ in immunosuppressed patients. Isolated cases of cerebral toxoplasmosis were excluded. Clinical data on admission and risk factors for 60-day mortality were collected.
  
  
  RESULTS
  Thirty-eight patients were identified during the study period. Twenty-two (58%) had received an allogeneic hematopoietic stem cell transplant (median, 61 [interquartile range {IQR}, 43-175] days before ICU admission), 4 (10%) were solid organ transplant recipients, and 10 (27%) were infected with human immunodeficiency virus (median CD4 cell count, 14 [IQR, 6-33] cells/µL). The main indications for ICU admission were acute respiratory failure (89%) and shock (53%). The 60-day mortality rate was 82%. Allogeneic hematopoietic stem cell transplant (hazard ratio [HR] = 2.28; 95% confidence interval [CI], 1.05-5.35; P = .04) and systolic cardiac dysfunction (HR = 3.54; 95% CI, 1.60-8.10; P < .01) within 48 hours of ICU admission were associated with mortality.
  
  
  CONCLUSIONS
  Severe disseminated toxoplasmosis leading to ICU admission has a poor prognosis. Recipients of allogeneic hematopoietic stem cell transplant appear to have the highest risk of mortality. We identified systolic cardiac dysfunction as a major determinant of outcome. Strategies aimed at preventing this fatal opportunistic infection may improve outcomes.
authors.affiliation: Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
authors.forename: David
authors.initials: D
authors.lastname: Schnell
authors.forename: Naike
authors.initials: N
authors.lastname: Bigé
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hamidfar
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mongardon
authors.forename: Vincent
authors.initials: V
authors.lastname: Castelain
authors.forename: Keyvan
authors.initials: K
authors.lastname: Razazi
authors.forename: Antoine
authors.initials: A
authors.lastname: Marty
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.forename: Martin
authors.initials: M
authors.lastname: Dres
authors.forename: Stephane
authors.initials: S
authors.lastname: Gaudry
authors.forename: Charles Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Vincent
authors.initials: V
authors.lastname: Das
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Micol
authors.forename: Alexandre
authors.initials: A
authors.lastname: Demoule
authors.forename: Julien
authors.initials: J
authors.lastname: Mayaux
mesh_terms: D000328:Adult; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012131:Respiratory Insufficiency; D012189:Retrospective Studies; D014123:Toxoplasmosis / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
keywords: allogeneic stem cell transplant; disseminated toxoplasmosis; immunosuppression; multiorgan failure; outcome assessment