title: Molecular diagnosis of toxoplasmosis in immunocompromised patients: a 3-year multicenter retrospective study.
abstract: Toxoplasmosis is a life-threatening infection in immunocompromised patients (ICPs). The definitive diagnosis relies on parasite DNA detection, but little is known about the incidence and burden of disease in HIV-negative patients. A 3-year retrospective study was conducted in 15 reference laboratories from the network of the French National Reference Center for Toxoplasmosis, in order to record the frequency of Toxoplasma gondii DNA detection in ICPs and to review the molecular methods used for diagnosis and the prevention measures implemented in transplant patients. During the study period, of 31,640 PCRs performed on samples from ICPs, 610 were positive (323 patients). Blood (n = 337 samples), cerebrospinal fluid (n = 101 samples), and aqueous humor (n = 100 samples) were more frequently positive. Chemoprophylaxis schemes in transplant patients differed between centers. PCR follow-up of allogeneic hematopoietic stem cell transplant (allo-HSCT) patients was implemented in 8/15 centers. Data from 180 patients (13 centers) were further analyzed regarding clinical setting and outcome. Only 68/180 (38%) patients were HIV(+); the remaining 62% consisted of 72 HSCT, 14 solid organ transplant, and 26 miscellaneous immunodeficiency patients. Cerebral toxoplasmosis and disseminated toxoplasmosis were most frequently observed in HIV and transplant patients, respectively. Of 72 allo-HSCT patients with a positive PCR result, 23 were asymptomatic; all were diagnosed in centers performing systematic blood PCR follow-up, and they received specific treatment. Overall survival of allo-HSCT patients at 2 months was better in centers with PCR follow-up than in other centers (P < 0.01). This study provides updated data on the frequency of toxoplasmosis in HIV-negative ICPs and suggests that regular PCR follow-up of allo-HSCT patients could guide preemptive treatment and improve outcome.
authors.affiliation: Centre Hospitalier Universitaire de Rennes, Université Rennes 1, Service de Parasitologie-Mycologie, Rennes, France Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France florence.robert-gangneux@univ-rennes1.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Robert-Gangneux
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Centre Hospitalier Universitaire de Montpellier, Département de Parasitologie-Mycologie, UMR CNRS 5290, IRD 224, UM ("MiVEGEC"), Montpellier, France.
authors.forename: Yvon
authors.initials: Y
authors.lastname: Sterkers
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Université Paris Descartes, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Service de Parasitologie-Mycologie, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Yera
authors.affiliation: Centre Hospitalier Universitaire de Bordeaux, Service de Parasitologie-Mycologie, Bordeaux, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Accoceberry
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Université Paris Diderot, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Service de Parasitologie-Mycologie, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Menotti
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Centre Hospitalier Universitaire de Toulouse, Service de Parasitologie-Mycologie, Toulouse, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Cassaing
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Centre Hospitalier Universitaire de Grenoble, Service de Parasitologie-Mycologie, Université Joseph Fourier, Grenoble, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Brenier-Pinchart
authors.affiliation: Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Hennequin
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Centre Hospitalier Universitaire de Lille, Service de Parasitologie-Mycologie, Lille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Delhaes
authors.affiliation: Centre Hospitalier Universitaire de Caen, Service de Microbiologie, Caen, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Bonhomme
authors.affiliation: Centre Hospitalier Universitaire de Reims, Service de Parasitologie-Mycologie, Reims, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Villena
authors.affiliation: Centre Hospitalier Universitaire de Besançon, Service de Parasitologie-Mycologie, Besançon, France.
authors.forename: Emeline
authors.initials: E
authors.lastname: Scherer
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Centre Hospitalier Universitaire de Dijon, Service de Parasitologie-Mycologie, Université de Bourgogne, UMR 1347 Agroécologie, Dijon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dalle
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Hôpital Pitié Salpêtrière, Service de Parasitologie-Mycologie, Paris, France.
authors.forename: Feriel
authors.initials: F
authors.lastname: Touafek
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Centre Hospitalier Universitaire de Strasbourg, Service de Parasitologie-Mycologie Médicale, Les Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Filisetti
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Centre Hospitalier Universitaire de Montpellier, Département de Parasitologie-Mycologie, UMR CNRS 5290, IRD 224, UM ("MiVEGEC"), Montpellier, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Varlet-Marie
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Centre Hospitalier Universitaire de Grenoble, Service de Parasitologie-Mycologie, Université Joseph Fourier, Grenoble, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Pelloux
authors.affiliation: Pôle "Biologie Moléculaire" du Centre National de Référence de la Toxoplasmose, Montpellier, France Centre Hospitalier Universitaire de Montpellier, Département de Parasitologie-Mycologie, UMR CNRS 5290, IRD 224, UM ("MiVEGEC"), Montpellier, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bastien
mesh_terms: D005602:France / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D008828:Microbiological Techniques; D025202:Molecular Diagnostic Techniques; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012189:Retrospective Studies; D016019:Survival Analysis; D014122:Toxoplasma / Q000235:genetics / Q000302:isolation & purification*; D014123:Toxoplasmosis / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology / Q000473:pathology