Open forum infectious diseases · 2025
Usefulness and Limitations of Polymerase Chain Reaction (PCR) for the Diagnosis and Management of Toxoplasmosis Following Allogeneic Hematopoietic Cell Transplant: Single-center Experience With 31 Patients Over 16 Years.
СтатьяНазвание и аннотация: Перевод в очереди
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Czech Mary M, Jerussi Theresa, Das Sanchita, Lee Rose, Kanakry Christopher G, Kanakry Jennifer, Dimitrova Dimana, Hyder Mustafa A, Rechache Kamil, Trang Winnie, Fowler Daniel H, Bishop Michael R, Childs Richard W, Aue Georg, Tisdale John, Hsieh Matthew, Fitzhugh Courtney, Limerick Emily, Hickstein Dennis, Malech Harry L, Kang Elizabeth M, Pavletic Steven, Arnold Danielle E, Pai Sung-Yun, Cuellar-Rodriguez Jennifer, Gea-Banacloche Juan C
Аннотация
BACKGROUND: Toxoplasmosis is an early post-transplant complication in recipients of allogeneic hematopoietic cell transplant (HCT), typically arising from reactivation of latent infection. Toxoplasma gondii polymerase chain reaction (PCR) has improved detection.
METHODS: Single-center, retrospective review of allogeneic HCT recipients who developed toxoplasmosis from August 2008 to November 2024.
RESULTS: We identified 31 cases of toxoplasmosis among 1235 HCT recipients. Ten had infection and 21 had end-organ disease. Fever was the most common clinical manifestation (74.2%). Patients with pulmonary or central nervous system disease often lacked organ-specific symptoms. Toxoplasmosis primarily occurred in patients not on prophylaxis (90.3%), at a median of 28 days post-HCT (interquartile range 20-69 days). Whole blood Toxoplasma PCR diagnosed 80.6% cases and showed a cumulative sensitivity of 93.3%. However, PCR was not always positive at symptom onset, and some asymptomatic patients already had end-organ disease at the time of first PCR positivity. Trimethoprim-sulfamethoxazole (TMP-SMX) was the most used treatment (48.4%). Mortality directly attributable to toxoplasmosis was 12.9%, but all-cause mortality was 61.3%.
CONCLUSIONS: Toxoplasmosis is an early post-HCT complication with high morbidity and mortality. Prophylaxis is essential. TMP-SMX is effective, but sometimes it is withheld early post-HCT due to potential myelotoxicity. Given the short window between infection and progression to disease, we recommend twice-weekly monitoring with whole blood PCR while off TMP-SMX and early initiation of TMP-SMX post-HCT for Toxoplasma seropositive patients. Atovaquone may be considered as a bridging prophylaxis until TMP-SMX is started, but its absorption may be compromised early post-HCT and breakthrough cases have been reported.
METHODS: Single-center, retrospective review of allogeneic HCT recipients who developed toxoplasmosis from August 2008 to November 2024.
RESULTS: We identified 31 cases of toxoplasmosis among 1235 HCT recipients. Ten had infection and 21 had end-organ disease. Fever was the most common clinical manifestation (74.2%). Patients with pulmonary or central nervous system disease often lacked organ-specific symptoms. Toxoplasmosis primarily occurred in patients not on prophylaxis (90.3%), at a median of 28 days post-HCT (interquartile range 20-69 days). Whole blood Toxoplasma PCR diagnosed 80.6% cases and showed a cumulative sensitivity of 93.3%. However, PCR was not always positive at symptom onset, and some asymptomatic patients already had end-organ disease at the time of first PCR positivity. Trimethoprim-sulfamethoxazole (TMP-SMX) was the most used treatment (48.4%). Mortality directly attributable to toxoplasmosis was 12.9%, but all-cause mortality was 61.3%.
CONCLUSIONS: Toxoplasmosis is an early post-HCT complication with high morbidity and mortality. Prophylaxis is essential. TMP-SMX is effective, but sometimes it is withheld early post-HCT due to potential myelotoxicity. Given the short window between infection and progression to disease, we recommend twice-weekly monitoring with whole blood PCR while off TMP-SMX and early initiation of TMP-SMX post-HCT for Toxoplasma seropositive patients. Atovaquone may be considered as a bridging prophylaxis until TMP-SMX is started, but its absorption may be compromised early post-HCT and breakthrough cases have been reported.