PDF
ePub
Citation
Print
Abstract
Toxoplasmosis is an infection caused by Toxoplasma gondii. It can be lethal in immunocompromised hosts, such as a transplant recipients or patients infected with human immunodeficiency virus. In solid organ transplant recipients, toxoplasmosis results mainly from transmission of the parasite with an allograft in cases of serological mismatch. Toxoplasmosis in an immunocompromised host is associated with high mortality. Thus, early diagnosis and treatment is very important. We report on a case of toxoplasmosis in a 51-year-old male patient who had undergone deceased donor kidney transplantation. He suffered from fever of unknown origin. He was finally diagnosed with toxoplasmosis, and treated successfully with trimethoprim-sulphamethoxazole.
REFERENCES
1). Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006; 20:401–9.
2). Derouin F, Pelloux H. ESCMID Study Group on Clinical Parasitology. Prevention of toxoplasmosis in transplant patients. Clin Microbiol Infect. 2008; 14:1089–101.
3). Renoult E, Georges E, Biava MF, Hulin C, Frimat L, Hestin D, et al. Toxoplasmosis in kidney transplant recipients: a life-threatening but treatable disease. Transplant Proc. 1997; 29:821–2.
4). Fakhfakh N, Kallel K, Ennigro S, Kaouech E, Belhadj S, Chaker E. Risk factors for Toxoplasma gondii and im-mune status of pregnant women: cause and effect? Tunis Med. 2013; 91:188–90.
5). Innes EA. A brief history and overview of Toxoplasma gondii. Zoonoses Public Health. 2010; 57:1–7.
6). Wulf MW, van Crevel R, Portier R, Ter Meulen CG, Melchers WJ, van der Ven A, et al. Toxoplasmosis after renal transplantation: implications of a missed diagnosis. J Clin Microbiol. 2005; 43:3544–7.
7). Kappagoda S, Singh U, Blackburn BG. Antiparasitic therapy. Mayo Clin Proc. 2011; 86:561–83.
8). Siegel SE, Lunde MN, Gelderman AH, Halterman RH, Brown JA, Levine AS, et al. Transmission of toxoplasmosis by leukocyte transfusion. Blood. 1971; 37:388–94.
9). Caballero-Ortega H, Uribe-Salas FJ, Conde-Glez CJ, Cedillo-Pelaez C, Vargas-Villavicencio JA, Luna-Pastén H, et al. Seroprevalence and national distribution of human toxoplasmosis in Mexico: analysis of the 2000 and 2006 National Health Surveys. Trans R Soc Trop Med Hyg. 2012; 106:653–9.
10). Hill D, Dubey JP. Toxoplasma gondii: transmission, diagnosis and prevention. Clin Microbiol Infect. 2002; 8:634–40.
11). Renoult E, Georges E, Biava MF, Hulin C, Frimat L, Hestin D, et al. Toxoplasmosis in kidney transplant recipients: report of six cases and review. Clin Infect Dis. 1997; 24:625–34.
12). Vaughan LB, Wenzel RP. Disseminated toxoplasmosis presenting as septic shock five weeks after renal transplantation. Transpl Infect Dis. 2013; 15:E20–4.
13). Renoult E, Biava MF, Hulin C, Frimat L, Hestin D, Kessler M. Transmission of toxoplasmosis by renal transplant: a report of four cases. Transplant Proc. 1996; 28:181–3.
14). Fricker-Hidalgo H, Bulabois CE, Brenier-Pinchart MP, Hamidfar R, Garban F, Brion JP, et al. Diagnosis of toxoplasmosis after allogeneic stem cell transplantation: results of DNA detection and serological techniques. Clin Infect Dis. 2009; 48:e9–15.
15). Lappalainen M, Hedman K. Serodiagnosis of toxoplasmosis. The impact of measurement of IgG avidity. Ann Ist Super Sanita. 2004; 40:81–8.
16). Khalifa Ke-S, Roth A, Roth B, Arasteh KN, Janitschke K. Value of PCR for evaluating occurrence of parasitemia in immunocompromised patients with cerebral and ex-tracerebral toxoplasmosis. J Clin Microbiol. 1994; 32:2813–9.
17). Burg JL, Grover CM, Pouletty P, Boothroyd JC. Direct and sensitive detection of a pathogenic protozoan, Toxoplasma gondii, by polymerase chain reaction. J Clin Microbiol. 1989; 27:1787–92.
18). Bretagne S, Costa JM, Foulet F, Jabot-Lestang L, Baud- Camus F, Cordonnier C. Prospective study of toxoplasma reactivation by polymerase chain reaction in allogeneic stem-cell transplant recipients. Transpl Infect Dis. 2000; 2:127–32.
19). Costa JM, Munoz C, Krüger D, Martino R, Held TK, Dardé ML, et al. Quality control for the diagnosis of Toxoplasma gondii reactivation in SCT patients using PCR assays. Bone Marrow Transplant. 2001; 28:527–8.
20). Dabil H, Boley ML, Schmitz TM, Van Gelder RN. Validation of a diagnostic multiplex polymerase chain reaction assay for infectious posterior uveitis. Arch Ophthalmol. 2001; 119:1315–22.
21). Julander I, Martin C, Lappalainen M, Guy E, Isberg B, Evengård B. Polymerase chain reaction for diagnosis of cerebral toxoplasmosis in cerebrospinal fluid in HIV-positive patients. Scand J Infect Dis. 2001; 33:538–41.
22). Gallino A, Maggiorini M, Kiowski W, Martin X, Wun-derli W, Schneider J, et al. Toxoplasmosis in heart transplant recipients. Eur J Clin Microbiol Infect Dis. 1996; 15:389–93.
23). Wreghitt TG, Hakim M, Gray JJ, Balfour AH, Stovin PG, Stewart S, et al. Toxoplasmosis in heart and heart and lung transplant recipients. J Clin Pathol. 1989; 42:194–9.
24). Valar C, Keitel E, Dal Prá RL, Gnatta D, Santos AF, Bianco PD, et al. Parasitic infection in renal transplant recipients. Transplant Proc. 2007; 39:460–2.
25). Guerina NG, Hsu HW, Meissner HC, Maguire JH, Lynfield R, Stechenberg B, et al. Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection. The New England Regional Toxoplasma Working Group. N Engl J Med. 1994; 330:1858–63.
26). Schmidt DR, Hogh B, Andersen O, Hansen SH, Dalhoff K, Petersen E. Treatment of infants with congenital toxoplasmosis: tolerability and plasma concentrations of sulfadiazine and pyrimethamine. Eur J Pediatr. 2006; 165:19–25.
27). Soheilian M, Sadoughi MM, Ghajarnia M, Dehghan MH, Yazdani S, Behboudi H, et al. Prospective random-ized trial of trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine in the treatment of ocular toxoplasmosis. Ophthalmology. 2005; 112:1876–82.
28). Torre D, Casari S, Speranza F, Donisi A, Gregis G, Poggio A, et al. Randomized trial of trimethoprim-sulfa-methoxazole versus pyrimethamine-sulfadiazine for therapy of toxoplasmic encephalitis in patients with AIDS. Italian Collaborative Study Group. Antimicrob Agents Chemother. 1998; 42:1346–9.
29). Gourishankar S, Doucette K, Fenton J, Purych D, Kowa-lewska-Grochowska K, Preiksaitis J. The use of donor and recipient screening for toxoplasma in the era of uni-versal trimethoprim sulfamethoxazole prophylaxis. Transplantation. 2008; 85:980–5.
30). Keating MR, Wilhelm MP, Walker RC. Strategies for prevention of infection after cardiac transplantation. Mayo Clin Proc. 1992; 67:676–84.
31). Keogh A, Macdonald P, Richens D, Harvison A, Spratt P. Mini-dose trimethoprim with sulphamethoxazole pre-vents pneumocystis and toxoplasmosis infections after heart transplantation. Transplant Proc. 1992; 24:2263.
32). Baran DA, Alwarshetty MM, Alvi S, Arroyo LH, Lubitz S, Pinney S, et al. Is toxoplasmosis prophylaxis necessary in cardiac transplantation? Long-term follow-up at two transplant centers. J Heart Lung Transplant. 2006; 25:1380–2.
33). Baden LR, Katz JT, Franck L, Tsang S, Hall M, Rubin RH, et al. Successful toxoplasmosis prophylaxis after orthotopic cardiac transplantation with trimethoprim-sulfa-methoxazole. Transplantation. 2003; 75:339–43.
34). Foot AB, Garin YJ, Ribaud P, Devergie A, Derouin F, Gluckman E. Prophylaxis of toxoplasmosis infection with pyrimethamine/sulfadoxine (Fansidar) in bone marrow transplant recipients. Bone Marrow Transplant. 1994; 14:241–5.
XML Download