Low seroprevalence and low incidence of infection with Toxoplasma gondii (Nicolle et Manceaux, 1908) in pediatric hematopoietic cell transplantation donors and recipients: Polish nationwide study.

Krzysztof Czyzewski,Anna Pieczonka,Agnieszka Zaucha-Prazmo,Jowita Fraczkiewicz,Jolanta Gozdzik,Malgorzata Salamonowicz,Olga Zajac-Spychala,Jan Styczynski

doi:10.14411/fp.2019.019

Abstract

Toxoplasmosis is a potentially fatal complication after hematopoietic cell transplantation (HCT). Pre-transplant seropositivity of graft recipient to Toxoplasma gondii (Nicolle et Manceaux, 1908) is an important factor for disease reactivation after HCT. As toxoplasmosis epidemiology varies all over the world, we performed a Polish nationwide retrospective cohort study to determine the seroprevalence of toxoplasmosis in donors and pediatric allogeneic and autologous HCT recipients and the incidence of clinically evident toxoplasmosis in this patient group. Polish adult donors had higher anti-T. gondii seroprevalence than Polish pediatric donors (28% vs 8%; OR = 4.4; p = 0.02) and allo-HCT recipients (28% vs 17%; OR = 1.9; p = 0.01). Clinically apparent disease occurred in 1% of allo-HCT recipients: it was diagnosed by PCR as cerebral and/or ocular toxoplasmosis and successfully treated with antiprotozoal therapy. Regarding current practice, no prospective screening for infection of T. gondii in pediatric HCT centres is being performed, but, vast majority of HCT pediatric patients are receiving anti-T. gondii active prophylaxis. Since pre-HCT T. gondii serology was not assessed in all HCT; recipients, we propose this test should be a standard practice. Standardisation of management with infection of T. gondii in children after HCT is needed.

Highlights

Toxoplasma gondii (Nicolle et Manceaux, 1908) is an intracellular parasite that causes infection in most mammals worldwide (Olariu et al 2015)
Among allo-hematopoietic cell transplantation (HCT) recipients, pre-transplant Toxoplasma gondii serology was available for 87% (250/287) patients: 19% (47/250) were IgG-positive and 81% (203/250) naive for the infection (Table 2)
There are no studies on toxoplasmosis seroprevalence in Polish HCT donors and recipients

Summary

Introduction

Toxoplasma gondii (Nicolle et Manceaux, 1908) is an intracellular parasite that causes infection in most mammals worldwide (Olariu et al 2015). T. gondii causes asymptomatic infection in immunocompetent hosts and most newborns, it can severely affect congenitally infected infants and immunocompromised patients (Martino et al 2000, Olariu et al 2015). Recent data highlighted post-HCT toxoplasmosis as a potential life-threatening disease with a poor prognosis and reported mortality rates of 60–90% if the onset is early after transplantation (Decembrino et al 2017, Prestes et al 2018). An acute, fulminating, disseminated infection or single-organ disease (usually encephalitis) is usually seen in highly immunocompromised individuals, in whom these infections appear to result from reactivation of latent tissue parasites in seropositive individuals (Martino et al 2000). Isolation of the parasite by culture in these samples would be evidence of the disease

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