Transmission of Toxoplasmosis by Leukocyte (WBC) Transfusion

Abstract

Disseminated toxoplamosis infections without an obvious source have been documented frequently in cancer patients. Two children with acute leukemia given WBC transfusions for granulocytopenia from a donor with chronic myelogenous leukemia (CML) developed toxoplasma gondii infection. The CML donor, with no history of toxoplasma infection had received no anti-leukemic therapy prior to leukapheresis and remained clinically well. The first child was given 0.35 × 1011 CML leukocytes. Three weeks later she developed skin rash, pneumonia, congestive heart failure, hepatitis, and seizures, accompanied by a rising toxoplasma dye titer to 1:8,000 (IgM = 1:160). She expired 3 months later with disseminated toxoplasmosis. The second child received 2.5×1011 leukocytes over a 7-day period four weeks prior to splenectomy for an E. coli splenic abscess. Concomitantly, her dye titer rose to 1:128 (IgM = 1:40). Toxoplasma gondii was isolated from the spleen and a single toxoplasma cyst was found on histologic examination. She died 1 month following surgery with toxoplasma cysts found in the lung and heart at necropsy. Retrospective examination of stored serum samples from the CML donor revealed that at the time of WBC donation she had a toxoplasma dye titer of 1:8,000 (IgM = 1:10, CF = 1:16). Leukocytes from the same donor were given to other leukemic patients. Both died within one week of transfusion without pathologic evidence of toxoplasma infection. Toxoplasma infection in two patients receiving leukocyte transfusions from a CML donor with serologic evidence of toxoplasmosis suggests the role of WBCs in the transmission of this dissease.