Toxoplasmosis In Transplant Recipients Research Articles

Toxoplasmosis in Transplant Recipients, Europe, 2010-2014.

Transplantation activity is increasing, leading to a growing number of patients at risk for toxoplasmosis. We reviewed toxoplasmosis prevention practices, prevalence, and outcomes for hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT; heart, kidney, or liver) patients in Europe. We collected electronic data on the transplant population and prevention guidelines/regulations and clinical data on toxoplasmosis cases diagnosed during 2010–2014. Serologic pretransplant screening of allo-hematopoietic stem cell donors was performed in 80% of countries, screening of organ donors in 100%. SOT recipients were systematically screened in 6 countries. Targeted anti-Toxoplasma chemoprophylaxis was heterogeneous. A total of 87 toxoplasmosis cases were recorded (58 allo-HSCTs, 29 SOTs). The 6-month survival rate was lower among Toxoplasma-seropositive recipients and among allo-hematopoietic stem cell and liver recipients. Chemoprophylaxis improved outcomes for SOT recipients. Toxoplasmosis remains associated with high mortality rates among transplant recipients. Guidelines are urgently needed to standardize prophylactic regimens and optimize patient management.

ISSUES IN TOXOPLASMOSIS

Toxoplasma has become a well-recognized cause of disease in the last decade, primarily due to the prominence of AIDS. Diagnosis of toxoplasmic encephalitis is discussed, with emphasis on serologic tests, their pitfalls, and empiric therapeutic trials. Randomized trials for treatment of toxoplasmic encephalitis are few, but the combinations of pyrimethamine and sulfadiazine and of pyrimethamine and clindamycin appear comparable. Needs and methods for specific prophylaxis of toxoplasmic encephalitis are not well defined. It is now feasible to diagnose Toxoplasma infection in utero with a high degree of sensitivity and specificity, but whether such diagnosis is effective in the usual practice situation in the United States remains to be proved. Toxoplasmosis in transplant recipients is reviewed briefly.