Transpl Int. 2010 Oct 19. doi: 10.1111/j.1432-2277.2010.01173.x. [Epub ahead of print]
Toxoplasma gondii primary infection in renal transplant recipients. Two case reports and literature review
Martina MN, Cervera C, Esforzado N, Linares L, Torregrosa V, Sanclemente G, Hoyo I, Cofan F, Oppenheimer F, Miro JM, Campistol JM, Moreno A.
Renal Transplant Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain Infectious Diseases Service, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
Toxoplasmosis after solid organ transplantation is a complication associated with high morbidity and mortality. Universal prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is effective to prevent post-transplant toxoplasmosis. We report two cases of renal transplant recipients with negative antibodies against Toxoplasma gondii pretransplant who developed toxoplasmosis after TMP-SMX discontinuation. We have also performed a review of published cases of primary toxoplasmosis after renal transplantation. Of 20 cases reviewed, 11 were male and the mean age was 37.8 years (SD = 13.8). Donor serology for T. gondii was determined in 15 donors, two of them (13%) with negative immunoglobulin (Ig)G and four (27%) with positive IgG and IgM antibodies. Fever was present in 85% of primary toxoplasmosis and hematologic abnormalities were observed in 69% of the cases. Ten patients died (50%). All patients with fatal outcomes had clinical evidence of toxoplasmosis during the early post-transplant period (first 90 days), while no patient with late toxoplasmosis died (P = 0.003). Primary toxoplasmosis is associated with high mortality rates and TMP-SMX prophylaxis can delay the onset of symptoms resulting in an improvement of prognosis.
© 2010 The Authors. Transplant International © 2010 European Society for Organ Transplantation.
PMID: 20955469 [PubMed - as supplied by publisher]