Prospective study of toxoplasma reactivation by polymerase chain reaction in allogeneic stem-cell transplant recipients

Transpl Infect Dis. 2000 Sep;2(3):127-32. doi: 10.1034/j.1399-3062.2000.020305.x.

Abstract

Toxoplasmosis is a rare but life-threatening complication of allogeneic stem-cell transplantation. Polymerase chain reaction (PCR) offers the possibility to make the diagnosis earlier than conventional techniques, and is then expected to improve the prognosis. We undertook a prospective screening using a competitive PCR in blood in 32 stem-cell transplant recipients. The sampling covered the first 150 days post-transplant, at days 21, 30, 45, 60, 90, 120, and 150. Twenty-four patients had anti-toxoplasma antibodies before transplant. Three of them (12.5%) had transient PCR-positive samples at 21, 45, and 90 days post-transplant, respectively. The three PCR-positive patients were febrile but had no funduscopic examination or cerebral computerised tomography (CT) scan abnormalities. The PCR signal disappeared when the patients were given trimethoprim-sulfamethoxazole, and no full-blown toxoplasmosis was observed. Toxoplasma reactivation evidenced using PCR is frequent in seropositive patients not receiving trimethoprim-sulfamethoxazole during the 1-3 months post-transplant. Toxoplasma PCR should be included in the diagnostic strategy of fever of unexplained origin in allogeneic stem-cell transplant recipients. Then, prompt specific therapy can be initiated to avoid development of full-blown toxoplasmosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anemia, Aplastic / therapy
  • Animals
  • Anti-Infective Agents / therapeutic use
  • Antibodies, Protozoan / blood
  • Child
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Leukemia / therapy
  • Male
  • Middle Aged
  • Polymerase Chain Reaction / methods
  • Prospective Studies
  • Toxoplasma / growth & development*
  • Toxoplasma / isolation & purification
  • Toxoplasmosis / diagnosis
  • Toxoplasmosis / prevention & control*
  • Transplantation, Homologous
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Anti-Infective Agents
  • Antibodies, Protozoan
  • Trimethoprim, Sulfamethoxazole Drug Combination