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A case-series of Toxoplasmosis in hematopoietic stem cell transplantation: still a concern for endemic countries

Bone Marrow Transplantation volume 53, pages 1336–1339 (2018)Cite this article

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Toxoplasmosis, among hematopoietic stem cell transplant (HSCT) recipients, was formerly considered as a rare disease with incidences reported varying from 0.8 to 8% depending on the seroprevalence of T. gondii in the studied population [1, 2]. However, recent data highlighted post-HSCT toxoplasmosis as a potential life-threatening disease with a poor prognosis and reported mortality rates of up to 60% [3, 4]. Additionally, it has been shown that a considerable part of post-HSCT cases are diagnosed only after death, especially in those patients with disseminated disease [3, 4].

Post-HSCT toxoplasmosis is usually a result of a reactivation of a latent infection in seropositive patients instead of a primary infection [5]. Moreover, in this setting T. gondii may cause a severe invasive single-organ disease and the brain is the most frequently affected site, although disseminated disease has also been reported [6]. Most cases occur within the first 100 days after transplant and the highest-risk patients are seropositive allo-HSCT recipients who have received cord blood transplant, unrelated donor graft, T-cell depleted transplants, those who had high-grade graft-versus-host disease (GVHD), or are unable to take trimethoprin-sulphametoxazole (TMP/SMX) for Pneumocystis jirovecii prophylaxis (PJP) [2, 7].

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Acknowledgements

Presented in abstract form at ECCMID 2017, Viena, AU. Abstract 350

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This work was supported with departmental funds.

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Authors and Affiliations

  1. Division of Infectious Diseases, Hospital das Clínicas, São Paulo University, São Paulo, Brazil

    Daniel P. Prestes, Clara Mendes, Marjorie V. Batista, Jéssica F. Ramos & Silvia Figueiredo Costa

  2. Division of Hematology and Bone Marrow Transplant, Hospital das Clínicas, São Paulo University, São Paulo, Brazil

    Marjorie V. Batista, Jéssica F. Ramos, Jayr Schimidt Junior, Vanderson G. Rocha & Silvia Figueiredo Costa

  3. Tropical Medicine Institute, São Paulo University, São Paulo, Brazil

    Thelma Suely Okay & Silvia Figueiredo Costa

  4. Laboratory of Molecular Biology, Hospital das Clínicas, São Paulo University, São Paulo, Brazil

    Helio Caiaffa

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Correspondence to Daniel P. Prestes or Silvia Figueiredo Costa.

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Prestes, D.P., Mendes, C., Batista, M.V. et al. A case-series of Toxoplasmosis in hematopoietic stem cell transplantation: still a concern for endemic countries. Bone Marrow Transplant 53, 1336–1339 (2018). https://doi.org/10.1038/s41409-018-0179-4

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