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Infections Post Transplant

Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature

Bone Marrow Transplantation volume 29, pages 691–698 (2002)Cite this article

Abstract

Toxoplasma infection represents a rare but often fatal complication in bone marrow transplant (BMT) recipients. We report two cases of toxoplasmosis: one of successfully treated cerebral toxoplasmosis after peripheral blood stem cell transplantation, and a fatal case of pulmonary toxoplasmosis in a BMT recipient. We have systematically reviewed the 110 published cases of toxoplasmosis following BMT. We analyzed the pre-transplant and clinical features of BMT recipients developing toxoplasmosis, together with the diagnostic procedures used and treatment given. By univariate and multivariate statistical analysis we analyzed the risk factors for diagnosis (during life vs post-mortem) and Toxoplasma-related mortality. Ante-mortem diagnosis was made in 47% of cases. Site of infection (P = 0.02; odds ratio 10.8), presence of symptoms at onset (P = 0.01) and conditioning regimen (P = 0.04) were factors influencing whether the diagnosis was made before or after death. Overall mortality rate was 80% and that attributed to toxoplasmosis was 66%. Variables influencing outcome were: site of infection (P = 0.02; odds ratio 5.28), day of onset (P = 0.04) and conditioning regimen (P = 0.04). Underlying disease (P = 0.02; odds ratio 9.45), among patients diagnosed before death, was the most significant factor influencing outcome.

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Acknowledgements

The authors thank Dr Massimo Offidani (Department of Haematology, University School of Medicine, Ancona) for his assistance in reviewing the manuscript; Dr Richard Morris and Dr Alessandro Cozzi Lepri (Department of Primary Care and Population Services, Royal Free and University College Medical School, London) for their advice on statistical issues; Rita Drobner for review of the German literature and Clare Ling for her technical support (Department of Microbiology, Royal Free Campus and Royal Free Hospital, London). Dr Anna Mele is supported by a University Scholarship from the University School of Medicine, Ancona.

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Authors and Affiliations

  1. Department of Haematology, Royal Free and University College Medical School, London, UK

    A Mele, PJ Paterson & HG Prentice

  2. Department of Microbiology, Royal Free and University College Medical School, London, UK

    PJ Paterson & CC Kibbler

  3. Department of Haematology, University School of Medicine, Ancona, Italy

    A Mele & P Leoni

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Mele, A., Paterson, P., Prentice, H. et al. Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature. Bone Marrow Transplant 29, 691–698 (2002). https://doi.org/10.1038/sj.bmt.1703425

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