1. Correlation of parasite load determined by quantitative PCR to clinical outcome in a heart transplant patient with disseminated toxoplasmosis
- Author
-
Florence Robert-Gangneux, Claude Guiguen, Bernard Lelong, Sylvain Lavoué, Yves Le Tulzo, Jean-Pierre Gangneux, Solène Patrat-Delon, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Signalisation et Réponses aux Agents Infectieux et Chimiques (SeRAIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Centre de recherches (CRT), Société Lafarge, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], and Université de Rennes (UR)
- Subjects
Male ,Polymerase Chain Reaction/methods ,medicine.medical_treatment ,Anti-Infective Agents/therapeutic use ,Antibodies, Protozoan ,Polymerase Chain Reaction ,Protozoan/analysis ,Mice ,0302 clinical medicine ,Anti-Infective Agents ,030212 general & internal medicine ,Immunosuppression/adverse effects ,Heart transplantation ,0303 health sciences ,education.field_of_study ,medicine.diagnostic_test ,Immunosuppression ,Middle Aged ,3. Good health ,Toxoplasma/isolation & purification ,Immunosuppressive drug ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,Protozoan ,Toxoplasmosis/parasitology ,Toxoplasma ,Toxoplasmosis ,Microbiology (medical) ,medicine.medical_specialty ,Population ,Biology ,Antibodies ,03 medical and health sciences ,Toxoplasmosis/diagnosis ,Internal medicine ,Trimethoprim, Sulfamethoxazole Drug Combination ,parasitic diseases ,medicine ,Animals ,Humans ,education ,Immunosuppression Therapy ,030306 microbiology ,DNA ,DNA, Protozoan ,medicine.disease ,Toxoplasmosis/drug therapy ,Transplantation ,Regimen ,Bronchoalveolar lavage ,Toxoplasma/genetics ,Immunology ,Heart Transplantation ,Parasitology ,Trimethoprim-Sulfamethoxazole Combination/therapeutic use - Abstract
Disseminated toxoplasmosis is a life-threatening infection in transplant recipients, which results either from reactivation of latent infection or from organ-transmitted primary infection. Preventive measures and diagnostic screening methods differ between countries and are related to the seroprevalence of Toxoplasma spp. in the general population. Here we report a case of disseminated toxoplasmosis in a heart transplant recipient with previous immunity that occurred after cotrimoxazole prophylaxis for the prevention of Pneumocystis jiroveci i pneumonia was stopped. Quantitative PCR proved useful for the diagnosis and monitoring of Toxoplasma infection. Decreasing parasitic burdens in sequential samples of cerebrospinal fluid, blood, and bronchoalveolar lavage fluid correlated with a favorable outcome and allowed modulation of the immunosuppressive drug regimen. The duration of anti- Toxoplasma treatment and the need for maintenance prophylaxis are discussed, as well as prophylaxis for solid-organ transplant recipients. Although a rare event in heart transplant recipients, Toxoplasma reactivation must be investigated promptly, since early treatment improves the prognosis.
- Published
- 2010
- Full Text
- View/download PDF