Correlation of parasite load determined by quantitative PCR to clinical outcome in a heart transplant patient with disseminated toxoplasmosis.
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 jirovecii 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.
Keywords
DNA
Protozoan/analysis
Heart Transplantation
Humans
Immunosuppression/adverse effects
Male
Mice
Middle Aged
Polymerase Chain Reaction/methods
Toxoplasma/genetics
Toxoplasma/isolation & purification
Toxoplasmosis/diagnosis
Toxoplasmosis/drug therapy
Toxoplasmosis/parasitology
Trimethoprim-Sulfamethoxazole Combination/therapeutic use
Animals
Anti-Infective Agents/therapeutic use
Antibodies
Protozoan