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Molecular diagnosis of toxoplasmosis in immunocompromised patients: a three-year multicenter retrospective study

Florence Robert-Gangneux 1, 2 Yvon Sterkers 3, 4 Hélène Yera 5 Isabelle Accoceberry 6 Jean Menotti 7 Sophie Cassaing 8, 9 Marie-Pierre Brenier-Pinchart 10 Christophe Hennequin 11 Laurence Delhaes 12 Julie Bonhomme 13 Isabelle Villena 14, 15 Emeline Scherer 16 Frédéric Dalle 17 Feriel Touafek 18 Denis Filisetti 19 Emmanuelle Varlet-Marie 4, 3 Hervé Pelloux 10, 20 Patrick Bastien 3, 4
Abstract : Toxoplasmosis is a life-threatening infection in immunocompromised patients (ICPs). The definitive diagnosis relies on parasite DNA detection, but little is known about the incidence and burden of disease in HIV-negative patients. A 3-year retrospective study was conducted in 15 reference laboratories from the network of the French National Reference Center for Toxoplasmosis, in order to record the frequency of Toxoplasma gondii DNA detection in ICPs and to review the molecular methods used for diagnosis and the prevention measures implemented in transplant patients. During the study period, of 31,640 PCRs performed on samples from ICPs, 610 were positive (323 patients). Blood (n = 337 samples), cerebrospinal fluid (n = 101 samples), and aqueous humor (n = 100 samples) were more frequently positive. Chemoprophylaxis schemes in transplant patients differed between centers. PCR follow-up of allogeneic hematopoietic stem cell transplant (allo-HSCT) patients was implemented in 8/15 centers. Data from 180 patients (13 centers) were further analyzed regarding clinical setting and outcome. Only 68/180 (38%) patients were HIV(+); the remaining 62% consisted of 72 HSCT, 14 solid organ transplant, and 26 miscellaneous immunodeficiency patients. Cerebral toxoplasmosis and disseminated toxoplasmosis were most frequently observed in HIV and transplant patients, respectively. Of 72 allo-HSCT patients with a positive PCR result, 23 were asymptomatic; all were diagnosed in centers performing systematic blood PCR follow-up, and they received specific treatment. Overall survival of allo-HSCT patients at 2 months was better in centers with PCR follow-up than in other centers (P < 0.01). This study provides updated data on the frequency of toxoplasmosis in HIV-negative ICPs and suggests that regular PCR follow-up of allo-HSCT patients could guide preemptive treatment and improve outcome.
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Contributor : Laurent Jonchère Connect in order to contact the contributor
Submitted on : Monday, March 23, 2015 - 10:23:34 AM
Last modification on : Friday, October 22, 2021 - 3:10:10 PM

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Florence Robert-Gangneux, Yvon Sterkers, Hélène Yera, Isabelle Accoceberry, Jean Menotti, et al.. Molecular diagnosis of toxoplasmosis in immunocompromised patients: a three-year multicenter retrospective study. Journal of Clinical Microbiology, American Society for Microbiology, 2015, 53 (5), pp.1677-1684. ⟨10.1128/jcm.03282-14⟩. ⟨hal-01134189⟩



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