Toxoplasmosis in transplant patients

Toxoplasmosis is an uncommon cause of disease in transplanted patients in the Nordic countries. Historically, it has been a problem in recipients of heart transplants and in patients with combined heart and lung transplantations. International studies show an incidence between 6 and 10% of all heart transplanted patients. The sero-prevalence in immunocompetent adults in Sweden is essentially around 15%. The vast majority of these patients who contract toxoplasmosis reject the transplanted organ despite the fact that reactivation of latent infection is a possibility. When a sero-negative recipient receives an organ from a sero-positive donor, the risk of developing primary toxolasmosis has been estimated to be approximately 50%. The clinical picture in Toxoplasma differs in patients transplanted with different organs. The symptoms in these patients are often nonspecific which makes Toxoplasma diagnosis difficult. For instance, myocarditis due to Toxoplasma can be interpreted as rejection. This mistake may lead to an increase in immunosuppressive therapy followed by an increased risk for dissemination of the infection from the heart to the central nervous system (CNS). More than 50% of patients with clinical manifestations of toxoplasmosis indeed have intracerebral infection. The symptoms vary and can be focal or nonfocal. Changes in mental status occurs in 75%, fever in 10-70%, epilepsy in 30%, headache in 50%, and focal neurological signs in 60% of patients with neurological infection.

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