Transfer of Toxoplasma with transplants

Heart

Severity ranging from asymptomatic sero-conversion to myocardial infiltration or disseminated neurological disease or death has been described following heart transplantation (Michaels et al. 1992; Gallino et al. 1996). Onset of the disease was within the first 6.5 months after transplantation. This occurred if the recipient was sero-negative and the donor sero-positive. Prophylactic strategies are recommended.

Kidney

Re-activation of a latent infection has been described but the most common is a primary infection if a sero-negative donor receives an organ from a sero-positive donor (Renoult et al. 1997). Within three months following transplantation fever, neurological disturbances, and pneumonia due to toxoplasmosis occurred.

Liver

Sero-conversion after transplantation has been reported (McCabe and Chirurgi 1993), so has a case of fulminant disseminated infection (Mayes et al. 1995). Toxoplasma infection should be considered in the differential diagnosis in multi-organ failure in the early period following transplantation. Retinochoroiditis following liver transplantation has also been reported (Blanc-Jouvan et al. 1996).

Bone marrow

Re-activation of a latent infection is a serious problem in transplantation of bone marrow (Derouin et al.

1992; Chandrasekar and Momin 1997). The re-activation occurs within the first six months after marrow transplant, with the highest incidence in the second and third months. Cerebral or a disseminated infection has been described in addition to pulmonary toxoplasmosis (Saad et al. 1996) and retinochoroiditis (Peacock et al. 1995). Toxoplasma infection was considered to contribute to death in at least 40% of the cases (Slavin et al. 1994). Primary infection in the sero-negative recipient has also been reported. Diagnosis is mainly made by the demonstration of parasites in body fluids or tissues.

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