Document Detail


Disseminated toxoplasmosis following T cell-depleted related and unrelated bone marrow transplantation.
MedLine Citation:
PMID:  10800065     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
More than 95% of reported cases of disseminated toxoplasmosis following BMT have occurred following an unmodified transplant. Most have been fatal, diagnosed at autopsy and without antemortem institution of specific therapy. From 1989 to 1999, we identified 10 cases of disseminated toxoplasmosis, in 463 consecutive recipients of a T cell-depleted (TCD) BMT. Transplants were from an unrelated donor (n = 5), an HLA-matched sibling (n = 4) or an HLA-mismatched father (n = 1). In 40%, both the donor and recipient had positive IgG titers against T. gondii pre-transplant; in 30%, only the recipient was sero-positive. Three recipients of an unrelated TCD BMT developed toxoplasmosis despite both donor and host testing negative pretransplant. All 10 patients presented with high grade fever. CNS involvement ultimately occurred in seven patients, with refractory respiratory failure and hypotension developing in nine. Eight of 10 cases were found only at autopsy, involving the lungs (n = 7), heart (n = 5), GI tract (n = 5), brain (n = 8), liver and/or spleen (n = 5). The only survivor, treated on the day of presentation with fever and headache, was diagnosed by detection of T. gondii DNA by polymerase chain reaction (PCR) performed on the blood and spinal fluid. This study demonstrates the similar incidence of toxoplasmosis following TCD BMT and that reported post T cell-replete BMT, and underscores the need for rapid diagnostic tests in an effort to improve outcome.
Authors:
T N Small; L Leung; J Stiles; T E Kiehn; S A Malak; R J O'Reilly; K Sepkowitz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Bone marrow transplantation     Volume:  25     ISSN:  0268-3369     ISO Abbreviation:  Bone Marrow Transplant.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-06-13     Completed Date:  2000-06-13     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8702459     Medline TA:  Bone Marrow Transplant     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  969-73     Citation Subset:  IM    
Affiliation:
Department of Pediatrics (Bone Marrow Transplant Service),Memorial Sloan-Kettering Cancer Center, New York City, NY 10021, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Bone Marrow Transplantation*
Female
Humans
Lymphocyte Depletion / adverse effects*
Male
Middle Aged
Opportunistic Infections / etiology,  immunology
T-Lymphocytes / immunology*
Toxoplasmosis / etiology*,  immunology
Transplantation, Homologous
Grant Support
ID/Acronym/Agency:
P01 CA23766/CA/NCI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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