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Transmission of toxoplasmosis by bone marrow transplant associated with Campath-1G
1Westminster Bone Marrow Team, Westminster Children's Hospital, London, UK.
Insights
A boy with acute lymphoblastic leukaemia experienced prolonged neutropenia and fever after a bone marrow transplant. Toxoplasmosis was diagnosed using molecular methods, highlighting the importance of considering infections in immunocompromised patients.
Area of Science:
- Hematology
- Infectious Diseases
- Immunology
Background:
- A 12-year-old boy with acute lymphoblastic leukemia (ALL) in third remission underwent a mismatched bone marrow transplant from his mother.
- The patient experienced prolonged neutropenia and pyrexia post-transplant.
Observation:
- The prolonged neutropenia and pyrexia were challenging to diagnose.
- Standard diagnostic methods may have been hindered by immunosuppressive therapies.
Findings:
- Toxoplasmosis infection was confirmed using molecular biology techniques.
- The patient's positive response to treatment supported the diagnosis.
Implications:
- This case highlights the risk of opportunistic infections like toxoplasmosis following bone marrow transplantation.
- Molecular diagnostics are crucial for timely identification of infections in immunocompromised patients.
- Immunosuppressive treatments, such as cyclosporine A, can mask or delay the diagnosis of infections by inhibiting immune responses.
Abstract:
A 12-year-old boy in third remission acute lymphoblastic leukaemia was given a mismatched transplant from his mother. He suffered prolonged neutropenia and pyrexia which was only finally diagnosed as toxoplasmosis using molecular biology methods and by his response to appropriate treatment. This was probably transmitted by bone marrow transplant since maternal immune T cells were removed by the use of Campath-1G and treatment with cyclosporin A probably prevented his IgM immune response and impeded the diagnosis.