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Toxoplasmosis in pediatric recipients of heart transplants
M G Michaels1, E R Wald, F J Fricker
1Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pennsylvania 15232.
Insights
Toxoplasmosis poses a significant risk to heart transplant recipients, particularly those receiving organs from infected donors. Prophylactic strategies are crucial to prevent severe outcomes in seronegative patients.
Area of Science:
- Infectious Diseases
- Transplant Immunology
- Parasitology
Background:
- Toxoplasma gondii is a known pathogen causing severe illness in immunocompromised individuals and congenitally infected infants.
- Heart transplantation involves significant immunosuppression, increasing recipients' vulnerability to opportunistic infections.
Observation:
- This report details three pediatric cases of toxoplasmosis following heart transplantation.
- A review of 18 adult cardiac transplant recipients with postoperative toxoplasmosis was conducted.
- Disease onset occurred within 6.5 months post-transplant, with varied severity.
Findings:
- Most patients were seronegative for T. gondii antibodies before transplantation.
- Transmission of T. gondii was likely through the donor heart.
- Outcomes ranged from asymptomatic infection to fatal disseminated disease.
Implications:
- Seronegative heart transplant recipients receiving organs from seropositive donors face a high risk of severe toxoplasmosis.
- Development and implementation of effective prophylactic measures are urgently needed.
- This highlights the importance of donor-recipient screening for T. gondii in solid organ transplantation.
Abstract:
Toxoplasma gondii has long been recognized as a potential cause of severe disease in the congenitally infected infant and the immunocompromised host. This report describes three children with toxoplasmosis after heart transplantation and reviews the cases of 18 adult recipients of cardiac transplants (reported in the English-language literature) who developed toxoplasmosis postoperatively. Onset of disease was within the first 6 1/2 months following transplantation. Severity ranged from asymptomatic seroconversion to myocardial infiltration or disseminated neurological disease and death. Only one patient was known to be seropositive for antibody to T. gondii prior to transplantation. Transmission was most likely via the donor organ. Seronegative patients who receive organs from seropositive donors are at high risk for serious disease; prophylactic strategies need to be developed.