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Toxoplasmosis and heart transplantation
R E Holliman1, J D Johnson, S Adams
1Public Health Laboratory Service, St. George's Hospital, London, England.
Summary
Toxoplasmosis in heart transplant recipients is rare but can be fatal. Prophylaxis with pyrimethamine and prompt treatment of primary infections are effective strategies for preventing severe outcomes in these immunocompromised patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Immunology
Background:
- Toxoplasmosis poses a potential risk to heart transplant recipients due to their immunosuppressed state.
- Serological mismatch between donor and recipient is a critical factor in toxoplasmosis transmission.
- Understanding the clinical course and management of toxoplasmosis in this population is crucial.
Purpose of the Study:
- To review the experience with toxoplasmosis in a cohort of 33 heart transplant recipients.
- To evaluate the effectiveness of prophylactic and therapeutic strategies for toxoplasmosis in this patient group.
- To identify potential challenges in diagnosing and managing toxoplasmosis post-transplantation.
Main Methods:
- Retrospective review of 33 heart transplant cases.
- Analysis of toxoplasmosis incidence, transmission routes, and clinical outcomes.
- Evaluation of treatment regimens, including pyrimethamine prophylaxis and conventional therapy.
- Assessment of diagnostic test accuracy.
Main Results:
- One fatal case of toxoplasmosis occurred in a seronegative recipient from a seropositive donor.
- Two similar high-risk cases receiving pyrimethamine prophylaxis remained well.
- One patient with primary toxoplasmosis diagnosed preoperatively was successfully treated.
- No cases of secondary reactivation or transfusion-related antibody confusion were observed.
- Inaccurate results were noted with dye and latex agglutination tests.
Conclusions:
- Prophylaxis with pyrimethamine can effectively prevent toxoplasmosis in high-risk heart transplant recipients.
- Early diagnosis and treatment of primary toxoplasmosis are vital for favorable outcomes.
- Diagnostic assays for toxoplasmosis may yield false results, necessitating careful clinical correlation.