Problems with serological diagnosis of Toxoplasma gondii infections in heart transplant recipients

Of the first 128 patients to receive either heart or heart and lung transplants at Papworth Hospital, four developed Toxoplasma gondii infections acquired from the donor heart and two died. Six patients had passively acquired T gondii antibody as a result of blood transfusions around the time of transplantation. Eight patients developed antibodies against T gondii, which were detectable by changes in the latex agglutination test titres but not by those of the dye test. These false positive latex agglutination reactions occurred simultaneously with cytomegalovirus infection and were associated with the IgM serum fraction in the patients' sera. These reactions were not associated with cytomegalovirus specific IgM, Paul-Bunnell antibody, nor detectable rheumatoid factor. These findings emphasise the need for T gondii dye test confirmation of latex agglutination test titre rises in heart transplant recipients.