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Transplant recipients who are seronegative for Toxoplasma and receive an organ from a seropositive donor are at high risk for donor‐derived toxoplasmosis in the absence of prophylaxis. While the risk in cardiac transplant recipients is well known, this infection is often underrecognized in noncardiac transplant recipients. Toxoplasmosis in transplant patients is associated with high mortality, and diagnosis is challenging as the presentation is nonspecific. Recommendations for prophylaxis in cardiac transplant recipients are well‐defined, but the optimal prophylactic strategy in noncardiac transplant recipients, especially those with sulfa allergies, is unknown. We report a case of donor‐derived disseminated toxoplasmosis in a liver transplant recipient who did not receive prophylaxis due to documented sulfa allergy. The patient subsequently underwent a challenge with trimethoprim/sulfamethoxazole and was successfully treated with this therapy. This case underscores the variable clinical presentation of donor‐derived toxoplasmosis as well as the critical importance of accurate allergy evaluation pretransplant. [ABSTRACT FROM AUTHOR]

Background Recurrent Clostridioides difficile infection (rCDI) occurs frequently, and concomitant antibiotic (CA) during the initial episode for treatment of non-CDI is a major risk factor. We sought to address the comparative efficacy of fidaxomicin versus vancomycin in the setting of CA during the initial CDI episode. Methods We conducted a randomized, controlled, open-label trial at 2 hospitals in Ann Arbor, Michigan. We consecutively consented and enrolled hospitalized patients ≥18 years old with diarrhea, a positive test for C. difficile , and ≥1 qualifying CA. Complicated CDI, CDI treatment for >24 hours prior to enrollment, and planned long-term (>12 weeks) CA use were notable exclusions. Clinical cure was defined as resolution of diarrhea for 2 consecutive days maintained until 2 days after therapy, and rCDI as recurrent diarrhea with positive testing ≤30 days after initial treatment. Patients were randomized to fidaxomicin or vancomycin. Results Baseline characteristics were similar in the 2 groups of 144 patients. Rates of clinical cure (73% vs 62.9%, P =.195) and rCDI (3.3% vs 4.0%; P >.99) were similar for fidaxomicin and vancomycin in the intention-to-treat and per-protocol cohorts, respectively. Only 4 patients developed rCDI. Conclusions In this study of patients with CDI receiving CA, a numerically higher proportion were cured with fidaxomicin versus vancomycin, but this result did not reach statistical significance. Overall recurrence was lower than anticipated in both arms compared with previous studies that did not extend duration of CDI treatment during CA. Clinical Trials Registration www.clinicaltrials.gov (NCT02692651). [ABSTRACT FROM AUTHOR]