1. Toxoplasmosis encephalitis following severe graft-vs.-host disease after allogeneic hematopoietic stem cell transplantation: 17 yr experience in Fukuoka BMT group.
- Author
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Matsuo Y, Takeishi S, Miyamoto T, Nonami A, Kikushige Y, Kunisaki Y, Kamezaki K, Tu L, Hisaeda H, Takenaka K, Harada N, Kamimura T, Ohno Y, Eto T, Teshima T, Gondo H, Harada M, and Nagafuji K
- Subjects
- Animals, Antimalarials administration & dosage, Asian People, Bacterial Infections blood, Bacterial Infections cerebrospinal fluid, Bacterial Infections diagnostic imaging, Bacterial Infections drug therapy, Bacterial Infections etiology, CD4 Lymphocyte Count, DNA, Protozoan blood, DNA, Protozoan cerebrospinal fluid, Encephalitis blood, Encephalitis cerebrospinal fluid, Encephalitis diagnostic imaging, Encephalitis drug therapy, Fatal Outcome, Female, Graft vs Host Disease blood, Graft vs Host Disease cerebrospinal fluid, Graft vs Host Disease diagnostic imaging, Graft vs Host Disease drug therapy, Humans, Japan, Leukemia, Myelogenous, Chronic, BCR-ABL Positive blood, Leukemia, Myelogenous, Chronic, BCR-ABL Positive cerebrospinal fluid, Leukemia, Myelogenous, Chronic, BCR-ABL Positive diagnostic imaging, Leukemia, Myelogenous, Chronic, BCR-ABL Positive parasitology, Leukemia, Myelogenous, Chronic, BCR-ABL Positive therapy, Leukemia, Myeloid, Acute blood, Leukemia, Myeloid, Acute cerebrospinal fluid, Leukemia, Myeloid, Acute diagnostic imaging, Leukemia, Myeloid, Acute parasitology, Leukemia, Myeloid, Acute therapy, Magnetic Resonance Imaging, Male, Middle Aged, Polymerase Chain Reaction, Radiography, Remission Induction, Retrospective Studies, Severity of Illness Index, Toxoplasmosis, Cerebral blood, Toxoplasmosis, Cerebral cerebrospinal fluid, Toxoplasmosis, Cerebral diagnostic imaging, Toxoplasmosis, Cerebral drug therapy, Transplantation Conditioning, Transplantation, Autologous, Transplantation, Homologous, Encephalitis etiology, Graft vs Host Disease complications, Hematopoietic Stem Cell Transplantation, Toxoplasma, Toxoplasmosis, Cerebral etiology
- Abstract
Toxoplasmosis is a rare but rapidly fatal complication that can occur following hematopoietic stem cell transplantation (HSCT). Over a 17-yr period at our institutions, a definite diagnosis of toxoplasmosis was made in only two of 925 allogeneic HSCT recipients (0.22%) and none of 641 autologous HSCT recipients. These two patients received a conventional conditioning regimen followed by transplantation from an HLA-matched donor; however, they developed severe graft-vs.-host disease, which required intensive immunosuppressive therapy. Despite prophylactic treatment with trimethoprim/sulfamethoxazole, their immunosuppressive state, as indicated by a low CD4(+) cell count, might have resulted in toxoplasmosis encephalitis. Rapid and non-invasive methods such as a polymerase chain reaction (PCR) test of their cerebrospinal fluid for Toxoplasma gondii and magnetic resonance imaging of the brain were useful for providing a definitive diagnosis and prompt therapy in these patients: one patient stabilized and survived after responding to treatment with pyrimethamine/sulfodiazine whereas the other died of bacterial infection. In addition, retrospective PCR analyses of the frozen stored peripheral blood samples disclosed that detection of T. gondii preceded the onset of disease, indicating routine PCR testing of peripheral blood specimens may be an early diagnostic tool. It should be noted that when patients receiving HSCT have an unexplained fever and/or neurological complications, PCR tests should be considered to avoid cerebral lesions and improve the outcome of the patients.
- Published
- 2007
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