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Toxoplasmosis encephalitis following severe graft-vs.-host disease after allogeneic hematopoietic stem cell transplantation: 17 yr experience in Fukuoka BMT group.
- Source :
-
European journal of haematology [Eur J Haematol] 2007 Oct; Vol. 79 (4), pp. 317-21. Date of Electronic Publication: 2007 Aug 03. - Publication Year :
- 2007
-
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.
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 0902-4441
- Volume :
- 79
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- European journal of haematology
- Publication Type :
- Academic Journal
- Accession number :
- 17680814
- Full Text :
- https://doi.org/10.1111/j.1600-0609.2007.00919.x