Molecular Diagnosis of Toxoplasmosis in Immunocompromised Patients: a 3-Year Multicenter Retrospective Study
Molecular Diagnosis of Toxoplasmosis in Immunocompromised Patients: a 3-Year Multicenter Retrospective Study
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DOI：
10.1128/jcm.03282-14
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发表时间：
2015-05-01
影响因子：
9.4
通讯作者：
Bastien, Patrick
中科院分区：
文献类型：
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作者：
Robert-Gangneux, Florence;Sterkers, Yvon;Bastien, Patrick
弓形虫病是一种危及生命的免疫缺陷患者(ICPs)感染。确诊依赖于寄生虫DNA检测，但对HIV阴性患者的发病率和疾病负担知之甚少。对法国国家弓形虫病参考中心网络中的15个参考实验室进行了为期3年的回顾性研究，以记录ICP中弓形虫DNA的检出频率，并回顾了用于诊断的分子方法和在移植患者中实施的预防措施。在研究期间，在对ICP样本进行的31,640次PCR中，有610次呈阳性(323名患者)。血液(n=337例)、脑脊液(n=101例)和房水(n=100例)阳性率较高。移植患者的化学预防方案在不同的中心有所不同。异基因造血干细胞移植(allo-HSCT)患者的PCR随访在8/15个中心进行。对来自180名患者(13个中心)的数据进行了进一步的临床背景和结果分析。仅68/180(38%)患者为HIV+；其余62%包括72例造血干细胞移植、14例实体器官移植和26例其他免疫缺陷患者。脑弓形体病和播散性弓形虫病分别在HIV和移植患者中最常见。在72例聚合酶链式反应阳性的allo-HSCT患者中，23例没有症状；所有患者都在进行系统血液聚合酶链式反应随访的中心确诊，并接受了特定的治疗。在有聚合酶链式反应随访的中心，allo-HSCT患者2个月的总体存活率高于其他中心(P<；0.01)。这项研究提供了HIV阴性ICP中弓形虫感染频率的最新数据，并表明定期对allo-HSCT患者进行PCR随访可以指导先发制人的治疗并改善预后。
Toxoplasmosis is a life-threatening infection in immunocompromised patients (ICPs). The definitive diagnosis relies on parasite DNA detection, but little is known about the incidence and burden of disease in HIV-negative patients. A 3-year retrospective study was conducted in 15 reference laboratories from the network of the French National Reference Center for Toxoplasmosis, in order to record the frequency of Toxoplasma gondii DNA detection in ICPs and to review the molecular methods used for diagnosis and the prevention measures implemented in transplant patients. During the study period, of 31,640 PCRs performed on samples from ICPs, 610 were positive (323 patients). Blood (n = 337 samples), cerebrospinal fluid (n = 101 samples), and aqueous humor (n = 100 samples) were more frequently positive. Chemoprophylaxis schemes in transplant patients differed between centers. PCR follow-up of allogeneic hematopoietic stem cell transplant (allo-HSCT) patients was implemented in 8/15 centers. Data from 180 patients (13 centers) were further analyzed regarding clinical setting and outcome. Only 68/180 (38%) patients were HIV+; the remaining 62% consisted of 72 HSCT, 14 solid organ transplant, and 26 miscellaneous immunodeficiency patients. Cerebral toxoplasmosis and disseminated toxoplasmosis were most frequently observed in HIV and transplant patients, respectively. Of 72 allo-HSCT patients with a positive PCR result, 23 were asymptomatic; all were diagnosed in centers performing systematic blood PCR follow-up, and they received specific treatment. Overall survival of allo-HSCT patients at 2 months was better in centers with PCR follow-up than in other centers (P < 0.01). This study provides updated data on the frequency of toxoplasmosis in HIV-negative ICPs and suggests that regular PCR follow-up of allo-HSCT patients could guide pre-emptive treatment and improve outcome.