Toxoplasmosis after allogeneic hematopoietic stem cell transplantation: Impact of serostatus-based management
Toxoplasmosis after allogeneic hematopoietic stem cell transplantation: Impact of serostatus-based management
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DOI：
10.1111/tid.13506
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发表时间：
2020-11-27
影响因子：
2.6
通讯作者：
Mori, Takehiko
中科院分区：
文献类型：
--
作者：
Amikura, Takahito;Kikuchi, Taku;Mori, Takehiko
弓形虫病是由弓形虫（Toxoplasma gondii，T.弓形虫感染是异基因造血干细胞移植（HSCT）后严重的感染并发症。弓形虫病的发病率因患者人群血清阳性率的差异而差异很大。在血清阳性率低的患者人群中，同种异体HSCT后弓形虫病的发病率和最佳治疗尚未得到充分评价。我们进行了一项单中心回顾性研究，评价接受同种异体HSCT的日本患者的弓形虫病。在728例可评估的患者中，只有5例发生弓形虫病，中位发病时间为移植后60天（范围，第55-393天）。移植后第500天的累积发生率为0.7%（95% CI：0.3%-1.5%）。五名患者中有四名死于弓形虫病。最近接受治疗的220名患者（不是早期的508名患者）接受了T。弓形虫血清状态，并应用甲氧苄啶/磺胺甲恶唑预防性治疗。所有5名弓形虫病患者均在未筛查组，在引入筛查和预防性治疗后，没有弓形虫病病例。我们的研究结果表明，同种异体HST后弓形虫病是罕见的，但可以发展为一个危及生命的并发症，即使在血清阳性率低的人群，血清阳性患者的预防性治疗可以有效地预防弓形虫病。
Toxoplasmosis caused by Toxoplasma gondii (T. gondii) is a serious infectious complication after allogeneic hematopoietic stem cell transplantation (HSCT). The incidence of toxoplasmosis varies widely because of the variabilities of seroprevalence among patient populations. The incidence and the optimal management of toxoplasmosis after allogeneic HSCT in a patient population with a low seroprevalence have not been fully evaluated. We conducted a single-center retrospective study evaluating toxoplasmosis in Japanese patients who underwent allogeneic HSCT. Of the 728 evaluable patients, only 5 developed toxoplasmosis with a median onset of day 60 post-transplant (range, day 55-393). The cumulative incidence was 0.7% (95% CI: 0.3%-1.5%) at day 500 post-transplant. Four of the five patients succumbed due to toxoplasmosis. The more recently treated 220 patients (not the earlier 508 patients) were screened for the T. gondii serostatus, and prophylactic treatment with trimethoprim/sulfamethoxazole was applied. All five patients with toxoplasmosis were in the unscreened group, and there was no case of toxoplasmosis after the introduction of the screening and prophylactic treatment. Our results suggest that toxoplasmosis after allogeneic HST is rare but can develop as a life-threatening complication even in the populations with low seroprevalence, and that prophylactic treatment for seropositive patients could effectively prevent toxoplasmosis.