Reactivation toxoplasmic retinochoroiditis in patients undergoing bone marrow transplantation: is there a role for chemoprophylaxis?
Reactivation toxoplasmic retinochoroiditis in patients undergoing bone marrow transplantation: is there a role for chemoprophylaxis?
复制标题
接受骨髓移植的患者的弓形虫性视网膜脉络膜炎再激活：化学预防有作用吗？
作者：
J. Peacock;C. Greven;J. Cruz;D. Hurd
本研究的目的是报告骨髓移植(BMT)受者发生再激活眼弓形体病的情况，并为高危患者的识别和化学预防提出指南。这项研究设计了一系列来自三级护理大学医院的病例，该医院有一个活跃的骨髓移植计划。这些患者是两个接受自体骨髓移植的人，有弓形虫视网膜脉络膜炎的既往病史，在移植后早期，经正式眼科检查证实，他们出现了眼弓形体病的症状性再激活。两名接受自体移植的非霍奇金淋巴瘤患者在移植后第一周视力下降，眼底镜检查发现在旧性弓形虫病变附近复发的视网膜脉络膜炎。两名患者的移植前眼科检查都只显示了非活动性的脉络膜视网膜疤痕。磺胺嘧啶、乙胺嘧啶和泼尼松的治疗最终导致两名患者的视网膜炎得到缓解。对于弓形虫抗体血清阳性且移植前眼科检查结果与既往弓形虫视网膜脉络膜炎一致的骨髓移植受者，移植后早期眼弓形体病有再次激活的风险，可能需要对弓形虫病采取预防性化学预防措施。
The objective of this study was to report the occurrence of reactivation ocular toxoplasmosis in bone marrow transplant (BMT) recipients and to propose guidelines for identification and chemoprophylaxis of high-risk patients. The study design was a series of cases from the tertiary care university hospital which has an active BMT program. The patients were two recipients of autologous BMTs with past histories of toxoplasma retinochoroiditis who developed symptomatic reactivation of ocular toxoplasmosis as documented by formal opthalmologic examination in the early post-transplant period. Opthalmoscopic examinations in the two patients with non-Hodgkin's lymphoma who received autologous transplants and then developed decreased visual acuity in the first week after transplant revealed recurrent retinochoroiditis adjacent to old toxoplasma lesions. Pre-transplant eye examinations in both patients had demonstrated only inactive chorioretinal scars. Therapy with sulfadiazine, pyrimethamine and prednisone ultimately led to resolution of retinitis in both patients. BMT recipients who are seropositive for antibody to T. gondii and have findings consistent with previous toxoplasma retinochoroiditis on pre-transplant ophthalmologic examination appear to be at risk for reactivation of ocular toxoplasmosis in the early post-transplant period and may warrant preventive chemoprophylaxis for toxoplasmosis.