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骨髓移植后弓形虫感染诊断的前瞻性研究。

A prospective study of diagnosis of Toxoplasma gondii infection after bone marrow transplantation.

作者信息

Edvinsson Benjamin, Lundquist Jessica, Ljungman Per, Ringdén Olle, Evengård Birgitta

机构信息

Swedish Institute for Infectious Disease Control, Karolinska University Hospital Huddinge, Stockholm, Sweden.

出版信息

APMIS. 2008 May;116(5):345-51. doi: 10.1111/j.1600-0463.2008.00871.x.

Abstract

Active infection with Toxoplasma gondii in immunocompromised transplant recipients can lead to toxoplasmosis, which may have a rapid disease course and in some cases be fatal. It is of paramount importance to diagnose toxoplasmosis at an early stage, and to initiate specific treatment to improve the outcome. Polymerase chain reaction (PCR) is today the primary diagnostic tool to diagnose toxoplasmosis in immunocompromised patients. Timely diagnosis may, however, be difficult if toxoplasmosis is at first asymptomatic. To investigate the magnitude of toxoplasmosis after bone marrow transplantation (BMT), we conducted a screening study by PCR where 21 autologous and 12 allogeneic BMT recipients were included. Peripheral blood samples were taken one week prior to BMT; thereafter, blood samples were drawn weekly for the first 6 months, and monthly up to one year after BMT. The samples were analyzed by conventional PCR and real-time PCR. T. gondii DNA was detected in peripheral blood from one patient 5 days post allogeneic BMT. There were no clinical signs of toxoplasmosis. Medical records were reviewed and showed a previously undiagnosed eye infection in another allogeneic BMT recipient. These two patients were seropositive for T. gondii. We concluded that monitoring for T. gondii DNA in peripheral blood samples using PCR might be a valuable method for identifying toxoplasma-seropositive stem cell transplant recipients.

摘要

免疫功能低下的移植受者感染弓形虫后会引发弓形虫病,该病病程可能进展迅速,在某些情况下会导致死亡。早期诊断弓形虫病并启动特异性治疗以改善预后至关重要。聚合酶链反应(PCR)是目前诊断免疫功能低下患者弓形虫病的主要诊断工具。然而,如果弓形虫病最初没有症状,及时诊断可能会很困难。为了调查骨髓移植(BMT)后弓形虫病的发病率,我们进行了一项PCR筛查研究,纳入了21名自体BMT受者和12名异体BMT受者。在BMT前一周采集外周血样本;此后,在最初的6个月每周采集血样,在BMT后长达一年的时间里每月采集血样。通过常规PCR和实时PCR对样本进行分析。在一名异体BMT受者移植后5天的外周血中检测到弓形虫DNA。当时没有弓形虫病的临床症状。查阅病历发现,另一名异体BMT受者曾有未被诊断出的眼部感染。这两名患者弓形虫血清学检测呈阳性。我们得出结论,使用PCR监测外周血样本中的弓形虫DNA可能是识别弓形虫血清学阳性干细胞移植受者的一种有价值的方法。

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