Caner Ayşe, Döşkaya Mert, Karasu Zeki, Değirmenci Aysu, Guy Edward, Kiliç Murat, Zeytunlu Murat, Francis Janet, Bozoklar Ata, Gürüz Yüksel
Department of Parasitology, Ege University Medical School, Bornova/Izmir, Turkey.
Liver Transpl. 2008 Oct;14(10):1526-32. doi: 10.1002/lt.21558.
Toxoplasmosis is a serious and potentially life-threatening disease in liver transplant recipients while they are immunosuppressed. We report the clinical and laboratory findings related to active toxoplasma infection associated with 40 immunosuppressed liver transplant procedures that took place over a 12-month period at a major transplant unit in Izmir, Turkey. Twenty-seven (67.5%) of the 40 transplant recipients were found to be seropositive for toxoplasma infection and therefore at risk of reactivated infection. From the serological status of the donors, which was ascertained in 38 of 40 cases, we identified 3 (7.9%) of 38 transplants to be from a seropositive donor to a seronegative recipient. In 10 (26.3%) of 38 transplants, both the donor and recipient were seronegative, and this excluded toxoplasma as a risk. A comparison of real-time polymerase chain reaction (PCR) and nested PCR was undertaken in combination with a range of serological assays (the Sabin-Feldman dye test, enzyme immunoassay immunoglobulin M, and immunosorbent agglutination assay immunoglobulin M). Ethylene diamine tetraacetic acid blood samples from 3 of the 30 recipients at risk from toxoplasma were found positive by PCR, but only 1 of these was found positive in both assays. Among the 3 PCR-positive patients, immunoglobulin M and immunoglobulin G antibody levels increased in only 1 patient. Correlations between symptoms, laboratory findings, and clinical management (use of anti-toxoplasma therapy) are presented. Our findings suggest that toxoplasma presents a significant risk to our liver transplant population and that PCR is a helpful addition in identifying active infections and hence in informing clinical management decisions.
弓形虫病对于肝移植受者而言是一种严重且可能危及生命的疾病，尤其是在他们处于免疫抑制状态时。我们报告了与活动性弓形虫感染相关的临床和实验室检查结果，这些感染与土耳其伊兹密尔一家大型移植单位在12个月内进行的40例免疫抑制肝移植手术有关。40名移植受者中有27名（67.5%）弓形虫感染血清学检测呈阳性，因此有感染复发的风险。根据40例中38例供者的血清学状态，我们确定38例移植中有3例（7.9%）是从血清学阳性供者到血清学阴性受者。在38例移植中有10例（26.3%）供者和受者血清学均为阴性，这排除了弓形虫感染风险。我们结合一系列血清学检测方法（Sabin - Feldman染色试验、酶免疫法检测免疫球蛋白M以及免疫吸附凝集试验检测免疫球蛋白M）对实时聚合酶链反应（PCR）和巢式PCR进行了比较。30名有弓形虫感染风险的受者中，有3名受者的乙二胺四乙酸抗凝血样本经PCR检测呈阳性，但其中只有1例在两种检测中均呈阳性。在3例PCR阳性患者中，只有1例患者的免疫球蛋白M和免疫球蛋白G抗体水平升高。本文还呈现了症状、实验室检查结果与临床管理（使用抗弓形虫治疗）之间的相关性。我们的研究结果表明，弓形虫对我们的肝移植人群构成了重大风险，并且PCR有助于识别活动性感染，从而为临床管理决策提供依据。
