Uçkay I, Wunderli W, Giostra E, Majno P, Mentha G, van Delden C
Department of Surgery, Service of Transplantation, Hôpitaux Universitaires de Genève, Geneva 1211, Switzerland.
Transplant Proc. 2009 Dec;41(10):4425-7. doi: 10.1016/j.transproceed.2009.09.081.
Acute primary Toxoplasma gondii infection is usually considered to be a contraindication for solid organ transplantation. Recent reports of acute T. gondii infection have highlighted the need to include T. gondii serology in the pretransplant screening of solid-organ transplant recipients. However such serology might be misleading. We describe the case of a 25-year-old woman who received a liver transplantation for life-threatening liver failure due to hepatitis B virus infection. The presence of high IgM titers against T. gondii, as detected by membrane immunoassay, immunofluorescence, and mu-capture ELISA tests, together with the absence of IgG antibodies in the immediate pretransplant serology screening suggested acute primary T. gondii infection at the time of transplantation. We initiated a preemptive therapy with intravenous clindamycin and cotrimoxazole. However, negative PCR and IgA capture assays, together with the absence of a sustained IgG response finally excluded the initial diagnosis of primary toxoplasmosis, leading to discontinuation of antitoxoplasmosis therapy. This case illustrates the problem that, in the context of fulminant hepatitis B, serologic markers for acute primary toxoplasmosis can be falsely positive. Confirmation by PCR and IgA antibody determinations is required to confirm this diagnosis.
急性原发性弓形虫感染通常被认为是实体器官移植的禁忌证。近期关于急性弓形虫感染的报告强调了在实体器官移植受者的移植前筛查中纳入弓形虫血清学检测的必要性。然而，这种血清学检测可能会产生误导。我们描述了一名25岁女性的病例，她因乙型肝炎病毒感染导致危及生命的肝衰竭而接受了肝移植。通过膜免疫测定、免疫荧光和μ捕获ELISA检测发现针对弓形虫的高IgM滴度，且在移植前即刻血清学筛查中缺乏IgG抗体，提示移植时存在急性原发性弓形虫感染。我们开始用静脉注射克林霉素和复方新诺明进行抢先治疗。然而，PCR和IgA捕获检测结果为阴性，且缺乏持续的IgG反应，最终排除了原发性弓形虫病的初步诊断，导致抗弓形虫病治疗中断。该病例说明了在暴发性乙型肝炎的情况下，急性原发性弓形虫病的血清学标志物可能会出现假阳性的问题。需要通过PCR和IgA抗体测定来确诊。
