Galván-Ramírez Maria de la Luz, Sánchez-Orozco Laura V, Gutiérrez-Maldonado Adrián Fernando, Rodriguez Pérez Laura Roció
Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico.
Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico.
J Med Microbiol. 2018 Apr;67(4):499-506. doi: 10.1099/jmm.0.000694. Epub 2018 Feb 12.
Approximately one-third of the world's population has Toxoplasma gondii infection, and one of the main routes of transmission is organ transplantation. The aim of this study was to evaluate the impact of Toxoplasma infection on liver transplantation patients.
We searched PubMed, Lilacs, Medline, Science direct, Scielo, Ebsco, Springer, Wiley, Ovid and Google Scholar for reports published up to June 2017, and a systematic review was performed.
Twenty cases were analysed before and after liver transplantation. Primary and reactivated infections were investigated. Before transplantation, positive IgG antibodies were the predominant serological markers in donors and recipients: 40 % (D+/R-), 20 % (D+/R+) and 20 % (D-/R+). IgM was present in only 5 % of the donors (D+/R-). In four cases, the serological markers were not specified or were negative (D?/R? or D?/R-). After transplantation, IgM anti-Toxoplasma antibodies were found in 30 % of the recipients, and in 67 % of the seronegative recipients the presence of Toxoplasma DNA or tachyzoites was reported, suggesting a primary infection. Clinical symptoms were meningitis, massive cerebral oedema, encephalitis and seizures. Treatment was administered in 70 % of the patients, and 40 % died after presenting symptoms associated with Toxoplasma infection.
Although we review Toxoplasma infection and liver transplantation cases, problems associated with the parasite may be greater than identified. Hence, follow-up studies on Toxoplasma infection in liver transplantation patients are recommended.
全球约三分之一的人口感染弓形虫，其主要传播途径之一是器官移植。本研究旨在评估弓形虫感染对肝移植患者的影响。
我们检索了截至2017年6月发表在PubMed、Lilacs、Medline、Science direct、Scielo、Ebsco、Springer、Wiley、Ovid和Google Scholar上的报告，并进行了系统评价。
分析了20例肝移植前后的病例。调查了原发性感染和再激活感染。移植前，供体和受体中主要的血清学标志物是IgG抗体阳性：40%（供体阳性/受体阴性）、20%（供体阳性/受体阳性）和20%（供体阴性/受体阳性）。仅5%的供体（供体阳性/受体阴性）存在IgM。在4例病例中，血清学标志物未明确或为阴性（供体不明/受体不明或供体不明/受体阴性）。移植后，30%的受体中发现了抗弓形虫IgM抗体，在67%的血清学阴性受体中报告了弓形虫DNA或速殖子的存在，提示原发性感染。临床症状为脑膜炎、大面积脑水肿、脑炎和癫痫发作。70%的患者接受了治疗，40%在出现与弓形虫感染相关的症状后死亡。
尽管我们回顾了弓形虫感染和肝移植病例，但与该寄生虫相关的问题可能比已发现的更大。因此，建议对肝移植患者的弓形虫感染进行随访研究。
