38751例造血干细胞移植受者中的弓形虫病：疾病患病率的系统评价及影像学和尸检结果汇编
Toxoplasmosis Among 38 751 Hematopoietic Stem-cell Transplant Recipients: A Systematic Review of Disease Prevalence and a Compilation of Imaging and Autopsy Findings.
作者信息
Contopoulos-Ioannidis Despina G, Cho Stephanie M, Bertaina Alice, Leung Ann N, Fischbein Nancy, Lanzman Bryan, Schwenk Hayden T, Montoya Jose G
机构信息
Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA.
Dr. Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto Medical Foundation, Palo Alto, CA.
出版信息
Transplantation. 2021 Dec 1;105(12):e375-e386. doi: 10.1097/TP.0000000000003662.
BACKGROUND
Toxoplasmosis in hematopoietic stem-cell transplant (HSCT) recipients can be life threatening if not promptly diagnosed and treated.
METHODS
We performed a systematic review (PubMed last search March 29, 2020) of toxoplasmosis among HSCT recipients and calculated the toxoplasmosis prevalence across studies. We also created a compilation list of brain imaging, chest imaging, and autopsy findings of toxoplasmosis among HSCT recipients.
RESULTS
We identified 46 eligible studies (47 datasets) with 399 toxoplasmosis cases among 38 751 HSCT recipients. There was large heterogeneity in the reported toxoplasmosis prevalence across studies, thus formal meta-analysis was not attempted. The median toxoplasmosis prevalence among 38 751 HSCT recipients was 2.14% (range 0%-66.67%). Data on toxoplasmosis among at-risk R+HSCT recipients were more limited (25 studies; 2404 R+HSCT recipients [6.2% of all HSCT recipients]), although the median number of R+HSCT recipients was 56.79% across all HSCT recipients. The median toxoplasmosis prevalence across studies among 2404 R+HSCT was 7.51% (range 0%-80%) versus 0% (range 0%-1.23%) among 7438 R-HSCT. There were limited data to allow meaningful analyses of toxoplasmosis prevalence according to prophylaxis status of R+HSCT recipients.
CONCLUSIONS
Toxoplasmosis prevalence among HSCT recipients is underestimated. The majority of studies report toxoplasmosis prevalence among all HSCT recipients rather than only among the at-risk R+HSCT recipients. In fact, the median toxoplasmosis prevalence among all R+//R- HSCT recipients is 3.5-fold lower compared with the prevalence among only the at-risk R+HSCT recipients and the median prevalence among R+HSCT recipients is 7.51-fold higher than among R-HSCT recipients. The imaging findings of toxoplasmosis among HSCT recipients can be atypical. High index of suspicion is needed in R+HSCT recipients with fever, pneumonia, or encephalitis.
背景
造血干细胞移植（HSCT）受者中的弓形虫病若不及时诊断和治疗可能危及生命。
方法
我们对HSCT受者中的弓形虫病进行了系统综述（PubMed最后一次检索时间为2020年3月29日），并计算了各项研究中的弓形虫病患病率。我们还编制了一份HSCT受者弓形虫病的脑成像、胸部成像和尸检结果汇总清单。
结果
我们确定了46项符合条件的研究（47个数据集），在38751名HSCT受者中有399例弓形虫病病例。各项研究报告的弓形虫病患病率存在很大异质性，因此未进行正式的荟萃分析。38751名HSCT受者中弓形虫病患病率的中位数为2.14%（范围为0%-66.67%）。有风险的R+HSCT受者中弓形虫病的数据更为有限（25项研究；2404名R+HSCT受者[占所有HSCT受者的6.2%]），尽管所有HSCT受者中R+HSCT受者的中位数为56.79%。2404名R+HSCT受者中各项研究的弓形虫病患病率中位数为7.51%（范围为0%-80%），而7438名R-HSCT受者中的患病率中位数为0%（范围为0%-1.23%）。根据R+HSCT受者的预防状态对弓形虫病患病率进行有意义分析的数据有限。
结论
HSCT受者中弓形虫病的患病率被低估。大多数研究报告的是所有HSCT受者中的弓形虫病患病率，而不是仅在有风险的R+HSCT受者中的患病率。事实上所有R+//R-HSCT受者中弓形虫病患病率中位数比仅在有风险的R+HSCT受者中的患病率低3.5倍，R+HSCT受者中的患病率中位数比R-HSCT受者中的患病率高7.51倍。HSCT受者中弓形虫病的影像学表现可能不典型。对于发热、肺炎或脑炎的R+HSCT受者需要高度怀疑。
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