Lucile Packard Children's Hospital Stanford, Palo Alto, California; Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Lucile Packard Children's Hospital Stanford, Palo Alto, California; Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Transplant Cell Ther. 2021 Apr;27(4):292-300. doi: 10.1016/j.jtct.2020.11.003. Epub 2020 Dec 10.
Infection due to the protozoa Toxoplasma gondii can be life-threatening in hematopoietic stem cell transplantation (HSCT) recipients. Most cases of toxoplasmosis in HSCT recipients result from reactivation of latent infection in individuals who were Toxoplasma-seropositive before transplantation and did not receive appropriate prophylaxis. Pretransplantation screening with Toxoplasma IgG and IgM antibodies is suggested for all allogeneic HSCT recipients and their donors and all autologous HSCT recipients. Prevention of toxoplasmosis in T. gondii-seropositive HSCT recipients requires primary prophylaxis, preemptive screening, or both. Trimethoprim-sulfamethoxazole (TMP-SMX) is the preferred agent for Toxoplasma prophylaxis and should be continued for 6 months or until the patient is no longer receiving immunosuppression, whichever is longer, assuming that immune reconstitution has occurred. Preemptive weekly screening with whole blood Toxoplasma PCR should be considered for seropositive HSCT recipients if prophylaxis cannot be given or if prophylaxis other than TMP-SMX is used. The signs, symptoms, and radiographic findings of toxoplasmosis in HSCT recipients can be nonspecific, and the diagnosis requires a high degree of suspicion. Common presentations include fever, encephalopathy with mental status changes or seizures, and pneumonia. A Toxoplasma PCR analysis from whole blood (and other body fluids/tissues according to clinical symptoms) should be obtained in patients in whom there is a concern for toxoplasmosis. Treatment with oral pyrimethamine, sulfadiazine, and leucovorin for at least 6 weeks is the first-line therapy and should be followed by secondary prophylaxis. In this article, we review the published literature regarding the epidemiology, clinical presentation, treatment, and prevention of toxoplasmosis in HSCT recipients.
弓形虫引起的感染在造血干细胞移植（HSCT）受者中可能有生命危险。HSCT 受者中大多数弓形虫病是由于移植前 Toxoplasma 血清阳性且未接受适当预防的个体潜伏感染再激活引起的。建议所有异基因 HSCT 受者及其供者和所有自体 HSCT 受者进行 Toxoplasma IgG 和 IgM 抗体的移植前筛查。预防 T. gondii 血清阳性 HSCT 受者的弓形虫病需要进行初级预防、抢先筛查或两者兼施。复方磺胺甲噁唑（TMP-SMX）是预防弓形虫病的首选药物，应持续使用 6 个月或直至患者不再接受免疫抑制治疗（以较长者为准），假设免疫重建已经发生。如果不能进行预防或使用 TMP-SMX 以外的预防措施，应考虑对血清阳性 HSCT 受者进行每周一次的抢先全血 Toxoplasma PCR 筛查。HSCT 受者的弓形虫病的体征、症状和放射影像学表现可能是非特异性的，诊断需要高度怀疑。常见表现包括发热、伴有精神状态改变或癫痫发作的脑病和肺炎。对于怀疑患有弓形虫病的患者，应从全血（和根据临床症状的其他体液/组织）中获取 Toxoplasma PCR 分析。口服乙胺嘧啶、磺胺嘧啶和亚叶酸钙至少 6 周是一线治疗方法，随后进行二级预防。本文回顾了有关 HSCT 受者弓形虫病的流行病学、临床表现、治疗和预防的已发表文献。
