Luft B J, Naot Y, Araujo F G, Stinson E B, Remington J S
Ann Intern Med. 1983 Jul;99(1):27-31. doi: 10.7326/0003-4819-99-1-27.
We have attempted to define the serologic criteria for diagnosis of toxoplasmosis in heart transplant recipients. Of 31 patients who were seronegative before transplantation, 4 received a heart from a seropositive donor, and 3 of these 4 had seroconversion and developed life-threatening toxoplasmosis; the remaining 27 did not have seroconversion or develop clinical toxoplasmosis. Of 19 patients who had antibodies to Toxoplasma before transplantation, 10 developed significant increases in test titers of the dye test or double-sandwich IgM enzyme-linked immunosorbent assay but did not develop a clinical illness that could be attributed to toxoplasma infection. Significant serologic changes occurred more often in patients who received azathioprine, corticosteroids, and antithymocyte globulin than in those who received cyclosporine, corticosteroids, and antithymocyte globulin (p less than 0.05). These data show the wide clinical spectrum and differences in kinetics of antibody response of patients who develop toxoplasma infection after transplantation, and suggest that clinical disease occurs in those who have seroconversion but is rare in patients with preexisting antibody who have serologic evidence of recrudescence.
我们试图确定心脏移植受者弓形虫病诊断的血清学标准。在移植前血清学阴性的31例患者中，4例接受了来自血清学阳性供者的心脏，这4例中有3例发生血清转化并发展为危及生命的弓形虫病；其余27例未发生血清转化或临床弓形虫病。在移植前有弓形虫抗体的19例患者中，10例染料试验或双夹心IgM酶联免疫吸附试验的检测滴度显著升高，但未出现可归因于弓形虫感染的临床疾病。接受硫唑嘌呤、皮质类固醇和抗胸腺细胞球蛋白治疗的患者比接受环孢素、皮质类固醇和抗胸腺细胞球蛋白治疗的患者更常出现显著的血清学变化（p小于0.05）。这些数据显示了移植后发生弓形虫感染患者的广泛临床谱和抗体反应动力学差异，并表明血清转化者会发生临床疾病，但在已有抗体且有血清学复发证据的患者中很少见。
