Solid organ transplantation and toxoplasmosis

doi:10.12140/j.issn.1000-7423.2021.03.015

Abstract

Abstract:

Toxoplasma gondii infection in immunocompetent people is often asymptomatic, but may lead to severe clinical symptoms in immunocompromised patients, even with fatal consequences. Due to the diversity of solid organ transplants, the degrees of immunosuppression, and the relatively low incidence of toxoplasmosis among organ transplant recipients, the clinical risk of T. gondii infection in organ transplant patients remains poorly understood. Therefore, this paper reviews the clinical manifestations, pathogenesis, diagnosis, prevention, and treatment of toxoplasmosis in solid organ transplant recipients, in order to provide reference for clinical diagnosis and treatment of toxoplasmosis after solid organ transplantation.

Key words: Toxoplasma gondii, Solid organ transplantation, Pathogenesis, Diagnosis, Prevention, Treatment

CLC Number:

R531.8

HUANG Zi-yun, LV Fang-li. Solid organ transplantation and toxoplasmosis[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2021, 39(3): 386-392.

Figures/Tables 1

病例信息	心脏移植（42例）	肝移植（20例）	肾移植（32例）
年龄/岁	3~64	7~62	14~74
性别	男（19例）,女（10例）,未知（13例）	男（5例）,女（12例）,未知（3例）	男（20例）,女（11例）,未知（1例）
D/R血清学	D⁺/R^-（27例）,D^-/R⁺（1例）, 未知/R^-（11例）,未知/R⁺（1例）, 未知（1例）	D⁺/R^-（7例）,D^-/R⁺（5例）, 未知/R^-（2例）,未知/R⁺（1例）, D⁺/R⁺（4例）,未知（1例）	D⁺/R^-（20例）,D^-/R⁺（2例）,未知/R^-（1例）,未知/R⁺（2例）,D^-/未知（1例）,D⁺/未知（1例）,未知（5例）
预防药物	无（30例）,PY + LKV（5例）,TMP + SMX（2例）,SF（1例）,ATO（1例）,PY + SDZ（1例）	无（10例）,TMP+SMX（4例）,PY + SDZ + LKV（1例）,未知（5例）	无（10例）,TMP + SMX（7例）,SF（2例）,未知（13例）
免疫抑制药物	P（25例）,AZ（16例）,CSA（15例）,ATG（14例）,MMF（6例）,TAC（4例）,MET（4例）	TAC（10例）,MMF（8例）,P（8例）,CSA（5例）,AZ（4例）,MET（4例）,ATG（2例）	CSA（18例）,ATG（14例）,P（12例）,MMF（11例）,AZ（8例）,MET（7例）,TAC（6例）,OKT3（3例）
移植后初始发病天数	5~30 d（15例）,31~90 d（10例）,91~365 d（8例）,2~12年（2例）,未知（7例）	2~30 d（11例）,31~90 d（3例）,91~365 d（3例）,未知（3例）	16 h~30 d（18例）,31~90 d（3例）,91~365 d（6例）,2~11年（5例）
临床症状	发热（19例）,脑炎（8例）,肺炎（8例）,呼吸窘迫（8例）,播散性弓形虫病（8例）,心肌炎（6例）,神经系统症状（6例）,脉络膜视网膜炎（3例）	发热（10例）,巨细胞病毒感染（8例）,肺炎（5例）,神经系统症状（3例）,脑水肿（2例）,败血症（2例）,白细胞减少（2例）	发热（10例）,巨细胞病毒感染（8例）,肺炎（5例）,神经系统症状（3例）,脑水肿（2例）,败血症（2例）,白细胞减少（2例）
发病机制	D⁺传染给R^-（29例）,隐性弓形虫感染活化（4例）,未知（9例）,	D⁺传染给R^-（9例）,隐性弓形虫感染的活化（10例）,未知（1例）	D⁺传染给R^-（20例）,隐性弓形虫感染活化（6例）,食用未煮熟肉类（2例）,未知（4例）,
感染后治疗药物	无（13例）,PY + SDZ（12例）,PY + SDZ + LKV（3例）,TMP + SMX（2例）,CLR + PY（2例）,PY（2例）,PY + SDZ + SF + CLR（1例）,PZA + SDZ + LKV（1例）,TMP + PY + SDZ + SP（1例）,ATO（1例）,未知（4例）	无（6例）,PY + SDZ（3例）,PY + SDZ + LKV（1例）,TMP + SMX（4例）,TMP + SMX + VA + MEM（1例）,CLR + TMP + SMX（1例）,SMX + AZM（1例）,VA+PRL + TZP（1例）,PY（1例）,CAZ + CIP + TEC + FCA（1例）	无（9例）,PY + SDZ（7例）,PY + SDZ + LKV（2例）,TMP + SMX（2例）,CLR + PY（3例）,CLR + TMP + SMX（1例）,SMX（1例）,PY + SDZ + ATO（1例）,VA + PY + CLR + LKV（1例）,CLR + PY + TMP + SMX（1例）,AZM（1例）,未知（3例）
预后	死亡（26例）,存活（16例）	死亡（10例）,存活（10例）	死亡（14例）,存活（17例）,未知（1例）
参考文献	13-17, 30, 32, 37, 39, 40, 44-49	3, 19, 22, 23, 29, 38, 41, 50-58	7, 24-28, 59-71

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