Guidelines for the management of Toxoplasma gondii infection and disease in patients with haematological malignancies and after haematopoietic stem-cell transplantation: guidelines from the 9th European Conference on Infections in Leukaemia, 2022
- Author(s)
- Aerts, R; Mehra, V; Groll, AH; Martino, R; Lagrou, K; Robin, C; Perruccio, K; Blijlevens, N; Nucci, M; Slavin, M; Bretagne, S; Cordonnier, C; European Conference on Infections in Leukemia group;
- Details
- Publication Year 2024-05,Volume 24,Issue #5,Page e291-e306
- Journal Title
- Lancet Infectious Diseases
- Publication Type
- Guideline
- Abstract
- Patients with haematological malignancies might develop life-threatening toxoplasmosis, especially after allogeneic haematopoietic stem-cell transplantation (HSCT). Reactivation of latent cysts is the primary mechanism of toxoplasmosis following HSCT; hence, patients at high risk are those who were seropositive before transplantation. The lack of trimethoprim-sulfamethoxazole prophylaxis and various immune status parameters of the patient are other associated risk factors. The mortality of toxoplasma disease-eg, with organ involvement-can be particularly high in this setting. We have developed guidelines for managing toxoplasmosis in haematology patients, through a literature review and consultation with experts. In allogeneic HSCT recipients seropositive for Toxoplasma gondii before transplant, because T gondii infection mostly precedes toxoplasma disease, we propose weekly blood screening by use of quantitative PCR (qPCR) to identify infection early as a pre-emptive strategy. As trimethoprim-sulfamethoxazole prophylaxis might fail, prophylaxis and qPCR screening should be combined. However, PCR in blood can be negative even in toxoplasma disease. The duration of prophylaxis should be a least 6 months and extended during treatment-induced immunosuppression or severe CD4 lymphopenia. If a positive qPCR test occurs, treatment with trimethoprim-sulfamethoxazole, pyrimethamine-sulfadiazine, or pyrimethamine-clindamycin should be started, and a new sample taken. If the second qPCR test is negative, clinical judgement is recommended to either continue or stop therapy and restart prophylaxis. Therapy must be continued until a minimum of two negative PCRs for infection, or for at least 6 weeks for disease. The pre-emptive approach is not indicated in seronegative HSCT recipients, after autologous transplantation, or in non-transplant haematology patients, but PCR should be performed with a high level of clinical suspicion.
- Publisher
- Elsevier
- Keywords
- Humans; *Toxoplasmosis/diagnosis/drug therapy; *Hematopoietic Stem Cell Transplantation/adverse effects; *Toxoplasma; *Hematologic Neoplasms/complications/therapy; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use; Antiprotozoal Agents/therapeutic use
- Department(s)
- Infectious Diseases
- Publisher's Version
- https://doi.org/10.1016/s1473-3099(23)00495-4
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-06-25 08:02:22
Last Modified: 2024-06-25 08:02:45