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Atypical Strain of Toxoplasma gondii Causing Fatal Reactivation after Hematopoietic Stem Cell Transplantion in a Patient with an Underlying Immunological Deficiency

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2013
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Authors
Štajner, Tijana
Vasiljević, Zorica
Vujić, Dragana
Marković, Marija
Ristić, Goran
Micić, Dragan
Pasić, Srđan
Ivović, Vladimir
Ajzenberg, Daniel
Đurković-Đaković, Olgica
Article (Published version)
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Abstract
In immunocompromized patients, including hematopoietic stem cell transplant (HSCT) recipients, life-threatening toxoplasmosis may result from reactivation of previous infection. We report a case of severe disseminated toxoplasmosis that developed early after allogeneic HSCT for T-cell lymphoblastic leukemia/lymphoma in a 15-year-old Toxoplasma gondii-seropositive boy with Nijmegen breakage syndrome, a rare genetic DNA repair disorder associated with immunodeficiency. The donor was the patient's HLA-identical brother. Prophylaxis with cotrimoxazole was discontinued a day before the HSCT procedure. Signs of lung infection appeared as early as day 14 post-HSCT. The presence of tachyzoite-like structures on Giemsa-stained bronchoalveolar lavage (BAL) fluid smears suggested toxoplasmosis. Real-time PCR targeted at the T. gondii AF146527 gene revealed extremely high parasite burdens in both blood and BAL fluid. Although immediate introduction of specific treatment resulted in a marked reduct...ion of the parasite load and transient clinical improvement, the patient deteriorated and died of multiple organ failure on day 39 post-HSCT. Direct genotyping of T. gondii DNA from blood and BAL fluid with the PCR-restriction fragment length polymorphism method revealed type II alleles with SAG1, SAG2, and GRA6 markers but alleles of both type I and type II with GRA7. Additional analysis with 15 microsatellite markers showed that the T. gondii DNA was atypical and genetically divergent from that of the clonal type I, II, and III strains. This is the first report of increased clinical severity of toxoplasmosis associated with an atypical strain in the setting of immunosuppression, which emphasizes the need to diagnose and monitor toxoplasmosis by quantitative molecular methods in cases of reactivation risk.

Source:
Journal of Clinical Microbiology, 2013, 51, 8, 2686-2690
Publisher:
  • Amer Soc Microbiology, Washington
Funding / projects:
  • Control of infections by Apicomplexan pathogens: from novel drug targets to prediction (RS-41019)

DOI: 10.1128/JCM.01077-13

ISSN: 0095-1137

PubMed: 23761151

WoS: 000321951800030

Scopus: 2-s2.0-84880644407
[ Google Scholar ]
36
28
URI
http://rimi.imi.bg.ac.rs/handle/123456789/456
Collections
  • Radovi istraživača / Researchers' publications
Institution/Community
Institut za medicinska istraživanja
TY  - JOUR
AU  - Štajner, Tijana
AU  - Vasiljević, Zorica
AU  - Vujić, Dragana
AU  - Marković, Marija
AU  - Ristić, Goran
AU  - Micić, Dragan
AU  - Pasić, Srđan
AU  - Ivović, Vladimir
AU  - Ajzenberg, Daniel
AU  - Đurković-Đaković, Olgica
PY  - 2013
UR  - http://rimi.imi.bg.ac.rs/handle/123456789/456
AB  - In immunocompromized patients, including hematopoietic stem cell transplant (HSCT) recipients, life-threatening toxoplasmosis may result from reactivation of previous infection. We report a case of severe disseminated toxoplasmosis that developed early after allogeneic HSCT for T-cell lymphoblastic leukemia/lymphoma in a 15-year-old Toxoplasma gondii-seropositive boy with Nijmegen breakage syndrome, a rare genetic DNA repair disorder associated with immunodeficiency. The donor was the patient's HLA-identical brother. Prophylaxis with cotrimoxazole was discontinued a day before the HSCT procedure. Signs of lung infection appeared as early as day 14 post-HSCT. The presence of tachyzoite-like structures on Giemsa-stained bronchoalveolar lavage (BAL) fluid smears suggested toxoplasmosis. Real-time PCR targeted at the T. gondii AF146527 gene revealed extremely high parasite burdens in both blood and BAL fluid. Although immediate introduction of specific treatment resulted in a marked reduction of the parasite load and transient clinical improvement, the patient deteriorated and died of multiple organ failure on day 39 post-HSCT. Direct genotyping of T. gondii DNA from blood and BAL fluid with the PCR-restriction fragment length polymorphism method revealed type II alleles with SAG1, SAG2, and GRA6 markers but alleles of both type I and type II with GRA7. Additional analysis with 15 microsatellite markers showed that the T. gondii DNA was atypical and genetically divergent from that of the clonal type I, II, and III strains. This is the first report of increased clinical severity of toxoplasmosis associated with an atypical strain in the setting of immunosuppression, which emphasizes the need to diagnose and monitor toxoplasmosis by quantitative molecular methods in cases of reactivation risk.
PB  - Amer Soc Microbiology, Washington
T2  - Journal of Clinical Microbiology
T1  - Atypical Strain of Toxoplasma gondii Causing Fatal Reactivation after Hematopoietic Stem Cell Transplantion in a Patient with an Underlying Immunological Deficiency
EP  - 2690
IS  - 8
SP  - 2686
VL  - 51
DO  - 10.1128/JCM.01077-13
UR  - conv_3011
ER  - 
@article{
author = "Štajner, Tijana and Vasiljević, Zorica and Vujić, Dragana and Marković, Marija and Ristić, Goran and Micić, Dragan and Pasić, Srđan and Ivović, Vladimir and Ajzenberg, Daniel and Đurković-Đaković, Olgica",
year = "2013",
abstract = "In immunocompromized patients, including hematopoietic stem cell transplant (HSCT) recipients, life-threatening toxoplasmosis may result from reactivation of previous infection. We report a case of severe disseminated toxoplasmosis that developed early after allogeneic HSCT for T-cell lymphoblastic leukemia/lymphoma in a 15-year-old Toxoplasma gondii-seropositive boy with Nijmegen breakage syndrome, a rare genetic DNA repair disorder associated with immunodeficiency. The donor was the patient's HLA-identical brother. Prophylaxis with cotrimoxazole was discontinued a day before the HSCT procedure. Signs of lung infection appeared as early as day 14 post-HSCT. The presence of tachyzoite-like structures on Giemsa-stained bronchoalveolar lavage (BAL) fluid smears suggested toxoplasmosis. Real-time PCR targeted at the T. gondii AF146527 gene revealed extremely high parasite burdens in both blood and BAL fluid. Although immediate introduction of specific treatment resulted in a marked reduction of the parasite load and transient clinical improvement, the patient deteriorated and died of multiple organ failure on day 39 post-HSCT. Direct genotyping of T. gondii DNA from blood and BAL fluid with the PCR-restriction fragment length polymorphism method revealed type II alleles with SAG1, SAG2, and GRA6 markers but alleles of both type I and type II with GRA7. Additional analysis with 15 microsatellite markers showed that the T. gondii DNA was atypical and genetically divergent from that of the clonal type I, II, and III strains. This is the first report of increased clinical severity of toxoplasmosis associated with an atypical strain in the setting of immunosuppression, which emphasizes the need to diagnose and monitor toxoplasmosis by quantitative molecular methods in cases of reactivation risk.",
publisher = "Amer Soc Microbiology, Washington",
journal = "Journal of Clinical Microbiology",
title = "Atypical Strain of Toxoplasma gondii Causing Fatal Reactivation after Hematopoietic Stem Cell Transplantion in a Patient with an Underlying Immunological Deficiency",
pages = "2690-2686",
number = "8",
volume = "51",
doi = "10.1128/JCM.01077-13",
url = "conv_3011"
}
Štajner, T., Vasiljević, Z., Vujić, D., Marković, M., Ristić, G., Micić, D., Pasić, S., Ivović, V., Ajzenberg, D.,& Đurković-Đaković, O.. (2013). Atypical Strain of Toxoplasma gondii Causing Fatal Reactivation after Hematopoietic Stem Cell Transplantion in a Patient with an Underlying Immunological Deficiency. in Journal of Clinical Microbiology
Amer Soc Microbiology, Washington., 51(8), 2686-2690.
https://doi.org/10.1128/JCM.01077-13
conv_3011
Štajner T, Vasiljević Z, Vujić D, Marković M, Ristić G, Micić D, Pasić S, Ivović V, Ajzenberg D, Đurković-Đaković O. Atypical Strain of Toxoplasma gondii Causing Fatal Reactivation after Hematopoietic Stem Cell Transplantion in a Patient with an Underlying Immunological Deficiency. in Journal of Clinical Microbiology. 2013;51(8):2686-2690.
doi:10.1128/JCM.01077-13
conv_3011 .
Štajner, Tijana, Vasiljević, Zorica, Vujić, Dragana, Marković, Marija, Ristić, Goran, Micić, Dragan, Pasić, Srđan, Ivović, Vladimir, Ajzenberg, Daniel, Đurković-Đaković, Olgica, "Atypical Strain of Toxoplasma gondii Causing Fatal Reactivation after Hematopoietic Stem Cell Transplantion in a Patient with an Underlying Immunological Deficiency" in Journal of Clinical Microbiology, 51, no. 8 (2013):2686-2690,
https://doi.org/10.1128/JCM.01077-13 .,
conv_3011 .

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