03009nas a2200313   4500008004100000022004200041245017400083210006900257250001000326260001000336300001300346490000700359520196600366653002702332653001002359653001102369653001102380653001402391653005602405653006202461653003102523100001802554700001802572700001502590700001702605700001302622700001602635856004402651       2006                        eng d  a0041-1337 (Print) 0041-1337 (Linking)00aFirst case of toxoplasmosis following small bowel transplantation and systematic review of tissue-invasive toxoplasmosis following noncardiac solid organ transplantation0 aFirst case of toxoplasmosis following small bowel transplantatio  a38764  c42036  a408 - 170 v813 aBACKGROUND: Toxoplasmosis prophylaxis is standard following heart and heart lung transplantation, when an increased risk of allograft transmitted Toxoplasma is well-recognized. In contrast, prophylaxis and routine serologic evaluation of donors and recipients for Toxoplasma in noncardiac solid organ transplantation (SOT) is not recommended. We report the first case of disseminated toxoplasmosis following small bowel transplantation, presumably transmitted via the transplanted intestine and systematically review reported cases of toxoplasmosis in noncardiac SOT recipients to determine if current guidelines should be reconsidered. METHODS: Systematic MEDLINE review was performed for tissue invasive toxoplasmosis in noncardiac SOT recipients and analysis of clinical features, serologic status, and treatment regimens with respect to mortality. RESULTS: Fifty-two cases of toxoplasmosis in noncardiac SOT recipients were identified. Eighty-six percent developed disease within 90 days of transplantation. Presentation was nonspecific and consisted of fever (77%), respiratory distress (29%), neurologic manifestations (29%), and bone marrow suppression (26%). Multivariate analyses demonstrated that localized disease (odds ratio [OR]=37.36, 95% CI 1.85-754.85), treatment received (OR=1.814, 95% CI 1.193-3.480) and donor and recipient serostatus (OR=1.39, 95% CI 1.068-1.815) were predictors of survival. High-risk recipients (donor seropositive/recipient seronegative) developed disease earlier (16 days vs. 31 days P=0.002) and were less likely to survive (OR=0.14, 95% CI 0.03-0.69) than standard-risk recipients. CONCLUSIONS: Toxoplasmosis is recognized following noncardiac SOT. Reduction of morbidity and mortality necessitates knowledge of donor and recipient Toxoplasma serostatus, prophylaxis, early diagnosis, and treatment. The findings support a reconsideration of pretransplantation evaluation and prophylaxis strategies in SOT recipients.10a*Organ Transplantation10aChild10aFemale10aHumans10aIncidence10aIntestine, Small / *parasitology / *transplantation10aToxoplasmosis / *diagnosis / drug therapy / *epidemiology10aTransplants / parasitology1 aCampbell, A L1 aGoldberg, C L1 aMagid, M S1 aGondolesi, G1 aRumbo, C1 aHerold, B C  uhttps://notifylibrary.org/reference/285