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Adverse Occurrence type:
Very infrequent. More probable in the setting of heart transplantation
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Blurred vision of the left eye. No pain. Ocular fundoscopy revealed multifocal (and not unifocal) chorioretinitis. Aqueous humor Toxoplasma DNA positive by PCR
Demonstration of imputability or root cause:
Imputability based on the serological mismatch: recipient negative but donor Toxoplasma IgG positive pre-transplant. Recipient developed IgM and seroconverted to Toxoplasma IgG. Antibodies against sporozoite-specific antigens were not detected; authors note that the absence of such antibodies support the fact that acquisition of infection through oocyst ingestion was therefore less likely.
Suggest new keywords:
Toxoplasma gondii, chorioretinitis, donor derived infection, serology
Post-prophylaxis Toxoplasma chorioretinitis following donor–recipient mismatched liver transplantation. Webb et al. Transpl Infect Dis 2016: 18: 805–808
Donor mismatched for toxo - so transmission expected. Should we include this? I think not but am willing to summarize if this is what we are doing. IUL - Thanks. I reviewed and modified the text ; let's keep the record as there are some interesting observations that I tried to capture We do not consider routinely toxoplasma missmatch to start cotrimoxazole prophylaxis as it seems a very infrequent event a part from heart transplantation. IUL - again, practice varies and some centres do use D/R serology to inform prophylaxis.
Expert comments for publication:
Toxoplasma transmission is an explanation for the development of chorioretinitis. However this presentation is more frequent in cases of reactivation and not a new infection as the authors suggest. Primary disseminated infection is the expected presentation when transmission occurs under immunosuppression. However, the recipient received cotrimoxazole for 3 months for prevention of Pneumocystis jeroveci pneumonia. This could have played a role in modifying and delaying disease presentation. Other sources of infection cannot be discarded, for example, contact with cats, contaminated soil or ingestion of undercooked contaminated food but the authors give their views in that respect and discuss the relevance of the negative antibodies against sporozoite-specific antigens. Where local epidemiology and guidance indicates the need for toxoplasma serology, this needs to be done pre-transplant, in both donors and recipients.