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
Copyright © 2024 Elsevier Ltd. All rights reserved..
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.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2024 |
---|---|
Erschienen: |
2024 |
Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
---|---|
Enthalten in: |
The Lancet. Infectious diseases - 24(2024), 5 vom: 01. Apr., Seite e291-e306 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Aerts, Robina [VerfasserIn] |
---|
Links: |
---|
Themen: |
8064-90-2 |
---|
Anmerkungen: |
Date Completed 26.04.2024 Date Revised 27.04.2024 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1016/S1473-3099(23)00495-4 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM366256084 |
---|
LEADER | 01000caa a22002652 4500 | ||
---|---|---|---|
001 | NLM366256084 | ||
003 | DE-627 | ||
005 | 20240428231904.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231227s2024 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1016/S1473-3099(23)00495-4 |2 doi | |
028 | 5 | 2 | |a pubmed24n1391.xml |
035 | |a (DE-627)NLM366256084 | ||
035 | |a (NLM)38134949 | ||
035 | |a (PII)S1473-3099(23)00495-4 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Aerts, Robina |e verfasserin |4 aut | |
245 | 1 | 0 | |a Guidelines for the management of Toxoplasma gondii infection and disease in patients with haematological malignancies and after haematopoietic stem-cell transplantation |b guidelines from the 9th European Conference on Infections in Leukaemia, 2022 |
264 | 1 | |c 2024 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 26.04.2024 | ||
500 | |a Date Revised 27.04.2024 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Copyright © 2024 Elsevier Ltd. All rights reserved. | ||
520 | |a 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 | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Review | |
650 | 4 | |a Research Support, Non-U.S. Gov't | |
650 | 7 | |a Trimethoprim, Sulfamethoxazole Drug Combination |2 NLM | |
650 | 7 | |a 8064-90-2 |2 NLM | |
650 | 7 | |a Antiprotozoal Agents |2 NLM | |
700 | 1 | |a Mehra, Varun |e verfasserin |4 aut | |
700 | 1 | |a Groll, Andreas H |e verfasserin |4 aut | |
700 | 1 | |a Martino, Rodrigo |e verfasserin |4 aut | |
700 | 1 | |a Lagrou, Katrien |e verfasserin |4 aut | |
700 | 1 | |a Robin, Christine |e verfasserin |4 aut | |
700 | 1 | |a Perruccio, Katia |e verfasserin |4 aut | |
700 | 1 | |a Blijlevens, Nicole |e verfasserin |4 aut | |
700 | 1 | |a Nucci, Marcio |e verfasserin |4 aut | |
700 | 1 | |a Slavin, Monica |e verfasserin |4 aut | |
700 | 1 | |a Bretagne, Stéphane |e verfasserin |4 aut | |
700 | 1 | |a Cordonnier, Catherine |e verfasserin |4 aut | |
700 | 0 | |a European Conference on Infections in Leukaemia group |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t The Lancet. Infectious diseases |d 2001 |g 24(2024), 5 vom: 01. Apr., Seite e291-e306 |w (DE-627)NLM117564362 |x 1474-4457 |7 nnns |
773 | 1 | 8 | |g volume:24 |g year:2024 |g number:5 |g day:01 |g month:04 |g pages:e291-e306 |
856 | 4 | 0 | |u http://dx.doi.org/10.1016/S1473-3099(23)00495-4 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 24 |j 2024 |e 5 |b 01 |c 04 |h e291-e306 |