Folia Parasitologica 66:019 (2019) | DOI: 10.14411/fp.2019.019

Low seroprevalence and low incidence of infection with Toxoplasma gondii (Nicolle et Manceaux, 1908) in pediatric hematopoietic cell transplantation donors and recipients: Polish nationwide study

Krzysztof Czyzewski¹, Jowita Fraczkiewicz², Malgorzata Salamonowicz², Anna Pieczonka³, Olga Zajac-Spychala³, Agnieszka Zaucha-Prazmo⁴, Jolanta Gozdzik⁵, Jan Styczynski¹

¹ Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland;

² Department of Pediatric Transplantation, Oncology and Hematology, Medical University, Wroclaw, Poland;

³ Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland;

⁴ Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland;

⁵ Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland.

Toxoplasmosis is a potentially fatal complication after hematopoietic cell transplantation (HCT). Pre-transplant seropositivity of graft recipient to Toxoplasma gondii (Nicolle et Manceaux, 1908) is an important factor for disease reactivation after HCT. As toxoplasmosis epidemiology varies all over the world, we performed a Polish nationwide retrospective cohort study to determine the seroprevalence of toxoplasmosis in donors and pediatric allogeneic and autologous HCT recipients and the incidence of clinically evident toxoplasmosis in this patient group. Polish adult donors had higher anti-T. gondii seroprevalence than Polish pediatric donors (28% vs 8%; OR = 4.4; p = 0.02) and allo-HCT recipients (28% vs 17%; OR = 1.9; p = 0.01). Clinically apparent disease occurred in 1% of allo-HCT recipients: it was diagnosed by PCR as cerebral and/or ocular toxoplasmosis and successfully treated with antiprotozoal therapy. Regarding current practice, no prospective screening for infection of T. gondii in pediatric HCT centres is being performed, but, vast majority of HCT pediatric patients are receiving anti-T. gondii active prophylaxis. Since pre-HCT T. gondii serology was not assessed in all HCT; recipients, we propose this test should be a standard practice. Standardisation of management with infection of T. gondii in children after HCT is needed.

Keywords: bone marrow transplantation, children, prophylaxis, toxoplasmosis, treatment, trimethoprime, sulfamethoxazole

Received: November 16, 2018; Accepted: August 21, 2019; Published online: November 11, 2019  Show citation