TOXOPLASMOSIS AS AN OPPORTUNISTIC PROTOZOAN INFESTATION AND ITS SIGNIFICANCE IN TRANSPLANTATION
https://doi.org/10.15825/1995-1191-2015-4-95-103
Abstract
The pathogen of toxoplasmosis called Toxoplasma gondii is able to persist for a long time in various human tissues. Toxoplasmosis is referred to as an opportunistic disease, since it presents a danger to the life of the patient for the immune dysfunction. Reactivation of latent infestation in HIV infection and transplantation procedures is a serious problem for healthcare. If a dominant clinical form in patients with HIV infection is represented by cerebral toxoplasmosis, then a broader range of lesions is observed after organ transplantation. Toxoplasmosis myocarditis and pericarditis are reliably more frequently observed. This paper analyzes mortality rate in transplantation of various organs, timing of invasive reactivation in the postoperative period and relation between reactivation and withdrawal of preventive drugs. Objectively it is rather difficult to diagnose the disease due to inaccessibility of the pathogen, atypical clinical picture and low sensitivity of laboratory indication methods. In this regard, there is a useful experience of foreign and domestic research studies in searching and using clinical, instrumental, immunological and molecular criteria of reactivation of toxoplasmosis in human immunodeficiency. The given facts convincingly demonstrated the danger of toxoplasmosis; the role of the disease is shown for various fields of medicine, particularly in transplantation of organs and tissues.
About the Authors
D. B. Goncharov
N.F. Gamaleya Federal Research Center of Epidemiology and Microbiology of the Ministry of Healthcare of Russian Federation, Moscow, Russian Federation
Russian Federation
Russian Federation
N. I. Gabrielyan
V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
Russian Federation
Russian Federation
E. V. Abbazova
N.F. Gamaleya Federal Research Center of Epidemiology and Microbiology of the Ministry of Healthcare of Russian Federation, Moscow, Russian Federation
Russian Federation
Russian Federation
E. S. Ievleva
N.F. Gamaleya Federal Research Center of Epidemiology and Microbiology of the Ministry of Healthcare of Russian Federation, Moscow, Russian Federation
Russian Federation
Russian Federation
T. V. Krupenio
V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
Russian Federation
Russian Federation
References
1. Лысенко АЯ, Владимирова МГ, Кондрашин АВ, Майори ДВ. Клиническая паразитология. ВОЗ. Женева, 2002; Токсоплазмоз: 319–338. Lysenko AYa, Vladimirova MG, Kondrashin AB, Maiory DV. Klinicheskaya parazitologiya. VOZ. Zheneva, 2002; Toksoplazmoz: 319–338.
2. Гончаров ДБ. Значение персистенции Toxoplasma gondii в клинической патологии человека. Журнал микробиологии, эпидемиологии и иммунобиологии. 2006; 4: 92–97. Goncharov DB. The role of Toxoplasma gondii persistence in human clinical pathology. Journal of microbiology, epidemiology and immunobiology. 2006; 4: 92–97. [English abstract].
3. Hill D, Dubey JP. Toxoplasma gondii: transmission, diagnosis and prevention. Clin. Microbiol. Infect. 2002; 8: 634–640.
4. Jenun PA, Holberg-Petersoen M, Melby KK, Stray-Pedersen B. Diagnosis of congenital Toxoplasma gondii infection by polymerase chain reaction (PCR) in amniotic fluid samples. The Norvegian experience. 1998; 106: 680–686.
5. Vidal J, Colombo FA, Penalva de Oliveira AC, Focaccia R, Pereira-Chioccola VL. PCR assay using cerebrospinal fluid for diagnosis of cerebral toxoplasmosis in brasilian AIDS patients. J. Clin. Microbiol. 2004; 42 (10): 4765–4768.
6. Ferguson DJP. Toxoplasma gondii: 1908–2008, homage to Nicolle, Manceaux and Splendore. Mem. Inst. Oswaldo Cruz. 2009; 104 (2): 133–148.
7. Вершинин ИИ. Кокцидиозы животных и их дифференциальная диагностика. Екатеринбург, 1996: 264. Vershinin II. Koktsidiozy zhivotnykh i ikh differentsialinaya diagnostika. Yekaterinburg, 1996: 264.
8. Fayer R, Reid WH. Control of coccidiosis. The biology of coccidian. Ed. P.L. Baltimore. 1982; 453–487.
9. Robert-Gangneux F, Darde ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin. Microbiol. Rev. 2012; 25 (2): 264–296.
10. Garweg J, Garweg S-DL, Flueckiger F, Jacquier P, Boehnke M. Aqueous humor and serum immunoblotting for immunoglobulin types G, A, M and E in cases of human ocular toxoplasmosis. J. Clin. Microbiol. 2004; 42 (10): 4593–4598.
11. Luft BJ, Chua A. Central nervous system toxoplasmosis in HIV: pathogenesis, diagnosis and therapy. Curr. Infect. 2000; 2: 358–362.
12. Засухин ДН. Проблема токсоплазмоза. М.: Медицина, 1980: 309. Zasukhin DN. Problema toksoplazmoza. М.: Meditsina, 1980: 309.
13. Кузнецова ЭА, Нестеренко ЛН, Грачева ЛИ, Гончаров ДБ, Бенедиктов ИИ, Романова ЮМ. Сборник тезисов докладов III Всероссийской научно-практической конференции «Генодиагностика в современной медицине». М., 2000: 192–194. Kuznetsova EA, Nesterenko LN, Grachyova LI, Goncharov DB, Benediktov II, Romanova YuM. Sbornik tezisov dokladov III Vserossijskoy nauchno-prakticheskoy konferentsii «Genodiagnostika v sovremennoi meditsine». М., 2000: 192–194.
14. Fayer R, Reid WH. Control at coccidiosis. The biology of the coccidia. Ed. P.L. Long. Baltimore, 1982: 453–487.
15. Гончаров ДБ. Токсоплазмоз: роль в клинической патологии человека и методы диагностики. Медицинская паразитология и паразитарные болезни. 2005; 4: 52–58. Goncharov DB. Toksoplazmoz: rol' v klinicheskoi patologii cheloveka i metody diagnostiki. Meditsinskaya parazitologiya i parazitarnyie bolezni. 2005; 4: 52–58.
16. Орехов КВ. Врожденный токсоплазмоз. Орехов КВ. (ред.). Инфекционные заболевания у детей и экология человека. Ставрополь, 1999; 69–92. Orekhov KV. Vrozhdyonnyi toksoplazmoz. Orekhov KV. (red). Infektsionnyie zabolevaniya u detei i ekologiya cheloveka. Stavropol', 1999; 69–92.
17. Ряпис ЛА, Брико НИ, Покровский ВИ. Вертикальная передача возбудителей болезней человека и ее соотношение с неклассическими механизмами передачи. Эпидемиология и инфекционные болезни. 2000; 4: 47–49. Ryapis LA, Briko NI, Pokrovskyi VI. Vertical transmission of pathogens of human diseases and its correlation with non-classical mechanisms of transmission. Epidemiology and infectious diseases. 2000; 4: 47–49. [English abstract].
18. Ткаченко ЮП, Ткаченко АВ, Каменщик АВ. Врожденный токсоплазмоз у детей первого года жизни. Международный медицинский журнал. 1998; 4: 107–109. Tkachenko YP, Tkachenko AV, Kamenschik AV. Vrozhdyonnyi toksoplazmoz u detei pervogo goda zhizni. Mezhdunarodnyi meditsinskyi zhurnal. 1998; 4: 107–109.
19. Roizen L, Swisher CN, Stein MA, Hopkins J, Boyer KM, Holfels E et al. Neurologic and developmental out come in treated congenital toxoplasmosis. Pediatrics. 1995; 95 (1): 11–20.
20. Daffos F, Foresrier M, Capella-Pavlovssky M, Thulliez P, Aufrant C, Valenti D et al. Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis. N. Engl. J. Med. 1988; 318: 271–275.
21. Тишкевич ОА, Шахгильдян ВИ, Пархоменко ЮГ. Структура летальных исходов и патологическая анатомия у больных ВИЧ-инфекцией в Москве. Эпидемиология и инфекционные болезни. 2004; 4: 42–46. Tishkebich OA, Shakhgil'dyan VI, Parkhomenko YuG. Struktura letal'nykh iskhodov i patologicheskaya anatomiya u bol'nykh VICH-infektsiyei v Moskve. Epidemiologiya i infektsionnyye bolezni. 2004; 4: 42–46.
22. Цинзерлинг ВА, Комарова ДВ, Рахманова АГ, Яковлев АА, Леонова ОН. Актуальные проблемы морфологической диагностики и патоморфоз ВИЧ-инфекции. Архив патологии. 2010; 72 (2): 26–30. Tsinzerling VA, Komarova DV, Rakhmanova AG, Yakovlev AA, Leonova ON. The topical problems of morphological diagnosis and the pathomorphism of HIV infection. Arkhiv patologii. 2010; 72 (2): 26–30. [English abstract].
23. Перегудова АБ, Шахгильдян ВИ, Гончаров ДБ, Ермак ТН, Тишкевич ИМ, Шипулина ОЛ и др. Церебральный токсоплазмоз у больных ВИЧ-инфекцией. Терапевтический архив. 2007; 79 (11): 36–39. Peregudova AB, Shakhgil'dyan VI, Goncharov DB, Ermak TN, Tishkevich IM, Shipulina OL et al. Cerebral toxoplasmosis in HIV-infected patients. Therapeutic archive. 2007; 79 (11): 36–39. [English abstract].
24. Перегудова АБ, Шахгильдян ВИ, Цветкова ОА, Ермак ТН, Груздев БМ, Юдицкий МВ и др. Структура поражения центральной нервной системы у больных ВИЧ-инфекцией специализированного отделения инфекционной больницы. Терапевтический архив. 2010; 82 (11): 22–27. Peregudova AB, Shakhgil'dyan VI, Tsvetkova OA, Ermak TN, Gruzdev BM, Yuditskij MV et al. The pattern of central nervous system lesions in HIVinfected patients of the specialized unit in infectious disease hospital. Therapeutic archive. 2010; 82 (11): 22– 27. [English abstract].
25. Губарева ЕВ, Гончаров ДБ, Кобец НВ, Долгих ТИ, Магда НА, Перегудова АБ и др. Разработка подходов к созданию системы диагностики и профилактики токсоплазмоза при ВИЧ-инфекции. Эпидемиология и вакцинопрофилактика. 2010; 4 (53): 60–65. Gubareva EV, Goncharov DB, Kobets NV, Dolgikh TI, Magda NA, Peregudova AB i dr. Razrabotka podkhodov k sozdaniyu sistemy diagnostiki i profilaktiki toksoplazmoza pri VICH-infektsii. Epidemiologiya i vaktsinoprofilaktika. 2010; 4 (53): 60–65.
26. Гончаров ДБ, Губарева ЕВ, Тишкевич ОА, Кобец НВ, Пархоменко ЮГ, Боровая ТГ и др. Изучение персистенции низковирулентного штамма Toxoplasma gondii на модели in vivo. Журнал микробиологии, эпидемиологии и иммунобиологии. 2009; 4: 107–111. Goncharov DB, Gubareva EV, Tishkevich OA, Kobets NV, Parkhomenko IuG, Borovaia TG et al. Study of persistence of low virulent strain of Toxoplasma gondii on in vivo model. Journal of Microbiology, epidemiology and Immunobiology. 2009; 4: 107–111. [English abstract].
27. Губарева ЕВ, Гончаров ДБ, Домонова ЭА, Сильвейстрова ОЮ, Перегудова АБ, Тишкевич ОА и др. Использование иммунологических и молекулярнобиологических методов для диагностики церебрального токсоплазмоза при ВИЧ-инфекции. Медицинская паразитология и паразитарные болезни. 2013; 1: 7–12. Gubareva EV, Goncharov DB, Domonova ÉA, Sil'veĭstrova OIu, Peregudova AB, Tishkevich OA. et al. Use of immunological and molecular biological methods to diagnose cerebral toxoplasmosis in HIV infection. Medical parasitology and parasitic diseases. 2013; 1: 7–12.
28. Stroehle A, Schmid K, Heinzer I, Naguleswaran A, Hemphill A. Performance of a Western immunoblot assay to detect specific anti-Toxoplasma gondii IgG antibodies in human saliva. J. Parasitol. 2005; 91 (3): 561–563.
29. Dzitko K, Staczek P, Gatkowska J, Dlugonska H. Toxoplasma gondii: Serological recognition of reinfection. Exp. Parasitol. 2006; 112 (2): 134–137.
30. Гончаров ДБ, Губарева ЕВ, Кобец НВ, Домонова ЭА, Иевлева ЕС. Токсоплазмоз при ВИЧ-инфекции: критерии реактивации инвазии. Журнал микробиологии, эпидемиологии и иммунобиологии. 2012; 4: 88–92. Goncharov DB, Gubareva EV, Kobets NV, Domonova EA, Ievleva ES. Toxoplasmosis in HIV-infection: invasion reactivation criteria. Journal of Microbiology, epidemiology and Immunobiology. 2012; 4: 88–92. [English abstract].
31. Colombo FA, Vidal JE, de Oliveira AC, Hernandez AV, Bonasser-Filho F, Nogueira RS et al. Diagnosis of cerebral toxoplasmosis in AIDS patients in Brazil: importance of molecular and immunological methods using peripheral blood samples. J. Clin. Microbiol. 2005; 43 (10): 5044–5047.
32. Williams SL, Burton EC. Disseminated toxoplasmosis in a patient with undiagnosed AIDS. Proc (Bayl. Univ. Med. Cent.). 2009; 22 (1): 20–22.
33. Покровский ВВ, Ермак ТН, Беляева ВВ, Юрин ОГ. ВИЧ-инфекция: клиника, диагностика и лечение. М.: ГЕОТАР-МЕД, 2003: 488. Pokrovskyi VV, Yermak TN, Beliayeva VV, Yuring OG. VICH-infektsiya: klinika, diagnostika i lecheniye. M.: GEOTAR-MED, 2003: 488.
34. Oliveira JF, Greco DB, Oliveira GC, Christo PP, Guimaraes MDC, Correa-Oliveira R. Neurological disease in HIV-infected patients in the era of highly active antiretroviral treatment: a Brazilian experience. Rev. Soc. Bras. Med. Trop. 2006; 39 (2): 146–151.
35. Leak D, Meghji M. Toxoplasmic infection in cardiac disease. Am. J. Cardiol. 1979; 43 (4): 841–849.
36. Засухин ДН. Проблема токсоплазмоза. М.: Медицина, 1980: 312. Zasukhin DN. Problema toksoplazmoza. M.: Meditsina, 1980: 312.
37. Ryning FW, Mcleod R, Maddox JC, Hunt S, Remington JS. Probable transmission of Toxoplasma gondii by organ transplantation. Ann. Intrn. Med. 1979; 90: 47–49.
38. Speirs GE, Hakim M, Calne RY, Wreghitt TG. Relative risk of donor-transmitted Toxoplasma gondii infection in heart, liver and kidney transplant recipients. Clin. Transplant. 1988; 2: 257–260.
39. Orr KE, Gould FK, Short G, Dark JH, Hilton CJ, Corris PA et al. Outcome of Toxoplasma gondii mismatches in heart transplant recipients over a period of 8 years. J. Infect. 1994; 29: 249–253.
40. Mele A, Paterson PJ, Prentice HG, Leoni P, Kibbler CC. Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature. Bone Marrow Transplantation. 2002; 29: 691–698.
41. Gallino A, Maggiorini M, Kiowski W, Martin X, Wunderli W, Schneider J et al. Toxoplasmosis in heart transplant recipients. Eur. J. Clin. Microbiol. Infect. Dis. 1996; 15 (5): 389–393.
42. Wulf MWH, van Crevel R, Portier R, ter Meulen CG, Melchers WJG, van der Ven A et al. Toxoplasmosis after renal transplantation: implications of a missed diagnosis. J. Clin. Microbiol. 2005; 43 (7): 3544–3547.
43. Nasser QJ, Power RE, Eng MP, Hickey DP, Little DM. Toxoplasmosis after a simultaneous pancreas and kidney transplantation. Transplant. Proc. 2004; 36 (9): 2843– 2844.
44. Vaessen N, Verweij JJ, Spijkerman IJ, van Hoek B, van Lieshout L. Fatal disseminated toxoplasmosis after liver transplantation: improved and early diagnosis by PCR. Neth. J. Med. 2007; 65 (6): 222–223.
45. Arora S, Jenum PA, Aukrust P, Rollag H, Andreassen AK, Simonsen S et al. Pre-transplant Toxoplasma gondii seropositivity among heart transplant recipients is associated with an increased risk of all-cause and cardiac mortality. J. Am. Coll. Cardiol. 2007; 50 (20): 1967–1972.
46. Doesch AO, Ammon K, Konstandin M, Celik S, Kristen A, Frankenstein L et al. Negative pretransplant serostatus for Toxoplasma gondii is associated with impaired survival after heart transplantation. Transpl. Int. 2010; 23 (4): 382–389.
47. Fernàndez-Sabé N, Cervera C, Fariñas MC, Bodro M, Muñoz P, Gurguí M et al. Risk factors, clinical features, and outcomes of toxoplasmosis in solid-organ transplant recipients: a matched case-control study. Clin. Infect. Dis. 2012; 54 (3): 355–361.
48. Baliu C, Sanclemente G, Cardona M, Castel MA, PerezVilla F, Moreno A et al. Toxoplasmic encephalitis associated with meningitis in a heart transplant recipient. Transpl. Infect. Dis. 2014; 16 (4): 631–633.
49. Davis C, Manteuffel J. Unusual presentation of Toxoplasma gondii encephalitis. West J. Emerg. Med. 2012; 13 (6): 488–490.
50. Mastrobuoni S, Dell'aquila AM, Herreros J. Fatal Toxoplasma gondii dissemination in a heart transplant recipient: description of a case. Case Rep. Transplant. 2012; 2012(ID 524279): 3. Published online.
51. Strabelli TM, Siciliano RF, Vidal Campos S, Bianchi Castelli J, Bacal F, Bocchi EA et al. Toxoplasma gondii myocarditis after adult heart transplantation: successful prophylaxis with pyrimethamine. J. Trop. Med. 2012; 2012: ID 853562, 4 p. Published online.
52. Avkan OV, Koçak N, Köse H, Unek T, Ozbilgin M, Karademir S et al. Ocular toxoplasmosis developed after liver transplantation. Mikrobiyol. Bul. 2012; 46 (4): 702–706.
53. Van Hellemond JJ, van Domburg RT, Caliskan K, Birim O, Balk AH. Toxoplasma gondii serostatus is not associated with impaired long-term survival after heart transplantation. Transplantation. 2013; 96 (12): 1052–1058.
54. Doesch AO, Ammon K. Konstandin M, Celik S, Kristen A, Frankenstein L et al. Negative pretransplant serostatus for Toxoplasma gondii is associated with impaired survival after heart transplantation. Transpl. Int. 2010; 23 (4): 382–389.
55. Payá E, Noemí I, Tassar R, Catalán P, Avilés CL. Prophylaxis against Toxoplasma gondii disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation. Rev. Chilena Infectol. 2012; 29 (l): 37–39.
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For citations:
Goncharov D.B., Gabrielyan N.I., Abbazova E.V., Ievleva E.S., Krupenio T.V. TOXOPLASMOSIS AS AN OPPORTUNISTIC PROTOZOAN INFESTATION AND ITS SIGNIFICANCE IN TRANSPLANTATION. Russian Journal of Transplantology and Artificial Organs. 2015;17(4):95-103. (In Russ.) https://doi.org/10.15825/1995-1191-2015-4-95-103
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