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Primary and Reactivated Toxoplasma Infection in Patients with Cardiac Transplants: Clinical Spectrum and Problems in Diagnosis in a Defined Population

BENJAMIN J. LUFT, M.D.; YEHUDITH NAOT, D.Sc.; FAUSTO G. ARAUJO, Ph.D.; EDWARD B. STINSON, M.D.; and JACK S. REMINGTON, M.D.
[+] Article and Author Information

Grant support: by grant AI 04717, National Institutes of Health. Dr. Luft is a recipient of a NIH Training Grant no. AI 07089 and an Edith Milo Fellowship.

▸Requests for reprints should be addressed to Jack S. Remington, M.D.; Research Institute, Palo Alto Medical Foundation; Palo Alto, CA 94305.


Palo Alto, California


© 1983 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1983;99(1):27-31. doi:10.7326/0003-4819-99-1-27
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We have attempted to define the serologic criteria for diagnosis of toxoplasmosis in heart transplant recipients. Of 31 patients who were seronegative before transplantation, 4 received a heart from a seropositive donor, and 3 of these 4 had seroconversion and developed life-threatening toxoplasmosis; the remaining 27 did not have seroconversion or develop clinical toxoplasmosis. Of 19 patients who had antibodies to Toxoplasma before transplantation, 10 developed significant increases in test titers of the dye test or double-sandwich IgM enzyme-linked immunosorbent assay but did not develop a clinical illness that could be attributed to toxoplasma infection. Significant serologic changes occurred more often in patients who received azathioprine, corticosteroids, and antithymocyte globulin than in those who received cyclosporine, corticosteroids, and antithymocyte globulin (p <0.05). These data show the wide clinical spectrum and differences in kinetics of antibody response of patients who develop toxoplasma infection after transplantation, and suggest that clinical disease occurs in those who have seroconversion but is rare in patients with preexisting antibody who have serologic evidence of recrudescence.

Topics

toxoplasma ; heart

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