{"id":2164,"date":"2020-09-07T14:03:00","date_gmt":"2020-09-07T12:03:00","guid":{"rendered":"https:\/\/www.newslab.sk\/povodne-prace-prevencia-toxoplazmozy-u-pacientov-v-transplantacnom-programe\/"},"modified":"2020-09-07T14:08:57","modified_gmt":"2020-09-07T12:08:57","slug":"prevention-of-toxoplasmosis-in-patients-in-an-organ-transplant-program","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/prevention-of-toxoplasmosis-in-patients-in-an-organ-transplant-program\/","title":{"rendered":"Prevention of toxoplasmosis in patients in an organ transplant program"},"content":{"rendered":"

*<\/strong>All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.<\/strong><\/span><\/p>\n

 <\/p>\n

\u00davod<\/strong><\/p>\n

U pacientov s AIDS, pacientov s imunosupres\u00edvnou terapiou, pri lymfoproliferat\u00edvnych a hematologick\u00fdch malignit\u00e1ch, malignit\u00e1ch, u pacientov po transplant\u00e1ci\u00e1ch je toxoplazm\u00f3za potenci\u00e1lnym rizikom vzniku v\u00e1\u017enych por\u00fach kon\u010diacich \u010dasto fat\u00e1lne. Ak\u00fatna toxoplazm\u00f3za u imunosuprimovan\u00fdch pacientov m\u00f4\u017ee by\u0165 sp\u00f4soben\u00e1 reaktiv\u00e1ciou latentnej infekcie, pri ktorej doch\u00e1dza k rupt\u00fare tkanivov\u00fdch c\u00fdst s uvo\u013e\u0148ovan\u00edm trofozoitov alebo aj akvirovan\u00edm infekcie prostredn\u00edctvom transplantovan\u00fdch org\u00e1nov, resp. krvnou transf\u00faziou od infikovan\u00e9ho darcu(1). U t\u00fdchto pacientov je nutn\u00e9 syst\u00e9mom efekt\u00edvnych opatren\u00ed eliminova\u0165 alebo minimalizova\u0165 riziko prenosu toxoplazmovej infekcie z darcu na pr\u00edjemcu org\u00e1nu, resp. akvirovania novej infekcie u pacientov po transplant\u00e1cii. Po zv\u00e1\u017een\u00ed potreby prevencie toxoplazm\u00f3zy u pacientov v transplanta\u010dnom programe oddelen\u00edm zlyh\u00e1vania a transplant\u00e1cie srdca NUSCH v Bratislave a mo\u017enost\u00ed kvalifikovan\u00e9ho zabezpe\u010denia jej laborat\u00f3rnej diagnostiky sme v roku 1998 zah\u00e1jili s\u00e9rologick\u00fd skr\u00edning pacientov v transplanta\u010dnom programe na toxoplazm\u00f3zu u pacientov pred a po transplant\u00e1cii srdca. Toxoplazm\u00f3za sa stala s\u00fa\u010das\u0165ou navrhovan\u00fdch minim\u00e1lnych \u0161tandardov mikrobiologickej surveillance pri transplant\u00e1ci\u00e1ch v r\u00e1mci koncepcie Slovensk\u00e9ho transplanta\u010dn\u00e9ho programu.<\/p>\n

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Materi\u00e1l a met\u00f3dy<\/strong><\/p>\n

V rokoch 1998 \u2013 2019 sme s\u00e9rologicky vy\u0161etrili 325 pacientov pred a po transplant\u00e1cii srdca, 265 mu\u017eov a 60 \u017eien vo veku 16 \u2013 71 r. Pred transplant\u00e1ciou sme s\u00e9rologicky vy\u0161etrovali na toxoplazm\u00f3zu 213 pacientov, po HTx 112 pacientov, ktor\u00ed pred transplant\u00e1ciou neboli vy\u0161etrovan\u00ed. Pr\u00edjemcu srdca sme vy\u0161etrovali spravidla 1 \u2013 2 t\u00fd\u017edne po oper\u00e1cii a pravidelne sme ho s\u00e9rologicky monitorovali pri ka\u017edej kontrole zdravotn\u00e9ho stavu. U ka\u017edej vzorky sme vy\u0161etrili celkov\u00e9 protil\u00e1tky reakciou v\u00e4zby komplementu a protil\u00e1tky IgG a IgM imunoenz\u00fdmovou reakciou (EIA). Pre potreby determin\u00e1cie toxoplazmov\u00e9ho statusu sme v druhom kroku vy\u0161etrovali IgA protil\u00e1tky, aviditu IgG protil\u00e1tok. Priamy d\u00f4kaz T. gondii sme vykonali polymer\u00e1zovou re\u0165azovou reakciou (PCR \u2013 polymerase chain reaction).<\/p>\n

 <\/p>\n

V\u00fdsledky<\/strong><\/p>\n

Toxoplazmov\u00e9 protil\u00e1tky sme zistili u 176 (54,2 \u00b1 6,7 %) pacientov, primoinfekciu sme diagnostikovali u 11 pacientov (3,4 %). Ich preh\u013ead uv\u00e1dzame v tabu\u013eke 1. Osem pacientov pred transplant\u00e1ciou s\u00e9rologicky negat\u00edvnych sa infikovalo rok a\u017e 12 rokov po HTx. U pacienta \u010d. 4 sme zistili ak\u00fatnu toxoplazmov\u00fa primoinfekciu 6 rokov pred HTx, 14 dn\u00ed po transplant\u00e1cii srdca zomrel. U pacientov s akvirovanou infekciou po HTx infekcia prebiehala bez sympt\u00f3mov (pac. 2, 6, 9, 11) alebo s miernymi respira\u010dn\u00fdmi sympt\u00f3mami (pac. \u010d. 1, 3, 5).
\nU v\u0161etk\u00fdch t\u00fdchto pacientov sme toxoplazmov\u00fd status darcu nezistili, pod\u013ea recipientov srdca sa d\u00e1 predpoklada\u0165, \u017ee darcovia neboli infikovan\u00ed. Recipientom srdca (\u010d. 7 a 8) bolo transplantovan\u00e9 srdce od Toxoplasma pozit\u00edvneho darcu a pribli\u017ene dva mesiace po HTx sme s\u00e9rologicky zistili topxoplazmov\u00fa primoinfekciu, ktor\u00e1 sa prejavila z\u00e1va\u017en\u00fdmi sympt\u00f3mami. U pacienta \u010d. 7 toxoplazm\u00f3za prebiehala pod obrazom myokardit\u00eddy a u recipienta \u010d. 8 do\u0161lo k bilater\u00e1lnej bronchopneum\u00f3nii. U oboch pacientov bola T. gondii zisten\u00e1 tie\u017e v biopsii myokardu a u pac. \u010d. 8 sme DNA parazita potvrdili met\u00f3dou PCR z p\u013e\u00facneho v\u00fdplachu. V\u0161etci pacienti absolvovali lie\u010dbu trojkombin\u00e1ciou pyrymethamin, trimetoprim sulfametoxazol a kyselina listov\u00e1, s\u00fa bez klinick\u00fdch prejavov a pravidelne s\u00e9rologicky monitorovan\u00ed na toxoplazm\u00f3zu.<\/p>\n

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Diskusia<\/strong><\/p>\n

V\u0161etci imunosuprimovan\u00ed pacienti s\u00fa v st\u00e1lom riziku akvirovania, reaktiv\u00e1cie latentnej toxoplazm\u00f3zy, alebo aktiv\u00e1cie infekcie prenesenej transplant\u00e1tom, ktor\u00e1 m\u00f4\u017ee v\u00e1\u017ene ohrozi\u0165 zdravie a\u017e \u017eivot pacienta(2). Srdce je org\u00e1n, v ktorom sa popri kostrovom svalstve, mozgu, pe\u010deni, oku parazit vo forme tkanivov\u00fdch c\u00fdst naj\u010dastej\u0161ie usadzuje, preto pacienti s transplant\u00e1ciami srdca s\u00fa vystaven\u00ed frekventovanej\u0161ie riziku prenosu infekcie ako pri transplant\u00e1cii in\u00fdch org\u00e1nov(3). Ak\u00fatna infekcia s\u00e9ronegat\u00edvnych pr\u00edjemcov po z\u00edskan\u00ed toxoplazmovej infekcie od pozit\u00edvneho darcu b\u00fdva \u010dastej\u0161ia ako reaktiv\u00e1cia latentnej infekcie s\u00e9ropozit\u00edvneho pr\u00edjemcu po transplant\u00e1cii. Klinick\u00e9 pr\u00edznaky sa prejavia mesiac i viac po transplant\u00e1cii a \u010dasto m\u00e1vaj\u00fa fat\u00e1lny koniec(2,4). Potvrdilo sa to aj u na\u0161ich dvoch s\u00e9ronegat\u00edvnych pacientov, ktor\u00ed dostali srdce od s\u00e9ropozit\u00edvneho darcu, infekcia sa manifestovala po dvoch mesiacoch. Ve\u013emi \u00fa\u010dinn\u00fdm prostriedkom ochrany
\npred ochoren\u00edm je preto funguj\u00faci syst\u00e9m prevencie, ktor\u00e9ho s\u00fa\u010das\u0165ou je systematick\u00fd s\u00e9rologick\u00fd monitoring pr\u00edjemcu, a pokia\u013e je to mo\u017en\u00e9, aj darcu org\u00e1nu pred a po transplant\u00e1cii org\u00e1nu s cie\u013eom v\u010dasn\u00e9ho odhalenia exacerb\u00e1cie latentnej toxoplazm\u00f3zy, resp. v\u010dasnej identifik\u00e1cie posttransplanta\u010dne akvirovanej infekcie neim\u00fannym pacientom. Potvrdzuje sa to aj v na\u0161ej akt\u00edvne prebiehaj\u00facej \u0161t\u00fadii.<\/p>\n

 <\/p>\n

Z\u00e1ver<\/strong><\/p>\n

V na\u0161ej pr\u00e1ci sme dok\u00e1zali v\u00fdznam a efektivitu prevent\u00edvneho skr\u00edningu na toxoplazm\u00f3zu, \u010doho d\u00f4kazom je rast\u00faci po\u010det odhalen\u00fdch a \u00faspe\u0161ne lie\u010den\u00fdch toxoplazmov\u00fdch primoinfekci\u00ed u pr\u00edjemcov srdca.<\/p>\n

Po\u010fakovanie:<\/strong> \u0160t\u00fadia bola podporen\u00e1 projektom KEGA \u010d. 013TTU-4\/2019.<\/p>\n

 <\/p>\n

LITERAT\u00daRA<\/strong>
\n1. Strabelli TMV, Siciliano RF, Campos SV, et al. Toxoplasma gondii myokarditis after adult heart transplantation: Successful prophylaxis with pyrymethamine. J Trop Med 2012; 2012: 853562.
\n2. Hermanns B, Brunn A, Schwarz ER, et al. Fulminant toxoplasmosis in a heart transplant recipient. Pathol Res Pract 2001; 197(3): 211-215.
\n3. Urbanov\u00e1 D, M\u00e1lek I, Straka F, Tolarov\u00e1 V. Toxoplazm\u00f3za u pacient\u016f po transplantaci srdce. Cor Vasa 1996; 38(2): 82-85.
\n4. Gallino A, Maggiorini M, Kiowski E, et al. Toxoplasmosis in heart transplant recipient. Eur J Clin Microbiol Infect Dis 1996; 15(5): 389-393.<\/p>\n","protected":false},"excerpt":{"rendered":"

*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.   \u00davod U pacientov s AIDS, pacientov s imunosupres\u00edvnou terapiou, pri lymfoproliferat\u00edvnych a hematologick\u00fdch malignit\u00e1ch, malignit\u00e1ch, u pacientov po transplant\u00e1ci\u00e1ch je toxoplazm\u00f3za potenci\u00e1lnym rizikom vzniku v\u00e1\u017enych por\u00fach kon\u010diacich \u010dasto fat\u00e1lne.<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[1596],"tags":[1651,1424,1646,1645,1650],"class_list":["post-2164","post","type-post","status-publish","format-standard","hentry","category-parazitologia-en","tag-heart-transplantation","tag-toxoplasma-gondii-en","tag-toxoplasmosis","tag-toxoplazmoza-en","tag-transplantacia-srdca-en","typ_clanku-original-work"],"acf":{"abstrakt":"

As part of the prevention of toxoplasmosis in patients in the transplant program, we serologically examined 325 patients before and after heart transplantation (HTx \u2013 heart transplantation) in the years 1998 \u2013 2019. With this targeted serological screening, we found primary toxoplasmosis after HTx in 11 (3.4%) patients that were negative before transplantation. Eight patients acquired primary infection one to twelve years after HTx. They were clinically asymptomatic or with mild respiratory syndromes. Two patients acquired the infection from a Toxoplasma gondii positive donor. Acute toxoplasmosis was detected approximately two months after HTx with a severe clinical course of myocarditis or bilateral bronchopneumonia. All patients successfully completed triple therapy: pyrimethamine, trimethoprim sulfamethoxazole, folic acid.<\/p>\n

Keywords:<\/strong> Toxoplasma gondii, toxoplasmosis, heart transplantation<\/p>\n","casopis":[{"ID":2132,"post_author":"7","post_date":"2020-09-04 08:09:57","post_date_gmt":"2020-09-04 06:09:57","post_content":"SUPPLEMENT\r\n\r\nPri pr\u00edle\u017eitosti odbornej konferencie\r\n\r\nI. Aktu\u00e1lne probl\u00e9my hum\u00e1nnej parazitol\u00f3gie<\/strong>\r\n