{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:09:17Z","timestamp":1792069757143,"version":"4.4.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"8","funder":[{"DOI":"10.13039\/100017540","name":"Division of Intramural Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017540","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021671","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021671","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"National Institutes of Health Clinical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Toxoplasmosis is an early post-transplant complication in recipients of allogeneic hematopoietic cell transplant (HCT), typically arising from reactivation of latent infection. Toxoplasma gondii polymerase chain reaction (PCR) has improved detection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Single-center, retrospective review of allogeneic HCT recipients who developed toxoplasmosis from August 2008 to November 2024.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 31 cases of toxoplasmosis among 1235 HCT recipients. Ten had infection and 21 had end-organ disease. Fever was the most common clinical manifestation (74.2%). Patients with pulmonary or central nervous system disease often lacked organ-specific symptoms. Toxoplasmosis primarily occurred in patients not on prophylaxis (90.3%), at a median of 28 days post-HCT (interquartile range 20-69 days). Whole blood Toxoplasma PCR diagnosed 80.6% cases and showed a cumulative sensitivity of 93.3%. However, PCR was not always positive at symptom onset, and some asymptomatic patients already had end-organ disease at the time of first PCR positivity. Trimethoprim-sulfamethoxazole (TMP-SMX) was the most used treatment (48.4%). Mortality directly attributable to toxoplasmosis was 12.9%, but all-cause mortality was 61.3%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Toxoplasmosis is an early post-HCT complication with high morbidity and mortality. Prophylaxis is essential. TMP-SMX is effective, but sometimes it is withheld early post-HCT due to potential myelotoxicity. Given the short window between infection and progression to disease, we recommend twice-weekly monitoring with whole blood PCR while off TMP-SMX and early initiation of TMP-SMX post-HCT for Toxoplasma seropositive patients. Atovaquone may be considered as a bridging prophylaxis until TMP-SMX is started, but its absorption may be compromised early post-HCT and breakthrough cases have been reported.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf462","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T19:53:59Z","timestamp":1754337239000},"source":"Crossref","is-referenced-by-count":2,"title":["Usefulness and Limitations of Polymerase Chain Reaction (PCR) for the Diagnosis and Management of Toxoplasmosis Following Allogeneic Hematopoietic Cell Transplant: Single-center Experience With 31 Patients Over 16 Years"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7421-5473","authenticated-orcid":false,"given":"Mary M","family":"Czech","sequence":"first","affiliation":[{"name":"Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1457-8833","authenticated-orcid":false,"given":"Theresa","family":"Jerussi","sequence":"additional","affiliation":[{"name":"Clinical Center, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanchita","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5112-8766","authenticated-orcid":false,"given":"Rose","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G","family":"Kanakry","sequence":"additional","affiliation":[{"name":"Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Kanakry","sequence":"additional","affiliation":[{"name":"Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4868-6852","authenticated-orcid":false,"given":"Dimana","family":"Dimitrova","sequence":"additional","affiliation":[{"name":"Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa A","family":"Hyder","sequence":"additional","affiliation":[{"name":"Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamil","family":"Rechache","sequence":"additional","affiliation":[{"name":"Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8133-768X","authenticated-orcid":false,"given":"Winnie","family":"Trang","sequence":"additional","affiliation":[{"name":"Biomedical Translational Research Information System, Clinical Center, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H","family":"Fowler","sequence":"additional","affiliation":[{"name":"Rapa Therapeutics , Rockville, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R","family":"Bishop","sequence":"additional","affiliation":[{"name":"The David and Etta Jonas Center for Cellular Therapy, University of Chicago , Chicago, Illinois ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard W","family":"Childs","sequence":"additional","affiliation":[{"name":"Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Aue","sequence":"additional","affiliation":[{"name":"Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Tisdale","sequence":"additional","affiliation":[{"name":"Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5306-7167","authenticated-orcid":false,"given":"Courtney","family":"Fitzhugh","sequence":"additional","affiliation":[{"name":"Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, Maryland 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