{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:33:08Z","timestamp":1790742788624,"version":"4.1.0"},"reference-count":56,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      Toxoplasmosis has long been recognized as a serious complication in immunocompromised host, particularly those with advanced HIV\/AIDS, hematopoietic stem\u2010cell transplantation (HSCT), solid\u2010organ transplant (SOT), and hematological malignancies. The rapid expansion of targeted immunomodulators, including chimeric antigen receptor T\u2010cell (CAR\u2010T) therapies, monoclonal antibodies, and small\u2010molecule inhibitors, is creating new at\u2010risk populations beyond traditional transplant settings. We present a 9\u2010year\u2010old boy with high\u2010risk B\u2010cell acute lymphoblastic leukemia (B\u2010ALL), who developed prolonged fever and macrophage activation syndrome (MAS). After an extensive unrevealing workup, disseminated acute toxoplasmosis was identified incidentally on bone marrow aspirate via morphologic identification of tachyzoites and confirmed by\n                      <jats:italic>Toxoplasma gondii<\/jats:italic>\n                      PCR. This case exemplifies the emerging threat of toxoplasmosis in non\u2010transplant immunomodulated hosts and supports three core mitigation strategies. First, baseline\n                      <jats:italic>Toxoplasma<\/jats:italic>\n                      IgG and IgM serology should be obtained in all patients initiating targeted immunotherapy, recognizing that B\u2010cell depletion or hypogammaglobulinemia may render IgG unreliable, and that IgM may be falsely negative, delayed, or persistently positive in immunocompromised individuals. Second, targeted PCR from clinically relevant compartments or metagenomic next\u2010generation sequencing when conventional diagnostics is unrevealing should be applied early. Third, prevention requires a bundled approach: baseline screening, patient education for seronegative individuals, and trimethoprim\u2010sulfamethoxazole prophylaxis with or without serial qPCR monitoring for seropositive patients. Toxoplasmosis is no longer a transplant\u2010exclusive concern. As targeted immunomodulators reshape practice across rheumatology, oncology, neurology, and autoimmune disease, infectious diseases specialists must lead efforts to raise cross\u2010specialty awareness, establish guidelines, and build registries to define the true burden of toxoplasmosis in these growing populations.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tid.70263","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:56:39Z","timestamp":1782885399000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Toxoplasmosis Beyond Transplantation: Diagnostic and Prevention Challenges in a Patient Receiving Targeted Immunomodulators"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6461-7488","authenticated-orcid":false,"given":"Joy","family":"Mouanes\u2010Abelin","sequence":"first","affiliation":[{"name":"Laboratory of Hematology H\u00f4pital de l'ARCHET  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6192-3293","authenticated-orcid":false,"given":"Christelle","family":"Pomares","sequence":"additional","affiliation":[{"name":"Laboratoire De Parasitologie\u2010Mycologie, Centre Hospitalier Universitaire De Nice Inserm U 1065 H\u00f4pital de l'ARCHET Universit\u00e9 De La C\u00f4te d'Azur  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3378-8071","authenticated-orcid":false,"given":"Jos\u00e9 G.","family":"Montoya","sequence":"additional","affiliation":[{"name":"Dr. Jack S. Remington Laboratory for Specialty Diagnostics Sutter Health, Palo Alto Medical Foundation  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgane","family":"Pondrom","sequence":"additional","affiliation":[{"name":"Pediatric Onco\u2010Hematology Department H\u00f4pital de l'ARCHET  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5573-7926","authenticated-orcid":false,"given":"Lucille DE","family":"MARIA","sequence":"additional","affiliation":[{"name":"Laboratory of Hematology H\u00f4pital de l'ARCHET  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1460-0774","authenticated-orcid":false,"given":"Andrea J.","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine University of Nebraska Medical Center  Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.","family":"Gomez","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine University of Nebraska Medical Center  Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"A.M\u00f6ricke M.Zimmermann M. G.Valsecchi et\u00a0al. \u201cA Treatment Study Protocol of the ALLTogether Consortium for Children and Young Adults (1\u201345 Years of Age) With Newly Diagnosed Acute Lymphoblastic Leukaemia \u201d2025 ClinicalTrials.gov Identifier: NCT04307576 https:\/\/clinicaltrials.gov\/study\/NCT04307576."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1400972"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2020.247031"},{"key":"e_1_2_8_5_1","unstructured":"National Comprehensive Cancer Network \"NCCN Clinical Practice Guidelines in Oncology: Pediatric Acute Lymphoblastic Leukemia \" accessed March 18 2026 https:\/\/www.nccn.org."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.07.031"},{"issue":"7254","key":"e_1_2_8_7_1","first-page":"142","article-title":"Sources of Toxoplasma Infection in Pregnant Women: European Multicentre Case\u2010Control Study","volume":"321","author":"Cook A. 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