The close relationship between toxoplasmosis and kidney function

LETTER TO THE EDITOR

The close relationship between toxoplasmosis and kidney function

August 29, 2012

Dear Sir

The recent article by TOPOROVSKY et al. was highly interesting⁹. The association of toxoplasmosis and renal function extends beyond nephrotic syndrome.

For instance, toxoplasmosis is common after renal transplantation. An incidence rate of 0.14 % was reported in a recent study³. GHARAVI et al. in another study have reported secondary infection in 3% of renal transplant patients⁴. Primary infection usually occurs in a majority of the patients with incidence as high 81.8% being reported. Sero-negative patients are 15 times more likely to develop toxoplasmosis following renal transplant.

Toxoplasmosis secondary to renal transplantation is associated with significant morbidity. The median time to diagnosis of toxoplasmosis following renal transplantation is about 92 days³. Mortality rates as high as 14% have been reported. Toxoplasma infection usually causes enlargement of the spleen and lymphadenopathy. Atypical cerebral toxoplasmosis may occur following renal transplantation². Encephalitis secondary to toxoplasmosis infection may occur in chronic renal failure patients secondary to immunosuppressive steroid therapy. Other patients may develop brain abscess. Lung infestation may result in pneumonia. Similarly cardiac tissue can be affected resulting in myocarditis. Rarely left ventricular failure has been reported⁷. Hemo-phagocytic syndrome is another rare manifestation of post transplantation toxoplasmosis⁵.

Enzyme-linked immunosorbent assay (ELISA) and enzyme-linked fluorescence assay (ELFA) tests are commonly used in detecting anti-Toxoplasma antibodies in renal transplant recipients⁸. NISSAPATORN et al. in a recent study have reported an overall sero-prevalence of latent toxoplasmosis of 51% in renal patients. The highest positivity rate for anti-Toxoplasma IgG & IgM antibodies is seen in the 20 years to 30 years age group⁶. In chronic renal failure the risk of toxoplasmosis is increased with higher exposure to dialysis. Anti-Toxoplasma IgM antibodies are detected in sero-positive patients following renal transplants during the first year in nearly 86% of patients. Nearly 57% of patients on hemodialysis demonstrate anti-Toxoplasma IgG antibodies in one recent study¹. All renal transplant donors should be screened for anti-Toxoplasma IgM antibodies. Infact, all renal transplant recipients should be administered trimethoprim/sulfamethoxazole for at least half a year following renal transplantation.

The above examples clearly illustrate the close association between toxoplasmosis and renal function and the need to fully screen renal transplant patients for toxoplasmosis.

Shailendra KAPOOR

Private practice, Mechanicsville, VA, USA

University of Illinois at Chicago, Chicago, USA

E-mail: [e-mail]

• 1. Aufy SM, Mahgoub AM, Saadi MG, Adel Elmallawany M. Serological detection of Toxoplasma gondii in chronic renal failure patients and renal transplant recipients. J Egypt Soc Parasitol. 2009;39:943-50.
• 2. Bohlsen D, Vollmann R, Simbrunner J. Atypical cerebral toxoplasmosis after kidney transplantation. Rofo. 2011;183:762-4.
• 3. Fernández-Sabé N, Cervera C, Fariñas MC, Bodro M, Muñoz P, Gurgui 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;54:355-61.
• 4. Gharavi MJ, Jalali S, Khademvatan S, Heydari S. Detection of IgM and IgG anti-Toxoplasma antibodies in renal transplant recipients using ELFA, ELISA and ISAGA methods: comparison of pre- and post-transplantation status. Ann Trop Med Parasitol. 2011;105:367-71.
• 5. Hebraud B, Kamar N, Borde JS, Bessieres MH, Galinier M, Rostaing L. Unusual presentation of primary toxoplasmosis infection in a kidney-transplant patient complicated by an acute left-ventricular failure. NDT Plus. 2008;1:429-32.
• 6. Mahgoub AM, Aufy SM, Saadi MG, Adel Elmallawany M. Risk factors predisposing to toxoplasmosis in chronic renal failure patients and renal transplant recipients. J Egypt Soc Parasitol. 2009;39:963-73.
• 7. Nissapatorn V, Leong TH, Lee R, Init-Ithoi, Ibrahim J, Yen TS. Seroepidemiology of toxoplasmosis in renal patients. Southeast Asian J Trop Med Public Health. 2011;42:237-47.
• 8. Segall L, Moal MC, Doucet L, Kergoat N, Bourbigot B. Toxoplasmosis-associated hemophagocytic syndrome in renal transplantation. Transpl Int. 2006;19:78-80.
• 9. Toporovski J, Romano S, Hartmann S, Benini W, Chieffi PP. Nephrotic syndrome associated with toxoplasmosis: report of seven cases. Rev Inst Med Trop Sao Paulo. 2012;54:61-4.

Publication Dates

• Publication in this collection
  12 Nov 2012
• Date of issue
  Dec 2012