Tissue and blood protozoa including toxoplasmosis, Chagas disease, leishmaniasis, Babesia, Acanthamoeba, Balamuthia, and Naegleria in solid organ transplant recipients- Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.

• 影响指数: 3.456
• 发表时间: 09 2019
• 来源期刊: Clin Transplant
• DOI: 10.1111/ctr.13546
• PMID: 30900295
• 文章类型: Journal Article
• 中科院分区: Q3
• 方向: 医学
• 作者列表: La Hoz RM,Morris MI,

关键词: Acanthamoeba; Babesia; Balamuthia; Naegleria; Toxoplasma gondii; Trypanosoma cruzi; donor-derived; leishmaniasis; malaria; parasites; transplant

Mesh: Acanthamoeba / isolation & purification; Amebiasis / diagnosis drug therapy etiology; Antiprotozoal Agents / therapeutic use; Babesia / isolation & purification; Babesiosis / diagnosis drug therapy etiology; Central Nervous System Protozoal Infections / diagnosis drug therapy etiology; Chagas Disease / diagnosis drug therapy etiology; Humans; Leishmania / isolation & purification; Leishmaniasis / diagnosis drug therapy etiology; Naegleria / isolation & purification; Organ Transplantation / adverse effects; Practice Guidelines as Topic / standards; Protozoan Infections / diagnosis drug therapy etiology; Societies, Medical; Toxoplasma / isolation & purification; Toxoplasmosis / diagnosis drug therapy etiology; Transplant Recipients; Trypanosoma cruzi / isolation & purification

Abstract

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of tissue and blood protozoal infections in the pre- and post-transplant period. Significant new developments in the field have made it necessary to divide the previous single guideline published in 2013 into two sections, with the intestinal parasites separated from this guideline devoted to tissue and blood protozoa. The current update reflects the increased focus on donor screening and risk-based recipient monitoring for parasitic infections. Increased donor testing has led to new recommendations for recipient management of Toxoplasma gondii and Trypanosoma cruzi. Molecular diagnostics have impacted the field, with access to rapid diagnostic testing for malaria and polymerase chain reaction testing for Leishmania. Changes in Babesia treatment regimens in the immunocompromised host are outlined. The risk of donor transmission of free-living amebae infection is reviewed. Changing immigration patterns and the expansion of transplant medicine in developing countries has contributed to the recognition of parasitic infections as an important threat to transplant outcomes. Medications such as benznidazole and miltefosine are now available to US prescribers as access to treatment of tissue and blood protozoa is increasingly prioritized.