Original Article

Diagnosis of Toxoplasma Infection in Allogenic Pre HCTSP Patients Using Molecular Methods


Background: We aimed to estimate the incidence of Toxoplasma infection in T. gondii-seropositive patients under allogeneic hematopoietic stem cell transplantation (HSCT).

Methods: The present research was a prospective study on 54 whole blood samples of allogeneic HSCT recipients, who were referring to bone narrow transplantation centers affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran in 2018. All patients were IgG positive against T. gondii.

Results: Overall, 54 Toxoplasma positive pre-HCTSP patients were enrolled. 53.7% (n= 29) were male, also 1.9% (n=1) had germ-line type of the disease. The Multiple myeloma patients had higher age in comparison with other disease, but pairwise comparison showed the difference of age between Multiple myeloma patients were statistically significant with Acute lymphoblastic leukemia, Acute myeloblastic leukemia and Huntington's disease (P< 0.05). The results of PCR assay showed 5.6% (n= 3) of the patients were infected with Toxoplasma.

Conclusion: PCR method has detected considerable incidence of Toxoplasma infection for monitoring HSCT recipients at risk for toxoplasmosis, and many patients who showed the incidence of toxoplasmosis had previous infections with the Toxoplasma parasite.

1. Arab-Mazar Z, Fallahi S, Koochaki A, et al. Immunodiagnosis and molecular validation of Toxoplasma gondii-recombinant dense granular (gra) 7 protein for the detection of toxoplasmosis in patients with cancer. Microbiol Res. 2016;183:53-59.
2. Burg JL, Grover CM, Pouletty P, Boothroyd J. Direct and sensitive detection of a pathogenic protozoan, Toxoplasma gondii, by polymerase chain reaction. J Clin Microbiol. 1989;27:1787-1792.
3. Dubey J. Toxoplasmosis–a waterborne zoonosis. Vet Parasitol. 2004;126:57-72.
4. Javadi Mamaghani A, Seyyed Tabaei SJ, Ranjbar MM, et al. Designing diagnostic kit for Toxoplasma gondii based on gra7, sag1, and rop1 antigens: An in silico strategy. Int J Pept Res Ther. 2020;26:2269-2283.
5. Selseleh M, Keshavarz H, Mohebali M, et al. Production and evaluation of Toxoplasma gondii recombinant surface antigen 1 (sag1) for serodiagnosis of acute and chronic Toxoplasma infection in human sera. Iran J Parasitol. 2012;7:1-9.
6. Mamaghani AJ, Fathollahi A, Arab-Mazar Z, et al. Toxoplasma gondii vaccine candidates: A concise review. Ir J Med Sci. 2022:1-31.
7. Mamaghani AJ, Fathollahi A, Spotin A, et al. Candidate antigenic epitopes for vaccination and diagnosis strategies of Toxoplasma gondii infection: A review. Microb Pathog. 2019; 137:103788.
8. Khanmohammadi M, Mamagani AJ, Rezamand A, et al. Case report of a Strongyloides stercoralis infection in a child with acute lymphocytic leukemia in tabriz, iran. Medical Journal of Tabriz University of Medical Sciences. 2013;35:88-91.
9. Sepahvand F, Mamaghani AJ, Ezzatpor B, et al. Gastrointestinal parasites in immunocompromised patients; a comparative cross-sectional study. Acta Trop. 2022; 231:106464.
10. Switaj K, Master A, Skrzypczak M, Zaborowski P. Recent trends in molecular diagnostics for Toxoplasma gondii infections. Clin Microbiol Infect. 2005;11:170-176.
11. Mamaghani AJ, Tabaei SJS, Ranjbar MM, et al. Designing Diagnostic Kit for Toxoplasma gondii Based on GRA7, SAG1, and ROP1 Antigens: An In Silico Strategy. Int J Pept Res Ther.1-15.
12. Chandrasekar P, Momin F. Disseminated toxoplasmosis in marrow recipients: a report of three cases and a review of the literature. Bone Marrow Transplant Team. Bone Marrow Transplant. 1997; 19(7):685-9.
13. Derouin F, Devergie A, Auber P, et al. Toxoplasmosis in bone marrow-transplant recipients: Report of seven cases and review. Clin Infect Dis. 1992;15:267-270.
14. De Medeiros B, De Medeiros C, Werner B, et al. Disseminated toxoplasmosis after bone marrow transplantation: Report of 9 cases. Transpl Infect Dis. 2001;3:24-28.
15. Martino R, Bretagne S, Rovira M, et al. Toxoplasmosis after hematopoietic stem transplantation. Report of a 5-year survey from the infectious diseases working party of the european group for blood and marrow transplantation. Bone Marrow Transplant. 2000;25:1111-4.
16. Gajurel K, Dhakal R, Montoya JG. Toxoplasma prophylaxis in haematopoietic cell transplant recipients: A review of the literature and recommendations. Curr Opin Infect Dis. 2015;28:283-292.
17. Dunay IR, Gajurel K, Dhakal R, et al. Treatment of toxoplasmosis: Historical perspective, animal models, and current clinical practice. Clin Microbiol Rev. 2018; 31(4):e00057-17.
18. Ali-Heydari S, Keshavarz H, Shojaee S, Mohebali M. Diagnosis of antigenic markers of acute toxoplasmosis by IgG avidity immunoblotting. Parasite. 2013;20:18.
19. Wei HX, Wei SS, Lindsay DS, Peng HJ. A systematic review and meta-analysis of the efficacy of anti-Toxoplasma gondii medicines in humans. PLoS One. 2015;10:e0138204.
20. Martino R, Bretagne S, Einsele H, et al. Early detection of Toxoplasma infection by molecular monitoring of Toxoplasma gondii in peripheral blood samples after allogeneic stem cell transplantation. Clin Infect Dis. 2005;40:67-78.
21. Benichou G, Gonzalez B, Marino J, et al. Role of memory t cells in allograft rejection and tolerance. Front Immunol. 2017;8:170.
22. da Silva MB, da Cunha FF, Terra FF, Camara NOS. Old game, new players: Linking classical theories to new trends in transplant immunology. World J Transplant. 2017; 7(1):1-25.
23. De Vries E, Van Tol M, van den Bergh R, et al. Reconstitution of lymphocyte subpopulations after paediatric bone marrow transplantation. Bone Marrow Transplant. 2000;25:267-75.
24. Shekar Abi M, Bahar B, Behbin M, et al. The evaluation of serum levels of Ifn-y, il-12 and percentage of cd4+, cd8+ and nk cells in peripheral blood of metastatic, nonmetastatic breast cancer patients and normal individuals. Razi Journal of Medical Sciences. 2008;14:113-120.
25. Worth D. Immune response to developmentally-dependent expression of Toxoplasma gondii antigens. 2017
26. Rasti S, Hassanzadeh M, Soliemani A, et al. Serological and molecular survey of toxoplasmosis in renal transplant recipients and hemodialysis patients in kashan and qom regions, central iran. Ren Fail. 2016;38:970-973.
27. Karimi M, Tabaei SJS, Ranjbar MM, Fathi F, Jalili A. Construction of a synthetic gene encoding the multi-epitope of Toxoplasma gondii and demonstration of the relevant recombinant protein production: A vaccine candidate. Galen Med J. 2020;9:e1708.
28. Naghi Vishteh M, Javadi Mamaghani A, Rashidi S, et al. Peptide-based monoclonal antibody production against sag1 (p30) protein of Toxoplasma gondii. Monoclon Antib Immunodiagn Immunother. 2020;39:51-56.
29. Shad Dm, Ourmazdi H, Akhlaghi L, et al. Opportunistic protozoan parasites in heart transplant donor patients. 2005
30. Vejdani M. The presence of anti- toxoplasmosis antibodies in 50 donors and recipients of renal toxoplasmosis. Behbood the Scientific Quarterly. 2009;13
31. Arab-Mazar Z, Fallahi S, Yadegarynia D, et al. Immunodiagnosis and molecular validation of Toxoplasma gondii infection among patients with end-stage renal disease undergoing haemodialysis. Parasitology. 2019: 146(13):1683-1689.
32. Rostami A, Karanis P, Fallahi S. Advances in serological, imaging techniques and molecular diagnosis of Toxoplasma gondii infection. Infection. 2018;46:303-315.
33. Arab‐Mazar Z, Javadi Mamaghani A, Fallahi S, et al. Immunodiagnosis and molecular validation of Toxoplasma gondii‐recombinant dense granular (gra) 5 protein for the detection of toxoplasmosis in hemodialysis patients. Semin Dial. 2021;34:332-337
34. Badparva E, Javadi Mamaghani A, Kheirandish F, et al. Development and evaluation of a loop-mediated isothermal amplification (lamp) technique for rapid, accurate, and specific detection of blastocystis spp. In aids patients. Infection. 2022; 10.1007/s15010-022-01818-7.
35. Jones CD, Okhravi N, Adamson P, et al. Comparison of pcr detection methods for b1, p30, and 18s rdna genes of T. gondii in aqueous humor. Invest Ophthalmol Vis Sci. 2000;41:634-644.
36. Reusser P, Einsele H, Lee J, et al. Randomized multicenter trial of foscarnet versus ganciclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation: Presented in part at the 39th interscience conference on antimicrobial agents and chemotherapy, san francisco, ca, september 1999 (abstract h144). Blood. 2002;99:1159-1164.
37. Ryning Fw, Mcleod R, Maddox Jc, et al. Probable transmission of Toxoplasma gondii by organ transplantation. Ann Intern Med. 1979;90:47-49.
38. Rogers N, Peh CA, Faull R, et al. Transmission of toxoplasmosis in two renal allograft recipients receiving an organ from the same donor. Transpl Infect Dis. 2008;10:71-74.
39. Arab-Mazar Z, Zamanian MH, Yadegarynia D. Cerebral toxoplasmosis in an HIV-negative patient: A case report. Arch Clin Infect Dis. 2016;11: e30759.
40. Patel R, Paya CV. Infections in solid-organ transplant recipients. Clin Microbiol Rev. 1997;10:86-124.
41. Costa J-M, Pautas C, Ernault P, et al. Real-time pcr for diagnosis and follow-up of Toxoplasma reactivation after allogeneic stem cell transplantation using fluorescence resonance energy transfer hybridization probes. J Clin Microbiol. 2000;38:2929-2932.
42. Held T, Krüger D, Switala A, et al. Diagnosis of toxoplasmosis in bone marrow transplant recipients: Comparison of pcr-based results and immunohistochemistry. Bone Marrow Transplant. 2000;25:1257-62.
43. Bretagne S. Molecular diagnostics in clinical parasitology and mycology: Limits of the current polymerase chain reaction (PCR) assays and interest of the real-time pcr assays. Clin Microbiol Infect. 2003;9:505-511.
44. Ellis J. Polymerase chain reaction approaches for the detection of Neospora caninum and Toxoplasma gondii. Int J Parasitol. 1998;28:1053-1060.
45. Lebech M, Lebech A-M, Nelsing S, et al. Detection of Toxoplasma gondii DNA by polymerase chain reaction in cerebrospinal fluid from aids patients with cerebral toxoplasmosis. J Infect Dis. 1992;165:982-983.
46. Pelloux H, Guy E, Angelici MC, et al. A second european collaborative study on polymerase chain reaction for Toxoplasma gondii, involving 15 teams. FEMS Microbiol Lett. 1998;165:231-237.
47. Atilla E, Ataca P, Balli S, et al. Seroprevalence for Toxoplasma gondii in allogeneic hematopoietic stem cell transplantation recipients. Blood. 2015; 126 (23): 5459.
IssueVol 17 No 2 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijpa.v17i2.9541
Toxoplasma Hematopoietic stem cell transplantation Toxoplasmosis

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How to Cite
Yusefi M, Arab-Mazar Z, Fallahi S, Javadi Mamaghani A, Sali S, Nikpour N, Barati M, Karimi Rouzbahani A, Kheirandish F. Diagnosis of Toxoplasma Infection in Allogenic Pre HCTSP Patients Using Molecular Methods. Iran J Parasitol. 2022;17(2):231-239.