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Multicenter Study
. 2013 Dec;57(11):1535-41.
doi: 10.1093/cid/cit557. Epub 2013 Aug 30.

Clinical features and outcomes in patients with disseminated toxoplasmosis admitted to intensive care: a multicenter study

Matthieu Schmidt  1 , Romain Sonneville, David Schnell, Naike Bigé, Rebecca Hamidfar, Nicolas Mongardon, Vincent Castelain, Keyvan Razazi, Antoine Marty, François Vincent, Martin Dres, Stephane Gaudry, Charles Edouard Luyt, Vincent Das, Jean-Baptiste Micol, Alexandre Demoule, Julien Mayaux
Affiliations
Multicenter Study

Clinical features and outcomes in patients with disseminated toxoplasmosis admitted to intensive care: a multicenter study

Matthieu Schmidt et al. Clin Infect Dis. 2013 Dec.

Abstract

Background: Characteristics and outcomes of adult patients with disseminated toxoplasmosis admitted to the intensive care unit (ICU) have rarely been described.

Methods: We performed a retrospective study on consecutive adult patients with disseminated toxoplasmosis who were admitted from January 2002 through December 2012 to the ICUs of 14 university-affiliated hospitals in France. Disseminated toxoplasmosis was defined as microbiological or histological evidence of disease affecting >1 organ in immunosuppressed patients. Isolated cases of cerebral toxoplasmosis were excluded. Clinical data on admission and risk factors for 60-day mortality were collected.

Results: Thirty-eight patients were identified during the study period. Twenty-two (58%) had received an allogeneic hematopoietic stem cell transplant (median, 61 [interquartile range {IQR}, 43-175] days before ICU admission), 4 (10%) were solid organ transplant recipients, and 10 (27%) were infected with human immunodeficiency virus (median CD4 cell count, 14 [IQR, 6-33] cells/µL). The main indications for ICU admission were acute respiratory failure (89%) and shock (53%). The 60-day mortality rate was 82%. Allogeneic hematopoietic stem cell transplant (hazard ratio [HR] = 2.28; 95% confidence interval [CI], 1.05-5.35; P = .04) and systolic cardiac dysfunction (HR = 3.54; 95% CI, 1.60-8.10; P < .01) within 48 hours of ICU admission were associated with mortality.

Conclusions: Severe disseminated toxoplasmosis leading to ICU admission has a poor prognosis. Recipients of allogeneic hematopoietic stem cell transplant appear to have the highest risk of mortality. We identified systolic cardiac dysfunction as a major determinant of outcome. Strategies aimed at preventing this fatal opportunistic infection may improve outcomes.

Keywords: allogeneic stem cell transplant; disseminated toxoplasmosis; immunosuppression; multiorgan failure; outcome assessment.

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