부산대학교 도서관

Background: Cases of Toxoplasma reactivation or more severe primary infection have been reported in patients receiving immunosuppressive (IS) treatment for autoimmune diseases (AID). The purpose of this study was to describe features of toxoplasmosis occurring in patients with AID treated by IS therapy, excluded HIV-positive and transplant patients. Methods: A multicenter descriptive study was conducted using data from the French National Reference Center for Toxoplasmosis (NRCT) that received DNA extracts or strains isolated from patients, associated with clinical data. Other cases were retrieved through a questionnaire sent to all French parasitology and internal medicine departments. Furthermore, a systematic literature review was conducted. Results: 61 cases were collected: 25 retrieved by the NRCT and by a call for observations and 36 from a literature review. Half of the cases were attributed to reactivation (50.9%), and most of cases (49.2%) were cerebral toxoplasmosis. The most common associated AID were rheumatoid arthritis (28%) and most frequent treatments were antimetabolites (44.3%). Corticosteroids were involved in 60.7% of cases. Patients had a favorable outcome (50.8%) but nine did not survive. For 12 cases, a successful Toxoplasma strain characterization suggested the possible role of this parasitic factor in ocular cases. Conclusion: Although this remains a rare condition, clinicians should be aware for the management of patients and for the choice of IS treatment. Author summary: Severe forms of toxoplasmosis are well described in HIV-infected or transplant patients. However, they have been described in a less studied category of patients: those with autoimmune diseases and treated with immunosuppressive agents, corticosteroid and biotherapies. We report, conjointly with the French National Reference Center for Toxoplasmosis, the largest collection of cases of toxoplasmosis occurring in these patients to clarify the risk factors and epidemiology associated with these serious forms of toxoplasmosis. In our series, as well as in the literature, rheumatoid arthritis and systemic lupus erythematosus are the most common autoimmune diseases associated with toxoplasmosis, and antimetabolites, anti-TNF-α and corticosteroids were involved in most cases. The originality of this work lies in the molecular characterization of Toxoplasma to study the possible role of the strain factor in diverse clinical forms. Atypical strains, as those observed in South America, were more often observed in ocular toxoplasmosis cases. The significant proportion of cerebral toxoplasmosis (49,2%) and a 14.8% mortality risk highlight the necessity to inform clinicians of this opportunistic infectious complication and encourages them to evoke toxoplasmosis quickly even in case of occurrence of non-specific symptoms. [ABSTRACT FROM AUTHOR]