Toxoplasmosis in patients with an autoimmune disease and immunosuppressive agents: A multicenter study and literature review

by Marie-Fleur Durieux, Jean-Guillaume Lopez, Maher Banjari, Karine Passebosc-Faure, Marie-Pierre Brenier-Pinchart, Luc Paris, Gilles Gargala, Sabine Berthier, Julie Bonhomme, Cathy Chemla, Isabelle Villena, Pierre Flori, Emilie Fréalle, Coralie L’Ollivier, Florian Lussac-Sorton, José Gilberto Montoya, Estelle Cateau, Christelle Pomares, Loïc Simon, Dorothée Quinio, Florence Robert-Gangneux, Hélène Yera, Marc Labriffe, Anne-Laure Fauchais, Marie-Laure Dardé

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.