Toxoplasma gondii Myocarditis after Adult Heart Transplantation: Successful Prophylaxis with Pyrimethamine

Table 1

Clinical and laboratorial data for six cases of Toxoplasma infection after cardiac transplantation without toxoplasmosis prophylaxis occurring before 1996.

Patient sex/age (years)	Toxoplasmosis serostatus D/R—IgG	Time from transplant to toxoplasmosis diagnosis (days)	Source of diagnosis	Signs/symptoms	Treatment (days)	In-hospital lethal outcome*
M/52	NA/Neg	21	EMB	Heart failure	S + P	Yes
F/61	NA/Neg	534	EMB	None	S + P	No
M/44	NA/Neg	70	EMB	Heart failure	S + P	No
M/66	NA/NA	69	Necropsy (CNS and heart)**	Heart failure and low-level consciousness	—	Yes
M/49	NA/Neg	25	EMB	Heart failure	S + P	No
F/49	NA/Neg	69	Necropsy (CNS, heart and lungs)	Heart and respiratory failure and low-level consciousness	—	Yes

Note: M: male; F: female; D/R: donor/recipient; NA: not available; Neg: negative; EMB: endomyocardial biopsy; CNS: central nervous system; S + P: sulfadiazine plus pyrimethamine.
*Survival after discharge not analyzed.
**The EMB was misdiagnosed as a rejection, and the patient subsequently received methylprednisolone 1 g/d for 3 days. At necropsy, the EMB was reviewed and the diagnosis of toxoplasmosis was determined.