Clinical features and outcomes in patients with disseminated toxoplasmosis admitted to intensive care: a multicenter study.
Clin Infect Dis. 2013 Aug 30;
Authors: Schmidt M, Sonneville R, Schnell D, Bigé N, Hamidfar R, Mongardon N, Castelain V, Razazi K, Marty A, Vincent F, Dres M, Gaudry S, Luyt CE, Das V, Micol JB, Demoule A, Mayaux J
Background. The characteristics and outcomes of adult disseminated toxoplasmosis patients admitted to the intensive care unit (ICU) have rarely been described. Methods. We performed a retrospective study on consecutive cases of adult patients with disseminated toxoplasmosis who were admitted from January 2002 through December 2012 to the ICU of 14 University-affiliated hospitals in France. Disseminated toxoplasmosis was defined as microbiological or histological evidence of disease affecting more than one organ in immunosuppressed patients. Isolated cases of cerebral toxoplasmosis were excluded. Clinical data on 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 transplantation (61 [43-175] days before ICU admission), 4 (10%) were solid organ transplantation recipients and 10 (27%) were HIV-positive (CD4-cell count, 14 [6-33] cells/µL). The main indications for ICU admission were acute respiratory failure (89%) and shock (53%). Sixty-day mortality rate was 82%. Allogeneic hematopoietic stem cell transplantation recipient (hazard ratio [HR]=2.28, 95% confidence interval [95%CI] 1.05-5.35, P=0.04) and systolic cardiac dysfunction (HR=3.54, 95%CI, 1.60-8.10, P <0.01) within 48 hours of ICU admission were associated with mortality. Conclusions. Severe disseminated toxoplasmosis leading to ICU admission has a poor prognosis. Allogeneic hematopoietic stem cell transplantation recipients 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.
PMID: 23994819 [PubMed - as supplied by publisher]