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

Marie-Fleur Durieux (1) , Jean-Guillaume Lopez (2) , Maher Banjari , Karine Passebosc-Faure (3) , Marie-Pierre Brenier-Pinchart (4) , Luc Paris (5, 6) , Gilles Gargala (7) , Sabine Berthier (8) , Julie Bonhomme (9, 10) , Cathy Chemla (11, 12) , Isabelle Villena (12, 11) , Pierre Flori (13) , Emilie Fréalle (14) , Coralie L’ollivier (15, 16) , Florian Lussac-Sorton (17) , José Gilberto Montoya , Estelle Cateau (18) , Christelle Pomares (19, 20) , Loïc Simon (21) , Dorothée Quinio (22) , Florence Robert-Gangneux (23, 24) , Hélène Yera , Marc Labriffe , Anne-Laure Fauchais , Marie-Laure Dardé (1)

1 Hôpital Dupuytren [CHU Limoges]
2 APHM - Assistance Publique - Hôpitaux de Marseille
3 Service de Parasitologie Mycologie [CHU Limoges]
4 IAB - Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble)
5 Service de Parasitologie - Mycologie [CHU Pitié-Salpétrière]
6 SU - Sorbonne Université
7 COVID-Mucor study group
8 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
9 ABTE - Aliments Bioprocédés Toxicologie Environnements
10 Service de Microbiologie [CHU Caen]
11 CHU Reims - Centre Hospitalier Universitaire de Reims
12 ESCAPE - Epidémiosurveillance de protozooses à transmission alimentaire et vectorielle
13 Service des Agents Infectieux et Hygiène [CHU Saint-Etienne]
14 Service de Parasitologie-Mycologie [CHRU LIlle]
15 VITROME - Vecteurs - Infections tropicales et méditerranéennes
16 IHU Marseille - Institut Hospitalier Universitaire Méditerranée Infection
17 Hôpital Pellegrin
18 Laboratoire de Parasitologie-Mycologie (CHU de Poitiers)
19 Laboratoire de Parasitologie-Mycologie, Nice
20 C3M - Centre méditerranéen de médecine moléculaire
21 GREYC - Groupe de Recherche en Informatique, Image et Instrumentation de Caen
22 CHU Strasbourg
23 Irset - Institut de recherche en santé, environnement et travail
24 CHU Pontchaillou [Rennes]

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.

Domains: Life Sciences [q-bio]

Marie-Fleur Durieux, Jean-Guillaume Lopez, Maher Banjari, Karine Passebosc-Faure, Marie-Pierre Brenier-Pinchart, et al.. Toxoplasmosis in patients with an autoimmune disease and immunosuppressive agents: A multicenter study and literature review. PLoS Neglected Tropical Diseases, 2022, 16 (8), pp.e0010691. ⟨10.1371/journal.pntd.0010691⟩. ⟨hal-03996340⟩