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Transplant recipients are a population at high risk for various opportunistic infections, including toxoplasmosis. Toxoplasma infection is particularly lifethreatening in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients, primarily occurring through reactivation of latent infection or primary infection, respectively. Epidemiological, clinical features and levels of risk vary according to the transplanted organ, the pretransplant serologic status of both donor and recipient, and the time after engraftment. The diagnosis is guided by clinical symptoms and signs (although frequently nonspecific), imaging, and other diagnostic findings. Molecular methods, i.e., real-time PCRs, are the mainstay of Toxoplasma detection and should be performed for diagnosis in the blood or any other pertinent site. Despite the lack of transplantspecific therapeutic guidelines, the combination of pyrimethamine-sulfadiazine has been proposed as the first-line curative treatment, based on clinical trials in HIV-infected population. Prevention of toxoplasmosis includes patient education about hygienic rules to prevent primary infection, but also serologic screening of donors and recipients, chemoprophylaxis, and follow-up of patients after transplantation. Although there are not well-standardized protocols adapted to the type of graft, patient management is extensively discussed in this chapter, which provides an overview of the usual diagnostic, therapeutic, and preventive strategies aimed at improving the clinical management of transplant recipients.

DOI: 10.1007/978-3-030-01751-4_51-1