Multiple serous effusions：toxoplasmosis in a case with severe aplastic anemia.case report

Multiple serous effusions：toxoplasmosis in a case with severe aplastic anemia.case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Multiple serous effusions：toxoplasmosis in a case with severe aplastic anemia.case report xiaoning wang, Hao Li, Le Ma, JUAN REN, Jing Zhao, Mei Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4377306/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Nov, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted 4 You are reading this latest preprint version Abstract Toxoplasmosis is a rare parasitic disease that can cause fatal multi-organ failure in immunocompromised patients. Non-specificity of the symptoms and confirm diagnosis of tachyzoites in fluids or tissues by microscopic examination resulting in a delay before diagnosis. A 28-year-old woman with severe aplastic anemia received stem cell transplantation seven months ago, presented with fever.Computed Tomography scan and ultrasonography showed moderate pleural, pericardial, peritoneal, and pelvic effusions. Metagenomic next generation sequencing of blood and alveolar lavage fluid were done, 11082 and 17154 sequence readings of toxoplasma gondii were detected and accounting for 1.34% and 17.09% of genome coverage respectively. Then, Marrow aspirate smears showed toxoplasma gondii tachyzoites and pseudocyst. These data confirm that highlights the need for enhance vigilance against toxoplasma gondii infection in stem cell transplantation patients with multiple serous effusions and fever. toxoplasma gondii stem cell transplantation multiple serous effusions Figures Figure 1 Introduction Toxoplasmosis is a rare parasitic disease that can cause fatal multi-organ failure in immunocompromised patients. Stem cell transplantation patients routinely receive trimethoprim-sulfamethoxazole (SMZ) for pneumocystis pneumonia and toxoplasmosis infection prevention and have a lower risk of toxoplasma gondii infection, especially those with toxoplasma-seronegative recipients and donors. However, once ignored, it can be fatal [ 1 – 3 ] . Case presentation A 28-year-old female with severe aplastic anemia underwent haploidentical stem cell transplantation seven months ago, presented with fever for four days.Continuous oral administration of cyclosporine A, acyclovir, and trimethoprim- sulfamethoxazole from conditioning for preventing graft versus host disease and virus, pneumocystis pneumonia and toxoplasmosis infection.She lived in a city of Shaanxi province, China, and gave no history of recent travel.No history of pet ownership.The donor and recipient had negative serological tests before transplantation. A computed tomography of the head, chest,abdomen and pelvis demonstrated pleural, pericardial,peritoneal, and pelvic effusions (Fig. 1a−1c).Laboratory investigations showed pancytopenia (hemoglobin, 6.2 g/dL; absolute neutrophil count, 0.64×10 9 /L; and platelets, 43×10 9 /L)and albumin31.8g/L.Procalcitonin 2.8ng/mL,Pro-Brain natriuretic peptide 7723pg/mL, cardiac troponin I 2126.17pg/mL,cardiac troponin T 1.120ng/mL, glutamic-pyruvic transaminase 147u/L, glutamic oxaloacetic transaminase275u/L,Urea nitrogen 16.08mmol/L,creatinine 190umol/L and serum amylase 230U/L were all raised.Blood culture was negative.Metagenomic next generation sequencing (mNGS) of blood and alveolar lavage fluid were done,11082 and 17154 sequence readings of toxoplasma gondii were detected and accounting for1.34% and 17.09% of genome coverage respectively. One day later,we done bone marrow aspiration,and bone marrow smears showed toxoplasma gondii tachyzoites (Fig. 1d, red arrow) and pseudocyst(Fig. 1e, green arrow). Diagnosis of toxoplasmosis was confirmed. Figure 1: Imaging and pathology findings. (a)Computed tomography (CT) of thoracic cavity.(b)CT of abdominal, cavity.(c) CT of pelvic cavity.(d) Bone marrow smear of toxoplasma gondii tachyzoites (Red arrow) .(e) Bone marrow smear of toxoplasma gondiipseudocyst (Green arrow). Discussion Common presentations of toxoplasmosis include fever, encephalopathy and pneumonia. Febrile pancytopenia may be a clinical manifestation of disseminated toxoplasmosis.The other frequently involved organs include eyes, heart, liver, pancreas, bone marrow, bladder, lymph nodes, kidney, spleen, and skin. Non-specificity of the symptoms, resulting in a delay before diagnosis [ 4 ] .This patient presented with fever and multiple serosal cavity effusions, which could easily be misdiagnosed as ordinary pneumoni and hypoproteinemia. However, it was speculated that the heart, pancreas, lungs, bone marrow, liver, and kidneys were all involved and it was disseminated toxoplasmosis. Timely and accurate diagnosis of toxoplasmosis is critical. Post-transplantation toxoplasma serology is unreliable due to profound immunosuppression. PCR-based testing has become the preferred method for diagnosis [ 5 – 6 ] . Confirm diagnosis is provided by the demonstration of tachyzoites in fluids or tissues by microscopic examination.Although a direct examination of tachyzoites is the fastest and cheapest means of diagnosis, it frequently lacks sensitivity. Metagenomic next generation sequencing of bronchoalveolar lavage fluid, blood, bone marrow aspirate, cerebrospinal fluid may give clues for early diagnosis and avoid missed diagnosis.For this patient, toxoplasma gondii was identified in peripheral blood and alveolar lavage fluid by metagenomic next generation sequencing.Then,marrow aspirate smears showed toxoplasma gondii tachyzoites and pseudocyst. For stem cell transplantation patients with toxoplasmosis should be started as soon as possible with first-line medications, including pyrimethamine, sulfadiazine, and leucovorin [ 7 ] . This patient was infected on the basis of oraltrimethoprim- sulfamethoxazole prevention, and it may be related to poor drug enteric absorption. Intravenous trimethoprim-sulfamethoxazole was given once diagnosed. Unforturenatly,the patient died of multiple organ failure. This report has several limitations. First, pleural, pericardial, peritoneal, and pericardial effusions were not pathologically tested for toxoplasma gondii. We could not confirm that damage of pancreatic and liver as well as myocarditis were caused by toxoplasma gondii infection.Second, we did not detect the concentration of trimethoprim-sulfamethoxazole and coud not explain why we failed to prevent the toxoplasma gondii infection for this patient. Conclusion This case highlights the need for enhance vigilance against toxoplasma gondii infection in stem cell transplantation patients with multiple serous effusions and fever, and remind of the importance of early diagnosis of toxoplasmosis through metagenomic next generation sequencing. Declarations Funding Project of Clinical Research Center of Xi'an Jiaotong University（2023-XKCRC-06） and National Key R&D Program (grant no. 2022YFC2502700) Conflicts of interest The authors have no conflicts of interest. Ethics approval and consent to participate The study was approved by the ethical review boards of the first affiliated hospital of Xi’an jiaotong university. Patient provided written informed consent. Availability of data and material The datasets used may be made available by the corresponding author upon reasonable request. Consent for publication The patient and all authors appreoved for the case publication. Authors' contributions Xiaoning wang, writing original draft. Hao Li and Le Ma,Data collection. Zhao Jing and Zhang Mei, investigation. Pengcheng He, Design and data analysis. All authors revised and approved the final manuscript. References Aerts R, Mehra V, Groll AH, Martino R, Lagrou K, Robin C, Perruccio K, Blijlevens N, Nucci M, Slavin M, Bretagne S, Cordonnier C. European Conference on Infections in Leukaemia group.Guidelines for the management of Toxoplasma gondii infection and disease in patients with haematological malignancies and after haematopoietic stem-cell transplantation: guidelines from the 9th European Conference on Infections in Leukaemia, 2022.Lancet Infect Dis 2023 Dec 19:S1473- 3099(23)00495-4. https://doi.org/10.1016/S1473- 3099(23)00495-4 . Zhai WH, Zhang LN, Wang JL, He Y, Jiang EL, Feng SZ, Han MZ. Toxoplasma gondii infection after allogeneic hematopoietic stem cell transplantation in patients with hematological diseases: 2 cases report and literature reviews. Zhonghua Xue Ye Xue Za Zhi. 2023;44(10):861–3. https://doi.org/10.3760/cma.j.issn.0253-2727.2023.10.013 . Asensi Cantó P, Mayordomo E, Dorado A, Villalba M, Mañez RB, González E, Salavert M, Facal A, Chorão P, Balaguer A, Sivera R, Montoro J, Vilchez JJ, Piñana JL, Sanz M, Sanz J, Muelas N. Guerreiro M.Disseminated toxoplasma infection after hematopoietic stem cell transplantation with myositis and encephalitis.Transpl Infect Dis. 2023;25(4):e14067 https://doi.org/10.1111/tid.14067 . Epub 2023 May 13. Schwenk HT, Khan A, Kohlman K, Bertaina A, Cho S, Montoya JG, Contopoulos-Ioannidis DG. Transpl Cell Ther. 2021;27(4):292–300. https://doi.org/10.1016/j.jtct.2020.11.003 . Toxoplasmosis in Pediatric Hematopoietic Stem Cell Transplantation Patients. Yusefi M, Arab-Mazar Z, Fallahi S, Mamaghani AJ, Sali S, Nikpour N, Barati M, Karimi Rouzbahani A, Kheirandish F. Diagnosis of Toxoplasma Infection in Allogenic Pre HCTSP Patients Using Molecular Methods. Iran J Parasitol 2022 Apr-Jun;17(2):231–9. https://doi.org/10.1016/10.18502/ijpa.v17i2.9541 . Aerts R, Mercier T, Beckers M, Schoemans H, Lagrou K, Maertens J. Toxoplasmosis after allogeneic haematopoietic cell transplantation: experience using a PCR-guided pre-emptive approach. Clin Microbiol Infect. 2022;28(3):440–5. https://doi.org/10.1016/j.cmi.2021.09.033 . Rauwolf KK, Floeth M, Kerl K, Schaumburg F, Groll AH. Toxoplasmosis after allogeneic haematopoietic cell transplantation-disease burden and approaches to diagnosis, prevention and management in adults and children. Clin Microbiol Infect. 2021;27(3):378–88. https://doi.org/10.1016/j.cmi.2020.10.009 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Nov, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 14 May, 2024 Submission checks completed at journal 09 May, 2024 Editor assigned by journal 09 May, 2024 First submitted to journal 06 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4377306","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":302355914,"identity":"0664ba88-ee9b-4ae2-83b0-88f71e3c3dae","order_by":0,"name":"xiaoning wang","email":"","orcid":"","institution":"the First Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"xiaoning","middleName":"","lastName":"wang","suffix":""},{"id":302355915,"identity":"e249c449-b2fd-45fc-8f55-933f83ff83a3","order_by":1,"name":"Hao Li","email":"","orcid":"","institution":"the First Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Li","suffix":""},{"id":302355916,"identity":"c27443aa-5cc6-4641-886f-0cbe99b8e683","order_by":2,"name":"Le Ma","email":"","orcid":"","institution":"the First Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Le","middleName":"","lastName":"Ma","suffix":""},{"id":302355917,"identity":"f0d96936-c5cb-40cd-bf13-1e1d84f97149","order_by":3,"name":"JUAN REN","email":"","orcid":"","institution":"the First Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"JUAN","middleName":"","lastName":"REN","suffix":""},{"id":302355918,"identity":"ec310498-6744-4c21-aee8-fb4277b9265d","order_by":4,"name":"Jing Zhao","email":"","orcid":"","institution":"the First Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zhao","suffix":""},{"id":302355919,"identity":"6a3f7ce7-6a79-49f4-a74e-fc2a8cea6e85","order_by":5,"name":"Mei Zhang","email":"","orcid":"","institution":"the First Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Mei","middleName":"","lastName":"Zhang","suffix":""},{"id":302355920,"identity":"68c4b9cd-4810-46ed-bcfa-8e2a38833157","order_by":6,"name":"Pengcheng He","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIie3PsQrCMBDG8SuFTJFzbMCHiJMIRV/lSiEuPkSg0MkHqC/inFKom65CFyfndM9gHdyvm2D+0w33Gz6AWOwnEwBPyCWinUMIzEo1bh7pcm2JCfTDFJ7CXWpwiR+PDKIa02VFPchNalN1vjAIZocaCjvIrXUiXXCI+BAKN6kdMQlmpgcSbgZRp1c5bSmlatqKt0Vfzdr7sNsjVq0fOQSW9L0Sy/mfQsd8jMVisf/tDbQPNSxULf6eAAAAAElFTkSuQmCC","orcid":"","institution":"the First Affiliated Hospital of Xi'an Jiaotong University","correspondingAuthor":true,"prefix":"","firstName":"Pengcheng","middleName":"","lastName":"He","suffix":""}],"badges":[],"createdAt":"2024-05-06 13:55:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4377306/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4377306/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-024-10249-8","type":"published","date":"2024-11-28T15:58:03+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57034432,"identity":"e1520445-231b-48bd-bfbe-a82343bd394f","added_by":"auto","created_at":"2024-05-23 18:28:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":831834,"visible":true,"origin":"","legend":"\u003cp\u003eImaging and pathology findings. (a)Computed tomography (CT) of thoracic cavity.(b)CT of abdominal, cavity.(c) CT of pelvic cavity.(d) Bone marrow smear of toxoplasma gondii tachyzoites (Red arrow) .(e) Bone marrow smear of toxoplasma gondiipseudocyst (Green arrow).\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4377306/v1/fb81c1a87eeb1cc64d24ab4f.png"},{"id":70382804,"identity":"960588e4-f313-4dd5-8e48-3af49f9474e9","added_by":"auto","created_at":"2024-12-02 16:31:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1667711,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4377306/v1/b1126010-1f89-4de9-a080-06d427c1a1c8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Multiple serous effusions：toxoplasmosis in a case with severe aplastic anemia.case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eToxoplasmosis is a rare parasitic disease that can cause fatal multi-organ failure in immunocompromised patients. Stem cell transplantation patients routinely receive trimethoprim-sulfamethoxazole (SMZ) for pneumocystis pneumonia and toxoplasmosis infection prevention and have a lower risk of toxoplasma gondii infection, especially those with toxoplasma-seronegative recipients and donors. However, once ignored, it can be fatal\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 28-year-old female with severe aplastic anemia underwent haploidentical stem cell transplantation seven months ago, presented with fever for four days.Continuous oral administration of cyclosporine A, acyclovir, and trimethoprim- sulfamethoxazole from conditioning for preventing graft versus host disease and virus, pneumocystis pneumonia and toxoplasmosis infection.She lived in a city of Shaanxi province, China, and gave no history of recent travel.No history of pet ownership.The donor and recipient had negative serological tests before transplantation.\u003c/p\u003e\u003cp\u003eA computed tomography of the head, chest,abdomen and pelvis demonstrated pleural, pericardial,peritoneal, and pelvic effusions (Fig.\u0026nbsp;1a−1c).Laboratory investigations showed pancytopenia (hemoglobin, 6.2 g/dL; absolute neutrophil count, 0.64×10\u003csup\u003e9\u003c/sup\u003e/L; and platelets, 43×10\u003csup\u003e9\u003c/sup\u003e/L)and albumin31.8g/L.Procalcitonin 2.8ng/mL,Pro-Brain natriuretic peptide 7723pg/mL, cardiac troponin I 2126.17pg/mL,cardiac troponin T 1.120ng/mL, glutamic-pyruvic transaminase 147u/L, glutamic oxaloacetic transaminase275u/L,Urea nitrogen 16.08mmol/L,creatinine 190umol/L and serum amylase 230U/L were all raised.Blood culture was negative.Metagenomic next generation sequencing (mNGS) of blood and alveolar lavage fluid were done,11082 and 17154 sequence readings of toxoplasma gondii were detected and accounting for1.34% and 17.09% of genome coverage respectively. One day later,we done bone marrow aspiration,and bone marrow smears showed toxoplasma gondii tachyzoites (Fig.\u0026nbsp;1d, red arrow) and pseudocyst(Fig.\u0026nbsp;1e, green arrow). Diagnosis of toxoplasmosis was confirmed.\u003c/p\u003e\u003cp\u003eFigure 1: Imaging and pathology findings. (a)Computed tomography (CT) of thoracic cavity.(b)CT of abdominal, cavity.(c) CT of pelvic cavity.(d) Bone marrow smear of toxoplasma gondii tachyzoites (Red arrow) .(e) Bone marrow smear of toxoplasma gondiipseudocyst (Green arrow).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCommon presentations of toxoplasmosis include fever, encephalopathy and pneumonia. Febrile pancytopenia may be a clinical manifestation of disseminated toxoplasmosis.The other frequently involved organs include eyes, heart, liver, pancreas, bone marrow, bladder, lymph nodes, kidney, spleen, and skin. Non-specificity of the symptoms, resulting in a delay before diagnosis\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.This patient presented with fever and multiple serosal cavity effusions, which could easily be misdiagnosed as ordinary pneumoni and hypoproteinemia. However, it was speculated that the heart, pancreas, lungs, bone marrow, liver, and kidneys were all involved and it was disseminated toxoplasmosis.\u003c/p\u003e\u003cp\u003eTimely and accurate diagnosis of toxoplasmosis is critical. Post-transplantation toxoplasma serology is unreliable due to profound immunosuppression. PCR-based testing has become the preferred method for diagnosis\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Confirm diagnosis is provided by the demonstration of tachyzoites in fluids or tissues by microscopic examination.Although a direct examination of tachyzoites is the fastest and cheapest means of diagnosis, it frequently lacks sensitivity. Metagenomic next generation sequencing of bronchoalveolar lavage fluid, blood, bone marrow aspirate, cerebrospinal fluid may give clues for early diagnosis and avoid missed diagnosis.For this patient, toxoplasma gondii was identified in peripheral blood and alveolar lavage fluid by metagenomic next generation sequencing.Then,marrow aspirate smears showed toxoplasma gondii tachyzoites and pseudocyst.\u003c/p\u003e\u003cp\u003eFor stem cell transplantation patients with toxoplasmosis should be started as soon as possible with first-line medications, including pyrimethamine, sulfadiazine, and leucovorin\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. This patient was infected on the basis of oraltrimethoprim- sulfamethoxazole prevention, and it may be related to poor drug enteric absorption. Intravenous trimethoprim-sulfamethoxazole was given once diagnosed. Unforturenatly,the patient died of multiple organ failure.\u003c/p\u003e\u003cp\u003eThis report has several limitations. First, pleural, pericardial, peritoneal, and pericardial effusions were not pathologically tested for toxoplasma gondii. We could not confirm that damage of pancreatic and liver as well as myocarditis were caused by toxoplasma gondii infection.Second, we did not detect the concentration of trimethoprim-sulfamethoxazole and coud not explain why we failed to prevent the toxoplasma gondii infection for this patient.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights the need for enhance vigilance against toxoplasma gondii infection in stem cell transplantation patients with multiple serous effusions and fever, and remind of the importance of early diagnosis of toxoplasmosis through metagenomic next generation sequencing.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProject of Clinical Research Center of Xi\u0026apos;an Jiaotong University（2023-XKCRC-06） and National Key R\u0026amp;D Program (grant no. 2022YFC2502700)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethical review boards of the first affiliated hospital of Xi\u0026rsquo;an jiaotong university. Patient provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used may be made available by the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient and all authors appreoved for the case publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiaoning wang, writing original draft. Hao Li and Le Ma,Data collection. Zhao Jing and Zhang Mei, investigation. Pengcheng He, Design and data analysis. All authors revised and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAerts R, Mehra V, Groll AH, Martino R, Lagrou K, Robin C, Perruccio K, Blijlevens N, Nucci M, Slavin M, Bretagne S, Cordonnier C. European Conference on Infections in Leukaemia group.Guidelines for the management of Toxoplasma gondii infection and disease in patients with haematological malignancies and after haematopoietic stem-cell transplantation: guidelines from the 9th European Conference on Infections in Leukaemia, 2022.Lancet Infect Dis 2023 Dec 19:S1473- 3099(23)00495-4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S1473- 3099(23)00495-4\u003c/span\u003e\u003cspan address=\"10.1016/S1473- 3099(23)00495-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhai WH, Zhang LN, Wang JL, He Y, Jiang EL, Feng SZ, Han MZ. Toxoplasma gondii infection after allogeneic hematopoietic\u0026ensp;stem\u0026ensp;cell\u0026ensp;transplantation\u0026ensp;in patients with hematological diseases: 2 cases report and literature reviews. Zhonghua Xue Ye Xue Za Zhi. 2023;44(10):861\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3760/cma.j.issn.0253-2727.2023.10.013\u003c/span\u003e\u003cspan address=\"10.3760/cma.j.issn.0253-2727.2023.10.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsensi Cant\u0026oacute; P, Mayordomo E, Dorado A, Villalba M, Ma\u0026ntilde;ez RB, Gonz\u0026aacute;lez E, Salavert M, Facal A, Chor\u0026atilde;o P, Balaguer A, Sivera R, Montoro J, Vilchez JJ, Pi\u0026ntilde;ana JL, Sanz M, Sanz J, Muelas N. Guerreiro M.Disseminated toxoplasma infection after hematopoietic\u0026ensp;stem\u0026ensp;cell\u0026ensp;transplantation\u0026ensp;with myositis and encephalitis.Transpl Infect Dis. 2023;25(4):e14067\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/tid.14067\u003c/span\u003e\u003cspan address=\"10.1111/tid.14067\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2023 May 13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwenk HT, Khan A, Kohlman K, Bertaina A, Cho S, Montoya JG, Contopoulos-Ioannidis DG. Transpl Cell Ther. 2021;27(4):292\u0026ndash;300. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jtct.2020.11.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jtct.2020.11.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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Clin Microbiol Infect. 2021;27(3):378\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.cmi.2020.10.009\u003c/span\u003e\u003cspan address=\"10.1016/j.cmi.2020.10.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"toxoplasma gondii, stem cell transplantation, multiple serous effusions","lastPublishedDoi":"10.21203/rs.3.rs-4377306/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4377306/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eToxoplasmosis is a rare parasitic disease that can cause fatal multi-organ failure in immunocompromised patients. Non-specificity of the symptoms and confirm diagnosis of tachyzoites in fluids or tissues by microscopic examination resulting in a delay before diagnosis.\u003c/p\u003e\n\u003cp\u003eA 28-year-old woman with severe aplastic anemia received stem cell transplantation seven months ago, presented with fever.Computed Tomography scan and ultrasonography showed moderate pleural, pericardial, peritoneal, and pelvic effusions. Metagenomic next generation sequencing of blood and alveolar lavage fluid were done, 11082 and 17154 sequence readings of toxoplasma gondii were detected and accounting for 1.34% and 17.09% of genome coverage respectively. Then, Marrow aspirate smears showed toxoplasma gondii tachyzoites and pseudocyst.\u003c/p\u003e\n\u003cp\u003eThese data confirm that highlights the need for enhance vigilance against toxoplasma gondii infection in stem cell transplantation patients with multiple serous effusions and fever.\u003c/p\u003e","manuscriptTitle":"Multiple serous effusions：toxoplasmosis in a case with severe aplastic anemia.case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-23 18:28:11","doi":"10.21203/rs.3.rs-4377306/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-14T12:53:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-09T17:30:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-09T17:30:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2024-05-06T13:53:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cae69d20-c370-49a8-9290-b1f266988e6b","owner":[],"postedDate":"May 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-02T16:04:11+00:00","versionOfRecord":{"articleIdentity":"rs-4377306","link":"https://doi.org/10.1186/s12879-024-10249-8","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2024-11-28 15:58:03","publishedOnDateReadable":"November 28th, 2024"},"versionCreatedAt":"2024-05-23 18:28:11","video":"","vorDoi":"10.1186/s12879-024-10249-8","vorDoiUrl":"https://doi.org/10.1186/s12879-024-10249-8","workflowStages":[]},"version":"v1","identity":"rs-4377306","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4377306","identity":"rs-4377306","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}