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Barakat M.T.,Stanford University | Gajurel K.,Stanford University | Fischer K.,Stanford University | Stevens K.,Stanford University | And 3 more authors.
Open Forum Infectious Diseases | Year: 2016

The clinical spectrum of Neisseria meningitidis can range from nasopharyngeal colonization to life-threatening invasive diseases such as meningitis. However, its etiologic role in invasive pyomyositis (PM) has never been reported before in the English language. In this study, we report the first case of PM in the English language and the second case in the literature caused by N meningitidis. © The Author 2016.


Gajurel K.,Stanford University | Dhakal R.,National Reference Center for the Study and Diagnosis of Toxoplasmosis | Montoya J.G.,Stanford University | Montoya J.G.,National Reference Center for the Study and Diagnosis of Toxoplasmosis
Current Opinion in Infectious Diseases | Year: 2015

Purpose of review Toxoplasmosis in haematopoietic cell transplant (HCT) recipients is associated with high morbidity and mortality rates. Prophylaxis following HCT is recommended for high-risk pre-HCT toxoplasma-seropositive (pre-HCTSP) recipients. However, there is no agreement or consistency among programmes on whether to adopt prophylaxis or not, or if used, on the chosen antitoxoplasma prophylactic regimen. This review discusses the role of prophylaxis, and preemptive treatment, for toxoplasmosis in the setting of HCT. Recent findings Approximately two-thirds of toxoplasmosis cases following HCT are reported in allogeneic pre-HCTSP (allo pre-HCTSP) patients. This finding confirms a major role of reactivation of latent infection in the pathogenesis of toxoplasmosis in this patient population. Toxoplasma disease-related mortality in allo pre-HCTSP patients was reported at 62%, but it can be significantly decreased with early detection and treatment of toxoplasma infection. There are no randomized trials comparing the efficacy of different prophylactic agents to prevent toxoplasmosis after HCT. Several observational studies have demonstrated the efficacy of trimethoprim-sulfamethoxazole (TMP/SMX) in decreasing the incidence of toxoplasmosis following HCT. There is limited information regarding efficacy of other prophylactic agents. Preemptive treatment using routine blood PCR monitoring seems to be beneficial in detecting infection early and preventing disease in several observational studies and has been adopted for allo pre-HCTSP HCT patients when universal prophylaxis is not possible. Summary Universal prophylaxis with TMP/SMX in allo pre-HCTSP patients should be implemented by all transplant programmes. Preemptive treatment with routine blood PCR monitoring is an option if prophylaxis cannot be used. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Gajurel K.,Stanford University | Gomez C.A.,Stanford University | Dhakal R.,National Reference Center for the Study and Diagnosis of Toxoplasmosis | Vogel H.,Stanford University | And 2 more authors.
Transplant Infectious Disease | Year: 2016

The efficacy of primary prophylaxis with atovaquone in preventing Toxoplasma reactivation and disease in hematopoietic cell transplant (HCT) recipients is unknown. We describe 2 cases of atovaquone prophylaxis failure in pre-HCT Toxoplasma-seropositive (pre-HCTSP) recipients who underwent allogeneic HCT (allo-HCT) and review the literature on atovaquone prophylaxis in HCT recipients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

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