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Risk of Undetected Toxoplasmosis in Neutropenic or Immune-Suppressed Patients.

After her fourth course of chemotherapy in a clinical trial for Non Hodgkin's, T-cell peripheral lymphoma at a prestigious institute, my wife (aged 65) was declared in complete remission.  While neutropenic following her sixth course, she was hospitalized with a low-grade fever and remained febrile for sixteen days until her death which was attributed to hemophagocytosis.  Comprehensive testing during this time detected no bacterial, viral, or fungal infection, and no malignancy.  No malignancy was found in her subsequent autopsy.  What happened?  The autopsy concluded that dormant single-cell parasites, Toxoplasma gondii, had reactivated and that Toxoplasmosis drove the hemophagocytic syndrome.  The lymphoma and infectious disease diagnostic protocols where she was being treated did not include a test for the parasite or its disease.  Bactrim, given prophylactically to suppress pheumocystis carinii and which also suppressed the parasite during its administration, had been discontinued because she had allergic reaction to it.  The drug substituted for Bactrim, pentamidine, has no effect on the parasite.

I want to get the word out that chemotherapy or other immune-suppressed patients who develop a fever should be proactive in prompting their Attending Physicians to consider parasites, and to assume that standard diagnostic protocols are not designed to automatically test for them.   My goal is to get this central message widely disseminated since it will take at least six months for the institute to get the case published.  .
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