2693. Clinical Presentation of Toxoplasmosis and 30-Day Mortality in Transplant Recipients at Two Academic Medical Centers

BACKGROUND: Toxoplasma gondii causes opportunistic infections in transplant recipients after primary, donor-derived, or reactivated infection. Diagnosis in solid-organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients may be delayed due to varied clinical presentations, which can mimic bacterial sepsis. These delays could contribute to significant associated mortality, with a reported rate exceeding 50% in disseminated disease. Further exploration of expanded donor screening, targeted recipient prophylaxis, and enhanced early detection may be warranted. We therefore examined patient characteristics, clinical presentation, time to toxoplasmosis diagnosis, and mortality in transplant recipients at two centers. METHODS: A retrospective chart review of SOT and HSCT recipients diagnosed with toxoplasmosis from 2002–2018 at Emory Healthcare and Duke University Hospital was performed, with cases identified via an electronic query of relevant ICD codes, positive serum or CSF toxoplasmosis PCRs, and pathologic diagnoses. Patient characteristics, including age, sex, race, time since transplantation, method of toxoplasmosis diagnosis, and symptoms, were abstracted. Primary outcomes included time from transplant to diagnosis and estimated 30- and 90-day all-cause mortality. RESULTS: 16 patients were identified, with a median age of 56 years at diagnosis. 50% were male, and the majority were white (63%) and SOT recipients (56%; see table). Median time from transplant to diagnosis was 295 days, with PCR the most common diagnostic modality (63%). In 31% of cases, toxoplasmosis was diagnosed after patient death. The most common clinical presentations were encephalitis (69%), respiratory failure (63%), renal failure (50%), diarrhea (50%), and septic shock (50%). The estimated all-cause 30-day and 90-day mortality rates were 56% and 69%, respectively. CONCLUSION: Toxoplasmosis has diverse presentations in transplant recipients, likely contributing to diagnostic delays and high mortality. Future study is needed to determine clinical scenarios and risk factors where donor and recipient serologic screening may beneficial. [Image: see text] [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.