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Life-saving organ transplants accompanied by unexpected pathogens

This month's Annals of Internal Medicine reports on a public health investigation of microsporidiosis acquired through solid organ transplantation.

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Encephalitozoon cuniculi, a microsporidial species most commonly recognized as a cause of renal, respiratory, and central nervous system infections in immunosuppressed patients, was identified as the cause of a temporally associated cluster of febrile illness among 3 solid organ transplant recipients from a common donor.

Dr Susan Hocevar and colleagues confirmed the source of the illness, assess donor and recipient risk factors, and provide therapy recommendations for ill recipients.

The research team performed a public health investigation of 2 transplant hospitals and community interview with the deceased donor's family.

There were 3 transplant recipients and the organ donor.

Surviving recipients received albendazole
Annals of Internal Medicine

Specimens were tested for microsporidia by using culture, immunofluorescent antibody, polymerase chain reaction, immunohistochemistry, and electron microscopy.

Donor medical records were reviewed and a questionnaire was developed to assess for microsporidial infection.

The research team reported that kidneys and lungs were procured from the deceased donor and transplanted to 3 recipients who became ill with fever 7 to 10 weeks after the transplant.

Results of urine culture, serologic, and polymerase chain reaction testing were positive for E. cuniculi of genotype III in each recipient; the organism was also identified in biopsy or autopsy specimens in all recipients.

The donor had positive serologic test results for E. cuniculi.

The team observed that surviving recipients received albendazole.

Donor assessment did not identify factors for suspected E. cuniculi infection.

Dr Hocevar's team concludes, "Microsporidiosis is now recognized as an emerging transplant-associated disease and should be considered in febrile transplant recipients when tests for routinely encountered agents are unrevealing."

"Donor-derived disease is critical to assess when multiple recipients from a common donor are ill."

Ann Intern Med 2014; 160(4): 213-220-220
20 February 2014

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