1. Transmission ofBalamuthia mandrillarisby Organ Transplantation
- Author
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Paul Byers, Bruce Kaplan, Jon A. Kobashigawa, Govinda S. Visvesvara, Chukwuma Mbaeyi, Jonathan Fratkin, Rama Sriram, Shiro Fujita, Sharon L. Roy, Eileen C. Farnon, Jim Stinson, Fauzia Butt, Philip J. Budge, Michele Cheung, Chad Viscusi, Rainer W.G. Gruessner, Phil Zakowski, Robert Lawrence, Christopher D. Paddock, Jonathan S. Yoder, Emily Lutterloh, Sherif R. Zaki, Eileen Navarro, Christine Hahn, Matthew J. Kuehnert, Alberto Ramos, Erica Bracamonte, Yvonne Qvarnstrom, Richard Manch, Regino P. Gonzalez-Peralta, K. E. Kokko, Ken Komatsu, J. Weiss, Alexandre J. da Silva, Patrick J. Geraghty, Ann Moore, William T. Mahle, Kirk R. Kanter, Michelle Kittleson, Michael L. Beach, Joel Trachtenberg, Tun Jie, Wun-Ju Shieh, and Leonor Echeverria
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,Pathology ,medicine.medical_treatment ,030106 microbiology ,Balamuthia ,Liver transplantation ,Balamuthia mandrillaris ,Organ transplantation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Child ,Kidney transplantation ,biology ,business.industry ,Brain ,Amebiasis ,Middle Aged ,medicine.disease ,biology.organism_classification ,Kidney Transplantation ,Tissue Donors ,Transplant Recipients ,Liver Transplantation ,Transplantation ,Infectious Diseases ,Balamuthia infection ,Child, Preschool ,Encephalitis ,Female ,business - Abstract
BACKGROUND During 2009 and 2010, 2 clusters of organ transplant-transmitted Balamuthia mandrillaris, a free-living ameba, were detected by recognition of severe unexpected illness in multiple recipients from the same donor. METHODS We investigated all recipients and the 2 donors through interview, medical record review, and testing of available specimens retrospectively. Surviving recipients were tested and treated prospectively. RESULTS In the 2009 cluster of illness, 2 kidney recipients were infected and 1 died. The donor had Balamuthia encephalitis confirmed on autopsy. In the 2010 cluster, the liver and kidney-pancreas recipients developed Balamuthia encephalitis and died. The donor had a clinical syndrome consistent with Balamuthia infection and serologic evidence of infection. In both clusters, the 2 asymptomatic recipients were treated expectantly and survived; 1 asymptomatic recipient in each cluster had serologic evidence of exposure that decreased over time. Both donors had been presumptively diagnosed with other neurologic diseases prior to organ procurement. CONCLUSIONS Balamuthia can be transmitted through organ transplantation with an observed incubation time of 17-24 days. Clinicians should be aware of Balamuthia as a cause of encephalitis with high rate of fatality, and should notify public health departments and evaluate transplant recipients from donors with signs of possible encephalitis to facilitate early diagnosis and targeted treatment. Organ procurement organizations and transplant centers should be aware of the potential for Balamuthia infection in donors with possible encephalitis and also assess donors carefully for signs of neurologic infection that may have been misdiagnosed as stroke or as noninfectious forms of encephalitis.
- Published
- 2016