A cluster of donor‐derived <i><scp>C</scp>ryptococcus neoformans</i> infection affecting lung, liver, and kidney transplant recipients: Case report and review of literature

Camargo, José F.; Simkins, Jacques; Schain, Denise C.; González, Andrés; Alcaide, María L.; Anjan, Shweta; Guerra, Giselle; Roth, David; Kupin, Warren; Mattiazzi, Adela; Tan, Yaohong; Milikowski, Clara; Morris, Michele; Abbo, Lilian M.

doi:10.1111/tid.12836

Cited by 25 publications

(28 citation statements)

References 24 publications

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“…As illustrated by this case, donor‐derived infections do not always present in the early (<30 days) post‐transplant period; thus, transplant patients should be educated about the risk of donor‐derived transmission, and clinicians should always consider the possibility of donor‐derived events in SOT recipients admitted with febrile illness or unexplained clinical syndromes even when presenting beyond the first month post‐transplant . Communication gaps are strongly associated with infection transmission events and quality improvement projects, such as the one presented here can overcome process barriers and improve patient safety …”

Section: Discussionmentioning

confidence: 95%

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

Camargo

Simkins

Anjan

et al. 2019

Clinical Transplantation

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Background Strongyloides stercoralis infects 100 million people worldwide. Mortality rates in hyperinfection syndrome exceed 50%. Donor‐derived Strongyloides infection has occurred after heart, kidney, kidney‐pancreas and liver transplantation; yet, only 10% of the US organ procurement organizations currently screen donors for strongyloidiasis. Methods We report a fatal case of donor‐derived disseminated Strongyloides infection in a liver transplant recipient. Following this case, we implemented universal screening and treatment of donors and recipients. We reviewed our local epidemiology and outcomes after protocol implementation. Results From a total of 355 deceased donors accepted at our center between January 2016, and March 2018, 14 (3.9%) had positive Strongyloides serology. Except for the index case, all other recipients of Strongyloides antibody‐positive donors within that period (including 10 kidneys, 3 livers, one combined liver/kidney, and one kidney/pancreas from eight seropositive donors) received post‐transplant prophylaxis with ivermectin, and to date are alive and doing well without signs of infection. Between October 2015, and September 2016, a total of 441 deceased donor solid organ transplants were performed at our center. 220 of these recipients had pretransplant Strongyloides serology available, and 23 of them were seropositive (10.5%). Within the first two years after the implementation of universal screening and treatment of donors and recipients, we had no cases of Strongyloides reactivation in our center. Conclusions Implementation of a Strongyloides screening and treatment protocol in our center was an effective strategy to prevent both recipient‐ and donor‐derived strongyloidiasis. Transplant centers should consider implementation of Strongyloides preventive strategies.

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Section: Discussionmentioning

confidence: 95%

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

Camargo

Simkins

Anjan

et al. 2019

Clinical Transplantation

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“…The pathogenesis of C neoformans is incompletely understood; however, immunocompetent individuals likely develop a state of latent infection following inhalation infectious propagules, which can then progress to clinically significant disease. Very early‐onset cryptococcosis post‐solid organ transplantation may be due to unrecognized pre‐transplant infection or colonization or de novo acquisition; however, Cryptococcus neoformans is well recognized as a potential DDI, particularly in the early post‐transplant period.…”

Section: Discussionmentioning

confidence: 99%

Very early‐onset ofCryptococcus neoformansdisease following liver transplantation: Report of two cases and a review of the literature

Marinelli

Anagnostou

Daniel

et al. 2019

Transplant Infectious Dis

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Cryptococcosis is the third most common invasive fungal infection following solid organ transplantation, and mortality is high. Most cases occur late and are due to reactivation of latent infection; however, very early reactivation and donor‐derived transmission can occur. Routine screening pre‐transplant and antifungal prophylaxis for cryptococcosis post‐transplant in solid organ transplantation are not standard practice. We present two cases of very early‐onset Cryptococcus neoformans disease following liver transplantation to highlight the need to consider individualized pre‐transplant screening and be aware that reactivation of Cryptococcosis neoformans can occur in the immediate post‐transplant period.

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“…Most cases are considered to represent latent infection reactivation and typically occur 16‐21 months after transplantation . Cryptococcus donor‐derived infections (DDIs) should be considered when diagnosis occurs within 30‐100 days post‐transplant; if diagnosed in more than one SOT recipient from a single donor; or if Cryptococcus is documented at the graft site . Late‐onset Cryptococcus DDIs may occur a few months after transplantation .…”

Section: Discussionmentioning

confidence: 99%

“…Cryptococcus donor‐derived infections (DDIs) should be considered when diagnosis occurs within 30‐100 days post‐transplant; if diagnosed in more than one SOT recipient from a single donor; or if Cryptococcus is documented at the graft site . Late‐onset Cryptococcus DDIs may occur a few months after transplantation . Only fourteen cases of proven/probable Cryptococcus DDIs have been reported in the literature with variable times of incubation …”

Section: Discussionmentioning

confidence: 99%

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Solving the mystery: Hyalinized cyst wall containing organism‐like structures in a lung transplant donor

Viotti

Loebe

Brozzi

et al. 2018

Transplant Infectious Dis

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A 59-year-old man with non-ischemic cardiomyopathy underwent orthotopic heart transplantation. The donor, a 31-year-old male declared brain dead after a gunshot wound to the head, was considered high risk due to history of incarceration, illicit drug use, and sex with a HIV-positive partner. At organ procurement, the heart, kidneys, pancreas, and liver looked grossly normal. A small right lower lobe nodule was noticed, and lung biopsy was performed. Bronchoscopy showed purulent secretions in the right lower lobe. Images from pathology are presented. Lung biopsy confirmed the presence of hyalinized cyst wall containing organism-like structures. A combination of culture, microscopic morphology, and gene sequencing was used to identify the causative organism. The patient and all other organ recipients received appropriate antifungal prophylaxis and remain asymptomatic 6 months post-transplant.

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A cluster of donor‐derived Cryptococcus neoformans infection affecting lung, liver, and kidney transplant recipients: Case report and review of literature

Cited by 25 publications

References 24 publications

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

Very early‐onset ofCryptococcus neoformansdisease following liver transplantation: Report of two cases and a review of the literature

Solving the mystery: Hyalinized cyst wall containing organism‐like structures in a lung transplant donor

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