Francisella tularensisTransmission by Solid Organ Transplantation, 20171

Abstract

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor’s residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation.

Francisella tularensis Subspecies holarctica and Tularemia in Germany

“…Thereby, hunters are a typical risk group exposed through handling (skinning, preparing, or consuming) meat of infected animals [ 10 , 11 , 12 , 13 ]. Human to human transmission has not been described thus far, despite a case of tularemia after organ transplantation [ 14 ].…”

Vector-Borne Zoonotic Lymphadenitis – the Causative Agents, Epidemiology, Diagnostic Approach and Therapeutic Possibilities – An Overview

“…Other routes of transmission include aerosol droplets, contact with contaminated water or mud and animal bites [14]. Also, inoculation from freshwater fishhook injury has been described as like transmissions during an autopsy and from solid organ transplantation [18][19][20][21]. F. tularensis is highly contagious for humans and because of the potential danger to laboratory workers they should be warned when tularemia is suspected so they can manipulate with specimens using Biosafety Level 3 practices, especially during procedures that might produce aerosols or droplets [22,23].…”

Characterization of three Francisella tularensis genomes from Oklahoma, USA

“…Besides rare clinical reports [17,18], tularaemia is not commonly reported in birds. In one case, F. tularensis was also reported to be transmitted by organ transplantation [19].…”