Sequelae of Donor-derived Mollicutes Transmission in Lung Recipients

Fernández, Ramiro; Chi, Monica; Ison, Michael G.; Waites, Ken B.; Crabb, Donna M.; Ratliff, Amy E.; Cajigas, Hector; DeCamp, Malcolm M.; Odell, David D.; Budinger, G. R. Scott; Bharat, Ankit

doi:10.1164/rccm.201607-1377le

Cited by 18 publications

(23 citation statements)

References 10 publications

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“…Donors with Ureaplasma species were found to be of a significantly younger age, were all reported to be sexually active with multiple sexual partners, and all had documented aspiration events. The authors hypothesized that sexual activity may increase the risk for oral cavity colonization of Ureaplasma species, which may then be introduced into the lungs during aspiration . At our hospital, testing for Ureaplasma species from donor BAL is not routinely done, and was not performed in our case.…”

Section: Discussionmentioning

confidence: 99%

“…Potential strategies for prevention in lung transplant recipients that have been proposed, and warrant further study, include universal screening of donors and recipients for Ureaplasma species, treatment of proven infections vs universal prophylaxis pending results, and systemic post‐transplant monitoring of ammonia levels in lung transplant recipients . Given the potential for antimicrobial resistance, prolonged time to culture confirmation, and high mortality with this syndrome, empiric therapy with two Ureaplasma directed antimicrobials may be warranted.…”

Section: Discussionmentioning

confidence: 99%

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Successful treatment of Ureaplasma‐induced hyperammonemia syndrome post‐lung transplant

Matson

Sonetti

2018

Transplant Infectious Dis

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Hyperammonemia, in the absence of significant liver dysfunction, is an uncommon but often fatal occurrence following orthotopic lung transplant. Prior reports have provided evidence to support Ureaplasma species as an etiology for this syndrome. This case report describes an individual post‐lung transplant, treated emperically with doxycycline along with other measures to lower ammonia levels, at the time hyperammonemia with encephalopathy was recognized. The patient clinically improved. Ureaplasma species were subsequently identified using 16S ribosomal RNA gene PCR/sequencing of pleural fluid, and by culture of bronchoalveolar (BAL) fluid. This case provides further support for empiric treatment of Ureaplasma species upon recognition of hyperammonemia syndrome post‐lung transplant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful treatment of Ureaplasma‐induced hyperammonemia syndrome post‐lung transplant

Matson

Sonetti

2018

Transplant Infectious Dis

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“…Post‐transplant hyperammonemia syndrome is a rare condition most commonly observed in the lung transplant population 2‐4,9,12,13 . It is characterized by elevated ammonia levels in the absence of synthetic liver dysfunction, with altered mental status and often cerebral edema 3 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, whether these post‐transplant infections are donor‐ or recipient‐derived is not always clear. In the lung transplant population, studies have suggested a donor origin for most, if not all, Ureaplasma infections causing hyperammonemia 12 . The pathogenesis of infection in our patient is not obvious.…”

Section: Discussionmentioning

confidence: 99%

“…Historically high mortality rates due to HS should be expected to decrease dramatically with better recognition and treatment of this entity. While some institutions have implemented protocols to universally screen lung transplant donors and recipients for Ureaplasma infection, 12 further studies are needed to determine the best practices for diagnosis, treatment, and prevention of hyperammonemia syndrome in all transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

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Hyperammonemia syndrome due to Ureaplasma infection after liver‐kidney transplant

Cannon

Corcorran

Shaw

et al. 2020

Transplant Infectious Dis

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Hyperammonemia syndrome, with high levels of ammonia and neurologic dysfunction, is a syndrome with historically high mortality that may occur after solid organ transplantation. Recently, this has been associated with infection due to Ureaplasma, mostly following lung transplantation. We describe the first case of hyperammonemia syndrome due to Ureaplasma infection after liver‐kidney transplantation. Our patient rapidly recovered after specific antibiotic treatment. It is important to consider these infections in the differential diagnosis for encephalopathy post‐transplant, as these organisms often do not grow using routine culture methods and polymerase chain reaction testing is typically required for their detection. This is particularly critical after liver transplantation, where a number of other etiologies may be considered as a cause of hyperammonemia syndrome.

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